Nursing Research Essay Assignment Paper
You have been asked to be a peer reviewer for a team of nurse researchers who are conducting a phenomenological study of the experiences of physical abuse during pregnancy. What specific questions would you ask the team during debriefing and what documents would you want the researchers to share?
I need at least 2 references including this book:
Polit, D. F., & Beck, C. T. (2012). Nursing research: generating and assessing evidence for nursing practice (Ninth ed.). Philadelphia: Wolters Kluwer, Lippincott Williams & Wilkins. Nursing Research Essay Assignment Paper
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Nurses are expected to provide the best standards of care possible for their patients and clients, and in order to do this, they are required to provide evidence-based practice wherever possible. Part of this process of providing care based on the best available evidence involves appraising primary research (Elliott, 2001, p 555). If nurses are to improve their practice, and apply evidence to improve their clinical and theoretical knowledge and skills, they must be able to assess the quality of the available research which is relevant to their practice (Freshwater and Bishop, 2003k p23; Hek, 2000, p 19). According to Hek (2000 p 19-21), evidence based practice incorporates professional expertise, patient need and preference, and the best available evidence. But in order to identify this ‘best evidence’, the nurse must undertake an evaluation and critical review of research studies, to see if the research is useful and of sufficient quality to be applied to their practice (Fink, 2005).
This essay evaluates a quantitative research article which has relevance to nursing practice, because it deals with a chronic condition and one which is prevalent in worldwide populations. The author will review Tangkawanich et al (2008 p 216) ‘Causal model of health: health-related quality of life in people living with HIV/AIDS in the northern region of Thailand.’ This article is published in a reputable journal, The Journal of Nursing and Health Sciences which addresses issues of interest and concern to nurses internationally, and as such, offers specific insight into HIV/AIDS and nursing within a global context.
There are a number of appraisal tools available to healthcare practitioners to assist them in analysing and critiquing primary research articles. Such models are developed over time in relation to standardised conceptualisations of what constitutes quality and rigour in research and in its reporting. For the purposes of this essay, the primary tool used is that proposed by Cormack (2000), but the author will make reference to other critiquing guides and information, including the popular CASP tool (PHRU, 2009, online). Nursing Research Essay Assignment Paper
The title is concise (Cormack, 2000) and describes the focus of the research itself. While it clearly indicates what the purpose of the study was (Cormack, 2000), it could be clearer and more indicative of the nature of the study. While the nature of the research in setting out to ‘examine the causal relationships between age, antriretroviral treatment, social support, symptom experience, self-care strategies and health related quality of life’ (Tangkawanich et al, 2008 p 216) in the chosen sample and population, is apparent in the abstract, there is little indication of these particular variables in the title, although the description of the ‘causal model’ (Tangkawanich et al, 2008 p 216) does indicate the nature of the research. The use of the word ‘causal’ (Tangkawanich et al, 2008 p 216) also suggests that this is a quantitative research article. It does not clearly indicate the research approach used (Cormack, 2000). To the less research-aware reader, it would be difficult to divine this information from the title alone, and it could be argued that it would be better to include in this title a clearer indication of the nature of the study. This would then help the reader to identify if this is the type of research study that would be applicable to their own practice or learning.
The authors’ qualifications are provided, and they all are registered nurses, all of which have postgraduate degrees, and two of which have doctorates. They all work within nursing education within a University context. This would suggest that they have the research skills and expertise to carry out such a study. However, there is no indication in the author list whether or not any of them have the statistical expertise for the study.
Tangkawanich et al, (2008 p 216) provide an abstract, which is identified by Cormack (2000) as an important introduction to the article. The study effectively summarises the research, by identifying the variables being tested. The authors do not, however, present the hypothesis in the abstract (Cormack, 2000). The abstract contains a summary of the study sample, and also identifies the research tools that have been used. They include the results and a summary of conclusions from these findings. As such, the abstract does represent the article itself (PHRU, 2009, online), and for the reader, it does make it easy to identify whether or not the article is relevant to their interest. In particular, it does indicate clearly that it is a quantitative paper which uses recognisable data collection tools. Nursing Research Essay Assignment Paper
4. Introduction and Literature Review
Although Cormack (2000) separates these two into distinct subheadings, within this article, the introduction and literature review are contiguous. The author has noted that this is often the case in the reporting of such studies, but this may simply be a convention of the publication itself, and not the preference of the authors of the study. The authors use the introduction to contextualise the problem in relation to published research, stating the importance of health-related quality of life (HRQL) for people living with HIV/AIDS (PLWHA), because of the impact of the disease on these individuals’ daily lives (Tangkawanich et al, 2008 p 216). They discuss changes and advances in treatment options for this condition, and relate this to HRQL, and then discuss the disease itself, and how these impact upon HRQL (Tangkawanich et al, 2008 p 216). They summarise some research about this topic, and also look at self-care strategies, symptom management and treatment (Tangkawanich et al, 2008 p 216). There is some exploration of HRQL and its relationship to nursing and to existing literature on this topic, which aids understanding of the concept prior to reading the rest of the article. They highlight some important topics in relation to the focus of the article, including treatment, social support, and other issues (Tangkawanich et al, 2008 p 216).
Although the introduction/literature review contextualises and introduces this study, this author believes that a more detailed critical analysis of the literature would be warranted here. It is not enough to cite previous research as a means of establishing the credentials of the study, as it were. A wider range of research could have been included Gerrish and Lacey, 2006, 38; Fontana, 2004, p 93), and this research could have been evaluated to identify its quality. It is left to the reader to pursue this matter and determine the quality of the research upon which they base the premise and justification for this study. This could be considered a limitation in the reporting of this research. Nursing Research Essay Assignment Paper
5. The Hypothesis
The authors do not state a hypothesis (Cormack, 2000), as such, but instead present a research question. ‘The purpose of this study was to examine the causal relationships between age, antiretroviral treatment, social support, symptom experience, self-care strategies, and the HRQL in Thai PLWHA’ (Tangkawanich et al, 2008 p 217). The nature of this statement would suggest that it is not an experimental study, but that it is within a quantitative research paradigm.
6. Operational definitions
Cormack (2000) suggests that people appraising research question whether operational definitions are clearly presented. In this study, operational definitions are explained within the introduction but in language that would make it inaccessible to the less experienced or less knowledgeable reader.
The methodology section does not clearly state or discuss the choice of a quantitative approach (Cormack, 2000). The focus of the section on Methods is rather on the instruments that are being used. The quality of this study seems to rest in the choice of a quantitative approach, and the choice of data collection instruments. Quantitative research approaches offer a better standards of evidence, with generally greater ability for replication and greater rigour (Kitson et al, 2000 p 149; Duffy, 2005, p 233). As far as research for healthcare practice is concerned, quantitative studies hold better status than those based with a qualitative paradigm (Hek, 2000 p 19; Newman et al, 1998 p 231; Pepler et al, 2006, p 23). There is however no real discussion of the underpinning principles of quantitative research (Parahoo, 2006). Nursing Research Essay Assignment Paper
It is good that the research instruments are explained in such detail, because it helps overcome one of the limitations of quantitative research, that of not asking the right questions to elicit answers that relate to person al experience (Johnson and Onwuegbuzie, 2004 p 14).
There is very limited detail given of sample selection, save stating that eight hospitals were randomly selected using a ‘lottery method without replacement’ and that the 422 participants were randomly sampled (Tangkawanich et al, 2008 p 217). This could constitute a limitation of this research, as it is not possible to identify if there was any sampling bias, how participants were recruited, who recruited them, and any ethical issues in relation to participant recruitment (Hek, 2000, p 20; PHRU, 2009, online, Bowling, 2002). This author would argue that this is a weakness of the study, as these are crucial elements of quality measurement in primary research within healthcare (Austin, 2001 p 1; Cooper, 2006, p 439; Nuremberg Code, 1949, online).
9. Sample selection
Sample selection is not discussed in any detail, which could be a weakness of the study, as mentioned above (Cormack, 2000). Sample size is stated, but it is not stated whether this was statistically determined, which could also be considered a weakness, as achieving a statistically sound sample size is important within quantitative research (Daggett et al, 2005, p 255; Donovan, 2002). Nursing Research Essay Assignment Paper
10. Data Collection
Data collection procedures are not adequately described in this study (Cormack, 2000). This would be problematic for replication and for rigour. There is no indication who administered the questionnaires, whether or not they were self-report in the participant’s own time and convenience, or whether a researcher was present at the time of completion. This could be considered a weakness of this study’s reporting. The issue of researcher bias is important in the completion of data collection tools, and while questionnaires may be considered a way of avoiding this, if they are remotely administered, it is not always possible to check they are full, or honest, or completed by the intended target (Gillham, 2000, p 48). Having the researcher present, however, could introduce bias or influence of some kind, particularly in vulnerable people (Bowling, 2001). As these are vulnerable adults attending clinics for their chronic condition, not discussion how the data was collected from them is a serious failing and may also constitute an ethical issue.
However, a strength of this study could be considered to be the use of multiple data collection instruments, and the detail with which they are described, and their provenance accounted for. They have used the Social Support Questionniare, the Symptom Experience Questionnaire, the Self-Care Strategies Questionnaire, and the Health-Related Quality of Life Questionnaire (Tangkawanich et al, 2008 p 217). These are described in detail, and where they are based on previously developed research or derived directly from previous studies, this is also described. As these are established research data collection tools, this would suggest they have been previously validated, which adds to the quality of the research (Yu and Cooper, 1983 p 36; Oppenheim, 1992; McDowell and Newell, 1996; McColl et al, 2001 p 1). The demographics of the sample are addressed to some extent, and the use of multiple tools also helps to address potential confounding variables or factors (PHRU, 2009, online). Nursing Research Essay Assignment Paper
11. Ethical Considerations
It is clearly stated within the study that ethical approval was derived from an appropriate body, and that informed consent was achieved, both of which signify good ethical consideration here (Cormack, 2000). However, there is no explanation of what information was given to the participants, how informed consent was achieved, or if there was any issue with communication or accessibility for people with different communication needs. It does not specifically address issues of anonymity and confidentiality (Cormack, 2000), but instead seems to focus on safety (Tangkawanich et al, 2008 p 218).
The results of this study are presented in tables, diagrams, and in great detail within the text of the paper. The key results and demographic issues are presented, but data presentation is summarised in a results section and then in more detail in the discussion. The findings are not very accessible, but p values are clearly stated, which is important in a study of this kind. PHRU (2009, online), within the CASP tool, poses the question of ‘do you believe the results?’. This is an important question. The results seem plausible, and relate to established statistical analysis procedures (see below). But because of the lack of detail about the sample, and the selection method, it is not possible to eradicate the doubts about these findings, in relation to potential bias. But in the context of the author’s wider knowledge and understanding about people living with HIV/AIDS, the results seem believable. However, the issue of bias cannot be overlooked. More transparency in reporting of key elements of this study would have made it easier to determine whether these results constitute good evidence for practice (Rosswurm and Larrabee, 1999 p 317; Pepler et al, 2006, p 23). Nursing Research Essay Assignment Paper
12. Data analysis
The authors carried out the statistical analyses using SPSS, which is an established statistical programme, and LISREL, which is not a programme this author is familiar with. They describe generating descriptive statistics for each of the variables under consideration, but do not present these in any detail (Tangkawanich et al, 2008 p 218). They then describe the use of multivariate analysis for specific model development, and using other tests, some of which are familiar to the author, some of which are not. While the multivariate analysis and X2 tests are acceptable tests of inference or relationships between variables (Duff, 2005 p 234), anyone who does not have the specialist knowledge of the other tests would find it hard to determine their appropriateness here. The level of specialist statistical knowledge required to understand this would be significant. More transparency could have been achieved by including an explanation of these tests.
The discussion appears quite balanced (Cormack, 2000), and is very detailed, which is good, given the complexity of this study, involving as it does multiple data collection instruments. The study relates the findings back to a wide range of other research studies, which is a strength of this part of the report, showing congruence with many other findings in relation to quality of life, age, socioeconomic status, social support, antiretroviral treatment, symptoms, and self-care (Tangkawanich et al, 2008 p 219). Limitations of the study are also acknowledged (Cormack, 2000). However, the implications for practice are presented in a separate section. Nursing Research Essay Assignment Paper
The conclusion supports the results obtained (Cormack, 2000), although it is not a very detailed summation of the complexity of the findings. However, this is referred to in the ‘Implications and Recommendations’ section. (Tangkawanich et al, 2008 p 217).
The authors of this study suggest that ‘social support’ would have the strongest effect on HRQL(Tangkawanich et al, 2008 p 220). They recommend a wide range of strategies to support this, and also look at all the other factors, making recommendations for improving care for this patient population. These are all consistent with the study. However, the only recommendation for future research is that it should be longitudinal rather than cross-sectional (Tangkawanich et al, 2008 p 217).
It is apparent from this study that social and other factors have a serious impact upon the lived experience and quality of life of the target population. It is also apparent that social factors may outweigh medical factors, other than in the provision of antiretroviral therapies for these patients. It would appear, therefore, that understanding these factors and the relationships between them could improve nursing and healthcare practice for people living with HIV/AIDS. However, this author would also conclude that because of some methodological and reporting weaknesses in this study, it would be better to find other research confirming these findings before using it as evidence for practice.
Through the Nursing and Midwifery Council (NMC) code of professional conduct (NMC, 2004) nurses supply high standards of care to patients and clients. One code nurses adhere to is clause 6 which pronounces nurses must maintain professional knowledge and competence, have a responsibility to deliver care based on current evidence, best practice and validated research (NMC, 2004). Validated research involves critiquing and acquiring the skills of synthesis and critical analysis, this enables nurses to distinguish the relationship between theory and practice in nursing (Hendry & Farley 1998). Nursing Research Essay Assignment Paper
This assignment will critique the research paper “Patients’ case – notes: look but don’t touch” written by Bebbington, Parkin, James, Chichester and Kubiak (2003) (Appendix 1) using Benton and Comack’s (2000) framework (Appendix 2). This was selected because of the publicity that surrounds hospital acquired infection (Barrett, 2005).
TitleThe framework suggests the title should be concise, informative, clearly specify the content and indicate the research approach. The title of the paper is concise; however it gives no information of content or research subject. Nursing Research Essay Assignment Paper
Moreover the research approach is unidentified consequently the reader is unsure what kind of research has been performed, perhaps an alternate title could have been “Case notes, do they pass infection: A quantitative study”. This may indicate that the authors have not used a standard format which Benton (2000) states reports should follow; nevertheless the title captured the imagination of the reader and warrants further reading.
AuthorsAccording to the framework, the author(s) should possess appropriate academic and professional qualifications and experience; this according to Carter & Porter (2000) establishes integrity. The qualifications and experiences of the authors are not documented. This could indicate the authors have no relevant qualifications or experiences in this field. However further reading identifies where the authors work which could be relevant to their subject, although there is no indication of their occupation. However the reader performed an online search and found the authors have had previous papers published suggesting research experience, which gives confidence in their abilities. Nursing Research Essay Assignment Paper
AbstractThe framework states an abstract should be included, should identify the research problem, state the hypotheses, outline the methodology, give details of the sample subjects and report major findings. The abstract is included and is outlined which makes it distinctive and captures the attention. Burns and Grove (2003) states this helps to influence the reader to read the remainder of the report. Additionally a distinctive abstract is beneficial for a rapid summary (Parahoo, 1997). The search question is included and is noticed immediately on the first line. Also incorporated are the methodology, sample subjects and major findings. Yet they do not state the hypothesis. The abstract is clear and precise which gives the reader belief in the capability of the researches. Nursing Research Essay Assignment Paper
IntroductionThe framework indicates the introduction should clearly identify the problem, include a rationale and state any limitations. The problem is identifiable and the rational is included, nevertheless the reader would have liked to see these presented earlier in the introduction. Dempsey & Dempsey (2000) concur and states the research problem should be identified early and Polit & Beck (2004) add that readers profit from learning the problem immediately. The authors did not indicate any limitations which could suggest inexperience or could question their professional responsibility (Polit & Beck, 2004), however the reader perceives a limitation as being only one study of hospital inpatients notes have been reported thus only one study to compare findings.
Literature reviewThe, framework indicates the literature review should be current, identify the underlying theoretical framework, produce a balanced evaluation of material and to look for absent references. The authors’ literature reviews produce twelve references which range from 1967 to 2002, four were classed as outdated (Burns & Grove, 2003) and nine were classed current. Although the reference from 1967 is outdated it is reasonable the authors included it since it is the only research paper found on their particular subject. However this causes the reader to speculate the reason this subject was studied. Because the authors and the reader did not discover any other literature concerned with the subject this, could indicate that the authors’ literature search was comprehensive which could prove validity of the study. However it is wondered if other researches believed case notes were irrelevant compared to other objects in the hospital or if this is ground breaking research. Improvement could have been made by the authors including the search engines they had used as this would allow replication and evaluation of the paper. Nursing Research Essay Assignment Paper
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The literature the authors cited used a quantitative approach as did the authors themselves thus identifying and employing the underlying theoretical framework and giving credibility to the paper. Cutlcliff & Ward (2003) suggests the literature review guides the researcher in discussing the results of the study in terms of agreement or non agreement with other studies, however there is no evidence of evaluation of material that supports or challenges the position being proposed .This suggests the researches appear to have only reported the finding of other studies and not examined the material, which, Peat (2001) states is essential for making decisions about whether or not to change practice on the basis of published report.
The outcome is a research paper without critical analysis which Beyea & Nicoll (1998) states is central to the delivery of evidence based patient care. Following duplication of the researches literature search using their keywords the reader could find no important references omitted which leads to the belief that they performed the search methodically. However it was discovered that one important reference in the text (Semmelweis) had been omitted in the reference list. This leads the reader to question if other things may also have been omitted resulting in an unsound paper.
The hypothesisThe framework asks if the hypothesis is capable of testing and if the hypothesis is unambiguous. There is no hypothesis in the paper only a research question. Cormack (2000) states that hypothesis can only be stated for studies which predict a relationship between two variables. Polic & Becks (2004) concur and believe hypotheses are predictions of expected outcomes. Since the authors do not state an expectation of the outcome they did not need to incorporate a hypothesis. This could suggest an understanding of research giving the reader faith in their capabilities. Nursing Research Essay Assignment Paper
Operational definitionsThe framework suggests the terms used in the research problem should be clearly defined. The terms that the author’s employ are clearly defined and can be found effortlessly. Nevertheless they are very limited in respect of the paper and the reader speculated how they found eleven of the twelve references using the keywords since they related to other objects. This could indicate that they decided upon key words prior to performing the literature research, thus limiting their search (Tarling & Crofts, 2002) which questions the validity of the paper. The reader searched Blackwell Synergy using own keywords such as hospital equipment, contamination and bacteria. Many more articles were discovered indicating the authors did not perform an adequate literature search.
MethodologyThe framework indicates that the methodology should clearly state the research approach, appropriate to the research problem and if strengths and weaknesses are noted. Although the authors do not identify the study as quantitative the reader understands that it is since it uses findings that can be measured and deals with quantity of results as opposed to interpretation (Munhall, 2001). Additionally the reader believed it is a deductive study since the authors looked at cross infection and objects in the hospital setting and narrowed it down to cross infection and case notes. No strengths or weaknesses were acknowledged, which, Byrne (1998) states is needed so the reader can ascertain if the research is valid.
Furthermore the authors state they sampled the spine of the case notes because this is where most hand contact occurs while reading them, however perhaps it could have been suggested sampling the inside since in, my experience, this is where most hand contact occurs. The researches also stated they did not wash their hands until the last set of notes had been tested because it simulates the typical daily handling of notes by HCW’s. However the Department of health (2000) state before and after patient contact hands should be washed, consequently the validity of their approach is questionable. Finally the reader would have liked the researches to explain why the notes were incubated at 37 degrees since an assumption could be made that they are simulating a hospital environment. Nursing Research Essay Assignment Paper
SubjectsThe framework suggests the subjects should be clearly identified in the title abstract and methodology. In this paper there are no subjects only case notes. However the reader would have liked there to be a rationale why the authors chose case notes as this according Polit & Beck (2004) gives the reader an understanding of the strengths and weaknesses of the sampling plan.
Sample selectionThe framework suggests the selection approach is congruent to the methodology, clearly stated and if sample size is clearly stated. It appears that convenience sampling was utilised though this is not clear; Burns & Grove (2003) suggest this approach should be avoided however as it provides the opportunity for bias. Since the sample selection method is unclear, it may have been inappropriate, denoting further flaws which affect the remainder of the paper. The sample size is clearly stated however but should have been included in the methodology giving the reader a reference when reading it.
Data collectionThe framework asks if the data collection procedures are adequately described. The authors describe the data collection procedure as recorded and analysed. This gives the reader no understanding of how the data was collected, who document it, who interpreted it and where it was stored. This could have implications on the results since there may have been weaknesses in these areas such as the reliability of the collection tools, if the people who recorded and analysis it had training and if there could there be any contamination to the notes.
Ethical considerationsThe framework asks if the study involves humans has the study received ethics committee approval, if informed consent was sought, if confidentiality was assured and anonymity guaranteed. Although the study does not directly involve human subject’s research involving personal information relating to human subjects requires the approval of the local ethics committee. (Cormack, 2000)(Royal college of physicians, 1998) The authors make no reference these three ethical codes so it is unknown if the patients agreed to their case notes being tested. This implies no consideration of ethical issues from the authors and questions what other considerations they have overlooked. Nursing Research Essay Assignment Paper
ResultsAccording to the framework the results should be clearly presented, internally consistent, have sufficient detail to enable the reader to judge, and asks how much confidence can be placed in the finding. The results that the authors present are unclear and misleading since the first two lines state 227/228 case notes contained bacteria; however it continues to inform that most were “environmental”. The authors use a table to portray their results which Crooks & Davis (1998) suggests is all that is needed to convey information. However the table appears complex, confusing and impossible to understand; therefore the reader would question the internal consistency. In addition since the results are difficult to interpret the reader can not judge the reliability of the findings.
Data analysisThe framework states the approach should be appropriate to the type of data collected, statistical analysis should be correctly performed, should be sufficient analysis to decide whether significant differences are not caused by differences in other relevant variables and if the complete information is reported. The authors approach was appropriate to the type of data collected since no other approach would be suitable. Nevertheless the researches do not state how they analysed the statistics so the reader can not judge any limitations.
DiscussionThe framework states the discussion should be balanced, drawn on previous research, weaknesses of the study acknowledged and clinical implications discussed. The discussion is not balanced since it focus upon the findings of pathogenic bacteria on case notes and subsequently formulates assumptions about MRSA surviving on case notes without research to back this up. It vaguely draws upon the only previous research and mentions the result, which contradicts their own findings. No failings or limitations of the study or literature review are recognized implying no review or evaluation of the literature, which, according to Benton & Cormack (2000) is central to the research process. One clinical implication is discussed briefly however the reader should remember that the authors have not proved the transmission of bacteria on case notes to HCW’s hands only the potential. Nursing Research Essay Assignment Paper
ConclusionThe framework asks if the conclusions are supported by the results obtained. The conclusion the authors established was the possibility of transferring bacteria, however since the results are indecipherable it is impossible to determine if the conclusions are supported by the results.
RecommendationThe framework states the recommendations should suggest further areas for research, and identify how any weaknesses in the study design could be avoided in future research. There is no suggestion for further research; no weaknesses in the study design mentioned and no recommendations on how issues can be avoided. Therefore the reader believes this paper does not establish contamination from case notes, so is unreliable and lacks validity.
Application to practiceThe Department of Health (2005) states Clinical governance is the system through which National Health Service organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care. Elcoat (2000) adds evidence-based practice and evidence-based nursing have very strong positions in the Clinical Governance agenda of quality improvement. Evidence-based practice can be defined as using contemporaneous best evidence ensuring actions are clinically appropriate cost effective and result in positive outcomes for patients (Trinder & Reynolds, 2000). Therefore every healthcare team member has to critique evidence, assess its reliability and application before combining it with their own clinical expertise (DePoy & Gitlin, 1998).
Before knowing how to critique I did not understand why nurses had to review articles and I would have taken them on face value, however since critiquing this article I have realized it is a very important part of my practice and taking articles on face value is unsafe practice. The authors discussed some important issues concerning cross infection and as a consequence I have reflected more on cross infection in my clinical area. This leads me to believe that every research paper is of value and has something to give to the reader. However the article will have little impact on my practice since the recommendation of hand washing before and after patient contact is already integrated in my nursing practice. Nursing Research Essay Assignment Paper
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