Quantitative Research in Critical Appraisal

This article provides an overview of quantitative research and its role in critical appraisal. It explains the process of quantitative research, its benefits, and limitations. The article also discusses the importance of using quantitative research methods in obtaining high-quality evidence. Find study material and solved assignments on Desklib.

Assessment task-3
Assessment 3
Critical Appraisal
Section A
Quantitative research
Quantitative research is formal, systematic as well as objective process that
utilizes numerical data to obtain information. According to Polit (2016), quantitative
research involves investigating the phenomena by appropriate measurement and
quantification through rigorous as well as controlled design. It is considered superior to
all other research methods as it aid in obtaining information, describing variables,
determining the relationship between variables and examining the cause & effect
interactions between variables. In addition to that, this method can give the chance to
redefine new measures and enhance understandings of the variables (Henly, 2016). It
includes true- experimental or RCTs (Randomized Controlled Trials), quasi- & non-
experimental types..
RCTs or randomized- clinical trials in which the researchers are the active agents
and not the passive observes are characterized with features as: manipulation (giving
intervention to subjects), control (introducing some control over the experimental
situation; control group (without intervention) and randomization (random assigning of
the subjects to interventional and control group) (Polit, 2016). This controlled
interventional design is regarded as the Gold standard for obtaining rich high quality
evidence by drawing relationship between the cause and its effect (LoBiondo-Wood,
2014). The greater confidence of the researchers in RCT trials for obtaining the best
genuine casual relationships between variables as they are conducted under controlled
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Assessment task-3
environments is its major strength. They also meet the criteria for establishing causality
which is its added advantage. .
Section-B: Critical Appraisal
Questions Answers
Q1. Did the study ask a
clearly focused question?
The researchers asked a clear as well as focused
study--question with the issue based on the given
treatment (HPHF-program) & the patient-related
outcomes.
Q2. Discuss the
appropriateness of using an
RCT for this study.
This RCT trial seems highly adequate and appropriate
for this study as because the study-researchers have
given home-based palliative HF (HPHF) program as
treatment to the interventional group while kept the
controls without intervention. They have undertaken a
two-group RCT in 3 of the hospitals located in Hong
Kong. They have randomly assigned the eligible
subjects for both experimental as well as control
groups. The experimental group alone were provided
with HPHF program for twelve weeks and were
followed up by home visits and/or by phone calling by
the nursing case managers.
Q3. Discuss how the
assignment of patients to
treatments was randomised
Randomization involves assigning samples to
treatment conditions randomly (Grove, 2015). In this
study, after collecting the baseline data and obtaining
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Assessment task-3
consent from the participants, the site-manager,
without any knowledge about the samples have
opened up a cover containing the random numbers
sequence generated by the computers for sample
assignment. They did block randomization and
determined six as block size.
Q4. Were all the patients who
entered the trial properly
accounted for at its
conclusion?
Ng & Wong. (2018) have assessed 389 patients with
ESHF for eligibility and have excluded 305 for not
meeting the inclusion criteria; n= 275, refused to take
part n= 26, and participated in programs conducted in
hospital; n= 4. Finally, eighty four patients were
selected and were randomized with 43 in interventional
and 41 in control group between the period of May ‘13
and June ‘15.. The text suggests that the trial went as
their mentioned basis and the subjects were
adequately analysed within the groups (where they
were randomised).
Q5. Were patients, health
workers and study personnel
‘blind’ to treatment?
According to Polit (2016), blinding is the process of
preventing those involved in a research-study
(participants, data collecting persons or experimenters)
from obtaining information which might create bias.
They have blinded only the data collecting persons to
the group assignment and have not blinded the
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interventionist & the subjects as it was not possible due
to the intervention’s nature..
Q6. Were the groups similar
at the start of the trial?
It is found that the participants in both the groups were
same from the start of this study and other confounding
factors that includes age, gender and societal status
hasn’t affected the study’s outcome,
Q7. Aside from the
experimental intervention,
were the groups treated
equally?
They have followed up the subjects in all the groups &
have collected the data in the similar manner. Thus,
they have treated the groups equally other than the
intervention provided to experiment group.
Q8. How were the data
analysed?
The researchers have utilized PASW software
Statistics-18 for data analyses. They performed
descriptive analyses to draw the frequency and
percentage of the variables and Repeated analysis of
variance to determine the effect of treatment and
control groups on outcome-variables They examined
within-group difference by using Sidak-correction. while
between group comparisons through Friedman &
Mann-Whitney U tests. They performed within-group
analysis by Wilcoxon ranks test while Bonferroni
correction to avoid Type-I error
Q9. How were the results
presented? What are the main
They have well-presented their comparison results in
tabular columns but could have given some pictorial
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Assessment task-3
results? representations for easy interpretation, as advised by
(Iverson, 2014). The text suggests that the group effect
with HPHF group’s QOL is statistically significant as
compared to controls at p= 0.016 and the group time
interaction’s effect is also statistically significant at p=
0.032 whereas group effects for symptom distress
and/or functional-status measure was noted to be not
significant. Overall, the treatment group was noted to
have high satisfaction rate and low caretaker’s burden
than that of control group.
Q10. Can the results be
applied to the local population,
or in the Australian context?
No, the results cannot be utilized to the local or
Australian people as because the current study was
conducted in Hong Kong’s ESHF-patients, having
different health system. Additionally, the subjects
covered by the study may not be similar to the subjects
to whom I will apply this study’s result as they differ in
their cultural, social and economical characteristics
with a varied health care system. Generalizability is
defined as the extent to which the study methods
justifies the inference that the study results are
absolutely true for broad group than the study’s
subjects. (Polit, 2016).
Q11. What were the identified Limitations include: study proposed in Hong-Kong,
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limitations of the study? having varied health system; inadequate size of
sample & larger exclusion of samples due to cognitive
impairment, weak body and at end-stage, which can
limit the generalizability of the results. Unpredictable
disease trajectory of HF can challenge the researchers
(Gomes, 2013). Additionally, more attrition rate due to
client death & clinical-deterioration can affect findings
of the study. It can be difficult to replicate the study as
the life expectancy of ESHF-patients remains 1 year.
Q12. What were the ethical
considerations for undertaking
this research?
Ethics are the set of values that are concerned with the
professional, societal as well as legal aspects of the
study. They got informed consents from their subjects
& have ensured the freedom to withdraw and
confidentiality of personal data. They got approval from
Ethics committee (the Human Subjects) of Polytechnic
University- Hong Kong as well as from the selected
hospitals.
Q13. Describe how this
research study could be
translated into clinical
practice.
The study’s findings can enhance the knowledge of the
transitional client care method. The study’s favourable
clinical outcomes that were found consistent with other
RCTs can be utilized to improve the QOLs minimize
symptom burden (Gomes, 2013, Kavalieratos, 2016),
promote client’s satisfaction and minimize use of health
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Assessment task-3
service (Sahlen, 2016) among ESHF patients. This
HPHF program reduces the caretaker burden (Ventura,
2014) while the conceptual underpinnings were also
based on the transitional-care framework (Wong,
2011). The holistic assessment, continuity of patient-
care various healthcare settings, as well as multi-
disciplinary approach of the HPHF program is highly
important in health-care delivery.
Part-B
Section A: introduction to EBP
Evidence based practice involves the conscientious utilization of rich available
evidence to guide develop decisions about client care (Polit, 2016). According to
Gerrish (2015), best evidence for practice includes empirical evidence obtained from
RCTs; evidence obtained from other scientific methods that includes descriptive as well
as qualitative research; and use of informations from patient reports, expert opinion and
scientific principles. If current high quality evidence is available, then the patient care
practices can be devised based on the rich evidence available by considering the client
values. In case, if satisfactory studies are unavailable, the health professional has to
drive healthcare decisions from non research evidence. Therefore, more researches
should be conducted in a selected healthcare area to gain high quality evidence so as
to improve patient safety as well as values.
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According to CNA (2019), there are several positive effects of EBP, “When
delivered in a context of complete caring & an organizational culture that improve best
practices, EBP is associated with high quality patient care and better client outcomes
than traditional care” EBP also minimizes differences in care practices, improve care’s
consistency and also contribute to quality of care & client safety agendas. Such
evidenced practice can improve the satisfaction of health care personnel (Levin, 2011),
particularly the nurse’s autonomy (Novak, 2008) and reduce nurse’s work stress (Van
Patter, 2009).,Moreover, high quality evidence utilized in nursing as well as healthcare
services can minimize costs at the health system level (Levin, 2011) and promote cost-
effectiveness.
According to Bradshaw (2010), several barriers were documented in the EBP’s
implementation in which absence of sufficient time is noted as the most crucial barriers.
Certain nursing-related barrier include: absence of research knowledge that are
required to understand data analytical results; absence of interest in conducting
research; absence of confidence in critically appraising studies (Bradshaw, 2010).;
absence of computer-based knowledge and skills for research searchers and analyzes;;
nurses’ perceptions of not getting cooperation and to alter patient care practices;
negative attitudes as well as values.
Organizational barriers include: absence of time to conduct study; excessive
organizational workloads; inadequate health care staffs; poor accessibility to health care
resources, poor nursing manager’s support; variation of nursing practice goals between
nursing administrators and staffs (Van Patter Gale, 2009); & absence of EBP mentors in
health-care systems.
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Assessment task-3
According to Douglas (2012), the health care professionals has to work to draw
solutions and find outcomes for nursing care that could indicate the rich high quality
evidence to constantly promote the patient care. In addition to that, the nurses who are
the primary care takers should strive to render best high quality care to all the clients
irrespective of any discrepancies in any settings ranging from community to tertiary care
settings. Hence all the nursing staffs should propose researches, develop best possible
evidences and utilize available evidence to provide best high quality evidence and
improve patient safety and values (Boswell, 2017). The nurses should render holistic
care to not only prevent illness but also to protect health as well as improve health.
Section-B: Reflection on EBP
Clinical Situation
Step-1: Description
A 16 year old male patient came to the clinic about 3 weeks ago with chief complaints of
feeling depressed and low self-esteem due to the presence of pimple and marks on his
face. His greater worry is that the young girls may not look at him due to his pimple
marks. At the consultation time, only I was present and no other nurses were present in
the room. The consultation lasted about 20 minutes during which time the patients and
myself discussed about his skin and emotional problems. He opened up to me that he
began to get spots at around 13 years which made him to feel negative about him. He
was prescribed with Oxytetracycline to overcome his skin and emotional problems for 3
months.
Step-2: Feelings
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Assessment task-3
During consultation, I felt sympathy and empathy for the patient. This is because. I
faced a similar situation in my teenage, when I suffered from the problems of acne from
the 14 to 20 years and which has adversely affected my emotion, self-image and self-
esteem. In 2011, Dunn, O’Neill has suggested that the patients who suffer from acne
are at increased risk for developing depression & psychological issues and that acne
treatment can improve the psychological issues. This assured me that oxytetracycline
can be the best choice for this patient with skin and emotional problems. My past
experiences of pimples have helped me to understand well about the patient’s
condition. I too felt anger at his friends who have taunted and teased him inhumanly. I
felt happy that this man had come to the clinic by himself with a greater courage.
Step-3: Evaluation
On evaluation, this incident was good to me in several ways. At first, it remains as a
greater experience for me to handle the teenagers with the skin problems that are
specific for a particular age group. In my career, I haven’t had much experience in
handling teenage patients previously but I am glad that I got this opportunity to deal with
young patients. It made me feel proud that I have taken nursing as a profession. But
there were certain negative elements. The consultation time for the patient was short
and it could have made the patient uncomfortable. The study by Purvis (2006), indicated
that the teenagers with spots are at higher suicidal risk and more attention should be
given to their psychological health. These informations have made me to be more
anxious about the care of young people.
Step-4: Analysis
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Reflection has increased my ability to handle teenagers efficiently by relating to the
patient’s condition. The client has ventilated all his feelings and emotions to me
because he might have sensed my empathy for him. It is supported by the review
conducted by Randall (2012) that the good nurse should communicate to the teenagers
efficiently and I think this is why he has opened up to me. I am convinced that the
patient has chosen to consult and ventilate the problems caused by acne. In 2010,
Gulliver has specified that youngsters often feel embarrassed and stigmatized to access
health-care. But, in this case, this young man has courageous come out to solve his
problems of skin and emotion, which is appreciable. During consultation, I had both
positive and negative emotions; I felt it is important provide best nursing care possible.
Step-5: Conclusion
On conclusion, In the future, if I get a similar situation, I will deal with it in a different
manner. I will refer them to the support services. Along with biological and meditational
support, they have to be counseled to handle their emotional problems. It would be
helpful for them to be referred to charities that build self-esteem and self-confidence.
Coyne (2008) has suggested that teenagers require more consultation time for decision-
making and hence more time should be allotted to rule-out their problems.
Step-6: Action Plan
I have planned several elements in my action plan. At first, I will keep posters,
broachers and leaflets in the consultation room with informations related to emotional
problems in teenagers. In 2005, Hayter has indicated that teenagers who access clinics
keep high values on health care professional’s non-judgmental approach and hence, I
will be aware of my own-attitude and will not make prejudice ideas about the client. The
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author added that teenagers were found to behave more concern about confidentiality.
Therefore, in the future, I will reassure the teenagers that their personal details will be
kept confidential. \
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