The essay facilitates the application of the principles

Running Head: RESEARCH CRITIQUE
RESEARCH CRITIQUE
Name of the student
Name of the University
Author Note

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Table of Contents
Introduction................................................................................................................................2
Discussion..................................................................................................................................2
Evidence based practice and its significance in nursing........................................................2
Outline of the chosen research paper and rationale...............................................................5
Analysis using the CASP framework.....................................................................................6
Conclusion..................................................................................................................................9
References................................................................................................................................10

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Introduction
The purpose of this essay is to develop an understanding of the theoretical as well as
practical aspects of evidence-based practice (EBP) with the help of critiquing a primary
research paper using the CASP appraisal tool. The essay facilitates the application of the
principles of EBP in order to critique the research paper effectively and consider its relevance
to clinical nursing practice. This essay will begin with an overview of EBP and the
implication of evidence based nursing in the present healthcare scenario. It will briefly
outline, analyse and justify the chosen research paper, and then discuss the significance of the
findings for professional improvement and nursing practice. The chosen article is of
particular importance to the clinical nursing settings as it addresses a vital age-related health
complication of hyperosmolar dehydration (HD) in elder adults (65 years and above),
admitted to the emergency department of a hospital and evaluates the effect of HD in the
short and long term health impacts. The prevalence of such cases is frequently associated
with poor health in older adults, and therefore, findings of this paper can shed light on this
concern.
Discussion
Evidence based practice and its significance in nursing
EBP may be described as “the integration of best research evidence with clinical
expertise and patient values” that when adopted by experts and professionals, eventually lead
to enriched patient outcomes and encourage safe healthcare practices (Rousseau and Gunia
2016). The three major components of EBP are:
 finest evidence that is typically found in research which is clinically relevant and has
been conducted using a rigorous methodology,

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 scientific or clinical expertise based on cumulative education, experience and clinical
skills of the clinician and
 each clinical encounter that the clinician comes across, which brings forth unique
patient preferences, apprehensions and outlooks.
It is the assimilation of these three components that classify a clinical resolution to be
evidence-based (Young et al. 2014). There are five A’s of EBP through which this
integration can be effectively achieved (Peterson et al. 2014; Stillwell et al. 2010). These are:
 ASK a relevant and answerable question-
Formulation of a well-built clinical question that is relevant and answerable at the
same is vital for the process of EBP. The clinician must possess these skills of
developing such questions to focus their efforts precisely on the areas of concern
successfully. Such questions are generally generated via patient encounters which
produce queries about aspects of the clinical practice like diagnosis, treatment,
prediction or aetiology.
 ACQUIRE the evidence most appropriate-
The second step is to find relevant evidence for the developed problems. This step
encompasses recognising search terms from the thoughtfully fabricated question
developed in the beginning and selecting resources for the search to be directed. An
effective search strategy can be framed by incorporation of MESH terms and filtering
the search results.
 APPRAISE the obtained evidence
Critical appraisal is the next step after the accumulation of appropriate evidence
through database searches. It is imperative to be capable of critical appraising so that
studies can be further clarified based on their type and level of strength. It can be

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achieved by using a simple critical appraisal framework that addresses questions
regarding the validation, focus point, and reliability of the results of the studies.
 APPLY the selected evidence-
Application of the evidence in clinical decisions by combining the best available
evidence helps in enhancing the clinical expertise and provides better patient
outcomes.
 ANALYSE the outcome-
Evaluation of the efficiency and value of the clinical decision directly related to the
patient is the final step of an EBP. Assessing the outcome of implementing the EBP
throughout the clinical practice is crucial to determine whether the clinical decision-
making process has been substantial or not.
The significance of evidence is determined by its level, and there are five levels of evidence
(Rumrill 2017):
 Level I includes randomised controlled trial (RCTs), systematic reviews, meta-
analysis and any evidence-based clinical guidelines that can be reliable
 Level II includes evidence acquired from no less than one well-structured RCT, for
example, multi-centre trials.
 Level III considers well-designed controlled trials that are not randomised (quasi-
experimental)
 Level IV includes case-control or cohort studies that are strategically designed
 Level V has descriptive and qualitative studies (meta-synthesis) systematic reviews
 Level VI includes evidence obtained from one descriptive or qualitative study
 Level VII includes the opinion of authoritative bodies or expert committee reports

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The evidence-based nursing practice involves the amalgamation of research proof,
adept clinical proficiency and consideration of a patient’s likings. The problem-solving
approach of evidence based nursing encourages nurses in clinical settings to focus on
personalised patient care. EBP supports them in identifying care strategies that will assist
their patients. Recently, EBP has become a significant element of outstanding patient care
(Boltz et al. 2016). Evidence-based nursing care and interventions facilitate better patient-
centred care, safety patient environment, and are more likely to achieve the desired outcomes
with a focus on care goals. Incorporating EBP in nursing aids nurses to base their decisions
on well rounded scientific research. Through EBP, they can gather up-to-date information
and stay alert about the latest patient care protocols. By thoroughly studying documented
interventions suited to their patients’ profiles, nurses can optimise the chances of patient
recovery. Additionally, EBP assists nurses to appraise research, so they apprehend the risks
or usefulness of a diagnostic trial and treatment plan, along with including their patients in
the development of the care process. This permits patients to proactively participate in their
healthcare since they can express their concerns, beliefs, preferences and suggest on how they
desire their care plan to be developed (Maughan and Yonkaitis 2017).
Outline of the chosen research paper and rationale
The purpose of this research paper was to inspect the hyperosmolar dehydration (HD)
predominance in older adults admitted as emergencies in large teaching hospitals in the UK
and to evaluate its impact on temporary and longstanding health consequences. This was a
prospective cohort study executed via primary data collection which included the “Charlson
comorbidity index (CCI), national early warning score (NEWS), Canadian Study of Health
and Aging (CSHA) clinical frailty scale, and Nutrition Risk Screening Tool (NRS) 2002”.
The methodology involved the measurement of serum osmolality via blood tests immediately
upon admission of the patients. A serum osmolality >300 mOsmol/kg was kept as the

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indicator of HD. Subjects of the study who remained admitted even after 48 hours were
studied, and the previous evaluations were repeated for them. Out of 200 participants,
dehydration was found in 37% of them at the time of admission. When they were reviewed
after 48 hours, it was observed that 62% of them were still dehydrated. Data was analysed via
Cox regression analysis, and the findings demonstrated that patients who are dehydrated at
the time of admission are more susceptible to face mortality during the hospital stay. The
study deduced that harmonised efforts are essential for the development of effective and
ample hydration evaluation tools to establish and screen a tangible perception change in
approaching the dehydrated older adults assigned in hospitals.
The rationale for selecting this paper for the critique appraisal is because it
appropriately recognises a relevant and concerning area in the geriatric health across hospital
settings. Although dehydration is a common occurrence in hospitalised older patients, it is
often poorly identified and treated as a priority health indicator. This leads to poorer health
outcomes and also increase the risk of dehydration-induced mortality for older adults. Lack of
hydration measurement tools and a deficit of evidence based knowledge regarding the
underlying factors are acknowledged in this paper, which are crucial elements that must be
considered to reduce the prevalence of dehydration.
Analysis using the CASP framework
Paper for appraisal and reference: Hydration and outcome in older patients admitted to
hospital (The HOOP prospective cohort study)
1. Did the trial address a clearly focused issue? YES
Comments- the study clearly states its purpose to be focused on the concern of HD in
hospitalised older adults (65 years or above) and evaluating the effect of dehydration on
the health outcomes of such patients

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2. Was the assignment of patients to treatments randomised? CANNOT TELL
Comments- while recruiting the patients, informed consent was obtained under ethical
recommendations. After screening 1409 patients on admission, 200 participants were selected
for the study. The criteria for exclusion included admission more than 12 h ago (n = 417),
presence of any severe illness, morbidities, terminal diseases (n = 298) and rejection to
participation (n = 494). Collection of blood samples from all partakers was completed at
admission.
3. Were all of the patients who entered the trial properly accounted for at its conclusion?
NO
Comments- reviewing was done for those participants only who were still in hospital 48
hours after they were admitted. Similar measurements were repeated for them. Discharged
(within 48 hours of admission) patients who were initially included in the study were not
reviewed.
4. Were patients, health workers and study personnel ‘blind’ to treatment? NO
Comments- informed consent was obtained from the participants before the commencement
of the study
5. Were the groups similar at the start of the trial? YES
Comments- the age group selected was 65 years and above. Demographic data were obtained
from the participants based on the medical notes or their relatives, which on statistical
analysis was not found to vary between the participants significantly
6. Aside from the experimental intervention, were the groups treated equally? CANNOT
TELL

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Comments- not enough information present in the study
7. How large was the treatment effect?
Comments- the measured outcome was primarily serum osmolality as an indicator of
hydration status in the participants; the study also found that six times greater risk of in-
hospital mortality was there in patients who were dehydrated as compared with those
euhydrated.
8. How precise was the estimate of the treatment effect?
Comments- the hydration outcome was estimated at a confidence interval of P = 0.001
9. Can the results be applied to the local population, or in your context? YES
Comments- the results of the study suggest a lack of hydration awareness in the hospitals for
older adults, and this identification of a relevant health issue can be utilised in a broader
perspective by initiating the implementation of tools that can adequately diagnose
dehydration and carefully planning care interventions
10. Were all clinically important outcomes considered? YES
11. Are the benefits worth the harms and costs? CANNOT TELL
The findings of the paper thus appropriately help to highlight a clinically significant issue
in hospitalised older adults that is often underdiagnosed, lead to poor health outcomes, and
contribute towards reducing the overall life expectancy in this age group. The paper
demonstrates the presence of a high rate of dehydration-induced morbidities which requires
immediate attention from the nurses and other healthcare practitioners. By acknowledging the
prevalence of dehydration within hospitalised patients, nurses will be able to provide more
robust care and develop successful interventions that effectively reduce such cases. The need

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for improvement in hydration and nutrition care for older adults should be addressed by the
nurses, and they should, therefore, adopt a collaborative approach in delivering the best
nursing care targeted to accomplish improved health outcomes. These results will
substantially contribute towards constructive development of the nursing profession and will
help in tackling similar situations in future with adept knowledge and capacity to identify the
crisis.
Conclusion
Having evaluated the chosen research paper in this essay, it can be concluded that
dehydration is a critical biomarker of poor health and malnutrition in older adults admi8tted
to hospitals as emergencies. There is a major concern of increased mortality and reduced
quality of life in such patients which often goes underdiagnosed by health practitioners due to
unavailability of adequate knowledge, awareness and measurement tools. Hence, the focus
must be put on improving the hydration care for older adults via proper care plans and
development of enhanced assessment techniques. Few nursing recommendations in this
context would be to mediate training for nurses to recognise the clinical signs and symptoms
related to dehydration caused by low fluid intake in the older patients, via testing the serum
osmolality test upon admission (Bunn et al. 2019). To obtain an accurate diagnosis, the
clinical manifestations such as thirst, dryness of tongue and mouth, reduced tear secretions,
hypotension and an increased capillary refill time, urine analysis to identify any
abnormalities, and pyrexia are relevant for the nurses to consider (Bunn and Hooper 2019).

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References
Boltz, M., Capezuti, E., Fulmer, T.T. and Zwicker, D. eds., 2016. Evidence-based geriatric
nursing protocols for best practice. Springer Publishing Company.
Bunn, D., Jimoh, O., Karrouze, I., Wyatt, K. and Hooper, L., 2019. Effective hydration care
for older people living in care homes. Nursing Times, 115(9), pp.54-58.
Bunn, D.K. and Hooper, L., 2019. Signs and Symptoms of Low-Intake Dehydration Do Not
Work in Older Care Home Residents—DRIE Diagnostic Accuracy Study. Journal of the
American Medical Directors Association, 20(8), pp.963-970.
Maughan, E.D. and Yonkaitis, C.F., 2017. What does evidence-based school nursing practice
even mean? Get a clue. NASN School Nurse, 32(5), pp.287-289.
Peterson, M.H., Barnason, S., Donnelly, B., Hill, K., Miley, H., Riggs, L. and Whiteman, K.,
2014. Choosing the best evidence to guide clinical practice: Application of AACN levels of
evidence. Critical Care Nurse, 34(2), pp.58-68.
Rousseau, D.M. and Gunia, B.C., 2016. Evidence-based practice: The psychology of EBP
implementation. Annual Review of Psychology, 67, pp.667-692.
RUMRILL, CCP, 2017. Research Methods and Evidence-based Practice. Certified
Rehabilitation Counselor Examination Preparation, p.229.
Stillwell, S.B., Fineout-Overholt, E., Melnyk, B.M. and Williamson, K.M., 2010. Evidence-
based practice, step by step: asking the clinical question: a key step in evidence-based
practice. AJN The American Journal of Nursing, 110(3), pp.58-61.
Young, T., Rohwer, A., Volmink, J. and Clarke, M., 2014. What are the effects of teaching
evidence-based health care (EBHC)? Overview of systematic reviews. PloS one, 9(1).

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