Critical Appraisal of a Randomized Control Trial in Healthcare

This report presents a critical appraisal of a randomized controlled trial (RCT) focusing on the effectiveness of emergency nurse practitioner (NP) services in achieving timely analgesia, based on an article by Jennings et al. (2015). The appraisal systematically addresses questions from the CASP RCT checklist to evaluate the validity, results, and applicability of the trial. Key aspects examined include the clarity of the research focus, the randomization process, maintenance of allocation, blinding, similarity of trial groups, equal treatment of groups, measurement of treatment effect, and the precision of results. The appraisal concludes that while the study has strengths in its design and execution, its applicability may be limited to specific healthcare contexts where nurse practitioners are appropriately trained. The report also notes the inclusion of clinically important outcomes, such as timely analgesia and pain score assessment, but points out the absence of cost-effectiveness analysis. Desklib offers a range of solved assignments and study resources for students.

Running head: CRITICAL APPRAISAL ASSIGNMENT
CRITICAL APPRAISAL ASSIGNMENT
Name of the Student
Name of the University
Author note

1CRITICAL APPRAISAL ASSIGNMENT
Jennings, N., Gardner, G., O'reilly, G. and Mitra, B., 2015. Evaluating emergency nurse
practitioner service effectiveness on achieving timely analgesia: a pragmatic randomized
controlled trial. Academic Emergency Medicine, 22(6), pp.676-684.
Answer 1
Yes, the trial addressed a clearly focused population, studied in this pragmatic
randomized controlled trial (Jennings et al. 2015).
Answer 2
Yes, the primary aim of the researchers was to conduct the research and maintain the
randomized allocation of patients to the standard care process or to the intervention care process.
For this, they had three primary parameters to be fulfilled, the process using which
randomization was carried out, completing the allocation randomly till the last patient is
allocated to any of the groups and thirdly, concealing the allocation of patients from researchers
as well so that complete randomization could be achieved (Jennings et al. 2015).
In this aspect, the clinical research assistants were allocated to complete the patient
allocation related task and these assistants used the examination cubicle to decide which patient
will be subjected to the research. Further to randomize the process, they used the sequence of
four and this sequence was generated by the computer software that generated the sequence
randomly and then transcribed the sequences into various sequentially numbered sealed
envelopes so that randomized nature of the research could be maintained. However, participants
and the hospital staff were aware of the allocation of subject to different intervention groups and
primary investigators of the research were blind to the research.

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Answer 3
Yes, these parameters were also achieved by the researchers as both the trail group
analyzed the research outcomes within their research environment. Two patents were not
allocated to any group or intervention as they did not provided complete consent so that the study
could be conducted with them. However, the study was conducted for the pre-decided time
period and it did not stopped prior to that. Further, allocation of patients were done with
complete precision under the supervision of researchers assistant’s so that completely
authenticated results could be achieved. Therefore, from these evidences it could be easily
determined that the research article completely accounted for its conclusion (Hockenberry and
Wilson 2013).
Answer 4
In this randomized control trial the primary aim of the researchers was to understand the
effectiveness of nursing practitioner’s role in providing care and assistance in patients suffering
from tremendous pain and providing them with analgesics within specific time so that it could be
controlled. Therefore, researchers appointed clinical research assistants so that randomization f
patient allocation to the trail group and intervention group could be achieved. However, it was
seen that except research personnel who are primary investigators of the complete research
process, every individual such as patients, medical workers and healthcare professionals were
aware of the allocation process and the randomized trial was not hidden to them. However, it was
also noted that the treating staff or the people involved in the randomized trail control research
were blind to the research process and they were unaware of the allocation of the patient to the
intervention group. Further, all the primary investigators involved in the trail group as well as for

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the traditional process were blind to the process and were not involved in the allocation of the
patients to any of the groups (Alligood 2013).
Answer 5
The trail groups of patients involved in the process were similar from starting to ending
of the trail process so that completely relevant and appropriate and authentic data regarding the
effectiveness of the nursing practitioners could be understood. In the research study it was
clearly mentioned that only two patients were not included prior to commencement of the study
because proper consent was lacking in both the cases and it was unethical to include these
patients in the trail group without a proper consent , as mentioned by (). Further, it should also be
noted that without proper consent, the research findings and values are not considered as
authentic and hence, the researchers of this context excluded those two patients prior to
commence the research. Therefore, it is evident that all the participants were present till the
research process was completed in both the trial groups.
Answer 6
Yes, both the groups of patients involved in the study were helped or treated equally by
the research investigators while conducting the pain management related research in both the
context. However, two different teams were allocated to take care of the patients and provide
them care as per the research intervention or control intervention. It was seen that patients
involved in the control group or traditional therapy were managed by medical officers and in this
team total 17 registrars who were trained prior to implement them in the study and they also had
a string educational background so that their practical and their knowledge could be used for the
betterment of the patient. On the other hand. The intervention group was handled by the nursing

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practitioners so that their care process and the effectiveness of it compared to the medical
interventions could be understood and comment on its future implications could be understood.
They managed each patient properly and provided care for their pain and associated symptoms
by providing them with analgesics and hence, it is clear from this aspect of the research process
that both the patent group included in either intervention group of in traditional medication group
were provided with equal treatment (Stanik-Hutt et al. 2013).
Answer 7
The treatment effect of the intervention was properly measured in this randomized
control trail research process (Savović et al. 2012). The primary outcome which was measured in
this research aspect was the proportion of the patients who were provided with analgesics within
the limits of Australian national target of 30 minutes of time. as per the result, after conducting
data analysis it was found that the proportion of patient who were provided with analgesics
within 30 minutes of time in both intervention and medication group was found as 49.2% and
29.7% in the nurse practitioner and medical care emergency department group respectively.
Therefore, it is clear that the research clearly identified the primary outcome (McFarland and
Wehbe-Alamah 2014).
Besides this, the research also assessed a secondary outcome which was assessing the at
which analgesics were given to the patient from the time of their arrival in the healthcare settings
and especially in both the target and traditional setting of research therefore, these two outcomes
were measured in the group (Savović et al. 2012).

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Answer 8
The precision of the test results could be assessed form the outcome or results achieved
as it was seen that the mean time for providing analgesics in the NP group was found to be 25.4
and in the traditional or standard group it was 43.0 and the difference was 17.6 minutes (Jennings
et al. 2015). Further when the median change in the pain score of the patients were assessed it
was found that the change in pain score in both the groups differed from 0.5 only. Therefore, it
was not a significant change and hence, it was inferred that the nurse practitioner group also
provided equally effective care to the patients with pain and managed it like the standard care
process (Jennings et al. 2015).
Answer 9
Yes it could be applied in local context in the healthcare facilities of Australia. However,
it cannot be applied in every context of care as the nurse practitioners are educated or trained as
experts who can provide care to patients in specific areas such as acute care, critical conditions
and specific situations and hence, they cannot be applied in cardio vascular or other units as they
might not be able to handle the critical situation as they can manage it in acute cases (Warren et
al. 2016). Therefore, despite the fact that they can be applied in local healthcare facilities of
Australia, they can only be appointed in the cases where they are able to provide care.
Answer 10
Yes, as per the research aim. Objectives and the research aspect targeted for this
particular research aspect, all the clinically important outcomes were involved in the research. It
was seen in the research that researchers completely maintained the randomized of the allocation
of patients in the target or standard group so that authentic research outcome could be generated.

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Further in the aspect they measured two aspects such as the application of analgesic s within the
time period of 30 minutes and the amount of pain score after the application of analgesic which
completely addresses the research question and its effectiveness. Therefore the researchers were
able to include the research aspect and all clinically important aspect in the research process
(Neal et al. 2013).
Answer 11
This aspect was not mentioned in the research article, however in the general point of
discussion, it is an important outcome which was important to be achieved so that the nurse
practitioners could be included in the primary care services and patients could be provided with
effective and quality care (Arnold and Boggs 2015). Further, it was also seen that nurse
practitioners are able to provide equal quality care to each of the patient equally to the standard
medical process and hence, it was an important finding which will help the healthcare service in
future as they will be able to manage and provide care to majority of the patients (Spencer,
Anderson and Ellis 2013).

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References
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practitioner service effectiveness on achieving timely analgesia: a pragmatic randomized
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