Chamberlain College of Nursing NR439: Reading Research Literature

This NR439 assignment is a worksheet analyzing a research article on the effectiveness of artificial tears in preventing dry eye in critically ill patients. The study employed a double-blind randomized controlled trial comparing artificial tears gel and liquid artificial tears. The assignment details the study's purpose, research design, sample characteristics (ICU patients), data collection methods (Schirmer and fluorescein tests), and data analysis techniques (Fisher's test). It highlights limitations, such as not testing alternative interventions and potential biases. The findings indicated artificial tears gel was more effective. The assignment also reflects on the student's understanding of research concepts, including statistical significance, sampling methods, and consent processes. The assignment emphasizes the importance of critical analysis in understanding research literature and the application of evidence-based practice in nursing.

Chamberlain College of Nursing
NR439: Evidence-Based Practice
Week 6: Reading Research Literature Worksheet
Name: _______________________________________________________________________
Date:_________________________________________________________________________
Purpose of the Study: Dry eye is a chronic and progressive condition of the eye causing changes
in the ocular surface of the eye causing eye discomfort or damage to the cornea. According to a
study conducted in the year 2011, two interventions has been proposed for the prevention of dry
eyes- a polyethylene film and carbomer drops. Hence this is a comparative analysis of the two
interventions in preventing dry eyes in patients admitted in an ICU- : liquid artificial tears
(Lacribell; Latinofarma) and artificial tears gel (Vidisic Gel; Bausch and Lomb.
Research & Design: A double blind randomized controlled trial has been conducted with two
parallel groups. 70 participants have been included in the group receiving artificial tears gel and
70 participants were chosen for getting liquid artificial tears. Before the conduction of the final
study, a pilot study has been conducted with only 10 patients in three groups- (liquid artificial
tears, artificial tears gel, and 0.9% sodium chloride solution. The results obtained in the pilot
study, using the power analysis showed that around 67 patients needs to be taken in each of the
groups.
A block randomization is done such that equal number of participants are assigned for each
treatment, it is normally done to achieve a balance between the study arm and reduces any chances
of bias and confounding (Efird, 2011). The use of a double blinded randomized control trial is to
eliminate any bias, especially the confounding and the selection bias (Misra, 2012).
Sample:
Patients of 18 years older or more , with no diagnosis of dry eye with ICU admission, receiving
mechanical ventilation, with a blink rate of less than 5 times a minute and GCS scale 7 or lower
has been chosen.
Initially 546 patients had been chosen, but later on 70 patients had been assigned in each of
groups.
In this study, a cluster sampling has been done, when the entire sample has been divided in to wo
sub-groups each having similar characteristics to the entire sample.
NR439_Reading_Research_Literature_Worksheet 3/2019 ST 1

Chamberlain College of Nursing
NR439: Evidence-Based Practice
Data Collection: For five consecutive days after the interventions have been commenced with,
data was collected and the ocular assessment was performed for each of the participants of the two
groups that have received the intervention. The assessment was done by using the Schirmer test
and the fluorescein test (de Araujo et al., 2010). These tests are normally used to detect ear
fluorescein clearance with the CytoFluor II fluorometer, sensitivity of cornea and conjunctiva.
Since the trial was a double blinded trial the patient’s eyes were cleaned with 0.9 % sodium
chloride solution for removing any traces of the intervention components.
Data Analysis: After the collection of the data, categorical variables of the two interventions has
been measured by Fisher’s test It has also been used for measuring the incidence of dry eye and
the effect of nursing interventions(de Araujo et al., 2010).. This test is normally used for
measuring the statistical significance. This test can be use used to find out the deviation from a
null hypothesis. Furthermore, it is appropriate in studies with small sample sizes, as a Chi-square
or t-test is used for larger sample size (Connelly, 2016). It is used to compare the treatments of the
frequencies of the side effects in two groups.
Limitations: While this study has a number of limitations, but of the notable limitation of this
study is that the researchers have not tested the application of the polyethylene film or any other
types of interventions that has been mentioned in the clinical guidelines. Hence, it cannot be said
that these two are the ultimate cost effective interventions. Again, the 0.9 % sodium chloride
solution that has been used was not removed entirely, hence the researcher might have understood
about the intervention used which might have nullified the purpose of a double blinded trial.
Findings/Discussion:
The study have shown that artificial tears gel is more effective than the liquid artificial tears for
the patents with dry eye in critically ill patients. It has been found that the liquid artificial tears
cannot prevent the evaporation of the film f tear in patients with lagopthalmos. The artificial tear
could form a thin film in the palpebral space (de Araujo et al., 2010). The P value of the study is
less than 1 (P=.04) , increasing the statistical significance of the data. There were no studies other
comparing these 2 intervention.
NR439_Reading_Research_Literature_Worksheet 3/2019 ST 2

Chamberlain College of Nursing
NR439: Evidence-Based Practice
Reading Research Literature: There are various sections in a research article which cannot be
understood unless one has critically analyzed it. It has helped me to understand the purpose of a
double blinded trial, to eliminate the type of bias, the reason why inclusion and exclusion principle
is being followed. Moreover, I have brainstormed through the websites an papers to understand
the terms like statistical significance, or why a Fisher’s test has been used and why not a Chi-
square test due to the small sample size. I have brainstormed through the various methods of
sampling like clustered sampling and stratified sampling and lot more. It also made be mindful
about the consent approval process that needs to be taken after each study.
References
Connelly, L. M. (2016). Fisher's exact test. Medsurg Nursing, 25(1), 58-60.
de Araujo, D. D., Silva, D. V. A., Rodrigues, C. A. O., Silva, P. O., Macieira, T. G. R., & Chianca,
T. C. M. (2019). Effectiveness of Nursing Interventions to Prevent Dry Eye in Critically Ill
Patients. American Journal of Critical Care, 28(4), 299-306.
https://doi.org/10.4037/ajcc2019360
Efird J. (2011). Blocked randomization with randomly selected block sizes. International journal of
environmental research and public health, 8(1), 15–20.
https://doi.org/10.3390/ijerph8010015
Misra S. (2012). Randomized double blind placebo control studies, the "Gold Standard" in
intervention based studies. Indian journal of sexually transmitted diseases and AIDS, 33(2),
131–134. https://doi.org/10.4103/0253-7184.102130
NR439_Reading_Research_Literature_Worksheet 3/2019 ST 3