Background/ Introduction
Evidence-based health-practice involves conscientious utilization of best available evidences to provide patient-care (Polit, 2016). This report carefully analyzes the appropriateness, trust-worthiness and relevance of the research-methods employed in a quantitative and a qualitative study.
Evidence Table
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A1:Quantitative study |
Bugden, S., Shean, K., Scott, M., Mihala, G., Clark, S., Johnstone, C., … Rickard, C. (2016). Skin glue reduces the failure rate of emergency department-inserted peripheral intravenous catheters: A randomized controlled trial. Annals of Emergency Medicine, 68, 196–201.https://dx.doi.org/10.1016/j.annemergmed.2015.11.026 |
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Background/ Introduction
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Peripheral IV catheters (PIVCs) are more commonly used in emergencies, among which most of them fail due to premature PIVC-dislodgment, occlusion and other causes. This study evaluates whether the PIVC-failure could be minimized by using skin-glue with standard-care. |
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Review of the Literature |
The review of literature includes studies based on the statistics of PIVC insertions in emergencies, contributing factors for PIVC failure and usage of skin-glue in minimizing failure of arterial catheters. Absence of previous studies to rule-out the best securement method has motivated the researchers to pose this study with skin-glue securement. |
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Discussion of Methodology |
Adopted two-armed, single-site randomized-controlled trial (RCT) with 380 PIVC insertions. They randomized the samples in 1:1 ratio to both control and experimental group by randomizer-software. |
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Data analysis |
Measured primary-outcome (PIVC-failure within 48 hours) by direct-observation and/or telephoning while secondary-outcomes (PIVC-occlusion, infection, PIVC-dislodgement and phlebitis) by direct-observation, chart reviewing and structured-questionnaire. Data analysis shows that PIVC failure was statistically reduced in experimental than control group. No infections in both groups. |
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Researcher’s conclusion |
They conclude that application of skin-glue with standard-securement minimize PIVC failure among adults in emergency department (ED) |
Critique
The balanced appraisal of this quantitative study suggests that the researchers have carefully selected their study-title to depict the fundamental nature of the study. Evaluation of a study’s abstract should clarify their focus for the research endeavor (Boswell, 2017). Their abstract gives a valuable insight into their study’s complexity and its applicability to a healthcare setting. They have stated an achievable objective as ‘to rule-out the effect of skin-glue plus standard-securement application in controlling the PIVC’s failure-rate inserted in emergencies’ (Melnyk, 2015). Bugden (2016) has used recent studies to discuss what is previously known about PIVC-securement; indentify knowledge gaps, mention their study’s significance and situate the research-study within the best available knowledge.
They have used RCT-rial under true-experimental quantitative study-design by which they have manipulated (skin-glue securement and standard-securement), kept control group and randomized the samples (LoBiondo-Wood, 2014). This design can yield a high-valuable evidence in-regard to the application of skin-glue to minimize PIVC-failure. Their selection of focused statistical-hypothesis, achievable research-question, appropriate setting is adequate. They have selected the samples through random-sampling to give an equal chance to the entire population of being selected for the study (Iverson, 2014).
Bugden (2016) have devised self-structured questionnaire to gather baseline and clinical data. Their assessment of primary outcomes by direct-visualization and/or telephonic method and secondary outcomes by direct-observation, chart-reviewing and structured-questionnaire seems adequate. But, absence of method of measurement (scoring or rating scale), origin of instruments, validity of self-structured questionnaire as well as reliability, questions the usability of study- findings. They have not blinded the participants and ED-nurses because of their intervention’s nature, but has randomized the samples to avoid bias. They performed quantitative analysis to manipulate numerical data by adapting descriptive and inferential measures to describe the phenomena and rule-out the relationship between variables (Polit, 2016).
They have obtained written consent from the study-participants to assure confidentiality and anonymity. They got approval from the hospital’s ethical committee and got registered in the Australia & New-Zealand Clinical-trial registry to protect human-subjects from harm. No mention about cultural considerations, yet text suggests that they haven’t forced samples to participate.
Strengths and limitations
The strengths include: being first RCT to analyze the use of skin-glue to adhere PIVCs; findings can be generalized in ED-settings as they are consistent with other recent literatures (Marsh, 2015). The limitations include: non-blinded RCT; collection of data in a single-site with local patient-mix; potential confounders (sclerotic, anticoagulants and PIVC accesses) weren’t measured; inadequate outcome measure of discharged patients through telephoning and improper study time of only 48 hours, questions the generalization of study-findings.
Review of the Literature
Relevance to nursing practice
This study helps nurses to use skin-glue to adhere PIVCs in-order to prevent PIVC-dislodgements, occlusion and other complications. Adopting this technique can promote patient values by avoiding unnecessary pain; improves nurse’s expertise; reduces staff-time, minimizes healthcare cost and hence enhances provision of evidence-based-care.
Evidence Table
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B1:Qualitative article |
George, S.R. & Thomas, S.P. (2010). Lived experience of diabetes among older, rural people. Journal of Advanced Nursing, 66(5), 1092–1100. doi: 10.1111/j.1365-2648.2010.05278.x |
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Background/ Introduction
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In worldwide, elder population are greatly affected by diabetes mellitus along with the related co-morbidities and disabilities. The guideline for managing diabetes that was created by the American’s Diabetes- Association doesn’t target this elderly population. This necessitates consideration of a newer diabetic educative model that comprises of consideration of client’s experiences. |
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Review of the Literature |
American’s Association of Diabetic- educators with American’s geriatric-society has developed guidelines for elderly people based on the self-management of diabetes, but awaits evaluation. Absence of previous long term studies among elderly people with diabetes. has motivated the researchers to propose this study to explore the lived experiences of elderly people living in rural area with diabetes. |
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Discussion of Methodology |
They have selected qualitative, phenomenological design with un-structured interview technique that was comprised of open-ended questions. Purposive samples were interviewed and were transcribed as well as analyzed based on the aspects existential- phenomenology |
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Data analysis |
The collected data was transcribed to evaluate the accuracy of data and was also analyzed for its pattern. After identification of patterns, the data were related to each other in-order to develop a completed thematic structure and were also presented to the study-participants. |
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Researcher’s conclusion |
They conclude that diabetic- educational models should be framed as per nursing models by considering the patient’s perceptions and experiences. Nurses should strive to re-formulate the study’s problem and exclude the compliance/non-compliance variable to formulate a conceptual pattern on self-management of diabetes. |
Critique
The researchers of this study have clearly framed the study title that gives a clear and concise description about the entire study. Their abstract condenses the study problem, aims, methodology, findings, conclusions with recommendations (Boswell, 2017). Their aim/objective as ‘to explore the experiences as well as perceptions of rural old-aged people with insulin-dependent diabetes about self-managing diabetes’ is adequate. They have quoted relevant, appropriate as well as comprehensive studies (Gerrish, 2015) that can definitely support the researcher’s conclusion.
George (2010) has selected purposive sampling method which is a non-probability method that involves selecting subjects in a subjective fashion (Grove, 2015). They have selected elderly people residing in local agencies with insulin-dependent diabetes within eligibility criteria. They used phenomenology method under qualitative design in which the phenomenon is investigated in an accurate and holistic fashion by gathering a rich narrative data (Polit, 2016). It empowers the participants to describe their experiences in their own words. The researchers have efficiently used this design to gather the lived experiences of insulin-dependent rural elderly people.
They gathered data through un-structured (face-to-face) interviews in which the researchers will not use give directions ot participants, rather allow the participants to ventilate their life-experiences with perceptions about diabetes and its self-management (Polit, 2016). Though it has got disadvantages, un-structured method best suits this study by encouraging the elderly to express their inner feelings. Then, a survey about self-management was conducted.
Their adoption of bracketing, in which the researchers should be capable of separating their personal-knowledge from self-experience during data collection to avoid bias is highly-adequate. They have clearly transcribed the collected data and analyzed its thematic pattern. Their identification of four related-themes about elderly with uncontrolled diabetes is adequate. Their conclusion is not clear as it has more recommendations for nurses in self-management of diabetes, rather than self-management of diabetes by the subjects.
They got clearance form ethical committee and have given informations to participants about study’s purpose, nature of data collection, time required, benefits and harm associated with participation. They obtained informed consent to enhance patient’s safety. They have focused only the rural people and have suggested nurses to provide care by understanding people’s cultural values. .
Discussion of Methodology
Strengths & Limitations
The study’s strengths include: being first study to elucidate a self-managing model for elderly-people; bracketing-technique to avoid bias; explains nurse’s role in self-management. The limitations include: only female participants; inclusion of particular community group and selection of only rural population.
Relevance to nursing practice
This study helps nurses to understand that self-management diabetes methods should be taught based on the age and should be given at an early stage of diabetes to avoid complications. It helps nurses to understand that they play a major role in controlling glucose level through proper communication with the elderly-diabetic patients.
Conclusion
Nurses should continuously contemplate and evaluate research studies to determine the application of relevant nursing care to the patients. This post analyzed the evidences provided in two studies and their strengths and short- comings, ethical considerations, strengths & limitations as well as their relevance to nursing practice. Despite certain drawbacks, both studies can be used to provide evidence based nursing care.
Reference
Boswell, C & Cannon. S. (2017). Introduction to nursing research- Incorporating evidence based practice Retrieved from https://books.google.co.in/books?id=nsQwCwAAQBAJ&pg= PA312&dq=Polit+tools+in+research&hl=en&sa=X&ved=0ahUKEwj6xdOJmpHbAhUBKJQKHYLMBKQQ6AEIXzAJ#v=onepage&q=Polit%20tools%20in%20research&f=fal
Bugden, S., Shean, K., Scott, M., Mihala, G., Clark, S., Johnstone, C., … Rickard, C. (2016). Skin glue reduces the failure rate of emergency department-inserted peripheral intravenous catheters: A randomized controlled trial. Annals of Emergency Medicine, 68, 196–201.https://dx.doi.org/10.1016/j.annemergmed.2015.11.026
George, S.R. & Thomas, S.P. (2010). Lived experience of diabetes among older, rural people. Journal of Advanced Nursing, 66(5), 1092–1100. doi: 10.1111/j.1365-2648.2010.05278.x
Gerrish, K., & Lathlean, J. (2015). The research process in nursing (7th ed.). Malden, MA: John Wiley & Sons.
Grove, S. K., Grey, J. R., & Burns, N. (2015). Understanding nursing research: Building an evidence-based practice (6th ed.). London, United Kingdom: Elsevier
Iverson, K.M. (2014). Women veterans’ preferences for intimate partner violence screening and response procedures within the Veterans Health Administration. Research in Nursing and Health, 37, 302-311
LoBiondo-Wood, G & Haber, J. (2014). Nursing Research: Methods and Critical Appraisal for Evidence-Based. Retrieved from https://books.google.co.in/books?isbn=0323100864
Marsh, N. (2015). Devices and dressings to secure peripheral venous catheters to prevent complications [review]. Cochrane Database Syst Rev, 6:CD011070.
Melnyk, B.M et al. (2014). The establishment of EBP competencies for practicing RNs and advanced practice nurses in real world clinical settings: Proficiencies to improve health care quality, reliability, patient outcomes and cost: worldview on Evidence based practice. 11 (1). 5-15. doi.10.1111./WBN.12021
Polit, D.F & Beck, C.T. (2016). Nursing Research: Generating and assessing evidence for nursing practice. Lippincott Williams & Wilkins: New Delhi.
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