Running head: QUANTITATIVE RESEARCH CRITIQUE AND ETHIC CONSIDERATIONS 1 Quantitative Research Critique and Ethical Considerations Armine Hakopyan Grand Canyon University: NRS 433V October 13, 2018 QUANTITATIVE RESEARCH CRITIQUE AND ETHIC CONSIDERATIONS 2 MY PICOT STATEMENT: In a long term hospitalized adult patient, how does recurrent evaluation of the appropriateness of a urethral catheter and bladder training compared to no protocol affect the number of catheter associated urinary tract infections over a six- month period? Quantitative Study Scanlon, K. A. (2017). Saving Lives and Reducing Harm: A CAUTI Reduction Program. Nursing Economic$, 35(3), 134–141. Retrieved from https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true& db=ccm&AN=123428995&site=eds-live&scope=site. In this article, the author notes the developing concerns amongst patients as well as hospital staff over the increase in recent years of hospital-acquired infections. He focuses mainly on catheter associated urinary tract infections (CAUTI) reported from 2013 to 2015. The Center for Disease Control and Prevention (CDC) notes that in 2011 alone, 93,300 cases of urinary tract infections (UTIs) were identified. According to the data collected, these cases represented 12% of acute care infections and of these, 75% were related to the way the catheter was used and the frequency of the monitoring of its use (Scanlon, 2017). Infections related to the catheter were on the rise and of grave concern to the patients due to infections that could arise as estimates indicated around 13,000 related deaths in 2013. Related costs had hit $500 million in 2013 alone according to the Center for Disease Control and Prevention. There were also high-cost implications not only for the hospital but also for the patients. There was a concerted effort to reverse the situation and reduce not only the QUANTITATIVE RESEARCH CRITIQUE AND ETHIC CONSIDERATIONS 3 cases of catheter associated urinary tract infections in a hospital setting but also to reduce significant costs of care for such cases (Scanlon, 2017). In clearer terms, the goal of this research was to reduce cases of catheter-related urinary tract infections in the hospital setting and to establish the best methods and techniques with the aim of transferring the knowledge to other health facilities. In this research, quantitative methods, as well as evaluation processes, were used in data collection. The data that was collected from North Shore University Hospital as well as the Northwell School of Medicine. The research used a standardized infection ratio (SIR), incidental case measurement as well as the number of catheter days for specialized care centers for the two hospitals. Purpose of SIR in the study was to measure the performance of the infection, with incidental reports indicating the number of catheter-related cases in the facility, and catheter days were used to monitor the impact of the length of catheter usage and monitoring and lack of impact on the patient's health (Scanlon, 2017). Data was therefore compiled systematically from each unit's level to the hospital level. The research team also developed a very effective framework to get accurate data by developing an organizational structure that helped in the collection of the required data. With continuous monitoring and evaluation of the process, the best practices were able to be effectively collected. For example, the team saw the need to use condom catheters as well as calibrated bags to determine quantity in vs. quantity collected (Scanlon, 2017). The author found that his research can help identify what is being done wrong and what is a better alternative, so the number of catheter associated urinary tract infections can decrease. According to the author, specific, measurable, and accurate results were collected. There was an overall reduction of the cases related to catheter use in SIR, catheter-related infections QUANTITATIVE RESEARCH CRITIQUE AND ETHIC CONSIDERATIONS 4 incidences, the number of days the catheter was used as well as a reduction of the cost implications. In 12 months, SIR reduced by 32% and 73% in 18 months. Incidents measures indicated a reduction of 46% and 89% respectively, while the days of catheter use decreased by 22% and 58% respectively in the same time frame (Scanlon, 2017). In staff outside the sampled units, there was a rippled reduction of SIR by 12 % in 12 months and 285 in a period of 18 months. Incidence cases registering a decrease of 25% in 12 months and 68% in 18 months, while the number of catheter application reduced by 9% and 54% respectively in a similar time frame. Costs implications at North Shore University Hospital decreased by 46% in 12 months and in 18 months by 89%. Northwell registered a 28% cost reduction in 12 months and 81% savings in costs in a period of 18 months (Scanlon, 2017). The implications for the nursing profession is very helpful since the best practice techniques from the study will be able to be replicated to other facilities to reduce the cases of catheter-related incidences, including protocol for catheter insertion as well as maintenance, using the procedure documentation, as well as the standard procedures to the removal of the catheters. Nurses as well as physicians and doctors can also benefit in learning new ways of identifying unique cases, handling them and most importantly, the guidelines to be used to reduce the infection of inserted catheters, monitoring the impact against the number of days in order to reduce cases of infection using monitoring and evaluation of patients using teamwork, and progressive designing of solutions to achieve low figure of catheter-related infections (Scanlon, 2017). Ethics, in this case, were well handled with strict adherence to procedure and protocol by staff as well as ensuring patient privacy as well as treatment preference practices. Selection of the team to conduct the research was also fairly used by considering the relevant factors that QUANTITATIVE RESEARCH CRITIQUE AND ETHIC CONSIDERATIONS 5 would increase the chances of success for the project amongst other suitability measures. Patients, as well as staff used in the research, were of a variety of color, background, and age and it was completely randomized. Patients requests, complaints, feedback, as well as that of project staff, were fairly used to improve the overall process and the research plan (Scanlon, 2017). In conclusion, daily and consistent assessment of the appropriateness of the urethral catheter decreased the cases of infection as well as the number of days and saved costs for the hospitals too. The author also notes improved motivation in the employees due to efficient planning and execution, therefore, improving care for patients with catheter associated urinary tract infections. The research successfully achieved its objectives of decreasing the urinary tract infections in acute care settings and improved the knowledge pool in making patient's health care more efficient. It is evident that this research will transform the healthcare practices for these patients, reduce operating costs as well as improve the medical care services in other facilities worldwide. QUANTITATIVE RESEARCH CRITIQUE AND ETHIC CONSIDERATIONS 6 References Scanlon, K. A. (2017). Saving Lives and Reducing Harm: A CAUTI Reduction Program. Nursing Economic$, 35(3), 134–141. Retrieved from https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true& db=ccm&AN=123428995&site=eds-live&scope=site. Armine, this was a quality improvement project for a hospital and not primary research. It cannot be generalized to other hospitals outside of the system. It was an educational project which you would need to discuss. You discussed the results but not the project. What were the nursing implications learned for this project? You can revise this paper or critique a new primary research article for week 5. Linn Running head: QUALITATIVE RESEARCH CRITIQUE AND ETHIC CONSIDERATIONS 1 Qualitative Research Critique and Ethical Considerations Armine Hakopyan Grand Canyon University: NRS 433V October 7, 2018 QUALITATIVE RESEARCH CRITIQUE AND ETHIC CONSIDERATIONS 2 MY PICOT STATEMENT: In a long term hospitalized adult patient, how does recurrent evaluation of the appropriateness of a urethral catheter and bladder training compared to no protocol affect the number of catheter associated urinary tract infections over a six- month period? Qualitative Study Gesmundo, M. (2016). Enhancing Nurses’ Knowledge on Catheter-Associated Urinary Tract Infection (Cauti) Prevention. Kai Tiaki Nursing Research, 7(1), 32–40. Retrieved from https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true& db=ccm&AN=119345448&site=eds-live&scope=site. In this article, the author discusses the importance of knowledge and understanding by the nurses of the indwelling catheter and how this may decrease the number of catheterassociated urinary tract infection (CAUTI). CAUTI is very common in the hospital settings and accounts for forty percent of healthcare associated infections (HAI), 80 percent of these HAI’s are attributed to indwelling catheters (Gesmundo, 2016). The author identified that the high infection rates in the hospital settings was a problem that needed to be issued which led to her study. The author was unaware as to what was the cause of such high rates in infection rates. She did identify that there are modifiable risk factors that can lower CAUTI numbers. Some risk factors that can be modifiable are reducing unnecessary insertions of catheters, minimizing the duration of use, maintain aseptic technique during insertion, and insertion of catheters outside the operation rooms (Gesmundo, 2016). This study purpose was aimed to understand what can be done to further decrease the number of CAUTI seen in hospital settings. The question asked by QUALITATIVE RESEARCH CRITIQUE AND ETHIC CONSIDERATIONS 3 the author in her research was, “What is the impact of a CAUTI education package on nurses’ knowledge of indwelling catheter management?”, this question was relatable to the purpose of the study she further on discussed (Gesmundo, 2016). The author stated strategies to prevent CAUTI which included strict adherence to hand hygiene, appropriate antimicrobial use, and appropriate catheter management by the nurse. The author also stated the recommendations by the CDC to lower CAUTI rates. These recommendations included: avoiding unnecessary use of catheters, using aseptic technique during insertion, maintain catheters based on recommended guidelines, and review the necessity of the use daily to ensure prompt removal (Gesmundo, 2016). In the research, the author discusses the prevention of CAUTI in New Zealand which included research that showed onethird of the catheters being inserted were inappropriate because the doctors were unaware they were being placed. This research had a CAUTI prevention intervention that includes educating nurses and doctors on ABCDEs (aseptic technique, bladder scan usage, usage of condom catheters, using catheters only when necessary, and early removal). CAUTI cases in New Zealand in the year of 2012 cost approximately $50,500 which increased to $63,300 in 2013. The author stated the number of CAUTI cases and the threat to patient safety was what led to her research and felt that the implementation of an evidence-based educational package for CAUTI would benefit the nurses and patient outcomes (Gesmundo, 2016). The investigator used a multi- phased approach to target this research question. She used focus groups and pre-test and post research. The objectives that pertained to this study included the baseline knowledge the nurses had on the practices of indwelling catheters, educational intervention development that can address the knowledge deficits seen in the nurse’s knowledge on catheter care and management, and evaluation of the education intervention. She used a QUALITATIVE RESEARCH CRITIQUE AND ETHIC CONSIDERATIONS 4 qualitative and quantitative research to gather information. The qualitative data was gathered using the focus groups. There were 13 nurses that participated in two focus groups, before the test the nurses were given a pre- test to evaluate their knowledge and was later given another test after to evaluate their learning. The tests given to the nurses were published by Schneider in 2012. The data was collected from March to June 2014 and it was over a 17-week period (Gesmundo, 2016). The qualitative data was analyzed one at a time to make sure the data was well understood. After taking the tests she would understand how well the participants understood the information and it predicted if the CAUTI rates would go down. The author set up a table for the focus group that showed the diversity of demographic characteristics, educational backgrounds, clinical experiences and their genders. The participants in the focus group were then asked questions on catheter care and to state the importance of maintenance of the catheter. Next, the participants in the study all stated how their current clinical practices were, depending on where they worked. There was one male in the study which also had stated that his gender role was a barrier since most patients preferred female nurses to care for their catheters and this issue was never reported as a factor in CAUTI. Other nurses also stated that some patients refused catheter care or even removal of catheters because they did not want to ambulate to the restroom from being in so much pain. The participants stated that most had protocols in place at their clinical areas for insertion and removal but did not have any in place for maintaining the catheter in place (Gesmundo, 2016). These questions helped her identify what is already in place for their clinical areas and how they are trying to decrease the number of CAUTIs. The author sought ethics approval from the DHB Research Committee and the University of Auckland Human Participants Ethics Committee for her research. This study ensured that the QUALITATIVE RESEARCH CRITIQUE AND ETHIC CONSIDERATIONS 5 participants would be benefited from the research and will be free of harm. Author also stated that fair treatment and protection of participants information would be in effect for the research. The ethical considerations regarding this study was full disclosure of the nature of the study (Gesmundo, 2016). After they recognized that there would be no harm out of this study, they allowed her to conduct her research. In conclusion, this research was well put together and thought out using evidence-based research to support the issue and interventions. She had a qualitative and quantitative approach to fully establish a good intervention. The qualitative research helped her understand what the nurses understood about catheters and CAUTI. The study measured before and after the introduction of their education package the author proposed to them. After allowing them time to learn and be educated in the new education, the participants were tested to understand how well they learned. Post education scores suggested an improvement in nurse’s catheter management education (Gesmundo, 2016). Limitations seen in this study was the number of participants in the study. Having a CAUTI bundle personalized for every work clinic is important and should be implemented. QUALITATIVE RESEARCH CRITIQUE AND ETHIC CONSIDERATIONS 6 References Gesmundo, M. (2016). Enhancing Nurses’ Knowledge on Catheter-Associated Urinary Tract Infection (Cauti) Prevention. Kai Tiaki Nursing Research, 7(1), 32–40. Retrieved from https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true& db=ccm&AN=119345448&site=eds-live&scope=site. Armine, you have a good topic, but you need a PICO question. Please see my comments and revise. Please discuss the literature review and how the interviews were transcribed as well as the implications from the article. Good work! Linn Research Critique Guidelines To write a critical appraisal that demonstrates comprehension of the research study conducted, address each component below for qualitative study in the Topic 2 assignment and the quantitative study in the Topic 3 assignment. Successful completion of this assignment requires that you provide a rationale, include examples, or reference content from the study in your responses. Qualitative Study Background of Study: • Identify the clinical problem and research problem that led to the study. What was not known about the clinical problem that, if understood, could be used to improve health care delivery or patient outcomes? This gap in knowledge is the research problem. • How did the author establish the significance of the study? In other words, why should the reader care about this study? Look for statements about human suffering, costs of treatment, or the number of people affected by the clinical problem. • Identify the purpose of the study. An author may clearly state the purpose of the study or may describe the purpose as the study goals, objectives, or aims. • List research questions that the study was designed to answer. If the author does not explicitly provide the questions, attempt to infer the questions from the answers. • Were the purpose and research questions related to the problem? Method of Study: • Were qualitative methods appropriate to answer the research questions? • Did the author identify a specific perspective from which the study was developed? If so, what was it? • Did the author cite quantitative and qualitative studies relevant to the focus of the study? What other types of literature did the author include? • Are the references current? For qualitative studies, the author may have included studies older than the 5-year limit typically used for quantitative studies. Findings of older qualitative studies may be relevant to a qualitative study. • Did the author evaluate or indicate the weaknesses of the available studies? • Did the literature review include adequate information to build a logical argument? • When a researcher uses the grounded theory method of qualitative inquiry, the researcher may develop a framework or diagram as part of the findings of the study. Was a framework developed from the study findings? © 2016. Grand Canyon University. All Rights Reserved. Results of Study • What were the study findings? • What are the implications to nursing? • Explain how the findings contribute to nursing knowledge/science. Would this impact practice, education, administration, or all areas of nursing? Ethical Considerations • Was the study approved by an Institutional Review Board? • Was patient privacy protected? • Were there ethical considerations regarding the treatment or lack of? Conclusion • Emphasize the importance and congruity of the thesis statement. • Provide a logical wrap-up to bring the appraisal to completion and to leave a lasting impression and take-away points useful in nursing practice. • Incorporate a critical appraisal and a brief analysis of the utility and applicability of the findings to nursing practice. • Integrate a summary of the knowledge learned. 2 Quantitative Study Background of Study: • Identify the clinical problem and research problem that led to the study. What was not known about the clinical problem that, if understood, could be used to improve health care delivery or patient outcomes? This gap in knowledge is the research problem. • How did the author establish the significance of the study? In other words, why should the reader care about this study? Look for statements about human suffering, costs of treatment, or the number of people affected by the clinical problem. • Identify the purpose of the study. An author may clearly state the purpose of the study or may describe the purpose as the study goals, objectives, or aims. • List research questions that the study was designed to answer. If the author does not explicitly provide the questions, attempt to infer the questions from the answers. • Were the purpose and research questions related to the problem? Methods of Study • Identify the benefits and risks of participation addressed by the authors. Were there benefits or risks the authors do not identify? • Was informed consent obtained from the subjects or participants? • Did it seem that the subjects participated voluntarily in the study? • Was institutional review board approval obtained from the agency in which the study was conducted? • Are the major variables (independent and dependent variables) identified and defined? What were these variables? • How were data collected in this study? • What rationale did the author provide for using this data collection method? • Identify the time period for data collection of the study. • Describe the sequence of data collection events for a participant. • Describe the data management and analysis methods used in the study. • Did the author discuss how the rigor of the process was assured? For example, does the author describe maintaining a paper trail of critical decisions that were made during the analysis of the data? Was statistical software used to ensure accuracy of the analysis? • What measures were used to minimize the effects of researcher bias (their experiences and perspectives)? For example, did two researchers independently analyze the data and compare their analyses? Results of Study • What is the researcher's interpretation of findings? 3 • Are the findings valid or an accurate reflection of reality? Do you have confidence in the findings? • What limitations of the study were identified by researchers? • Was there a coherent logic to the presentation of findings? • What implications do the findings have for nursing practice? For example, can the findings of the study be applied to general nursing practice, to a specific population, or to a specific area of nursing? • What suggestions are made for further studies? Ethical Considerations • Was the study approved by an Institutional Review Board? • Was patient privacy protected? • Were there ethical considerations regarding the treatment or lack of? Conclusion • Emphasize the importance and congruity of the thesis statement. • Provide a logical wrap-up to bring the appraisal to completion and to leave a lasting impression and take-away points useful in nursing practice. • Incorporate a critical appraisal and a brief analysis of the utility and applicability of the findings to nursing practice. • Integrate a summary of the knowledge learned. Reference Burns, N., & Grove, S. (2011). Understanding nursing research (5th ed.). St. Louis, MO: Elsevier. 4
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