Managing Patient Safety: Critical Appraisal in Clinical Practice - Essay Example

?Critical Appraisal Introduction Critical appraisal is an important tool in improving the quality of clinical practice in the delivery of health services. This paper will be a critical appraisal of two research papers discussing pain management. The two articles are: “Nurses’ Knowledge and Attitudes Regarding Pain Assessment and Intervention” by Deborah Al-Shaer, Pamela D. Hill, and Mary Ann Anderson and “The challenge of caring for patients in pain: from the nurse’s perspective” by Katrin Blondal and Sigridur Halldorsdottir. These studies were chosen because pain is one of the most common complaints and symptoms assessed on patients following surgery and managing such pain is important in order to reduce patient anxiety and improve patient outcomes. It is of particular interest to me because various studies have been carried out on pain management and assessment, and I believe that establishing which studies provide the best evidence on care would also assist me in my delivery of health services (Hammer and Collinson, 1999). This paper shall first present the method by which the studies were selected. It shall be followed by the critical summaries and then by the appraisal of method. Finally, a synthesis of findings and reflection on practice will also be presented. Body Selection of papers In the selection of the papers, I entered the following search words in Google Scholar; post-operative + nursing care, post-operative issues + nursing, pain assessment + post-operative nursing. Search results were further narrowed down using the following additional parameters: past 10 years, and results from the following databases: EMBASE, CINAHL, PubMed, and the Cochrane databases. Articles found were further narrowed down based on advanced search parameters, covering meta-analysis and other scholarly types of research. The credibility of the authors was also evaluated, assessing their expertise on the subject of the research. Critical summaries In the study by Blondal and Halldorsdottir (2008), the authors attempted to establish a though understanding of nurses’ experiences in the management of patients in pain. The authors understood that despite improved knowledge on patient care, these patients were still suffering from issues in relation to pain and nurses are the primary health professionals which can help relieve these symptoms. The authors carried out their study as a phenomenological study covering 20 dialogues with 10 experienced nurses. The research process revealed that caring for patients in pain is a major challenge for many nurses and nurses seem to feel a moral obligation to ease patient’s pain. Moreover, these nurses feel that they face a challenge in managing patient’s pain in terms of how they read their patient, how they deal with moral conflicts, and organizational issues. The authors also concluded that nurses require different patterns of knowledge and a favourable work environment in order to improve their pain management skills. In the study by Al-Shaer, et.al., (2011), the nurses’ knowledge and attitudes regarding pain assessment and intervention was considered. The authors undertook their study as a non-experimental, descriptive design, based on a convenience sample of 129 registered nurses working in various units of a Midwestern metropolitan hospital. The authors covered registered nurses on their knowledge and attitudes on pain management and the results indicated that their knowledge of pain management principles and interventions seem to be insufficient. Although the results of this study do indicate high knowledge scores, some nurses indicate an inadequate ability to care for patients experiencing pain. The authors were also able to acknowledge the fact that pain is a subjective experience and that nurses must not base their assessments on their personal beliefs of judgments. Critical review 1. Appraisal of method In the study by Blondal, the problem was specifically and clearly stated by the authors and it had sufficient background information in order to logically establish the foundation of the problem. The aims of the study are also clearly established by the author. The problem is also very much researchable, based on data provided by previous studies and more importantly from answers provided by the nurse-respondents (Hall and Hall, 2004). It is also an issue which is directly related to my field of practice which is nursing, where pain management is one of the major patient complaints. The researchers are also appropriately qualified to undertake the study, with post-graduate degrees in nursing and significant involvement in the academic, research, and clinical fields of practice (LoBiondo-Wood and Haber, 2005). Through such background, they have gained sufficient expertise, knowledge, and experience in the nursing practice and in pain management in order to ensure credible research processes. In the study by Al-Shaer, the authors did not clearly state the problem although they were able to provide a sufficient background for the issue they were discussing. They also provided a clear purpose for the study which was focused on nurses’ knowledge on pain assessment. They covered 129 nurses, chosen via convenience sampling. The problem chosen is also researchable with background data available to the researchers and with available respondent nurses from whom data can be extracted (Houser, 2011). It is also an issue very much significant to my practice as a post-operative nurse because pain is the usual complaint which patients have following surgery and I therefore need to know as much as I can about the subject matter. The researchers also have the sufficient qualifications to undertake the study. They have bachelor’s degrees in nursing, alongside post-graduate degrees also in nursing. They are also involved in the academe and in the field of research; this makes them credible authors for this research (Holzemer, 2009). 2. The Literature Review In the Blondal study, the literature review is very much relevant to the topic as it helps establish previous available data on the subject matter. It is also sufficiently comprehensive as it provides diverse and detailed information on the subject matter. Some of the literature sources are however not current, as they date more than 10 years from the time the study was made. The referencing method was also used correctly (Brokopp and Hastings-Tolsma, 2003). The review is also laid out logically, with various ideas on pain and nursing pain assessment presented based on similar and contrasting information (Brokopp and Hastings-Tolsma, 2003). A summary also spells out the implications on why the current study is being carried out. In the Al-Shaer study, the literature review also provides data which is significant to the issue being discussed. It is also very much comprehensive in terms of previously carried out studies related to the subject matter. Some of the literature sources are also not current as they date back 10 years beyond the time this study was made (Boswell and Cannon, 2011). The referencing style is also correct and is appropriately detailed and presented. It is also consistent throughout the research process. The review is presented logically and with a consistent balance in the studies presented (Boswell and Cannon, 2011). A summary of the literature was indicated at the end of the review, thereby providing a logical transition into the actual research. 3. The Study Design In the Blondal study, a statement on the overall design is indicated and theoretical framework is also laid out. The qualitative method applied in this study is appropriate because it covers a small population and it allows for a more personal response to the current topic being studied (Parahoo, 2006). It is also appropriate as it was able to address the purposes and aims of the study and it allowed such aims to be explored according to more specific goals. There was no clear hypothesis offered, but it is implied from the text. A clear description on how the ethical issues were resolved was also established by the authors, with efforts made towards maintaining the anonymity and protecting the confidentiality of the respondents (Parahoo, 2006). The methods of gathering information, how respondents would be chosen, how data would be collected was laid out clearly. The recruitment strategy was also appropriate for the aims of the research, allowing for a small and specific population to be recruited for this study (Fitzpatrick and Kazer, 2011). Such processes were followed by the researchers and how each method was used was also specifically described by the authors. The technical terms and operational definitions for each term were however not explained by the authors. In the Al-Shaer study, the overall design as well as the theoretical framework was laid out and described by the authors. This study hypothesizes that nurses’ knowledge of pain assessment and interventions is an essential component in promoting positive patient outcomes. The ethical research processes were also followed by the authors, including informed consent and approval from the ethics committee (Burns and Grove, 2005). The confidentiality and anonymity of the respondents was also assured by the authors. The data gathering procedures, data collection processes and the selection of the respondents was described in detail by the authors (Burns and Grove, 2005). The technical terms and the operational definition of the terms used in this paper were not established by the authors. 4. Data Collection In the Blondal study, the data collection method was described clearly by the authors and how such data would be collected from the respondents was also specified and defined by the authors. This study applied the NKAS or the Nurses’ Knowledge and Attitude Survey (NKAS) which has been modified with permission. Data was gathered in the winter months in the Midwest; however, the year when the study was carried out was not specified by the authors. Nevertheless, the data collected matched the research question and information collected serves to support the research question raised (Fontana, 2004). The researcher also justifies the different methods used, describing the interview process as a tool which provide more in-depth information on the subject matter. The sample is also discussed in terms of their relevance and size, mostly with nurses having the sufficient nursing experience and adequate numbers for a relevant result (Fontana, 2004). The stages of the sampling process were not specified by the researchers, nevertheless, it appears that the respondents could merely agree or disagree to be respondents and no additional criterion for participation into the study was indicated by the authors. The instruments for data collection were also described by the authors (Fontana, 2004). Issues on reliability and validity were discussed by the authors, referring to the inherent processes which ensure trustworthiness as allowed by the Vancouver School of doing phenomenology. The relationship between the researcher and the participants has been appropriately considered, mostly in relation to how the researcher can improve the practice of the participants in the management of pain (Parahoo, 2006). Moreover, a clear description on what the researcher did to collect the data was also apparent in the text. In the Al-Shaer study, the authors also described their data collection method, mostly a questionnaire which was fashioned to establish relevant data for this study. The methods used were explained, but not sufficiently justified. The sample is described in terms of relevance and size, explaining why and how they were chosen for this study (Burns and Grove, 2005). Instruments in the data collection process were also discussed specifically by the authors and however, issues on reliability and validity were not considered and described by the researchers. Nevertheless, the processes which the authors used in order to collect the data were clearly seen in the study (Burns and Grove, 2005). 5. Data Analysis The methods of analysis in the Blondal study were appropriate for the data because they ensured an appropriate treatment of the data collected. These methods were clearly described by the researchers and the process by which these methods unfolded in the research were also specifically discussed (Berg, 2004). The findings were clearly laid out through tables, easily ensuring the comprehensibility of such results. The discussion and findings were also adequately discussed in relation to the research problems, previous literature, as well as the hypothesis. The correlations of the variables were also discussed (Berg, 2004). The data was analysed with sufficient rigour, considering all factors involved, inconsistencies, as well as related theories on the subject matter. This study is valuable to the overall body of knowledge in pain management because it seeks to establish a more in-depth and specific knowledge on pain management, one which is based on specific nurse experiences. The methods of analysis in the Al-Shaer study matched the data as they allowed for the appropriate and adequate management of data gathered. Such methods were specifically described by the authors and these methods also ensured the appropriate treatment of the data collected (Martin, 2002). The findings were also indicated in the tables, and as a result, the data presented was orderly and clear. The findings and discussion presented a comprehensive analysis of the study, in relation to the research issue, the variables, and the findings from previous studies (Martin, 2002). 6. Conclusions and Recommendations The conclusions raised by the authors in the Blondal study were justified and adequately supported by the findings and the discussion. These conclusions are also established in relation to the original goals of the researcher. Their recommendations are also practical and are related to the research results, as well as issues in methodology (Munhall, 2011). The implications of the study for future research were also discussed, and these implications were mostly based on limitations of their current study. The conclusions raised by the authors in the Al-Shaer study were adequately justified and sufficiently supported by the results, as well as the discussion of the variables and implications of the study (Keele, 2011). These conclusions are also based on the original research question and purpose established by the authors. The recommendations made by the authors are doable and they can be adopted in improving the nursing practice. Implications of the study for future research mostly referred to what other aspects of the pain assessment process can be studied and evaluated with the goal of improving patient outcomes. Discussion and findings Based on the above evaluation of the two studies, it is apparent to note how qualitative and quantitative studies differ from each other. In qualitative studies, the sample population is usually smaller, but the participant observation is more in-depth because the data gathering process is usually through personal and one-on-one interviews (Hoskins and Mariano, 2004). The interview and data gathering process can be more detailed in qualitative studies, and it is possible to gain a more personal insight into the pain assessment and management process which nurses go through. On the other hand, for quantitative studies, participant observation is not as efficiently achieved because the data gathering process with each participant is carried out through questionnaires and there is limited personal contact between the researchers and the participants (Fitzpatrick and Merwin, 2008). Both research perspectives and methods have their strengths and weaknesses. For quantitative studies, a greater population is often covered and as such, the results can have a more generalized applicability to the greater population. On the other hand, the sample population is usually much smaller for qualitative studies and as a result, their results would not be applicable to the general population (Tappen, 2010). Quantitative research uses numerical figures and statistical analysis in order to analyze the data results (Scott and Mazhindu, 2005). The results are often based on average responses of participants, cumulated from various data based on the questionnaire (Tappen, 2010). As was mentioned, it is possible to cover a larger population for quantitative research because the data gathering process is usually via questionnaires distributed and later retrieved. For qualitative research on the other hand, the focus is less on the cumulative or average responses, but on the overall themes which can be deduced from the participants (Polit and Beck, 2008). In general, despite the differences in methodology, both studies do offer a similar insight on pain management in nursing. Both studies indicate that there are gaps in the knowledge that nurses have on pain management. Both studies also express that nurses encounter various barriers in pain assessment and this often interferes with their eventual management of pain symptoms (Gerrish and Lacey, 2010). Differences in insights are however apparent in the representations used where the quantitative study uses percentages and knowledge scores in order to establish such insights (Gerrish and Lacey, 2010). The qualitative study uses the personal responses of the participants, classified into themes in order to build an insight into the issue of pain management and assessment. All in all, insights from both studies present with similar results. Since the research process for quantitative studies are more cumulative and numerical in approach, it tends to produce more objective results. Hardly any possibility for any researcher impact on the establishment of results is possible because the researcher would simply tally answers and apply statistical tools to establish answers to the hypothesis (Stommel and Willis, 2004). However, for qualitative studies, the interview process itself can be subjective and personal. Moreover, interpreting such results is entirely based on how the researchers would perceive and analyse the responses of the participants. Possible follow-up questions during the interview process are also entirely based on the interviewer (Macnee and McCabe, 2008). In effect, there may often be issues on the uniformity of the questions and the interview process which, in the end, can impact on how the respondent would answer. These subjective elements in the interview process can often impact on the validity and the reliability of the results. For which reason, the qualitative study is often considered less reliable (Macnee and McCabe, 2008). Nevertheless, it is a research process which produces rich data results which can help improve the quality of nursing care. They are also able to provide more specific and personal suggestions which can serve to improve the clinical practice and the delivery of services to patients. Conclusion This critical analysis of the two studies by Blondal and Al-Shaer establish that pain management and assessment is a major issue in the clinical practice and nurses do not have the adequate knowledge and skills in order to assess and to manage these pain symptoms. These studies represent two different research approaches, quantitative and qualitative research. The Al-Shaer study is the quantitative study and the Blondal study is the qualitative study. Both studies were able to inform me about the problem and the possible strategies which can be used in order to address the issue in my practice. In the Blondal study, the research was able to inform me that nurses must remember always that pain is a subjective experience for patients and these patients often have different pain experiences. It is up to the nurse to make individual interpretations of the patient’s pain experience. The Al-Shaer study was also able to inform me that nurses’ knowledge on pain assessment and management is lacking. This informs me that I also need to improve my knowledge on pain assessment and that I need to seek a clear understanding of patient’s pain experience. References Berg, B., 2004. Qualitative methods of research for the social sciences, California State University [online] Available at: http://digilib.bc.edu/reserves/sc210/piat/sc21007.pdf [Accessed 01 July 2012]. Boswell, C. and Cannon, S., 2011. Introduction to nursing research: incorporating evidence-based practice. London: Jones & Bartlett Publishers. Brockopp, D. and Hastings-Tolsma, M., 2003. Fundamentals of nursing research. London: Jones & Bartlett Learning. Burns, N. and Grove, S., 2005. The practice of nursing research: conduct, critique, and utilization. London: Elsevier/Saunders. Fitzpatrick, J. and Merwin, E., 2008. Annual review of nursing research: focus on rural health. London: Springer Publishing Company. Fitzpatrick, J. and Kazer, M., 2011. Encyclopedia of nursing research. London: Springer Publishing Company. Fontana, J., 2004. A methodology for critical science in nursing. Advances in Nursing Science, 27(2), pp. 93-101. Hamer, S. and Collinson, G., 1999. (eds.) Achieving evidence-based practice: a handbook for practitioners. Edinburgh: Bailliere Tindall. Hall, I and Hall, D., 2004. Evaluation and social research: introducing small scale practice. Palgrave Macmillan: Basingstoke Holzemer, W., 2009. Improving health through nursing research. London: John Wiley & Sons. Hoskins, C. and Mariano, C., 2004. Research in nursing and health: understanding and using quantitative and qualitative methods. London: Springer Publishing Company. Houser, J., 2011. Nursing research: reading, using, and creating evidence. London: Jones & Bartlett Publishers. Keele, R., 2010. Nursing research and evidence-based practice. London: Jones & Bartlett Publishers. LoBiondo-Wood, G. and Haber, J., 2005. Nursing research - text and e-book package: methods and critical appraisal for evidence-based practice. London: Elsevier Health Sciences. Macnee, C. and McCabe, S., 2008. Understanding nursing research: using research in evidence-based practice. Philadelphia: Lippincott Williams & Wilkins. Martin, C., 2002. The theory of critical thinking of nursing. Nursing Education Perspectives, 23(5), 243-247. Munhall, P., 2011. Nursing research. London: Jones & Bartlett Publishers. Parahoo, K., 2006. Nursing Research (2nd Edition). London: Palgrave MacMillian. Polit, D., and Beck, C., 2009. Essentials of nursing research: appraising evidence for nursing practice. Philadelphia: Lippincott Williams & Wilkins. Scott, I. and Mazhindu. D, 2005. Statistics for healthcare professionals. London: Sage. Tappen, R., 2010. Advanced nursing research. London: Jones & Bartlett Publishers. Stommel, M. and Wills, C., 2003. Clinical research: concepts and principles for advanced practice nurses. Philadelphia: Lippincott Williams & Wilkins. Read More