Critique of Clinical Skill: Wound Management - Essay Example

? Critique of Clinical Skill - Wound Management of Critique of Clinical Skill - Wound Management Introduction Clinical officers need to apply scientific research findings to the practice of evidence-based medicine. This should be done with reference to the individual patient’s circumstance as part of decision-making process by clinicians. In that case, clinicians have to appraise and select scientific literature that is appropriate to the field, understand research finding implications for specific patients, obtain client’s preferences and establish a management plan that is appropriate. Critical appraisal is a systematic process utilized to identify research strengths and weaknesses inherent in a research article. This is done with an aim of assessing the validity, reliability and usefulness of research findings. The primary components of critical appraisal include the evaluation of the study design’s appropriateness for the research questions used, and the careful assessment of key methodological design features. Other factors that should be taken into consideration while critically appraising an article are such as the examination of the suitability of the statistical methods used to analyze data, potential conflict of interest and the research relevance to an individual practice. Thus, the purpose of this paper is to appraise the below named article on wound management. Article: Annells, M., O’Neill, J., & Flowers, C. (2008). Compression bandaging for venous leg ulcers: the essentialness of a willing Patient. Journal of Clinical Nursing, 17(3), 350-359.doi 10.1111/j. 1365-2702.2007.01996.x Analyzing whether the Research Study Questions Are Relevant A research can be of the highest methodological rigor but it may be of little value if it does not address a significant topic or add value to the already existing knowledge about the subject under discussion (Mays & Pope, 2000). The article sought to find answers to the following question “why do or why don’t district nurses use compression bandaging as a component of the management of venous leg ulcers?” The aim of the study was to help identify both constraints and enablers. The research question is relevant because it seeks to explain why some and not all nurses utilize compression management to manage venous leg ulcers. In addition to that, the study findings contribute to the existing knowledge because less has been documented as to why compression bandaging is not often used by district nurses in the treatment of venous leg ulcers. Furthermore, the research question is relevant to the clinical practice. As a result of the study, factors that might constrain the willingness of the patient to apply compression bandaging in the treatment and maintenance of the venous leg ulcer were identified. Then, the actions that need to be performed to facilitate patient willingness were recommended. Does the Study Add Anything New? Any scientific research aims at developing new knowledge and ideas on the basis of work done previously (Hawking, 2003). As a result of this particular research, district nurses were made aware of the significance of evidence-based practice. Proper understanding of the findings of the study will support the planning carried out by the district nursing organization. As a result, there will be an improvement in the rate of appropriate use of compression bandage on venous leg ulcers. The increased use will be facilitated via the provision of relevant resources and the needed education. Moreover, the research findings will update nurses on how to appropriately asses venous leg ulcer patients. Similarly, the nurses are able to plan and implement strategies for best practice care which is sustainable and patient driven. The research adds new knowledge to the work done previously. The Type of Questions Posed By the Study The most significant task of critical appraisal is the identification of the specific research questions being addressed by the article. This process is essential as it determines the suitable study design which has an impact on the validity and reliability of the findings. A well structured research question should identify three main components: The parameter to be studied, the target population and the outcomes of the study (National Health and Medical Research Council, 2000). The article being appraised addresses the questions about the effectiveness of the applied treatment approach. The study’s main aim was to explore and describe the main reason behind the use or non-use of compression bandaging by district nurses despite it being the best practice of venous leg ulcer management. The target population for the study was registered district nurses focused on establishing the effectiveness of compression bandaging in containing venous leg ulcers. Was the Study Design was Appropriate Given the Research Question? The study design used by the article was descriptive-exploratory research design. The study design was effective as it was undertaken to comprehend the attributes of an organization that follows a specific common practice. For instance, district nurses were randomly selected in order to be interviewed. The interview was based on whether or not they used compression bandaging for the management of venous leg ulcers. The aim the study design was to provide the researcher with a profile to describe the relevant aspects of the study from an individual, organization or industry perspective. In addition, this type of design helps the researcher to understand the attributes of a specific group in a given situation. In the study, the characteristics of district nurses in relation to the use of compression bandaging to maintain venous leg ulcers were analyzed as a basis for the research. Were Potential Sources Of Bias Are Addressed By The Study Methods? In any research, the presence of bias indicates that the findings of the study have deviated from reality (Last, 2001). Bias results from the manner in which, data was collected, analyzed and interpreted and how study participants were selected (Young & Solomon, 2003). The study participants were recruited via non-probabilistic sampling methodology. In this type of sampling, each and every item in the population has a chance of being selected. The major limitation with this type of sampling is that it does not guarantee the inclusion of each item under study. As a result, it is extremely difficult to identify any possible bias. In order to reduce bias, the participants (nurses) who were selected had to be registered by the Community Nursing Organization. In addition, the nurses had to possess sufficient skills of administering patients with clinical nursing care. Does The Study Adequately Test The Hypothesis? A hypothesis entails specific and clear statements which hint the prerequisite of a research. Hypothesis forms the central aspects of the study as it expounds on the intension of the research question (Elwood, 2008). The hypothesis of the study under appraisal is to explore the reason behind utilizing or not utilizing the compression bandaging treatment method by district nurses in management of venous leg ulcers. In most cases, the results of the research are always expected to conform to the expectation of research hypothesis. Research findings are in most cases projected to test the research hypothesis. In these cases, the study findings have confirmed the significance of using compression bandaging by districts nurses in the management of venous leg ulcers. According to the research findings, although there are other methods of managing the venous leg ulcers, the usage of compression bandaging is more effective than any other available method. A study that aims at testing a hypothesis most effectively should ensure that, all the relevant data in the study objectives are clearly reported. The researcher in the study has reported all the relevant information to substantiate the objective of the study. In the situation where the technique of treating a specific medical condition is in existence, the trial of alternative therapy is also significant to evaluate whether the new therapy has a superior outcome than the existing one. This form of trial is referred to as non-inferiority trail or equivalence trial (Knottnerus, 2003). In this case, the researcher has placed several other hypotheses into trial. The equivalence study confirmed that, compression bandaging is more effective than alternative therapies. The cost for compression bandaging was also cheaper compared to other therapies. The results of the trail were also analyzed appropriately as per the requirement of a good scientific research. The sample used in the research was adequate enough to test the hypothesis. The sample involved people from different ages. It is therefore appropriate to state that, the study was successful in testing the research hypothesis. Were the Statistical Analyses Performed Correctly? As a requirement, all scientific researchers are expected to have a section in the methodology part that expounds on the tools that will be used in statistical analysis of the research (Crombie, 2006). This section should also include the rationale used in the selection of the tool. The study under appraisal has explained the method and tools that were used in the analysis of the research findings. The researcher planned to use software packages, memo, report writing and modeling in the analysis and reporting of the research findings. The researcher had a specific technique to use in the analysis of the data. To address cases of missing data, the researcher used conceptualization, open coding and categorization techniques. The researcher also had an intension of addressing the medical conditions of all participants in the study in compliance with the core principles of statistical data analysis in a health care setting. The group of people who participated in the research was that of ailing people who intended to get medical treatment. There was also a baseline which helped in evaluating the participants treated using compression bandaging and patients who were treated using other means of treatment. The practitioner used several data analysis methods in evaluating the study findings. To ensure quality analysis, the researcher used several flowcharts to facilitate the analysis of the research findings. Does the Data Justify the Conclusions? The conclusion presented by the authors was extremely reasonable and in accordance with the research findings (Sutton-Tyrrell, 2001). In reference to the research conclusion, although compression bandaging is the most effective means of managing venous leg cancer, patients should be given an opportunity to select their most preferred therapy. The author has also commented on some differences in the research findings that are valuable in clinical treatment. In conclusion, the author generalized the research findings in the broader perspective of all patients. The result findings were also properly interpreted in the conclusion section. The conclusion complied with the entire scientific requirements in a research thus the data justified the research conclusion. Are There Any Conflicts of Interest? Conflict of interest in a research occurs in a situation where individual factors have an influence on professional responsibilities and roles (Furukawa and Guyatt, 2006). In this research, members of the research team came up with judgments which affected the validity of the research findings as well as safety of the participants. Researchers had the authority of selecting the study topic in the research. Researchers also acted intelligently throughout the research with very no influence to facilitate institutional or personal gain. There was also no financial conflict of interest reported in the study. The researchers and participants were all supportive in the accomplishment of the research mission. The expenses involved in the research were reasonable to the magnitude of the study. The research setting was also superb. The detected conflict of interest such as lack of inclusion of professional from other disciplines was addressed in a productive manner aimed at advancing future development. The author did not report any conflict of interest in the allocation of resources and usage of the available resources. Was The Study Performed In Line with the Original Protocol? Deviation from the laid down protocol has adverse effect on the relevance, reliability and validity of the study (Little, 1999). The recruited number of researchers coincided with the planned number. The researchers also used the proposed number of participants in the study. The adherence to the original protocol helped the author to come up with significant research findings. The research also followed out the original criteria, technique, duration, and technology. Conclusion Appropriate study appraisal helps in the identification of strengths and weakness in a research study. It helps in the identification of the worthiness and usefulness of a research. The appraisal also aids in the evaluation of the credibility of study design, potential conflict of interest, interpretation and analysis of the research findings, evaluation of the credibility method used to interpret data, methodology used and the conclusion contents. The process of research appraisal also helps the clinicians in identifying the most effective means of guiding the clinical practices. References Crombie, I. (2006). The pocket guide to critical appraisal: A handbook for health care professionals. London: Blackwell Medicine Publishing Group. Elwood, J. (2008). Critical appraisal of epidemiological studies and clinical trials (2nd ed.).Oxford: Oxford University Press. Furukawa T., & Guyatt, G. (2006) Sources of bias in diagnostic accuracy studies and the diagnostic process. CMAJ 174: 481–482. Hawking, S.W. (2003). On the shoulders of giants: The great works of physics and astronomy. Philadelphia, PN: Penguin. Knottnerus, J. (2003) Assessment of the accuracy ofdiagnostic tests: the cross-sectional study. Journals Clinical Epidemiology, 56: 1118–1128. Last, J. E. (2001). A dictionary of epidemiology. New York: Oxford University Press Little, M. (1999). Research, ethics and conflicts of interest. Journals of Medical Ethics 25: 259– 262 Mays, N., & Pope, C. (2000). Assessing quality in qualitative research. BMJ, 320: 50–52 National Health and Medical Research Council. (2000). How to review the evidence: Systematic identification and review of the scientific literature. Canberra: NHMRC Sutton-Tyrrell, K., (2001) Assessing bias in case-control studies: proper selection of cases and controls. Stroke 22: 938–942 Young, J.M., & Solomon, M. J. (2003). Improving the evidence-base in surgery: sources of bias in surgical studies. ANZ J Surg, 73: 504–506 Read More