NRS 433 Week 2 Rough Draft Qualitative Research Critique and Ethical Considerations
For this assignment, use the nursing practice problem and two qualitative peer-reviewed research articles you identified in Topic 1 (or two new articles based on instructor feedback in Topic 1). In a 1,000-1,250-word essay, summarize two qualitative studies.
Use the “Research Critique Guidelines – Part I” document to organize your essay.
Research Critique Guidelines – Part I Qualitative Studies Sample Approach
The problem of interest is pressure ulcers among elderly and critically ill patients. Pressure ulcers are injuries to pressure areas caused by prolonged exposure to pressure, primarily due to a lack of turning. Critically ill and elderly patients have serious musculoskeletal issues, are mostly unconscious, and face coordination problems. Studies show that elderly and critically ill patients report the highest prevalence of pressure ulcers and are prone to severe pressure ulcers.
Pressure ulcers are prone to infections, and such pressure ulcers take long periods to heal due to the decreased blood supply to the skin. Pressure ulcers can progress to gangrene and affect bones such as the sacrum and calcaneus (heel bone) (Bazaliński et al., 2018). According to Bazaliński et al. (2018), infections to bone, skin, and muscle secondary to pressure ulcers are always serious and carry an increased risk of patient death.
Patient turning and routine skin care are the standard procedures in patient care. Nurses turn patients, wash, massage, and apply skin care products (Mitchell et al., 2018). The procedure can be effective when carried out routinely. However, patient turning is difficult, especially due to the global nursing staff shortage, and patient conditions such as injuries limit the procedure’s application.
Pressure ulcer prevalence is a safety and care quality indicator in healthcare institutions showing the importance of managing it. Pressure ulcers thus pose a threat to patient safety and patient care outcomes hence the need for care interventions that reduce pressure ulcers. The goal is to relieve pressure off the vulnerable areas and promote proper circulation in pressure areas to prevent pressure ulcer development.
The PICOT question of interest is “Among critically ill and elderly patients, does using ripple mattresses compared to usual care prevent pressure ulcers and improve their management?”
Background of Studies
Sachs et al. (2018) evaluated how nurses prevent pressure ulcers for patients undergoing subacute rehabilitation after severe brain injury. The article aimed to observe the healthcare professional’s intent to prevent pressure ulcers. The article adds to existing knowledge and helps determine gaps in care delivery and patient safety. It points out the factors affecting pressure ulcers; “mobility, perfusion, skin/pressure ulcer status, skin hydration, age, hematological measures, nutrition, and general health” (Sachs et al., 2018).
The study shows a gap between national guidelines in preventing pressure ulcers and implementing these interventions. A major research question in this study was to determine professionals’ utilization of evidence-based strategies recommended by the relevant bodies and institution leadership.
Gasper et al. (2018) studied the perceptions of 11 Portuguese nurses’ stakeholders regarding pressure ulcer prevention practice and reality in the hospital setting. The study focused on understanding how nurses perceive pressure prevention. The themes evaluated were PU risk assessment, monitoring, profiles, and effective interventions to improve patient safety. The research question was to determine if nursing knowledge and practices were adequate to prevent pressure ulcers.
The article evaluated current professional and institutional practices that aim to improve care delivery. The propeller of the study was the constantly high prevalence of pressure ulcers in healthcare settings, which indicates poor healthcare service delivery. The study identifies that healthcare institutions and relevant bodies develop evidence-based strategies, but the prevalence of pressure ulcers remains high, hence the need to evaluate the reasons. The article is significant to nursing because it unearths the major causes of the underutilization of evidence-based strategies developed.
How Do These Two Articles Support the Nursing Practice Problem You Chose?
Sachs et al. (2018) support the problem by identifying one of the most common problems in healthcare settings that negatively impact patient safety and care quality. The article also shows the importance of caring for critical care patients while ensuring they do not develop pressure ulcers. It also shows that pressure ulcers are expensive healthcare events and are prevalent in primary and secondary care. The articles show that severe brain injury affects consciousness and subsequent mobility, and patients require assistance with turning to prevent them from developing pressure ulcers.
The study identifies that the problem can be managed through professional evaluation/ assessment, clinical practices, and interactions with the patient. The study will thus be used to explain the importance of the intervention in critically ill patients and help determine the effectiveness of routine versus selected intervention. The article provides a template for the evaluation n of the effectiveness of the intervention by determining if it is evidence-based, acceptable, and increases patient interaction (Sachs et al., 2018).
Gaspar et al. (2018) also support the nursing practice problem of pressure ulcers. It identifies that pressure ulcers affect patients in all healthcare settings. The article also shows that the problem exists in healthcare institutions and that nurses play a vital role in preventing these pressure ulcers. The article evaluates themes related to the problem, as shall be discussed later in this paper. The article also states that pressure ulcers lead to poor quality of life, which is costly yet avoidable.
The article emphasizes the importance of healthcare professionals’ efforts in preventing pressure ulcers. The global burden of pressure ulcers is rising, and current interventions begin prevention in patient assessment to management of these pressure ulcers. The article supports the nursing practice problem and states that despite the goring body of research and evidence-based practices, the prevalence of pressure ulcers is rising, making it a growing concern requiring containment. The article will thus be used to determine the reasons for the current practices’ failure and what changes the new intervention will bring to pressure ulcers.
There was no intervention or comparison group for the two articles because no intervention was implemented. Gasper et al. (2018) evaluated pressure ulcer prevention among nursing stakeholders, who are the implementors and evaluators of the desired intervention. Sachs et al. (2018) evaluated four patients in a rehabilitation unit after severe brain injury. In addition, Sachs et al. (2018) used a population akin to the population of interest: critically ill and elderly patients. The two articles thus differ in their study participants.
Method of Studies
Sachs et al. (2018) utilized a qualitative and non-participant observational study. A major limitation of the study relates to bias in collecting and entering data. The participants understand they are being observed; thus, their performance may not be affected by being watched. Observations also fail to capture all details in a research study where the researcher does not participate. In addition, they enter and report data based on their understanding which could be wrong.
Non-participant observational studies are extremely difficult and uncomfortable for the researcher and subjects. Gasper et al. (2018) utilized an in-depth qualitative interview using semi-structured interviews with nursing stakeholders. In-depth interviews are suitable qualitative research methods but time-consuming because they require transcription, organization, and analysis and require experienced interviewers to succeed (Coleman, 2019).
Results of Studies
Sachs et al. (2018) identified four vital themes in pressure ulcer prevention: “professionalism expressed by implemented intervention, patient involvement, feasible clinical practices, and professional pride.” The study showed that evidence-based practices are available, but their utilization to promote better patient outcomes is questionable. These themes should be considered when implementing any healthcare intervention.
As mentioned earlier, Gasper et al. (2018) focused on four themes on which they collected data from the nurses. Regarding motivations, “interest, responsibility, autonomy, leadership, and prioritization” were the major contributing factors. Concerning competence/awareness/knowledge theme, “Braden scale operationalization, undergraduate degree education, continuous professional education, missing care, and reliability of patient records and clinical characteristics” were the major contributing factors.
More so, “understaffing, health policies, EHRs and clinical language used, access to appropriate resources (equipment and staff), teamwork, and specialist availability” were the major factors identified as opportunity areas.
Ethical Considerations
Ethical considerations in research include respect for persons that entails informed consent and full disclosure. Hasan et al. (2021) note that all research participants should be given information regarding the research, after which they consent or decline participation. Research should also be based on voluntary participation, and no participant should be deceived or coerced into participating in any research study (Hasan et al., 2021).
Any risk for harm should be disclosed, and no information should be concealed. In addition, an internal review board should review any research intervention for which the author is affiliated/studies/works—for example, education institutions, healthcare institutions, and private research bodies’ internal review boards. Dissemination of information is also critical. Any information given to research professionals should be used for the intended purposes only to enhance confidentiality. In addition, information should be deidentified to maintain anonymity.
The researchers in these two articles ensured internal review boards in their respective institutions before they proceeded with the studies. All their participants were informed before their participation, and informed consent was sought from the nurses and the patients. Sachs et al. (2018) did it give informed consent because the patients did not meet the criteria for giving informed consent.
The participant information was also deidentified in both studies, and no participant information could lead to their discovery. The researchers also published their articles for educational purposes and in reputable journals. Thus, the research studies followed the ethical considerations using human subjects.
Conclusion
Qualitative studies present vital perspectives into patient care and nursing practice problems’ mitigation. Pressure ulcers, the problem of interest, affects patient safety and negatively impact patients’ health and quality of life. The major interest is pressure ulcers among elderly and critically ill patients in healthcare facilities.
The two qualitative studies present vital perspectives to pressure ulcer prevention, such as factors leading to increased prevalence and those preventing success I n their management. They add to the nursing knowledge and clinical practice, and using their perspectives will enhance the management of the practice problem and implementation of the PICOT.
NRS 433 Week 2 Rough Draft Qualitative Research Critique and Ethical Considerations References
- Bazaliński, D., Więch, P., Kaczmarska, D., Sałacińska, I., & Kózka, M. (2018). Use of controlled negative pressure in the management of phlegmon caused by a fulminant complication of pressure wound: A case report. Medicine, 97(28), e11319. https://doi.org/10.1097/MD.0000000000011319
- Coleman, P. (2019). In-depth interviewing as a research method in healthcare practice and education: Value, limitations, and considerations. International Journal of Caring Sciences, 12(3).
- Gaspar, S., Botelho Guedes, F., Vitoriano Budri, A. M., Ferreira, C., & Gaspar de Matos, M. (2022). Hospital‐acquired pressure ulcer prevention: What is needed for patient safety? The perceptions of nurse stakeholders. Scandinavian Journal of Caring Sciences, 36(4), 978-987. https://doi.org/10.1111/scs.12995
- Hasan, N., Rana, R. U., Chowdhury, S., Dola, A. J., & Rony, M. K. K. (2021). Ethical considerations in research. Journal of Nursing Research, Patient Safety and Practise (JNRPSP) 2799-1210, 1(01), 1-4. https://doi.org/10.55529/jnrpsp11.1.4
- Mitchell A. (2018). Adult pressure area care: preventing pressure ulcers. British journal of nursing (Mark Allen Publishing), 27(18), 1050–1052. https://doi.org/10.12968/bjon.2018.27.18.1050
- Sachs, M. B., Wolffbrandt, M. M., & Poulsen, I. (2018). Prevention of pressure ulcers in patients undergoing subacute rehabilitation after severe brain injury: An observational study. Journal of Clinical Nursing, 27(13-14), 2776-2784. https://doi.org/10.1111/jocn.14266
Rough Draft Qualitative Research Critique and Ethical Considerations
Background of the study
Reputable research from the Centers for Disease Control and Prevention CDC and other authorized health care organizations show that Congestive heart failure (CHF) is one of the health issues affecting most people. It is important to note that CHF is caused by impaired functioning of the heart. The heart can fail to perform its normal function because of either structural or functional abnormalities (Gjeka et al., 2021). Once the heart has developed the complex clinical syndrome, other parts such as the brain, liver, and kidney are affected since the heart is responsible for supplying blood. Empirical evidence shows that approximately twenty-six million people in the world have suffered from CHF. United States of America has the highest number of patients suffering from CHF.
Evidence-based research show that CHF can only be treated using two approaches. The first solution is the use of medicine. Diuretics, cardiac glycosides, antihypertensive, and vasodilators are some of the medicines used to treat this disease (Du et al., 2018). In addition, this disease can be treated through lifestyle modification. Most people, especially Americans, usually fail to observe their lifestyles, and they end up contracting such diseases. Individuals can modify their lifestyles through physical exercise. Physical exercises are significant to human health because they cause extra weight loss and burn calories. Losing extra weight protects one from developing heart complications that result in diseases such as CHF.
The problem of the study
Today, a lot of health concerns have been raised regarding CHF because of the increased rate of morbidity, mortality, and increased cost of taking care of the sick. Morbidity has become a major problem in current health care because the population suffering from CHF keeps on increasing. This has affected all human facets since the disease limits individuals from engaging in constructive activities.
The United States is one country with several cases of patients suffering from CHF, which has affected individual products, such as a low-profit margin. It has also become expensive to take care of CHF patients since they require continuous nursing care, which is expensive (Gjeka et al., 2021). Families and caregivers are finding it difficult to handle such patients because of the continuous care and a high budget. Currently, this issue has escalated, and patient outcome has been recorded in different healthcare organizations.
Significance to Nursing
The study is of great significance to nursing since it helps the health care providers to understand some of the most appropriate approaches they can deploy to ensure they render quality nursing care services to patients. Furthermore, through the study, health care practitioners learn different strategies such as aerobic exercises that can help individuals to avoid developing the disease. By doing so, patient outcome is likely to reduce because they will exercise, which will act as a preventive measure to CHF. Nurses can use this study to encourage their patients to exercise regularly so that they can prevent themselves from developing such diseases.
Objectives of the study
- To find out the most appropriate preventive measures for CHF.
- To determine some of the nursing care services that are effective and efficient for CHF treatment.
- To find out mortality rate annually as a result of CHF in the United States.
Research questions
- What are the most appropriate preventive measures for CHF?
- What are some of the nursing care services that are effective and efficient for CHF treatment?
- What is the mortality rate annually as a result of CHF in the United States?
The two articles are of great significance to answering the PICOT question because they address issues related to the patient, give a variety of interventions, allow for comparison, and address the expected outcome after one has been treated. Also, the two articles can be used to answer the question by highlighting that most people, especially Americans, usually fail to observe their lifestyles and end up contracting such diseases. Individuals can modify their lifestyles through physical exercise. Physical exercises are significant to human health because they cause loss of extra weight and burn calories.
Methods of the study
The methodology approach of this study was focused on the quantitative type of research where instruments used were focused on. The evidence-based methodology was deployed. It is important to understand that quantitative research studies have a better status for any type of nursing or health care research than those with a qualitative paradigm (Lira & Rocha, 2019). Research instruments were explained in detail to ensure that there were no limitations. Random sampling was used to select eight health care organizations.
The researcher selected 422 respondents using the random sampling method. The sample size is specified, but it is not stated whether this was statistically attained, which could also be termed as a weakness, as achieving a statistically sound sample size is significant within the quantitative study. There are high chances of experiencing sampling bias because no information was disclosed about the person who was responsible for sampling participants. This is one of the weaknesses that was noted in the study.
Procedures for data collection were not clearly outlined in the study. The study does not state who was responsible for administering questioners to the respondents. This could also be termed a weakness because of a lack of clear information. There are high chances that questioners were remotely administered, resulting in biases. In this context, bias could be regarded as an ethical issue since this type of study deals with human health, which is sensitive. The use of multiple data collection instruments could be one of the most outstanding strengths of this research because they allowed for the description of the research in detail. Also, the data collection tools were validated from the previously conducted research, and therefore, accurate data was collected. SPSS and LISREL programs were used to analyze data.
Results of the study
The obtained data is presented on tables and graphs after they were analyzed. All the finds are accessible to researchers and health care providers. However, the findings can be proven to be accurate because of the lack of detailed information about the sample and methods used for selection during the research process.
Ethical considerations
Seeking permission or consent from the authority is one of the research ethics that was considered. It is ethical for all researchers to seek permission from the authority before conducting any form of research. However, in the study, details on the consent and the person who authorized that consent were not revealed. In addition, the study considered the safety of the respondents. It ensured that all respondents were safe from any form of harm that could arise.
References
Du, H., Newton, P. J., Budhathoki, C., Everett, B., Salamonson, Y., Macdonald, P. S., & Davidson, P. M. (2018). The Home-Heart-Walk study, a self-administered walk test on perceived physical functioning, and self-care behavior in people with stable chronic heart failure: A randomized controlled trial. European Journal of Cardiovascular Nursing: Journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology, 17(3), 235–245. https://doi.org/10.1177/1474515117729779
Gjeka, R., Patel, K., Reddy, C. & Zetsche, N. (2021). Patient engagement with digital disease management and readmission rates: The case of congestive heart failure. Health Informatics Journal, https://doi.org/10.1177%2F14604582211030959
Lira, R., & Rocha, E. (2019). PICOT: Imprescriptible items in a clinical research question. Arquivos Brasileiros De Oftalmologia, 82(2). https://doi.org/10.5935/0004-2749.20190028
Also Read: NRS 433 Week 1 Picot Question and Literature Search