Critical Evaluation of Research Studies: Pressure Ulcer Prevention

Introduction

The analysis of research studies can provide a comprehensive understanding of a given phenomenon. Polit and Beck (2012, pg. 23) explain that research is a methodical process that uses scientific methods to find new information that can be used to answer a question or make a system better. The Nursing and Midwifery Council (2018) posits that nurses should always follow the best evidence. They have to make sure that the information they offer is based on evidence and keep the skills and knowledge they need for safe and effective practice up to date. Evidence-based practice is a worldwide process that includes evaluating research evidence, patient choices, and the context of care delivery.

Making evidence-based decisions is a vital part of improving the quality of care. Improve knowledge of best practices and the quality of care by making well-informed decisions (Glasgow et al., 2018). According to Hermann, Long, and Trotta (2019), as nursing has moved away from tasks that are told to nurses and toward care tailored to each person, it has become more important that guidelines are based on evidence. Ellis (2016) states that nurses should do what is best for their patients and be able to explain why they made the decisions. The purpose of this assignment is to use a crucial assessment instrument to look at and evaluate two research papers, one qualitative and one quantitative.

Research Questions

Gaining insight into nurses’ care, knowledge, and attitudes is essential for developing effective strategies for preventing ulcers. According to the National Institute for Health & Care Excellence (2014), pressure ulcers are common in patients, affecting anywhere from 5% to 32% of patients, based on who is being looked at. Risk factors include getting older, being less mobile, having more than one illness, and not eating well. (Kim, Lee and Lee, 2019, p. 2). People with these risk factors often end up in the hospital (NICE, 2015, p. 57). Pressure ulcers are wounds to the skin and tissue underneath, typically over a bony prominence, caused by pressure or pressure and shear (Mishra and Bhattacharya, 2015, p. 4). As such, gaining insight into nurses’ care, knowledge, and attitudes is essential for developing effective strategies for preventing ulcers.

The search question was developed using the PIO approach that describes the patient/problem (P), intervention (I), and outcome (O). The problem explains who exactly the project is trying to help (Chatten, 2022). The people in the population were described based on their demographics, such as their age or gender (Aslam and Emmanuel 2010, p.48). The intervention is the treatment, diagnostic tests, assessment, procedure, prognostic factors, or getting rid of the things that make people more likely to get sick (Frandsen et al., 2020, p. 72). The result is what the intervention is supposed to do, and it must be able to be measured (Eriksen and Frandsen, 2018, p.2). Drawing from the defined aspects of the PIO structure, the PIO is as follows;

  • Patient: elderly patients
  • Intervention: nurse’s care, knowledge, and attitudes
  • Outcome: prevention of pressure ulcers
  • PIO question: how effective are nurses’ care, attitudes, and knowledge in preventing pressure ulcers among elderly patients?

Research Critique

Critiquing research is a key component in the decision-making process for nursing practice. According to Roy (2019, p.32), critiquing research is essential in nursing because it determines the articles’ viability. Research articles can be analyzed using various models because they provide clear guidelines for the evaluation. The Holland and Rees (2010) approach will be employed to analyze two research papers: qualitative research by Lindhardt, Beck, and Ryg (2020) and a quantitative approach by Gre Halász et al. (2021). Therefore, critiquing research allows nurses to make informed decisions and use evidence-based practice to provide the best possible care for their patients.

Qualitative

Aim

The study offers valuable insights that can inform policies and practices related to nursing care for older adults with pressure ulcers. The purpose of research is documented to ensure that researchers and readers can comprehend what is being studied (Parahoo, 2014, p.). The study aims to understand nurses’ experiences and perceptions regarding nursing care for older patients with pressure ulcers. It matches the study because it focuses specifically on the experiences and perceptions of nurses regarding nursing care for older patients with pressure ulcers.

Methodology or Approach

Research design plays a critical role in the research process. In qualitative research, a research design is a plan that helps answer the research question or achieve the research goal (Polit and Beck, 2017, p. 98). Lindhardt, Beck, and Ryg study is qualitative research that follows a phenomenological design. Gerrish and Lathlean (2015) assert that phenomenology is a type of qualitative research that attempts to determine what people’s real-life experiences mean. Polit and Beck (2017, p. 98) assert that these types of research normally have a small number of subjects. This is clear in the study, which has a sample of 6 people. The design matches the aim of the study because it ensures that appropriate information is collected.

Tools of Data Collection

Qualitative research is a powerful tool for exploring and understanding social phenomena. This study’s tool used to collect data was a semi-structured interview, often in qualitative research (Holloway and Wheeler 2010, p.43). A semi-structured interview has drawbacks since it is open-ended and it can be enticing to ask pertinent questions, that could alter the responses (Miikkola et al., 2019, p. 29). Previous studies have used semi-structured interviews in qualitative research such as this. Therefore, interviews are among the techniques that provide researchers with a range of data that can be used to understand the research topic comprehensively.

Research settings are essential for conducting accurate and reliable research. Krick et al. (2019) define a research setting as the physical, social, or experimental setting where a study is done. The individual interviews occurred at a place of business where participants could freely engage. This is a good place to do qualitative research because the subjects will feel at ease and free to talk about their lives (Krick et al., 2019). The interviewer will be able to dig deeper into the responses, and the person being interviewed will be able to give a detailed account of their life and feelings Ellis and Rawicki, 2013, p.369). A research setting must be carefully considered to ensure the validity and reliability of the results.

Method of Data Analysis

In qualitative research, it is important to analyze and display the results. Williamson and Whittaker (2020, p. 90) assert that data analysis is the process that scholars use to gain a deep understanding of the data they have gathered and recognize the complicated story their data tell. The information for this study comes from what the participants said out loud. The interviews were taken down word for word and looked at. This article used Braun and Clark’s thematic analysis framework to examine interview transcripts (Braun and Clarke, 2006, p. 93). They said that thematic analysis is a way to find patterns and themes in data, study them, and report on them (Braun and Clarke, 2006, p. 93). All transcripts were read again and checked several times during the open-coding stage. Keywords, phrases, similarities, and differences were all written down to ensure the study was correct. Polit and Beck (2018, p.57) believe that coding qualitative data is challenging. The researchers may need help choosing the valid code and may have to reread the material many times to figure out what it is about.

In this research, the authors did not mention any software used in data analysis. This indicates that the analysis was performed manually. However, qualitative software is more of a support tool for data analysis (Cypress, 2019, p.2). According to (Kiger and Varpio, 2020, p. 2), some of the benefits of using qualitative data analysis software include freedom from manual and clerical tasks, time savings, the ability to manage large amounts of qualitative data, and enhanced validity and suitability of qualitative research. However, the software does not perform the researcher’s analysis, reduce bias, or improve reliability (Vignato et al., 2021). Qualitative software provides a platform for researchers to better explore and analyze their data in a systematic and organized manner.

Data analysis is critical for understanding the research question and connecting the findings to the literature. Braun and Clark (2006) stated that the themes should be related to the research question and the literature in the final phase of data analysis. This is done to ensure that the qualitative description and the thematic analysis are accurate. Lindhardt, Beck, and Ryg (2020) used a strict methodology for analyzing qualitative data to find the important themes linked to the literature. The article’s results were in line with its stated goals.

Sample

The article being analyzed was done with the help of six different people. Holland and Rees (2010, p.61) assert that a qualitative study’s sample size can be less than ten and usually less than twenty. The number of people in the sample is enough for the study. Qualitative research tries to figure out how things work conceptually and theoretically. For this kind of research, the people chosen to take part should have experienced these things ethically (Parahoo, 2014, p. 39). According to Pawlik and Sosa (2020, p. 78), the inclusion and exclusion criteria determine which subjects can or cannot participate in a research study. In this study, the inclusion criteria used were reasonable, and the participants were chosen based on their experience of the area being studied. However, the exclusion criteria were not mentioned in the study.

Strategic sampling was used to choose the people who participated in the study. Sampling involves choosing a group of people from a group for an investigation (Sharma, 2017, p. 750). The authors used purposeful sampling to choose people from the population to participate in the study. This sampling method is suitable for a qualitative study like this (Palinkas et al., 2015, p.1). However, the sample may suffer from self-selection bias as individuals who volunteer to participate in research may not be representative of the entire population (Housley et al., 2022, p. 93). Using strategic sampling, researchers can ensure the accuracy and relevance of their findings.

Ethical Considerations

Adhering to ethical principles in research ensures that research is conducted fairly, equitably, and with respect for the rights of participants. Ethical considerations in research provide a foundation for basic rules to protect the safety, rights, and dignity of the people taking part in the study (Holland and Rees, 2010, p.191). It is clear from the study that participants gave their informed consent and that their data were kept private, which is a sign of good ethical consideration (Holland and Rees, 2010, p. 192). However, there needs to be an explanation of what information was given to the participants, how informed consent was obtained, or how anonymity was handled.

The Ethics Committee should have approved the study because it did not meet their standard. According to Newson and Lipworth (2015, p. 171), an article should only be published if it has been approved by a Human Research Ethics Committee (HREC) for good research practice. This is because the Ethics Committee ensures that all aspects of the research are conducted according to ethical standards and that potential risks to participants are minimized. Based on this, this study cannot be ethically sound because it has not been approved. Therefore, any research article must be approved by an Ethics Committee before it is published.

Quantitative

Aim

The study aimed to determine how much nurses in certain Slovak hospitals knew about preventing pressure ulcers and the possible connections and differences between certain variables. The aim matches the study because it assesses nurses’ knowledge of pressure ulcer prevention and explores connections between variables.

Methodology

The methodology section should demonstrate how the chosen approach is suitable for answering the research question. Nichols and Cormack (2017, p. 77) imply that the methodology section should include a clear statement about the chosen research approach. Gre HalĂĄsz et al. (2021) make it clear that a quantitative approach was used to identify the information and attitudes of nurses. A cross-sectional design was utilized for the study to achieve the intended purpose. Cross-sectional studies are observational studies that examine data collected from a population at a single time point. (Wang and Cheng, 2020, p.65). This research methodology serves that purpose effectively because it ensures that viable data is collected. The data gathered by the researchers at that time were used to assess the nurses’ attitudes and knowledge. They will not require further investigation since the study’s primary objective is to assess nurses’ knowledge and attitudes toward the prevention of pressure ulcers.

Tools of Data Collection

A study was conducted to determine how much nurses knew about preventing pressure ulcers. Gre HalĂĄsz et al. (2021) used a survey to gather information from nurses. Surveys are a non-experimental study design used to get information from a sample of people by asking them questions (Check and Schutt, 2012, p. 160). Singh Chawla (2021, p.34) posits that researchers usually use a survey to get information from a sample. Surveys are easy to do and do not cost much money. One problem with using surveys in research is that people may not feel like they should give honest, accurate answers (Singh Chawla, 2021, p.21). Gre HalĂĄsz et al. (2021) will use the answers that the participants mark on their papers to judge the nurses’ knowledge and attitude. However, in this study, the research teams already knew the right responses to the questions.

The survey has two parts: the Pressure Ulcer Knowledge Assessment Tool (PUKAT) and the Attitudes towards Prevention of Pressure Ulcers (APuP). The PUKAT was used to determine how much nurses knew about what causes pressure ulcers, how to stop them, and how to treat them. The APuP was used to determine how nurses felt about stopping pressure ulcers. PUKAT is a reliable and valid tool that assesses knowledge related to preventing pressure ulcers (De Meyer et al., 2019, p. 63). APuP is another valid and reliable tool to assess nurses’ attitudes and beliefs toward pressure ulcer prevention (Habiballah, 2018, p. 15). The study states that the tools used for the research were constructed and rigorously tested by Beeckman et al. (2010). In addition, other researchers from different countries have also used the tools in previous studies (Dalvand, Ebadi, and Ghanei Gheshlagh, 2018, p.614). Therefore, the measurement instruments PUKAT and APuP are suitable for the study’s aim.

Choosing the right data collection tool is appropriate to ensure the reliability of the study. Gre HalĂĄsz et al. (2021) assert that the devices had been translated, re-translated from the original English to Slovak, and tested to ensure they could be used in the research. Gre HalĂĄsz et al. (2021) chose the tools they did because Slovak hospitals did not have any research about what people knew and how they felt about preventing pressure ulcers. Based on this, Gre HalĂĄsz et al. (2021) decided to use the tools to research the topic in the hopes that it would provide a foundation for more research in Slovak healthcare facilities. The authors did not mention a different tool being thought about, and the tools used seem reliable and suitable for the study’s goal.

Method of Data Analysis

The method of processing and analyzing the results is described in the methods section. The results were then analyzed using SPSS computer analysis GreĆĄĆĄ HalĂĄsz et al. (2021). Statistical Package for the Social Sciences (SPSS) is a software researchers use to analyze complex data quantitatively (Habes, Ali, and Pasha, 2021, p.37). In quantitative research, statistical analysis is employed to analyze the data, test hypotheses, and show evidence about the measurement properties of quantified variables (Polit and Beck, 2018). Using SPSS, the researchers could effectively and efficiently process and analyze the results, allowing for the most accurate conclusions.

The results section presents the findings with descriptive statistics such as means, frequencies, and percentages. The researchers clearly explain the statistical techniques and presentation methods used in the study. The authors explain that they used descriptive statistics to analyze the data, including frequencies, percentages, and means (GreĆĄĆĄ HalĂĄsz et al., 2021, p. 6). Tables were used to visualize the results of the descriptive statistics, such as the frequencies and percentages of the responses to the survey questions (Fettro, 2018, p. 286). Therefore, these visuals enabled the researchers to better explain the study’s findings.

Sample

The research was conducted on a sample because it was impossible to study the whole population. According to Kim and Wang (2018, p. 181), samples are used to make inferences about a population. The study results are based on data collected from the 225 nurses who responded to the questionnaire and participated in the study. A response rate of 49% was achieved, indicating that the sample size is relatively large and valid. In research, the dropout rate is the percentage of people who do not complete a survey because it is too long, they are not interested, or it is hard to use. (Bell et al., 2013, p.2). GreĆĄĆĄ HalĂĄsz et al. (2021) did not mention the dropout rate in the study, which suggests that the dropout rate was minimal and not likely to impact the results. According to Bell et al. (2013, p.1), the dropout rate can bias results, but it does not always do so.

The inclusion and exclusion criteria stated in the article were reasonable, given the research question and the nature of the sample. The inclusion criteria specified that only nurses with about 17 years of clinical experience and the average age of all respondents were 39.47 years and working in the hospital were included in the study. These criteria were reasonable as they limited the sample to nurses with experience in the clinical setting and who could understand the survey (Koskenvuori et al., 2018, p. 12). As a result, the criteria do limit to whom the results may apply since the sample was limited to nurses in Slovakia.

The sampling strategy used in this study was convenience sampling. In convenience sampling, the researchers choose participants who are easily accessible and willing to participate, such as those who are already part of the study population (Sarstedt et al., 2017, p. 654). This method is often used when researchers try to find out the opinions of a specific group, such as nurses. The sample can suffer from selection bias, meaning that the results of a study may not be representative of the population as a whole (Andrade, 2020, p. 87). Therefore, this could lead to a biased sample that does not accurately represent the population.

Ethical Considerations

Treating participants ethically is an important concept when conducting any research. Ethical considerations are an essential factor that must be considered when conducting any study (Newson and Lipworth, 2015, p. 173). Ethical considerations are rules that guide how and where research is done (Holland and Rees, 2010, p. 190). In this article, the ethical committee of four hospitals approved the study. The subjects were told about the purpose of the study and how it would be done, and they were also sure that their data would be kept private, anonymous, and safe, Gre HalĂĄsz et al. (2021). It was thought that keeping the data anonymous was important to get people to answer the questions based on clinical practice (Newson and Lipworth, 2015, p. 170). Data privacy, anonymity, and protection are all ethical issues that must be considered (Royal College of Nursing, 2009). Therefore, ethical considerations should not be seen as an obstacle but as an essential part of ensuring a successful study.

Informed consent is a process used in research studies to ensure that participants fully understand the nature of the study, the risks involved, and their rights as participants (Zolkefli, 2021, p. 101; Kaewkungwal and Adams (2019, p. 183). The study indicates that the subjects were required to fill out the survey on their own, without aid from others, and that the finished tool will be used as an indication of consent to participate. Taparra (2020, p. 6) claims that it is no longer safe to presume that permission to use the data has been given just because the questionnaire was filled out and sent back in any format. Consent must be clearly stated, including questions about privacy and anonymity, the right to stop sharing information, and protection. For this reason, the study could not be ethically rigorous because the researchers did not obtain informed consent from the participants.

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