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Health, Medicine, Nursing
Article Critique
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Picot Paper Part 1: Rapid Critical Appraisal Assignment (Article Critique Sample)




Rapid Critical Appraisal Assignment
Institutional Affiliation
Rapid Critical Appraisal Assignment
Article citation:Sving, E., Hogman, M., Mamhidir, A., &Gunningberg, L. (2014). Getting evidence-based pressure ulcer prevention into practice: a multi-faceted unit-tailored intervention in a hospital setting.International Wound Journal, 1-10. doi:10.1111/iwj.12337
PICOT Question: In the critically ill elderly patients, does nurses knowledge of evidence-based recommendations for pressure ulcer prevention affect the incidence and prevalence of pressure ulcers?
General Description of Study
Overview of Study
Purpose of Study
The purpose of the study was to find out how a planned intervention applying the evidence-based pressure ulcer prevention would affect important aspects of pressure ulcer care. These aspects of pressure ulcer management include; the practice of pressure ulcer prevention and the nurses’ knowledge of the updated evidence based pressure ulcer prevention recommendations. The above aspects of care influence the prevalence of pressure ulcer that was also the aim of the researchers in this study (Sving, Hogman, Mamhidir&Gunningberg, 2014).
Study Design
The researchers employed a quasi-experimental research design. This methodology is sometimes referred to as pre-post-intervention design because it involved testing before and after intervention (pre- and post-testing) during data collection. The study under review involved testing nurses’ level of knowledge about evidence-based pressure ulcer prevention strategies, in addition, the researchers established baseline data regarding pressure ulcer prevention and noting the prevalence of pressure ulcers before testing. Following the establishment of the baseline data (pre-testing), the researchers executed the planned intervention i.e. multi-faceted unit-tailored intervention (Sving, Hogman, Mamhidir& Gunningberg, 2014 p.1). The post-testing involved testing the resultant nurses’ knowledge of pressure ulcer prevention as well as observing how pressure ulcer prevention changed in the hospital units and the prevalence of pressure ulcers.
It should be noted that both patients and nurses were participated in the intervention. All patientsof aged ≥ 18 years admitted in the units under study were eligible. Although only 145 nurses participated, all nurses working in the units under study were eligible. The study therefore adequately employed the quasi-experimental study design. This research approach has exhibited substantial importance in the field of clinical research especially where the pursuit of complete randomised (pure experimental) is unethical or unfeasible (Eliopoulos et al., 2004).
Research Questions/hypotheses
From the purpose of the study, it can be deducted that the researchers’ main hypothesis was that the multi-faceted intervention applying evidence-based pressure ulcer recommendations enhanced the practice of pressure ulcer prevention. The researchers categorically stated that pressure ulcer prevention was their main area of interest (Sving, Hogman, Mamhidir&Gunningberg, 2014 p.2). The following research questions can then be derived from this hypothesis;
* How does a multi-faceted unit-tailored intervention using evidence-based recommendations affect the performance of pressure ulcer prevention?
* What is the effect of the intervention on the knowledge and attitudes of nurses on recommended pressure ulcer prevention strategies?
* The last question that the researchers aimed at answering was how the intervention affected the prevalence of pressure ulcers.
Study Aims
The aim of the study was to evaluate, through pre- and post-intervention testing, the effect of a applying updated pressure ulcer prevention recommendations on the practice of pressure ulcer prevention, prevalence of pressure ulcers and the knowledge and attitudes of nurses on pressure ulcer prevention strategies (Sving, Hogman, Mamhidir&Gunningberg, 2014).
The method of sampling employed can be categorised as simple random sampling because each nurse in the selected units had an equal chance of participating in the study. This also applied to the patients who participated in the study. The sample size for the nurses during pre-test was 145 out of 149 (97%) while at post-test those who participated were 130 out of 169 (76%). The sample size for the patients during pre-test was appropriate at 251 out of 304 (82%) while at post-test was 255 out of 312 (81%)(Sving, Hogman, Mamhidir & Gunningberg, 2014).
Major Variables
According to (Dereshiwsky, 1998), study variables refer to specific characteristics that can change through manipulation. Also according to (Dereshiwsky, 1998) these variables of a study can be classified to dependent, independent, extraneous and confounding variables. The dependent and independent variables are the major variables of the study. In this study by Sving and colleagues (2014) the use of evidence-based pressure ulcer recommendation (Multi-faceted intervention) is the independent variable because the independent variable refers to what the researcher is manipulating or the variable that the researcher has control over (Dereshiwsky, 1998).
The dependent variable can be simply defined as the characteristics that the researcher is measuring. In other words, the aspects of the study the researcher expects to change after manipulation of the independent variable. Therefore, from the study under appraisal the dependent variables were the prevalence of pressure ulcers, performance of pressure ulcer prevention by nurses and the knowledge and attitudes of nurses on pressure ulcer prevention recommendations.
Another type of variables is the confounding variable. A confounding variable refers to factors that may influence the dependent variable in a lesser degree than the independent variable but in a greater degree than an extraneous variable. The study by (Sving, Hogman, Mamhidir & Gunningberg, 2014) an example of confounding variable that may have an effect on the difference between the pre-intervention and post-intervention knowledge of nurses is prior knowledge of the evidence-based pressure ulcer prevention recommendations.
Statistical Analysis
Data analysis from the study was conducted using SPSS 22.0. The researchers applied regression models to evaluate the effect of the intervention. As supported by (Eliopoulos et al., 2007), regression analysis models are very effective in quantifying the relationship between an outcome and an intervention. The study applied regression analysis to evaluate the multifaceted intervention using pre- versus post-intervention measurements and unit as explanatory variables (Sving, Hogman, Mamhidir&Gunningberg, 2014 p.5).
In addition, two-group tests or bivariate analysis were applied in the data analysis process. The researchers used Student’s t-tests to test for between-group differences (Sving, Hogman, Mamhidir & Gunningberg, 2014). The method of data analysis chosen by the researcher is therefore appropriate for the research methodology that the study adopted. The results of the analysis indicated that there were significant increases in the knowledge of nurses (57% at pre-test to 63% at post-test) as well as the performance of pressure ulcer prevention(Sving, Hogman, Mamhidir & Gunningberg, 2014 pp.5-8) However, the observed difference in prevalence of pressure ulcers was not of any statistical significance(Sving, Hogman, Mamhidir & Gunningberg, 2014 p.5)
Are the results of the study valid?
Were the study methods appropriate for the questions?
The study methods used by the researchers were indeed appropriate for the questions that they aimed to answer. The purpose of the study was to investigate the impact of a planned intervention. The study methodology applied i.e. Quasi-experimental is appropriate for the study because the researchers wanted to achieve experimentation and avoid random controlled trial because it would be unethical to pursue full randomization. Thus it is very appropriate to apply a design that is very close to experimentation. As such, the study followed ethical considerations because no patient was put at risk of developing pressure ulcers or any other physical and/or psychological risk. In addition, all the participants (nurses and patients) participated voluntarily after giving their written consent.
Appropriateness of sampling methods to research questions
Sample Size Implications
The sample size and its implications were adequately discussed by the researchers. The nurses sample size was appropriate for the questions that the research sought to answer. Under the methods section (Sving, Hogman, Mamhidir&Gunningberg, 2014 p.2) the researchers stated that the population of nurses in the units studied was 169 (n=169). The number of participants in the pre-intervention test was 147 corresponding to a 97% response rate. The nurses response rate during post-testing was also high, approximately 76%. However, the researchers did not give reasons for the reduction in response rate and the implication on the results.
The response rate from the patients on the other hand remained relatively constant between pre- and post-testing. With a total of 304 patients during pre-intervention testing, 252 successfully participated corresponding to a response rate of 82%. The response rate during post-testing was 81% (Sving, Hogman, Mamhidir&Gunningberg, 2014 p.3).
Were the variables studied appropriate for the questions?
Yes, the variables studied i.e. the prevalence of pressure ulcers, knowledge and attitudes of nurses and the performance of pressure ulcer prevention were appropriate. They relevantly pointed back to the effects of the intervention. In quasi-experimenta...
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