Research Methodology (Term Paper Sample)

Research methodology
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Introduction
Understanding and using research helps us to utilize the knowledge it produces in our practice, making our practice evidence based. We are accountable for the quality of care we deliver, and our Code of Professional Conduct (NMC, 2008) requires us to justify our decisions. The development of treatments for conditions and diseases affecting people worldwide depends on clinical research (Fedor, Cola and Pierre, 2006), and helps nursing to continue to improve and advance (May and Holmes, 2012).
This year the Department of Health (DOH, 2013) published the new District Nursing Service Model, entitled ‘Care in Local Communities - District Nurse Vision and Model’. One of the three core elements is: ‘Support and care for patients who are unwell, recovering at home and at the end of life’. I have always had an interest in palliative care, and in particular caring for patients who have fungating malignant wounds. Dressing these wounds is always a difficult task due to high exudates and malodour from the wounds, which can be distressing for both the patient and the nurse (Wilkes, et al., 2003). Alexander (2010) agrees caring for a patient with a malignant wound can be emotionally draining, and can leave nurses feeling frustrated, helpless and even guilty. Although malignant wounds only occur in 5-10% of cancer patients (Lund-Nielsen, et al., 2011), the existence of these wounds is a constant reminder of the patient’s terminal illness, and can be devastating for the patient and their relatives (Alexander, 2010).
Patients with malignant wounds may suffer loss of identity, and sometimes isolate themselves from friends and family, possibly due to repulsion towards the disfiguring tumor, and also the uncontrollable malodorous fluids (Lawton, 2000 cited in Grocott, 2001). While symptom control should be the nurse’s priority, it is important to recognize the possible damaging effect of malignant wounds on a patient’s psychological and social wellbeing (Naylor, 2002). This has proved emotionally and clinically difficult for me, therefore in order to enhance my future practice and increase my knowledge; I have researched this topic further.
Literature Search
Initially, a quick search for ‘malignant wounds’ was performed in the Medline database, chosen as it specialises in journal articles related to life science with a concentration on biomedicine and research. This search returned 108 results; however, many articles were not available as full text. It was therefore not worthwhile to continue to search Medline.
A brief search of the database CINAHL (Cumulative Index to Nursing and Allied Health Literature) for ‘malignant wounds’ revealed 113 results, most of which were available as full text. An advanced search of the phrase ‘malignant wounds’, with the limits ‘research article’ and ‘all adult’, returned 17 results. A search of ‘treatment’, with the same limits, returned 131,367 results. To narrow the results, ‘dressing’ was searched instead, with the same limits, returning 1,063 results. The area of interest is ‘fungating wounds’, which, searched with the same limit, returned 12 results.
A combined search, to try and reduce irrelevant articles revealed by previous searches was undertaken using ‘fungating wounds’ and ‘dressing’. This produced four results, narrowing the results too much. A combined search for ‘fungating wounds AND dressing’ OR ‘malignant wounds’ was undertaken, as these wounds are often referred to as either malignant Research or fungating (O’Connor and Aranda, 2003). This resulted in 17 articles. Although Parahoo (2006) indicates research articles older than five years may be outdated, there is limited research surrounding this topic. By limiting the date, important and relevant research could be missed.
From these results the following articles were chosen:
‘The effect of honey-coated bandages compared with silver coated bandages on treatment of malignant wounds – a randomised study’ (Lund-Nielsen, et al., 2011)
‘Case study on the effectiveness of green tea bags as a secondary dressing to control malodour of fungating breast cancer wounds’ (Yian, 2005).
‘An intense and unforgettable experience: the lived experience of malignant wounds from the perspectives of patients, caregivers and nurses’ (Alexander, 2010).
As previously identified I have found both the emotional and practical side of caring for a patient with a malignant fungating wound challenging, therefore all of these articles were relevant to my needs.
To fairly and accurately critique each article, Cormack’s critiquing framework (Cormack, 2000) was used for all three articles. It is generic to both qualitative and quantitative research articles and is more user-friendly than some other frameworks which were researched.
Due to the limited word count of this assignment, I have decided to concentrate on the most important aspects of the articles. I am therefore not going to critique the titles, or the author’s credentials. As all articles have been published in peer reviewed journals, it is assumed they all have the appropriate qualifications.
I chose to first critique ‘The effect of honey-coated bandages compared with silver coated bandages on treatment of malignant wounds – a randomized study’ (Lund-Nielsen, et al., 2011).
Article One
The abstract clearly states the research problem is that malodor and exudates are the most common side effects of malignant wounds, which can be difficult to manage. The authors wanted to compare the use of honey-coated bandages (group A) with silver-coated bandages (group B). The research method used is not stated, however from the information, it is clear a quantitative approach was used. This was an experimental study, because an intervention or treatment was actively introduced (Polit and Beck, 2006), and subjects are randomly allocated to the two groups. (Moule and Hek, 2011). A total of 69 patients, aged 47-90 with malignant wounds and advanced cancer were used for their research. The patients were then randomly selected to enter either group A or group B.
An improvement was found in 62% of patients, regarding wound size, cleanliness, malodor and exudation. These patients had an average survival time of 387 days, compared with 134 days in the remaining patients. Whilst it was found both honey and silver helped improve the outcome of malignant wounds, no differences were found between the two regimes. Burns and Grove (2011), suggest abstracts should aim to capture your attention, making it desirable to read the rest of the report. While this abstract was interesting to read and provided a lot of information, a lot of figures were included which could be off putting to some readers.
The introduction deals with the physical and emotional effects of malignant wounds. Previous research has been based on experience rather than clinical trials. From the authors’ review of this previous research they found, to their knowledge, silver dressings had been researched, but not honey dressings. This was their rationale for creating a randomized control trial to test the effects of the two types of bandages on wound size, cleanliness, malodor and exudation.
The literature review is very short compared to the rest of the article. However, the authors do refer back to the literature review in the discussion. Current literature together with research undertaken within the last eight years was reviewed, showing the researchers have considered both past and present research. This ensured no duplication which would be a waste of time and unethical to the participants involved (Stommel and Wills, 2004). However, reasons for only researching the past eight years is not explained. Literature reviews are important to provide background for the study topic, to identify gaps in knowledge, and to identify the contribution the study will make to existing knowledge (Burns and Grove, 2011). The literature review supports the underlying theoretical framework by stating what is already known about their subject and how this supports their reasons for undertaking the research. It does not however present a balanced argument for and against the use of silver and honey-coated dressings, but they do state previous research is limited, hence the reason for the study. Research
The hypothesis is not stated in the research article, because the authors did not have a pre-conceived idea of which dressing would be the most effective. They therefore compared whether one was better than the other, by randomly selecting the patients to enter either group A or B. As the authors did not know which dressing was more effective, they could test them fairly and equally, which is an accepted approach in experimental research (Parahoo, 2006). Although no hypothesis is stated, the authors were clear when stating their aims.
May and Holmes (2012) believe randomized control trials only focus on a single population, making it difficult to generalize the data produced to the breadth and scope of nursing practice. However, this was the appropriate approach for this study as it enabled the researchers to test the effectiveness of each of the bandages and compare the results. Stommel and Wills (2004) suggest experimental designs provide the strongest evidence in supporting assumed relationships between variables. Although this design is widely regarded as the best approach for evaluating evidence, it is not always feasible or ethical to...