Quantitative Study
The quantitative research study that is to be critiqued is the one written by Pickham et al. in 2018. The researchers highlighted the problem of hospital-acquired pressure ulcers (HAPUs) and the benefits which routine patient-turning practices failed to demonstrate. The purpose of the study was to evaluate the effect of the wearable patient sensors on turning compliance and, consequently, patient outcomes related to the prevention of pressure injuries. The hypotheses which the study tested were as follows: the use of a wearable patient sensor
- reduces the occurrence of pressure injuries and
- enhances turning compliance.
The research study was designed as a two-arm randomized clinical trial. The study participants were 1312 patients from two intensive care units in a medical center in California who were randomly assigned to either an experimental or control group (Pickham et al., 2018, p. 15). Those assigned to an experimental group received optimal turning practices based on data obtained from a wearable sensor, and those assigned to a control group received standard care. Throughout their admission, participants were monitored to detect the occurrence of hospital-acquired pressure ulcers and turning compliance.
Data on the staging of pressure injuries were collected by the clinical team in the form of a standard report every 24 hours. Nurses independently performed a full skin assessment for each patient. A wearable sensor measured the total time with turning compliance and sent data to a database (Pickham et al., 2018). Fisher’s exact test was run to determine if the differences in the development of HAPUs between the two groups were significant. The data gathered were reported in the clinical record, and the study findings were reported in the research article only.
The robust design of the study allowed the researchers to answer the research question and reject the null hypothesis at a 3% significance level. Not only is the study novel, but its data measurement techniques are reliable and accurate. The study sample is adequate and representative of the served population. The randomization was performed at the point of care, which is why the differences between the two groups were minimized as participants were from the same environment. However, the study has a limitation since it did not take into account confounding variables which could reduce the internal validity (Heale & Twycross, 2015).
Besides, instead of performing unit cluster randomization, individual patients were randomized, which could adversely affect external validity. The knowledge gaps are associated with incomplete clinical data related to wearable patient sensors. Therefore, the study findings may be considered reliable and generalizable, yet the validity of the research was impacted by its limitations.
Ethical Implications
Ethical standards are important in research because they provide for adherence to the key principles of medical ethics, such as nonmaleficence, justice, and autonomy, and compliance with the law. Within these ethical guidelines, nurses are obliged to protect patients’ privacy and secure them from the risk of significant harm (Ingham-Broomfield, 2015b). The researchers have adhered to ethics procedures by gaining ethics approval prior to study commencement. However, it has not been made clear that by gaining this approval, the researchers comply with the key principle of confidentiality.
The ethical implications of this quantitative study are carefulness, objectivity, honesty, and integrity. Among criteria precluding study participation were extreme frailty or acuity determined by nurses, or just refusal to wear sensors. The researchers honestly revealed that the enrolled number of participants did not provide for the planned “80% power to detect a 50% difference” (Pickham et al., 2018, p. 17). The ethical consideration of nonmaleficence significantly impacts human subjects as the use of wearable sensors could cause harm to patients with extreme acuity. Moreover, the principle of autonomy is also important since patients have a right to decide which care they want to receive, be it standard turning practices or optimal ones.
Significance of the Research Problem
The research problem is significant to nursing practice as HAPUs place an enormous burden on people who suffer from permanent pain caused by skin lesions. Prevention of pressure injuries is a critical patient safety indicator and a great challenge that the US healthcare system faces. It is also important to note that pressure injuries represent a serious economic concern both to healthcare providers and the government since a large proportion of direct healthcare costs is associated with prolonged hospitalization due to HAPUs (Pickham et al., 2018).
The research article is significant to the practice problem of HAPUs as it assesses the effectiveness of a wearable patient sensor to reduce the prevalence of pressure injuries and enhance patient outcomes. The study of this research problem could lead to improvements in healthcare by presenting reliable evidence that the regular use of wearable patient sensors decreases the development of HAPUs.
Evaluation
The quantitative research study is an appropriate source of information for informing patient care decision-making for several reasons. Firstly, it studies the real-world problem which US hospitals face on a daily basis. Secondly, research has the first level of evidence, and sufficient sample size was chosen for the study design. Thirdly, the results are consistent and generalizable, and definitive conclusions are made by the researchers. Since this is the first quantitative study on the use of a wearable patient sensor, this research not only aligns with the best practices but establishes ones. However, the study could be improved by taking into account confounding variables.
Qualitative Study
The qualitative research study that is to be critiqued is the one written by Roberts et al. in 2017. The research problem on which the study focuses is pressure ulcers, the prevention of which is considered a national priority for healthcare organizations. The purpose of the study was to identify patients’ perceptions of the previously elaborated pressure ulcer prevention care bundle. The qualitative design does not use hypotheses and is concentrated on the exploration of how patients understand a pressure ulcer prevention care bundle intervention.
Since the researchers conducted an in-depth investigation of a specific care bundle within a specific setting, the qualitative study methodology is a case study. As to the study design, it is descriptive research that consisted of semi-structured interviews with 19 patients across the four intervention sites (Roberts et al., 2017, p. 385). These interviews were conducted at the patient’s bedside or another private area at a time convenient for the participant.
Then, the interviews were audiotaped, transcribed, and analyzed using thematic analysis. Data analysis was performed by three independent researchers who developed codes based on the patients’ statements, which were further compared and put into groups. The study findings were reported in the form of themes in which patients’ perceptions of the care bundle were represented.
The problem and objective of the research were clearly articulated by the researchers. The context of the study was provided in the introduction section, though the literature review was absent. Even though purposive sampling, which is an appropriate method for the qualitative study, was used, the sample size of 19 patients may be considered rather small, all the more because these patients represented four acute care hospitals.
The authors mentioned the methodology they used, yet a clear description of the nature of the study was not given. The use of semi-structured interviews is the commonly used approach within the majority of the qualitative methodologies. However, the data analysis section lacks clarity, and the steps of the thematic analysis were not described in detail, which makes the replication of this study almost impossible. Also, the justification for the thematic analysis was not given. Other limitations of research include low generalizability of findings and interviewing not at control sites.
Ethical Implications
The authors of the study do not include the ethical considerations section, but they briefly mention that ethical approval was gained at each intervention site. However, it is unclear whether informed consent was obtained and confidentiality was maintained. These standards are important in research when applied to patient care because it is unethical to interview patients and use this information further without obtaining their consent (Lipp & Fothergill, 2015). Moreover, it is assumed that nurses and other healthcare professionals have a professional obligation to protect any individual’s privacy (Ingham-Broomfield, 2015a). These ethical considerations impact human subjects as there are potential harms that might be inflicted upon study participants, such as the violation of the right to confidentiality.
Significance of the Research Problem
Successful prevention of pressure injuries depends not only on appropriate care bundles and regular patient-turning practices but also on how patients perceive these care bundles, as well as facilitators and barriers to participation in HAPU care. Thus, the problem researched by the study is significant, as it seeks insights into how the pressure ulcer prevention procedures may be optimized based on the feedback obtained from people who are care recipients. The study findings are important for the interpretation of the results of the trial about which the patients were interviewed and the implementation of such interventions.
The research problem of patients’ perceptions regarding the intervention could lead to improvements in healthcare by providing factors that should be considered if the intervention is adopted into practice. It is important to understand how patients perceive the care bundle to sustain it effectively and facilitate patient engagement in HAPU care.
Evaluation
It should be mentioned that the study findings directly relate to the specific care bundle and not pressure ulcer prevention in general, which is why the information about patient care which the study provides was applied to the mentioned care bundle and the healthcare setting where it was implemented. Nevertheless, this research may be an appropriate source of information for the promotion of uptake of the best pressure ulcer prevention practices as it gives insights into what patients perceive as facilitators and barriers to participation in HAPU prevention. It is not possible to make conclusions about the study’s validity and reliability since the authors did not adequately describe the data analysis procedure. Still, thematic analysis is a commonly used practice for interpreting themes within qualitative data.
However, one may note that the sample size is insufficient, which adversely affects research applicability and generalizability. Whether the study findings align with the best practices or not can be determined because no recommendations for practice are given. The study could be improved by increasing the sample size and interviewing research participants at control sites.
References
Heale, R., & Twycross, A. (2015). Validity and reliability in quantitative studies. Evidence-Based Nursing, 18(3), 66–67.
Ingham-Broomfield, R. (2015a). A nurse’s guide to qualitative research. Australian Journal of Advanced Nursing, 32(3), 34–40.
Ingham-Broomfield, R. (2015b). A nurse’s guide to quantitative research. Australian Journal of Advanced Nursing, 32(2), 32–39.
Lipp, A., & Fothergill, A. (2015). A guide to critiquing a research paper. Methodological appraisal of a paper on nurses in abortion care. Nurse Education Today, 35(3), 14–17.
Pickham, D., Berte, N., Pihulic, M., Valdez, A., Mayer, B., & Desai, M. (2018). Effect of a wearable patient sensor on care delivery for preventing pressure injuries in acutely ill adults: A pragmatic randomized clinical trial (LS-HAPI study). International Journal of Nursing Studies, 80(1), 12-19.
Roberts, S., Wallis, M., Mcinnes, E., Bucknall, T., Banks, M., Ball, L., & Chaboyer, W. (2017). Patients’ perceptions of a pressure ulcer prevention care bundle in hospital: A qualitative descriptive study to guide evidence-based practice. Worldviews on Evidence-Based Nursing, 14(5), 385-393.