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Critical Appraisal on Reliability of Clinical research Article: Managing Delirium Assessment 3 Answer

Institute of health and management

Unit Outline and Study Guide

HEALTH CAREERS

Assessment 3— Written Assignment of 2500 words (50%) due in week 9 Wednesday 3rd April 2019 12MN

Assignment topic: The aim of critical appraisal is to ensure the clinical research articles are reliable, valid and applicable before it is applied to a patient. In this assignment you are required to critically appraise a systematic review paper using the criteria given in the rubric. You must select a systematic review paper that is related to a nursing practice of your choice. You must attach a copy of the chosen systematic review paper with your assignment.

Assessment criteria

• Select one systematic review paper related to your nursing practice of your choice. Your article must be 07 years old. • Click here to download a sample systematic review paper. Do not copy this, just learn from it. • Your assignment must have an introduction, body and a conclusion. • USE APA FORMAT. APA website. Information cited from unreliable websites, pamphlets or magazines is not acceptable for this paper. • The assignment will be marked according to the rubric/marking guide below. Please attach a copy of the rubric to your assignment before submission. 

Answer

Assessment 3: Critical Appraisal

Introduction:

The research study that has been selected to carry out critical evaluation of the selected systematic review regarding managing delirium in the critical care of hospital settings. Delirium is one of the mostly prevalent health issues among hospitalised patients, when adequate care is provided the consequences can be prevented or reversed (Martinez F. T., Tobar, Beddings, Vallejo, & Fuentes, 2012)Rivosecchi, Smithburger, Svec, Campbell, & Kane-Gill, (2015) have opined that despite prevalence of delirium among elderly population at hospital admission is increasing, no specific non-pharmacological strategies and suggestions for preventing delirium in the acute care units are  carried out by nurses). Thus a significant gap prevails in the literature about non routine administration of interventions or use recommendations for managing the particular health issue. Hence prevention of the negative outcomes in the aged patients with delirium can be prevented by adequate understanding of effective non pharmacological strategies that is low cost and low risk at the same (Hshieh, et al., 2015)

Review problem:

Population studied: 

Aged patients in acute care unit suffering from delirium has been chosen as the population of the study. This complication is related with increased length of hospital. Delirium is common across all healthcare settings however the prevalence alters as per the acuteness to the illness. Highest prevalence of delirium is recorded in aged patients who are seriously ill  (Bellelli, et al., 2014). Hence aged patients in different intensive care unit, ICU, critically ill, intensive care, have been selected.

Interventions given: 

Pharmacological intervention for delirium have been reviewed in order to find out the effective strategy in improving treatment.  Research in this specific area and implementation of non-pharmacological therapies for treating delirium are selected. Nursing intervention such as mobilization, reorientation, education of nurses, and music therapy that were used in the chosen studies aimed at patient safety and wellbeing, recognizing, minimising or elimination of known causes, supporting care users to that they can carry out day to day physiological functions, minimising stresses and cope with restraints (Christensen, 2014)

Outcomes considered: 

Different studies have shown effective outcomes of non-pharmacological strategies that again may minimise adverse effects of medications such as antipsychotics to either prevent or treat delirium (Elliott, 2014). The standard of care may be improved through right implementation of non-pharmacological strategies in treating delirium in elderly patients who are critically ill. Owing to inadequate reliable data, the outcomes do not suggest for a pharmacological treatment or opt for combined pharmacological and nonpharmacological strategies in treating or preventing delirium.

Literature review:

Appropriateness of papers:

The research paper answers to the question which the most effective non pharmacological intervention for treating the selected health issue in critically ill patients. The study aims at identifying non pharmacological interventions to prevent delirium which includes identification and treatment of delirium in aged patients, identify possible barriers and facilitators to non-drug management of delirium. Therefore the research answers to the question whether adequate studies have been conducted in support of pharmacological studies have been conducted or not they recommend combined protocol of pharmacological and non-pharmacological protocols. Evidences are inadequate that support administering antipsychotics in either preventing or treating delirium. Further research paper includes journals that find out different non pharmacological strategies that is likely to benefit all types of clinically ill patients. Hence different papers related to non-pharmacological assessment, treatment or management of delirium cases have been focussed upon (Christensen, 2014). It includes papers that have shown different types of non-pharmacological interventions that are beneficial for critically ill patients with delirium.

Further studies are also included that show that different non pharmacological intervention are prevailing however effectiveness of a particular protocol has not accurately been investigated (Abraha, et al., 2015). However studies further have shown lack of adequate investigation supporting use of pharmacological interventions creates gap in the effective delirium prevention and treatment.

Therefore a wide range of papers have been included in the selected paper to summarise literature from non-pharmacological management of delirium among critically ill patients. Older patients with delirium thus are accurately chosen to carry out the investigation. However the utmost aim is to identify the most effective protocol that support the development of non-pharmacological intervention that could be used for patients who are critically ill. 

Appropriateness of the study design:

A research design includes specific research question, criteria and criteria measures, data analysis, discussion and conclusion, ethics and focus on a specific research problem. The research is well designed that has specific research problem, data collection method, followed with analysis. The research follows literature search by using MEDLINE and EMBASE. The research is a systematic literature review and hence it has collected various studies through secondary research method. The essential elements of the particular research design are accurate purpose statement, data collection techniques, data analysis method, research methodology, measuring the analysis, and selection of a definite research setting demonstrate that the research design is accurately framed as suggested by (Brannen, 2017)

The studies that have been selected for the particular systematic literature review is included certain criteria and criteria measures, research papers searched from 1946 to October 2013 delirium and critically ill and assessment and management. The studies were limited to research conducted on humans ad performed in English. Since the research has chosen clinical nursing attitude towards delirium patients in elderly care home and effects of intervention, hence solutions of the issue is sought through diagnosis of the issue that is improving health and wellbeing through clinical interventions that is diagnosis and addressing the problem of delirium. Therefore effectiveness of non-pharmacological intervention is critically assessed through this specific study. 

Use of database and outside resources: 

The research has used outside resources to carry out primary and secondary research. The sources that have been used to conduct secondary research are appropriate according to the selected subject area. Further data that has been collected from the database facilitates the researchers in gaining understanding about the attitudes of nurses towards elderly patients with delirium and the effectiveness of the non-pharmacological intervention used in the health care setting. 

Quality of the review:

Author assess quality/rigour of studies:

The authors assessed studies to be excluded or included based on the research areas. The studies that were conducted on elderly patients with delirium, have been included in the study.  Conclusions drawn in studies that are included in the particular research have been assessed critically. Studies that supported or refuted different areas related to delirium such intervention methods, identification and addresses of delirium such as pharmacological intervention and development of non-pharmacological strategies that are effective for treating delirium patients have only been included. Followed by initial review of abstract, with the application of same exclusion and inclusion full text were reviewed. However no inclusion or exclusion criteria were considered on population of patients and study settings. 

Data synthesis: 

The study is a systematic literature review that includes different studies based on certain inclusion and exclusion criteria. Data synthesis is the technique of inferring conclusions in the literature so to identify how the literature addresses the developed research question (Bryman, 2012).  The data synthesis of the selected study combines findings from various studies that have been conducted on pharmacological and no pharmacological treated and strategies evaluation. The study infers to a new conclusion from 17 selected research papers. The systematic literature review concludes that implementation of non-pharmacological interventions are essential in preventing and treating delirium in critically ill patients. These strategies have been found to be low risk and low cost strategies that were demonstrated to be beneficial in all the selected studies. 

Results combined: 

The particular study has combined 17 articles that met the inclusion criteria and were selected for review. 7 of the selected research paper were conducted in critically ill patients, 3 in postoperative care users,  5 in geriatric elderly care medicine care users, and 2 care users who had fractures in hip. The results combined. The result has combined that findings of all the chosen 17 research papers and thus has followed criteria of systematic literature review as stated by (Bryman.A. & Bell.E., 2015)

Results displayed:

The study results have been displayed with the use of statistical tools that is tables, numbers combined with analysis of the inferred outcomes. Statistical data that is studies that used pharmacological interventions and non-pharmacological strategies have been assessed were displayed with numerical representations. A comparative study has been carried out to demonstrate the different findings of the research papers. 

Similarities among individual studies: 

A comparative study has been taken into account in the particular research where findings from different research papers have been presented with areas of similarities and critically analysed when argued. For instance, studies were selected that have supported different non pharmacological strategies in managing health conditions of delirium in aged patients. Further similar findings of varied research papers that show non pharmacological strategies such as mobilization, reorientation, education of nurses, and music therapy to be safe and less expensive in managing elderly patients with delirium.

Similar results from different studies:

Similar results from different studies also have been considered in the particular research paper. The paper has demonstrated similar outcomes of different research papers identifying different underlying causes of delirium such as anesthesia, major surgery, and psychoactive medications while similar results of negating education of nurses as the factor of under treatment or under identification of delirium cases among elderly patients also have been witnessed. Among 12 studies that have highlighted prevalence of delirium among aged patient in hospital settings, results of 9 revealed a benefit of the nonpharmacological intervention. 

Variations in results: 

Variations in outcomes were discussed with reasoning and those information have been represented critically so that the readers come across both the sides of the information and data collected. Different studies that have come up with different conclusions about effective nonpharmacological strategies have been presented. For example majority of the research studies have identified effectiveness of non-pharmacological strategies in improving patient conditions of preventing patients from delirium after intervention. Additionally, 6 studies showed duration of delirium decreased after nonpharmacological intervention while one of the 6 studies has reported of decreased severity of delirium. Although all the selected studies have concluded that non pharmacological intervention to be effective in managing critically ill patients delirium, conclusion was different in identifying the most effective intervention for treatment. 

Results: 

Overall results of the reviews:

Overall result of the chose study shows that intervention strategies included multicomponent to manage delirium have proved beneficial. The non-pharmacological intervention includes training and education of nurses, early mobilization of care users, and cognitive stimulation with reorientation (Freeman, Hallett, & McHugh, 2016). The researchers of the selected study further add that a number of ways can be chose for mobility of patients depending on the severity of the illness. 

Precisions of the results: 

The true value is close to theoretical value about the effectiveness of non-pharmacological strategies in managing and treating elderly patients with delirium. The assessment and comparisons that have been used in the entire research are precise and accurate (Cohen, Manion, & Morrison, 2013)

Results expressed: 

Odd ratios were used to compare the relative odds of the conclusion of interest that is delirium where exposure is given to variable interest that is non pharmacological strategies, severity of illness. 

Discussion: 

Result applicable to local population:

Since very few studies have been conducted to identify benefits of non pharmacological  protocols in treating or preventing delirium in elderly patients in care homes, result of the selected research is applicable to the local community as the validity and reliability of the outcomes are highly dependable. Different non pharmacological strategies such as reorientation, mobilization, education and training of nurses, and music therapy are beneficial to all patients irrespective of severity of their illnesses in aged patients with delirium (Bellelli, et al., 2014; Chrysafiadi & Virvou, 2013). Although one strategy that fits for all is not available hence certain interventions that can be included are reorientation with cognitive stimulation, education of the medical professionals, and early mobility in any critical conditions. 

Did the review focus on all important outcomes:

The research has highlighted on all the significant outcomes that the research study aimed at to focus on. Those key areas that have been focussed are different non pharmacological interventions, effectiveness of different interventions in treating delirium, potential barriers and support in implementing those non pharmacological interventions in hospital settings. 

Advantages and disadvantages of outcomes:

The research has demonstrated that non pharmacological intervention that have been highlighted in all the selected studies will facilitate in managing elderly patients with delirium. Therefore with adequate support, education, training to the nurses they would improve their ability in identifying and addressing the issues of delirium. Hence the health care system can implement intervention that is education, training and adequately support to the nurses so that they are facilitated to provide adequate care to the aged patients with delirium (Martinez, Tobar, & Hill, 2014).

In contrast, the health care system need to invest on staffs training and assessment so that they improve tehri knowledge and experience about identifying and addressing this particular health issue which may lead to huge burden on the system. Further as it is evident from the undertaken research outcomes that non pharmacological intervention cannot be effective in identifying or eliminating elderly patients’ health issue of delirium without required support. Further the healthcare institutes may experience barriers to implement these changes which may lead to ineffective implementation of interventions. 

Recommendations:

The study is a systematic literature review that has selected a few previous conducted researchers, Hence outcomes may be different based on geographical region, education of nurses, health condition of the patients etc. In order to strengthen the reliability and validity of the research outcome, primary research can be carried out. 

Conclusion:

It can be concluded from the selected research findings that a non-pharmacological interventions are critical to improved elderly patients care with delirium. The study also has found effectiveness of non-pharmacological strategies in minimising off level administration of antipsychotics for treating delirium. Although one that fits all non-pharmacological protocol may not be available, reorientation with cognitive stimulation, education of the care professionals, and early mobility are likely to prevent and treat delirium patients, irrespective of their illness severity. 

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