2.4,2 Critical appraisal of a research paper
Weight: 50% Type of Collaboration: Individual
Format: Length: 2,000 words
Curriculum Mode: Essay
Aim of Assessment The aims of assessment are for students:
Appraise the quality of evidence from clinical trials, (or) Appraise the quality of evidence from qualitative research studies
The purpose of this assessment is to enable postgraduate students to their learning of conduct a critical appraisal of 7 a specified published journal article and incorporate the following learning outcomes:
— Apply critical appraisal techniques to a range of research methodologies; — Critically appraise research for its application to practice
Critically appraise one of the two papers (below) that are available on the unit vUWS site for this assessment item. The critique should focus on the methodology, results, overall quality and implications for clinical practice and further research. Please choose the correct critique check list for the research design of the study being evaluated.
1. Carlson et al. (2019). Nursing students perceptions of peer learning through cross-cultural student-led webinars: A qualitative study. Journal of Advanced Nursing impress 2. Lai et al. (2019). A nurse-led care program for breast cancer patients in a chemotherapy day center: A randomised controlled trial. Cancer Nursing, 42(1), 20-34.
CRITICAL APPRAISAL OF A RESEARCH PAPER
The focus of this essay is to identify various techniques that are adopted to analyse the effect of nurse-led program upon the minds of patients who are suffering from breast cancer in Hong-Kong. In order to conduct this research article parallel trial design with unequal randomization has been adopted. Primary quantitative research analysis method has been adopted in the selected article to obtain the desired results based in the viewpoints of sufferers.
This assignment aims to analyse the methods that have been used to conduct an article that is selected for this essay. It is essential to understand the methods that are used by various hospitals to provide sophisticated health-care facilities to the desired people. Here, the chosen article is about a nurse-led program that is developed to provide chemotherapy to patients who are suffering from breast cancer. In order to obtain the desired result primary quantitative method gas been used in this article which included the patients who are suffering from cancer and have already undergone chemotherapy. This method is highly effective since it has directly helped to obtain results from the victims. IBM SPSS has been used in managing all the primary as well as secondary data and the statistical algorithm has been selected to conduct the analysis, which is highly beneficial. This essay has helped to understand the effects of the nurse-led program to make the lives of patients free from stressful feelings and miseries.
Critique of methodology
In order to find the importance of nurse-led program participants has been appointed from the year 2013 June 2013 September. 399 medical reports have been considered to find out the number of people who are suffering from cancer and the right treatment that they are provided with to overcome their issues. Therefore, 124 patients participated in this study to share their views about the situation they have undergone while receiving the treatment to cure themselves. According to the views of Lock & Wilson, (2016) patients need proper guidance and information about the treatments they are undergoing to cure themselves so that they can keep themselves free from mental stress. Therefore, this method of analysis is beneficial since it not only helps to find the viewpoint of patients but they can also be provided with authenticated information about the treatments they are in need of. As stated by VazLuis et al. (2017) it is essential to understand the reference of patients about the treatments they require to cure themselves of cancer. The primary quantitative analysis allows a researcher to increase their access to broad objectives in order to increase the accuracy of the obtained results. Moreover, a higher number of studies can also be involved to understand the effects of chemotherapy to cure patients suffering from breast cancer, which in the other hand can be used to generalise the results.
Owner of the major advantage of this analysis is that it helps in collecting data personally by communicating with the eligible patients whose opinions are highly essential to make the research study fruitful. Two methods have been adopted to replace all the missing data that are treated with the people who are suffering from cancer. The criteria for selecting the patients has been that patients should be above 18 years and are disguised form the primary stage of breast cancer. Moreover, they should also have the ability to communicate with others in Chinese and Cantonese. The location that has been selected to conduct the research has been chemotherapy day centre of an acute care hospital in Hong Kong. 2-arm parallel trial design with unequal randomization has been selected for this article. However, one changes have also been made here which included the withdrawal of patient form the survey if their chemotherapy regimen has been changed. The sample size has been determined by developing an aim to differentiate the between-arm effects in primary outcomes. FACT-G has been used to find the appropriate sample size for this research article, 45 participants have been required for all particular arms to achieve the potential power, and 22 symptoms related to chemotherapy are analysed here. T0 questions are completed at home whereas T1 and T2 questions in the waiting room of the clinic selected for the survey.
The random allocation sequence has been generated by using an online allocation generator with a 1:1 allocation using a 4th sized block. The allocation sequence has been coached by the researchers before the commencement of study by a third party. The researchers also informed nurses about the allocation of patients in order to make the entire process easy. As stated by (Lai et al, 2019), IBM SPSS 19.0 has been used to manage all the primary, secondary, and statistical model expectation-maximization algorithm has also been used to calculate all the missing data. In order to analyse the missing data two methods have been used which include the replacement of missing data by using ‘0' and last-observation-carried-forward method. On the other hand, many other essential data have been analysed by using quantitative methods with self-efficacy and care. The distress level that is associated with symptoms of cancer is also computed by using the Mann-Whitney U test. The qualitative analysis software is highly effective to analyse the data that have been gathered by primary and secondary data collection techniques.
The patients have been recruited by the researchers themselves and are allocated in two groups. In-group A the participants have been selected who received 4-cycles of chemotherapy and on the other hand, patients who have attained 6-cycle of chemotherapies are grouped under group B. All the participants are ensured from the intervention nurses that they are going to receive the same care and treatment in the chemotherapy day centre. 60 patients have been selected for the intervention arm, 64 in the control arm and amongst all the members 62 control arm and 58 from intervention arms have been selected for data analysis. No significant differences have been found by analysing the scorecards in the treatment that are provided to both the groups.
However, there have also been several changes in the selection of participants if the treatment procedure of the patient has been changed due to the progress rate if their diseases. On the other hand, if a patient is possessing an intellectual impairment then also she has been removed from the groups. Since maximum women are suffering from breast cancer in Hong Kong, hence these patients have been selected randomly for this research paper. The survey results have helped to find that 88.95 patients have gained the confidence to cope up with the chemotherapy and their adverse effects. Moreover, 48.6% of patients have also said that the nurses who have helped them to overcome their fears and discomfort provide them with the right treatments. In order to provide further treatments telephone services have been started which included the hotline services and the nurse-led telephone services. It has been found that 32 patients of control-arm have dialled hotline services whereas 26 participants received their answers via telephone calls.
From the demographic and clinical data of the participants, it has been found that 17.5% of both the groups possessed primary education, 68.3% possessed secondary school education and on the other hand, 14.2% are from tertiary school. Furthermore, maximum participants, that is, 92 patients of the total 120 patients are married and the rest are single or divorced. Monthly income of all the participants varied, however, the range that has been selected for participation has been from 10,000 to 30,000 (Lai et al, 2019). The disease stage can also be evaluated from this table and it has been found that 35 patients are having 1st stage cancer, 65 patients are having 2nd stage cancer and the remaining 20 people are having cancer of 3rd stage. The population of the patients resulted at the end of a trial system that is adapted for this article. The limited awareness about the nurse-led program has also been a major reason to end this trial method of research. The adverse effects associated with the chemotherapy treatments tend to impose hardship amongst the patients, which often leads to negative consequences unintentionally. In order to understand the overall quality of life of patients belonging firm both the group's various aspects have been considered which includes their physical and mental well being, social and functional well-being.
There are various limitations of the trial methods that are adopted in this research paper. Certain times it becomes difficult to demonstrate all the possible effects by applying these techniques. As stated by Zeilstra et al. (2018), hence, it is essential to adopt various approaches so that they can be used to evaluate the study efficiently. This process is also not enough to provide genuine awareness about the effectiveness of nurse-led programs that are mainly developed for cancer patients. In this study the open-label and single-centre randomised control trial have been used in order to prevent the impact of incomplete binding, however, it has been difficult to teach all the patients who are involved in this research study. Since the main cause of this opera is to reach the women who are suffering from breast cancer in Hong Kong and all the patients are unable to be communicated, therefore, the trial possessed some limitations. It is essential to conduct this program at many hospitals so that all women can be reached easily and awareness level can be increased amongst them. Psychological support has also been lacking in many patients since they are adversely affected by the chemotherapy treatment they received to cure their disease. The methods that have been further used to manage the missing resulted to underestimate SEs or the smaller P values. However, the limitations of these trial methods have never decreased the value if the program in clinical settings. The nurses who are appointed to provide regular follow-ups to the cancer patients have been effective. In order to improve the challenges of self-care and monitoring the changes in behaviour, it is important to address all the important aspects of behavioural changes amongst patients. On the other hand, it is also important to facilitate the design of interventions to understand their impact on the self-efficacy of culture. Extra caution is also required at the time of interpreting results at statistical differences have been found. As stated by Toledo et al. (2015), these trial methods require confirmation by long-term studies with more number of incidences.
The generalisation of this study is limited in terms of social and clinical backgrounds of many patients involved in the study. This process initially also affected the handling of data of the patients who are involved in the research study to understand their critical conditions due to cancer. Since this is a crucial disease in Hong Kong and many men have been victims of the diseases, therefore, it is important to help all the women by reaching them in other hospitals also. In order to improve the confidence level of the patients, it is essential to understand their viewpoints by communicating with them personally, hence recommendations to adopt some other trials are also highly made to improve their strategies. The comparison of the obtained result with the previous evidence has also been poor since there are a limited number of multi-component interventions studies that are based on the patients who are suffering from cancer. Based on the findings section it can be said that the continuous support of the program to provide detailed information about the issues can help patients to get maximum benefits.
Maximum evidence is highly encouraging which helps to understand the benefits of nurse-led programs however; unknowingly chemotherapy treatment is also having adverse effects on the minds of some patients, which is required to diminish. In order to reduce the complexity level of the nurse-led programs, other is important to do more research, which can help to provide evidence that is more scientific. This can be used to demonstrate the usage of this care model for patients.
From the above study, it can be concluded that primary quantitative analysis helps in obtaining a detailed view of all the issues that are faced by patients. This helps to develop specific strategies to help patients overcome their troubles in future. However, it is also essential to adopt several other strategic tools to analyse data with previous results in order to understand the increase and decrease of nutrient conditions in a particular location. In order to increase amongst various patients who are suffering from chronic diseases, it is also essential to launch programs in all the hospitals so that they can be reached easily. Moreover, communication is required to understand the mental, social and physical state of patients so that genuine strategies can be developed to overcome their troubles.