A critique of a research article from a professional journal

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A critique of a research article from a professional journal

Evidence-based practice (EBP) is a wide ranging term with a large and multi-faceted meaning. Traditionally, a narrow definition may refer to EBP as “...de-emphasising intuition, unsystematic clinical experience...and stresses the examination of clinical evidence from research” (Evidence-Based Medicine Working Group, 1992). This definition misses the current broad and overarching nature of evidence-based practice. A more broad and current definition by the McMaster University Evidence Based Medicine Group (1996) identifies implications for the research used, for example concepts such as validity and appropriate data collection methods, as well as acknowledging patient preference as an important factor.  Evidence-based practice has become a cornerstone of a variety of professional conduct, for example, the Nursing and Midwifery Council (NMC) mandates, for example, that all advice given to patients is based upon the best available evidence (NMC, 2008). The evidence provided by research does not, however, necessarily mandate a change in practice: the whole purpose of EBP is to use available research to inform practice, and as a result of good judgement by practitioners ensure that as healthcare professionals we do what is best by our patients (Sackett, 1996).

The paper selected for analysis is called “Effective and Sustainable Multimedia Education for Children with Asthma: A Randomized Control Trial” (Krishna et al. 2006). Asthma is a common condition, affecting more than 5.2 million people in the UK as of 2004 (Asthma UK, 2004), costing the British economy more than £2.3 billion a year in a combination of NHS costs, lost days due to sickness etc. (Asthma UK, 2004). In 2001, 69,000 hospital admissions were directly related to asthma: more than 40,000 of these were adult admissions (Department of Health, 2001). With a combination of good education and access to appropriate healthcare services, these admissions could be reduced: children in good control of their condition are much less likely to require hospital admissions after transfer to adult services (Department of Health, 2004). Therefore, as an adult nurse, I can see that the correct education in relation to asthma as a child can only benefit the patients that I take care of in the future.

A possible specific question that the researchers aim to answer is presented as part of an introductory sentence. The overall aim of the study appears to be to improve asthma care by trying a different method of information-giving (i.e. multimedia presentation). The question appears to be equivocal: according to Cormack and Benton (2000) a ‘good’ question will involve some mention of the different variables involved, something that this question fails to do. Following on from this is a list of five specific hypotheses that the study aimed to examine. Despite the lack of a clear and explicit research question, these hypotheses serve to focus the research: they form a clear, measurable guide as to what the researchers expect from the results (Hek & Moule, 2006). However, this particular study only examines two of the five hypotheses, as the other three were already examined thoroughly in a previous study. This indicates that the bulk of the study was already completed, possibly in some form of pilot study. Therefore, this specific study only examines a small proportion of what it initially intended. Unfortunately, a copy of the previous research could not be found, and therefore specific details cannot be ascertained.

The paper appears to be quantitative in nature: the researchers are seeking to test hypotheses, have operationalised the concepts to be measured and have created, in advance, the tools with which to measure the outcomes (Parahoo, 2006). Further more, the title of the article states that the research is a randomised control trial (RCT). Research of quantitative design is intended to look at facts and figures rather than opinions, be objective, rather than subjective and produce hard and fast data that can be applied to a larger population (Carter, 1996). This study aims to test two hypotheses: one will be tested using numbers (the results of spirometry) and the other using results from a Likert-scale questionnaire, again producing a number (a percentage). Therefore, a qualitative design, whereby opinions and feelings would be recorded would be inappropriate (Carter, 1996). Of course, it could be argued that the quantitative method of asking opinions is a qualitative design, rather than quantitative. The very fact that the researchers are asking for opinions could be considered inherently qualitative, as any results obtained would be subjective, that is personal to the respondent. This potentially would make the study a mixed methods design, whereby both quantitative and qualitative design aspects are incorporated into a single study (Hek & Moule, 2006). This design has advantages, such as increasing the scope of research: not only is factual data obtained, but is then complemented by the thoughts and feelings of the target group. This allows conclusions to be broader and relevant (Arthur & Nazroo, 2003). Conversely, a mixed-method study may produce contradictory results, and it may be difficult, if not impossible to ascertain which data is accurate, therefore rendering the research potentially useless (Maggs-Rapport, 2000). True to the design of a RCT, the study incorporates two groups: an experimental group (receiving both traditional and multimedia interventions) and a control group (receiving only the traditional intervention). The purpose of the control group is primarily to give a comparison, in this case, comparing the new intervention with the old. This system can be inherently unethical, discussed in later sections.

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As previously stated, the study claims to be a randomised control trial (RCT), more specifically an open experiment, meaning that everyone participating in the study was aware of who was in which group and it was conducted within a controlled environment. In this case, it is quite appropriate to use an RCT, as the questions posed by the study seem best answered with this means. Randomised control studies are designed to be carried out within a practice environment, within which variables can be easily controlled or manipulated (Hek & Moule, 2006). Unfortunately, although experiment-design studies are easier to control, ...

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