Research Critique

Presenters:Bishnu Mainali

Puspalata GhimireM.Sc. Nursing 1st year

Batch 2012

Research Title• VIOLENCE IN THE EMERGENCY

DEPARTMENT: A MULTICENTRE SURVEY OF NURSES’ PERCEPTIONS IN NIGERIA.

• Kolawole Olubunmi Ogundipe, Amarachukwu Chiduziem Etonyeaku,Ismaila Adigun, Emmanuel O Ojo , Tunde Aladesanmi, Tunde Aladesanmi et.al

Introduction:• Emergency Department (ED)

violence is common and widespread.

EDs are high-stress areas where many patients may have conditions consequent on trauma, and they or their relations could have labile emotions that may predispose to violence against caregivers.

Contd:• Violence in the EDs is becoming

increasingly common and lethal.

• ED staff receive both verbal and physical abuse, with ED nurses bearing the brunt of this violence.

• The available evidence still suggests that many institutions are improperly prepared to deal with it.

• Researchers conducted survey to determine the epidemiology of violence against nurses working in the ED, their perception of what constitutes violence, effects of such violence on productivity and potential preventive strategies.

Methodology:• Research design: survey

• Setting: emergency department of selected six tertiary level hospital from 5 states.

• Method: questionnaire based survey

• Sample: certified emergency nurses from selected hospitals. Male female ratio 1:4

• Sample size: 81 nurses ,working in emergency.

Contd :• Sampling: all nurses under

inclusion criteria were taken as sample.

• Data collection tool: semi-structured questionnaire.

• Data collection method: individualized distribution of questionaire.

Data analysis technique• The data were entered into a

Microsoft Excel 2007 spreadsheet and analyzed using SPSS V.15. They were then summarized with medians for skewed continuous and ordinal data, means for normally distributed continuous data and proportions for categorical data.

Inclusion and exclusion:• Inclusion criteria not mentioned

• Exlusion Criteria: Nurses working in paediatric emergency,gynae. and obs.emergency were excluded.

Ethical consideration:• Ethical clearance was obtained

from the ethical review committee of each hospitals.

• All the informations were managed with strict confidentiality.

Validity and reliability:• For validity, external peer review

done

• Data collection duration: two months from october-november in 2009

Statistical analysis:• Data were analyzed using

SPSS V.15.they were summarized with medians for skewed continuous and ordinal data, means for normally distributed continuous data and proportions for categorical data.

• A total of 81 nurses with a male to female ratio of 1:4 from the six institutions completed the questionnaire, giving a response rate of about 90%. Ten of the respondents did not indicate their sex in the completed questionnaire.

Recommendations:• There is need to make the

emergency department safer for all users.

• This can be achieved by a deliberate management policy of zero tolerance to workplace violence, effective reporting systems, adequate security and staff training on prevention of violence.

Implications:• This study could be helpful to

determine the epidemiology of violence against nurses working in emergency department, rule out its causes and for establishment of preventive measures against violence.

Critique

Abstract• Structured • Beginning of the article• Objectives not mentioned.• Components are:

–Background–Methods –Results and Conclusions are

included and –Keywords not mentioned.• Total words: 203

Title • Title brief but not clear.• Outcome variable not clear• Population is not defined • Setting is not clearly defined• Total words used -8

Introduction: Concepts clearly stated, consistent with the title, related literature reviewed, most of the references used of last 5-12 years, some are older.

• Need of the study: Not Stated.• Objectives:mentioned in the

introduction part.

Methodology contd:• Variables: Not Stated clearly

•Research design–questionnaire based survey stated

–Target population is not defined

• Research instrument: semi-structured questionnaires were used.

• Data collection procedure:–Clearly stated

Validity of the tool: • Provenance and peer review

not commissioned, externally peer reviewed.

• Reliability: not mentioned.

• Ethical considerations– mentioned but respondent’s

permission is not mentioned. • Statistical analysis: by using SPSS

V 15 but presented only in mean and medians.

• Sample size: sample size stated but method of sample size calculation not mentioned.(total no of ED nursing staffs not mentioned).

Results:• Results are discussed using

figures ,graphs and tables.• Table headings, table number,

footnotes clearly stated.• The explanations in the text are

consistent with the tables.• Important results are missing.eg:

knowledge• Generalizability is questionable.

Discussion:–Research findings compared with other related studies also.

–Possible explanations for most of the findings stated.

Critique contd:o Conclusion: Clearly stated with

possible solutions of violence.o Implication for practice:

mentioned but not separately stated .

o Limitations: not mentioned.

o Reference: Stated,vancouver referencing style followed.

• Presentation of research report–Report is not well written and

documented.–Abstract adequately summarized.–No use of jargons.–No irrelevant details.– Important /valuable information

lacking.

- organization of report is complicated.

Recommendations:• Title could have been written clearly.

• Objectives of the study could have been stated separately.

• Report could have been well organized, so that readers can understand the evidence easily.

• Need of the study could have been stated clearly.

• Doctors also could be involved as a sample to make the study more effective.

•

• the study could be made more specific on a particular aspect.

• The limitations of the study could be mentioned.

Any suggestions???

Thank You

Research questions • (a) is there an increase in mental health

problems from the pre- to post-conflict period.

• (b) if there were an increase, could it be attributed to conflict-related exposures.

• (c) are some groups more vulnerable to the effects of conflict on mental health?

Methodology• Research design: Prospective cohort

• Setting and study participants: Jumla, a mountainous district In northwestern Nepal with no conflict mortality prior to 2001. Population of Jumla who were above 18 years.

• Sample size: 316

Methodology cont…• Instruments:

– The 21-item Beck Depression Inventory (BDI)– Beck Anxiety Inventory (BAI)– The 17-item Post-traumatic stress disorder (PTSD)

Checklist-Civilian Version (PCL-C)– The 64-item Stressful Life Events Rating Scale for

Cross Cultural Research (SLERS)– A self-report conflict exposure scale was

developed to assess exposures to political violence-related traumatic events during the People’s War.

Methodology cont…• Sampling technique: systematic random

sampling

• Data collection procedure: random sampling of one adult per household was used for recruitment with an nth household sampling strategy, for baseline study. After the war ended, the research team began tracking original participants for post conflict interviews.

Ethical consideration• Consent was recorded with a signature for literate

participants or a thumbprint for illiterate participants.

• The Department of Psychiatry at Tribhuvan University Teaching Hospital/Institute of Medicine (TUTH/IOM) in Kathmandu provided consultation prior to and during the assessment and gave final approval for the study in 2000.

• The protocol for the follow-up study in 2007–2008 was approved by the Institutional Review Board of Emory University and the Nepal Health Research Council, with modifications approved by TUTH/IOM.

Ethical consideration cont..• Interviews at both waves of assessment were

conducted in participants’ homes with only the interviewer and participant present.

• In 2007–2008, participants with high levels of psychological distress and impaired functioning (58 individuals) were evaluated by the study’s principal investigator. A subset of these was referred for psychosocial care (43 individuals).

Statistical analysis• Chi-square for categorical outcomes

• McNemar chi-squared tests

• Generalised estimating equations (GEEs) were used to model the effect of assessment period

 Results

Strengths and Limitations

• The strengths of this study include the use of validated instruments, the ability to employ a prospective sample, and a follow-up rate of 98% of living original participants.

• limitations, it is difficult to specify what qualifies as ‘pre-conflict’ mental health.

• A major limitation is that PTSD was not assessed in 2000, so the change in prevalence attributable to the conflict could not be quantified.

Implications • These findings have implications for global

mental healthcare.

• More detailed knowledge of the impact of political violence v. other chronic social problems can lead to better-informed interventions in post-conflict settings with scarce resources.

• Mounting evidence suggests that the impact on mental health of war is not inevitable, but rather intimately related to the social, economic and cultural conditions that precede and follow violent conflict.

Abstract• Structured • Beginning of the article• Components are:

– Background– Aims – Methods – Results and Conclusions are included and – Keywords not mentioned

• Words: 265

Critique cont…Introduction: Concepts clearly stated, consistent with the title, related literature reviewed, most of the references used of last 5-10 years, some are older.

• Need of the study: Not Stated.

Critique cont…• Variables: Stated clearly

•Research design– Clearly stated– Target population is clearly defined– Systematic random sampling is used but

not explained properly.• Research instrument: valid and reliable

tools are usedData collection procedure– Clearly stated.

• Ethical considerations– clearly stated

• Statistical analysis– Level of significance determined (at 95%

CI)– Use of appropriate test but not mentioned

the type of chi-square in table 1.• Sample size

Research findings• All the important results are discussed according to

research questions.• Use of tables and graphs.• Table headings, table number, footnotes clearly

stated, but titles are written in sentence case.• The explanations in the text are consistent with the

tables.• The explanations are complicated.• Generalizability is questionable.

Discussion– Research findings compared with other

related studies

– Possible explanations for most of the findings stated.

Critiques cont…o Conclusion: Clearly statedo Implication for practice: Not mentionedo Limitations: Mentionedo Reference: Vancouver style

Vancouver style format maintained.

Critiques cont…• Presentation of research report

– Report is well written and documented

– Abstract adequately summarized.

– No use of jargons.

– No irrelevant details.

– But organization of report is complicated

Recommendations • Title could have been written well.

• Basis for sample size could have been mentioned.

• Report could have been well organized, so that readers can understand the evidence easily.

• Before using GEE model, variables which have significant correlation, could have been mentioned.

Recommendations cont…• It would have been better if the researcher

has given explanation regarding pre-conflict period of Jumla district as well as reason for selecting that area.

• Data collection could have been done during conflict period also.

• It would be better if they mentioned whether the persons who conducted field research were trained or not.

Any suggestions???

Thank You