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1. describe the different ways that health research is conducted and how research results are presented

2. search for and retrieve health information, and professional literature from online sources

3. explain the principles of appraising evidence to inform clinical practice

4. interpret basic quantitative and qualitative analyses in health research

5. discuss ethical considerations associated with research

Research as a critical component of many professions

Research is a critical component of many professions and areas of study. It provides evidence that can be used in various ways like developing and evaluating health policies to improve health outcomes (Moore, Todd, & Redman, 2009). Furthermore, Breckon and Dodson (2016) list six categories of mechanisms via which research evidence can be used. In a way, Hood (2003) portrays that the research evidence is usually closely linked to evidence-based practice in the nursing profession, a fact that makes it significant. In this regard, this paper intends to explore, interpret, and comprehend current research evidence highlighted in two peer-reviewed articles and explain how the sources’ findings can inform clinical nursing practice.   

Annotation Article 1

Title & Abstract

Is the title appropriate?

Yes. It pinpoints the critical concepts to be talked about or assessed in the paper. Some of those concepts include hydration, nutrition, and symptoms management at end-of-life, experiences of health professionals, carers, and patients, and so forth. Furthermore, it highlights the type of the research employed as investigations were being conducted.

Is there a structured abstract?

Yes. The abstract presented in the article is structured. It is structured in a manner that provides five sections. The sections include the background, methods, results, conclusions, and keywords. Each section outlines the main information, statistics, or data that are to be found in the subsequent body of the article.

The Study

Study Type

Qualitative study. Ospina (2004) explains that a qualitative study answers a wide assortment of inquiries identified with human reactions to real or potential wellbeing problems. The motivation behind this study type is to depict, investigate, and clarify the wellbeing related wonders being considered, which are health professionals’, carers’, and patients’ end-of-life experiences in this case (Baillie et al., 2018).

Study Design

A study design can be considered a function of the hypothesis under assessment and the data that is present at the period of evaluation (Williams & Nelson, 2001). This article’s qualitative study design is a supplementary examination investigating the encounters and inquiries of PeolcPSP survey respondents concerning nutrition, hydration, and symptoms (Baillie et al., 2018). The PeolcPSP information was coded by a group of qualitative specialists in a supplementary investigation. Analysis of the information was done utilizing Braun and Clarke's approach (Baillie et al., 2018).

Was this Primary or Secondary research?

This research was primary. Primary research usually involves the development of hypotheses or research questions and collecting info on people, objects, or events that are replicable, observable, and measurable using methods like surveys, interviews, observations, and so forth (Driscoll, 2011). Since this research collected data on people’s experiences using surveys (Baillie et al., 2018), it qualifies to be considered primary.

Study Objective or Aims

The study had one main aim, which was to report on a supplementary examination investigating the encounters and inquiries of PeolcPSP survey respondents concerning nutrition, hydration, and symptoms (Baillie et al., 2018).

The setting in which the study was conducted

Baillie et al. (2018) portray that the study was conducted in the UK.

Inclusion / Exclusion Criteria

The study had no inclusion or exclusion criteria. Everyone could participate in the study by taking an online survey that was available via a link, which was widely advertised (Survey Monkey).

How was the data collected?

Data was collected using an online survey that had only two questions. The completed online survey could then be downloaded as a PDF file by the researchers.

What data was collected?

The data collected was majorly the perceptions and experiences of health professionals, carers, and patients regarding care, support, and treatment of individuals that are approaching their end-of-life. The majority of the data was associated with nutrition, hydration, and symptoms management.

How was the data analysed?

The data was analysed thematically using two approaches, which include Clarke’s and Braun frameworks (Baillie et al., 2018).

What ethical considerations are associated with the research?

The research was associated with three significant ethical considerations. First, the participants had to consent to take part in the survey. Second, no one was allowed to access the participants’ responses apart from the research team. The responses, therefore, were stored on a secure server. Lastly, no personal information was required from the participants.

Findings/Results

Sample size – How many participants were included in the research?

A total of 1403 completed responses were obtained during the study (Baillie et al., 2018). This figure means that 1403 participants were included in the research.

Was the sample size justified?

No. When considering the fact that the research setting was the UK in its entirety, it can be concluded that the sample size was small.

Key Findings/ Results

The participants perceive there to be degree and requirement for symptom management improvement for people toward the end-of-life, especially, when considering themes like hydration, nutrition, terminal agitation, breathing difficulties, and pain.

Annotation Article 2

Title & Abstract

Is the title appropriate?

Yes. It mentions the vital concepts to be discussed or evaluated in the paper. Some of those concepts include improving comfort, dying, and elderly individuals. Moreover, it underscores the type of the research employed as investigations were being conducted as a cluster randomised controlled trial.

Is there a structured abstract?

Yes. The abstract presented in the article is structured. It is structured in a manner that provides five sections. The sections include the background, methods, findings, interpretation, and funding. Each section outlines the main information, statistics, or data that are to be found in the subsequent body of the article.

The Study

Study Type

A cluster randomized controlled trial. This study type is characterized by randomization at the group level (Mazor et al., 2007). Since groups of hospitals were randomly selected to take part in the research, the study type qualifies to be considered a cluster randomized controlled trial.

Study Design

A study design alludes to the overall plan for associating the conceptual research issues with the achievable and pertinent empirical investigation (Mafuwane, 2011; van Wyk, 2012). This article’s study design included randomly selecting hospitals and assigning those particular healthcare facilities to the implementation of a care programme referred to as CAREFuL while other hospitals were required to implement the standard care framework. Assessments were done using CAD-FOLD and SM-FOLD systems to evaluate comfort around dying and symptoms management respectively.

Was this Primary or Secondary research?

This research was primary. As was explained earlier, primary research usually involves the development of hypotheses or research questions and collecting info on people, objects, or events that are replicable, observable, and measurable using methods like surveys, interviews, observations, and so forth (Driscoll, 2011). Since this research collected data on hospital’s ability to improve comfort around dying and manage symptoms using assessment frameworks already mentioned above as well as nursing and medical records and questionnaires (Beernaert et al., 2017), it qualifies to be considered primary.

Study Objective or Aims

The study had one main aim, which was to evaluate the effectiveness of a specific programme referred to as CAREFuL at enhancing care quality and comfort in the dying phase of elderly individuals (Beernaert et al., 2017).

The setting in which the study was conducted

Beernaert et al. (2017) portray that the study was conducted in Flemish Region, Belgium.

Inclusion / Exclusion Criteria

This study has an inclusion criterion. For hospitals to be part of the investigation, they had to possess at least one acute geriatric ward (Beernaert et al., 2017). Furthermore, the ward’s nursing or medical head had to consent for inclusion of the required wards. Beernaert et al. (2017) highlight that for patients to be part of the investigation; they had to provide consent for their personal information to be used in the study.

How was the data collected?

The data was collected using two significant methodologies, which include questionnaires and nursing and medical records.

What data was collected?

The data collected was majorly the comfort of elderly individuals around dying and the management of symptoms that these people manifest during the same dying phase of their lives.

How was the data analysed?

The analyses were by the expectation to treat. All outcomes in the primary content were analysed without a method for missing information, aside from where generally expressed. All data were additionally analysed with a strategy for missing information. SPSS version 22.0 was used for all analyses (Beernaert et al., 2017).

What ethical considerations are associated with the research?

The research was associated with various significant ethical considerations. First, the patients had to consent to take part in the survey and their personal data were taken. Second, the hospitals had to consent to be part of the study and their wars used for the same purpose. Lastly, approval had to be sought from relevant authorities like the hospital’s local ethics committees to enable undertaking of the investigation.

Findings/Results

Sample size – How many participants were included in the research?

A total of 4241 beds in ten hospitals were included in the research. This figure means that a total of 4241 patients took part in the study.

Was the sample size justified?

Yes. When considering the fact that the research setting was only the Flemish Region in Belgium, it can be concluded that the sample size was sufficient.

Key Findings/ Results

CAREFuL implementation might improve the care quality and comfort of elderly patients who are in the dying phase of their lives in acute geriatric hospital wards.

The first article by Baillie et al. (2018) aimed at reporting on a supplementary examination investigating the encounters and inquiries of PeolcPSP survey respondents concerning nutrition, hydration, and symptoms. The article found out that the participants perceive there to be degree and requirement for symptom management improvement for people toward the end-of-life, especially, when considering themes like hydration, nutrition, terminal agitation, breathing difficulties, and pain (Baillie et al., 2018). This finding seems to claim that symptom management improvement toward the end-of-life can lead to comfort as an elderly person is in his or her last phase of life. Reynolds, Drew, and Dunwoody (2013) agree with the sentiments in this first article in their study. They claim that pain is usually prevalent at the end-of-life stage of various individuals (Reynolds et al., 2013). Even so, the authors go ahead to state that effective management of symptoms and pain at this same stage of life can improve life quality, an occurrence that might prolong life instead of accelerating death (Reynolds et al., 2013). In this investigation, Reynolds et al. (2013) focused on one theme identified by Baillie et al. (2018), which is pain.

Similarly, when talking about palliative care role at life end, Rome, Luminais, Bourgeois, and Blais (2011) highlight that palliative care aims to soothe the torment of patients and their families by the far-reaching evaluation and treatment of physical, psychosocial, and profound indications experienced by those particular individuals. This sentiment also supports the need for symptom management at end-of-life because that move can assist in improving comfort and quality of care. The finding from the article of interest, which is supported by the other sources cited, can inform clinical nursing practice in various ways. First, it can provide additional clinical or nursing information and knowledge concerning the care that should be offered to elderly people who are at their end-of-life stage. Clinical or nursing knowledge and information stand out as the wheels that steer development and improvement in the nursing profession. They can aid nurses in making informed decisions concerning the care to offer to people in their clinical practice. Such decisions always have significant implications for the outcomes of patients (Thompson, Cullum, McCaughan, Sheldon, & Raynor, 2004). Second, the finding of the article can inform the clinical practice regarding specific symptoms or conditions of concern to many, which always manifest at the end-of-life stage. The article mentions some of them to be hydration, nutrition, agitation, breathlessness, and pain (Baillie et al., 2018). These themes or symptoms can provide the platform for the identification; determination, establishment, and implementation of measures that can assist in managing them to ensure end-of-life experience and care of elderly individuals are of high quality and comfort. For example, they can enable establishment of guidelines or principles that govern pharmacological management of terminal symptoms in clinical practice (Care & Toolkit, 2015).

Peer-reviewed Article 1: End-of-life Care

Regardless of these facts, the article underscores specific strengths and limitations of the study. When starting with the strengths, two of them can be identified. First, the methodology used to collect data was outstanding. The study used an online survey that could be accessed by anyone to collect data. This technique is one of the article’s strengths because it provided an avenue for massive data to be collected. Furthermore, it enabled the researcher to possess the most flexibility and control (Luo, 2009). Second, the tactics used in the analysis of data are other strengths. The analysis was done thematically using two approaches, which include Clarke’s and Braun frameworks (Baillie et al., 2018). The approaches enable outstanding analysis of collected data. Nevertheless, the study also had limitations. For instance, the researchers were unable to elicit further in-depth data from the respondents because they were not present or contolling the process of response-giving. Furthermore, they could not clarify the reports from respondents as well because of the same reason. This information presents only some of the strengths and limitations of the study among many that exist.

The main aim of the second article of interest in this paper is to evaluate the effectiveness of a specific programme referred to as CAREFuL at enhancing care quality and comfort in the dying phase of elderly individuals (Beernaert et al., 2017). The finding of the article was that CAREFuL implementation might improve the care quality and comfort of elderly patients who are in the dying phase of their lives in acute geriatric hospital wards (Beernaert et al., 2017). This finding is in line and supported by various studies conducted by diverse scholars and researchers. For instance, Verhofstede et al. (2016), when considering cute geriatric hospital wards, also conducted a study to determine the effects of the last days of life care programme implementation. The authors found out that such an implementation improve the end-of-life care quality (Verhofstede et al., 2016).

In the same note, Verhofstede et al. (2015) portrayed in their article that end-of-life care programmes are tools that should be developed to improve care for the elderly individuals during the last phase of their lives. This sentiment also supports the argument that care programmes are a necessity for the improvement of care quality and comfort of the elderly people at the end-of-life stage. Such programmes can always provide a guideline for the outstanding care that incorporates aspects like symptoms management (Ellershaw & Ward, 2003). In this regard, this information seems to prove that care programmes should always be integrated with the care of the elderly individuals at the end-of-life stage because they improve the quality and comfort of care. It, therefore, can inform clinical practice in a distinct way. It can ensure that the development and implementation of care programmes for the elderly at the end-of-life stage become a critical component of clinical practice. Richards (2008) highlight that such a component should include all conditions and cover all care settings to improve care quality towards life end. In this regard, it can ensure clinical practice incorporates all terminal conditions in the end-of-life care plan.

Peer-reviewed Article 2: Elderly Care Quality Improvement

Even with these desirable facts about the info in the article of interest, the study highlighted some of its strengths and limitations. Even though not explicitly underscored, some of the strengths can be implied. For example, when considering the fact that the research setting was only the Flemish Region in Belgium, it can be concluded that the sample size was sufficient to be used in the study. It involved 4241 participants, a number that proves that the data collected can be generalized to a large population (Beernaert et al., 2017). Similarly, the study managed to include a control sample during the investigation. This move enables comparisons to be performed and better results to be identified and determined. As for the limitations, only a small percentage of around 34-36 of patients provided consent for their personal data to be used (Beernaert et al., 2017). This small percentage prevented acquisition of critical info. Time was also another limitation. It was insufficient; hence, not all patients were approached, a fact that means so data might not have been collected.

Conclusion

Understanding research evidence is a critical component of any scholarly or professional undertaking. This paper has selected two articles and discussed their various aspects in an attempt to understand the evidence they offer. It shows that a procedural framework is significant in an attempt to understand the evidence in articles. 

References

Baillie, J., Anagnostou, D., Sivell, S., Van Godwin, J., Byrne, A., & Nelson, A. (2018). Symptom management, nutrition and hydration at end-of-life: a qualitative exploration of patients’, carers’ and health professionals’ experiences and further research questions. BMC Palliative Care, 17(1), 60. DOI: https://doi.org/10.1186/s12904-018-0314-4.

Beernaert, K., Smets, T., Cohen, J., Verhofstede, R., Costantini, M., Eecloo, K., ... & Deliens, L. (2017). Improving comfort around dying in elderly people: a cluster randomised controlled trial. The Lancet, 390(10090), 125-134. DOI: https://doi.org/10.1016/S0140-6736(17)31265-5.

Breckon, J., & Dodson, J. (2016). Using Evidence. London: Alliance for Useful Evidence. Retrieved 21st August 2018, from, https://www.alliance4usefulevidence.org/assets/Alliance-Policy-Using-evidence-v4.pdf.

Care, R. A., & Toolkit, P. A. (2015). Guide to the Pharmacological Management of End of Life (Terminal) Symptoms in Residential Aged Care Residents. State of Queensland. Retrieved 2nd September 2018, from, https://www.caresearch.com.au/caresearch/Portals/0/PA-Tookit/Guide_to_the_Pharmacological_Management_of_EoL%28Terminal%29Symptoms_in_RAC_Residents_A_Resource_for_GPs.pdf.

Driscoll, D. L. (2011). Introduction to primary research: Observations, surveys, and interviews. Writing spaces: Readings on writing, 2, 153-174. Retrieved 22nd August 2018, from, https://wac.colostate.edu/books/writingspaces2/driscoll--introduction-to-primary-research.pdf.

Ellershaw, J., & Ward, C. (2003). Care of the dying patient: the last hours or days of life. BMJ: British Medical Journal, 326(7379), 30-34.  Retrieved 24th August 2018, from, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1124925/pdf/30.pdf.

Hood, P. D. (2003). Scientific research and evidence-based practice. San Francisco: WestEd. Retrieved 21st August 2018, from, https://www.wested.org/online_pubs/scientrific.research.pdf.

Luo, Y. (2009). Using internet data collection in marketing research. International Business Research, 2(1), 196-202. Retrieved 2nd September 2018, from, https://pdfs.semanticscholar.org/f4cd/99e22d4661b632604bf56293964dc0a05ea4.pdf.

Mafuwane, B. M. (2011). The contribution of instructional leadership to learner performance. Doctoral dissertation, University of Pretoria. Retrieved 22nd August 2018, from, https://repository.up.ac.za/bitstream/handle/2263/24016/04chapter4.pdf?sequence=5.

Mazor, K. M., Sabin, J. E., Boudreau, D., Goodman, M. J., Gurwitz, J. H., Herrinton, L. J., ... & Platt, R. (2007). Cluster randomized trials: opportunities and barriers identified by leaders of eight health plans. Medical Care, S29-S37. Retrieved 22nd August 2018, from, https://pdfs.semanticscholar.org/48af/e16efd495c3d02b0cae496b71c69f92a342a.pdf.

Moore, G., Todd, A., & Redman, S. (2009). Strategies to increase the use of evidence from research in population health policy and programs: a rapid review. NSW Health. Retrieved 21st August 2018, from, https://www.health.nsw.gov.au/research/Documents/10-strategies-to-increase-research-use.pdf.

Ospina, S. (2004). Article qualitative research. Encyclopedia of Leadership. Retrieved 22nd August 2018, from, https://s3.amazonaws.com/academia.edu.documents/31483207/Qualitative_Research.pdf?AWSAccessKeyId=AKIAIWOWYYGZ2Y53UL3A&Expires=1534919241&Signature=Mac%2F2eIHADfxrnRnAR2p%2FVILEyI%3D&response-content-disposition=inline%3B%20filename%3DA_R_T_I_C_L_E_Qualitative_ResearchLincol.pdf.

Reynolds, J., Drew, D., & Dunwoody, C. (2013). American Society for Pain Management Nursing Position Statement: Pain management at the end of life. Pain Management Nursing, 14(3), 172-175. DOI: https://dx.doi.org/10.1016/ j.pmn.2013.07.002.

Richards, M. (2008). The end of life care strategy. Department of Health, London. Retrieved 2nd September 2018, from, https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/136445/EOLC_strategy_presentation.pdf.

Rome, R. B., Luminais, H. H., Bourgeois, D. A., & Blais, C. M. (2011). The role of palliative care at the end of life. The Ochsner Journal, 11(4), 348-352. Retrieved 23rd August 2018, from, https://www.ochsnerjournal.org/doi/pdf/10.1043/1524-5012-11.4.348?code=occl-site.

Thompson, C., Cullum, N., McCaughan, D., Sheldon, T., & Raynor, P. (2004). Nurses, information use, and clinical decision making—the real world potential for evidence-based decisions in nursing. Evidence-Based Nursing, 7(3), 68-72. Retrieved 2nd September 2018, from, https://ebn.bmj.com/content/ebnurs/7/3/68.full.pdf.

van Wyk, B. (2012). Research design and methods Part I. University of Western Cape. Retrieved 22nd August 2018, from, file:///C:/Users/Hov/Downloads/Research_and_Design_I.pdf.

Verhofstede, R., Smets, T., Cohen, J., Costantini, M., Van Den Noortgate, N., Van Der Heide, A., & Deliens, L. (2015). Development of the care programme for the last days of life for older patients in acute geriatric hospital wards: a phase 0–1 study according to the Medical Research Council Framework. BMC Palliative Care, 14(1), 24. DOI: 10.1186/s12904-015-0025-z.

Verhofstede, R., Smets, T., Cohen, J., Costantini, M., Van Den Noortgate, N., & Deliens, L. (2016). Implementing the care programme for the last days of life in an acute geriatric hospital ward: a phase 2 mixed method study. BMC Palliative Care, 15(1), 27. DOI: 10.1186/s12904-016-0102-y.

Williams, C. F. M., & Nelson, K. E. (2001). Study design. Infectious Disease Epidemiology: Theory and Practice, 51. Retrieved 22nd August 2018, from, https://www.jblearning.com/samples/0763728799/28799_CH03_061_116.pdf.

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