The Sample Employed
This paper essays a review of data-collection methods and their associated reliability. In one, the team of researchers employs a compact meta-analysis of published literature to survey the evidence for best nursing practices concerning mechanically-ventilated patients in intensive care units (Couchmana, Wetzig, Coyerc, and Wheeler, 2007). In the second study, Meltzer, Steinmiller, Simms, Li, and Grossman (2009) set out to investigate whether and how pediatric patients and their parents who proved difficult versus placid in a complex medical care situation influenced the degree of “engagement” and attention provided by attending physicians and nurses.
Couchman et al. justify their reliance on literature review because the available literature is disparate, “fragmentary” and frequently fails to give due consideration to both patient safety and comfort. In general, medical researchers may employ literature review when doing exploratory research or embarking on mixed-methods programs of study.
Given the nature of this research approach and the assertion of Houser (2007) that reviews of the literature bolster claims about the importance of the topic, the “sample” in this case is the universe of studies published over a decade – between 1996 and 2006 – which seems both comprehensive and recent enough to have didactic value for day-to-day evidence-based nursing practice.
In the case of the Meltzer et al. (2009) study on complex pediatric medicine, the sample consisted of 68 physicians and 85 registered nurses at The Children’s Hospital of Philadelphia. The participants engaged in a case study method, reviewing and rating their involvement in eight made-up patient record vignettes.
Bias in Sample Selection
As Couchmana et al. (2007) describe their search strategy for professional journal articles, the first part of the research that focused on patient safety (Part II, published separately, dealing with patient comfort) embarked on a comprehensive search for “current literature” in the electronic databases MEDLINE, CINAHL, EMBASE, and Psych-Review. The search was filtered by these terms: mechanical ventilation, patient assessment, airway management, sedation, and comfort. Since little work had been done in the area of safety for mechanically-ventilated patients, no exclusions were set for the 12 years 1995 to 2006 and the team, therefore, gathered what was effectively a census of all available literature.
The Meltzer et al. (2009) sample amounted to a sampling rate of 7.5% and 4%, respectively, from what was in effect the universe of 899 attending physicians and 2,231 registered nurses at this large tertiary care institution. As empirical studies go, such a sampling rate is comparatively high, yielding as it does an ±8.0% standard error of estimate at the 95% confidence level and given common assumptions about the proportion to be tested and the margin of error.
On the manner of sampling selection, however, the study seems less a systematic random survey and a more convenient, self-selected sample. While Meltzer et al. took care to diversify recruits across the typical medical division and inpatient units such as Cardiology, Critical Care Medicine, Endocrinology, General Pediatrics, Hematology, Oncology, and Pulmonary Medicine, the manner of respondent selection within each “stratum” depended on volunteering in the course of a regularly scheduled department or research meeting. This affects external validity to the extent that not every attending physician or nurse at Children’s Hospital of Philadelphia had a chance to be selected systematically.
Limitations in Collecting and Managing Data
Calling even the seven dozen-odd sources finally included in the study “scant”, Couchmana et al. (2007) supplemented findings from the literature review with peer and expert review. This is to be expected when the state of knowledge in a primary care area is not much more than exploratory.
The limitations that apply to secondary research (which is what a review of literature entails) chiefly consist of accessibility. That is, the authors Couchmana et al. could have missed unpublished clinical trials and pilot-scale assessments. Given the incentives for publication and the comprehensive nature of contemporary online databases, the likelihood of having missed something has to be very low.
The rationale for Measurement Strategies and Devices
Strictly speaking, the rationale for embarking on a review of literature is intrinsic to exploratory or mixed-methods studies. In the case of Couchman et al., the team had aimed to consolidate the varying aspects of care for mechanically ventilated patients. Secondly, the authors did take care to synthesize their findings according to the patient safety/comfort dichotomy and with due consideration to three clinical survey stages. The “primary survey” involved an examination of airway, breathing, circulation, disability, and exposure. A “secondary survey” tasks nurses with assessment by system: neurological, respiratory, cardiovascular, gastrointestinal, metabolic, renal, and skin integrity. Thirdly, there are emergency equipment and safety checks. The consolidated literature review reiterates for nurses, often on 1:1 assignment ratios with critically ill patients, just how intensive clinical practice has to be.
In the complex pediatric medicine study, the researchers justify the use of short clinical vignettes principally on the basis that ‘‘complex care patients’’ are subject to multi-regimen care (and hence, inter-specialty teamwork), is hampered with behavioral or developmental issues, and present with psychiatric diagnoses as well. The clear need for psychosocial support must therefore be filled by those who come in contact with them daily, i.e. physicians and nurses. The core research question then becomes how both professional types respond to the most difficult of patients and their families.
The stimulus device ran to eight vignettes, each featuring a combination of patient and family being cooperative or not, concerning either treatment or the health care staff, and length of stay. Participants rated these in random sequence, to avoid order-of-presentation bias.
Face/internal validity was enhanced by pre-testing the stimulus vignettes in focus groups of 10 attending physicians and 10 experienced RN’s.
Validity and Reliability of the Measurement Strategy
Since the work by Couchmana et al. was meant to be a compendium for clinical practitioners and their superiors, validity, and reliability are not called to question beyond the competence of clinical practitioners to correctly synthesize what seems a thorough literature review.
The Mertzel et al. research employed case studies in the form of vignette/scenarios that described short- versus long-stay patients (30 days being the cut-off) and their parents who were either cooperative or difficult. On reviewing each one, participants rated themselves on a scale from highly engaged/responsive to distancing/disconnected behaviors vis-à-vis the patients and their families.
Given that the study participants were both physicians and nurses and that one analysis cross-break focused on the differences in mean ratings between them, the study design was a 2 X 2 X 2 matrix. This means that the independent variable of engaged/distancing rating was hypothesized as an outcome of both professional level and patient type.
Threats to Internal and External Validity
For didactic purposes, one must nevertheless address considerations of internal and external validity of the research reported. In the case of the literature review approach, internal validity can be taken for granted owing to the universal access to electronic journal databases and to the presumption of professional competence of clinical practitioners such as Couchmana et al. A researcher wanting to subsequently replicate the findings on mechanically-ventilated patients need only employ the very same keywords. Anybody else with comparable diligence, professional and clinical training ought to arrive at the same conclusions (Houser, 2007; Paradis, 2008).
On the other hand, the generalizability or external validity of the findings in the literature review rests on the diversity by locale and the clinical status of patients reported in the literature.
Owing to the haphazard distribution of the case study vignettes during departmental meetings at Children’s Hospital of Philadelphia, external validity for the Meltzer et al. study is flawed. That is, one lacks confidence that the study can even be generalized to the population of physicians and nurses with privileges at, or employed by the hospital. On the other hand, convenience sampling involving patients one has ready access to is a fact of life in medical research.
More important perhaps is the fact the measurement strategy is flawed for relying exclusively on self-ratings. Surely, internal validity would have been immeasurably enhanced by including engagement feedback from patients and their families.
References
Couchmana, B. A., Wetzig, S. M., Coyerc, F. M., Wheeler, M. K. (2007). Nursing care of the mechanically ventilated patient: What does the evidence say? Part I. Intensive and Critical Care Nursing, 2007 (23), 4-14.
Houser, J. (2007). Nursing research: Reading, using, and creating evidence. Boston: Jones and Bartlett Publishers.
Meltzer, L. J., Steinmiller, E., Simms, S., Li, Y. & Grossman, M. (2009). Staff engagement during complex pediatric medical care: The role of patient, family, and treatment variables. Patient Education and Counseling, 74, 77–83.
Paradis, C., MD (2008). Bias in surgical research: Internal and external validity. Annals of Surgery, 248 (2):180-188.
Thinking About Retirement: Perceptions Of Retirement
Life expectancy is nowadays considerably higher than it was in the previous century thanks to the development of healthcare and society as such. Today the part of the elderly population has grown due to a decrease in fertility rates in developed countries. In the U.S., almost 15% of the population is retired, which means they play a significant role in the economy and life of communities (Retirement is all on you, 2020). When it comes to the personal choice of whether or not to retire, multiple aspects must be considered, including how a lack of activity and communication influences one’s health. The perception of retirement varies, but it is vital to create a stimulating and inviting environment for the elders of a community.
To begin with, one choosing the future paths at the elder age must consider the fact that retirement may cause long-term effects on health. For instance, as Heller-Sahlgren (2017) claims in her study, in a couple of years after retirement, individuals are more likely to experience age-related mental health problems. Partially it may be related to the lack of challenging tasks that people usually face at work. Hence, it is vital to find new objectives and activities that not only entertain but also develop one’s skills and knowledge. Volunteer projects for retirees of different spheres from music to nature preservation can provide such an opportunity as well as new career paths. Hopefully, when I reach the age of retirement, I will be able to follow a literature career with all the experience I will have gained by then. If this is not enough, there is always an option of discovering the world.
Another point to be made is that communication also impacts the conditions of retirees. First, it seems evident that involvement in family life may enrich the day-to-day routine of the elderly. However, this scenario becomes controversial: retirees are afraid to be seen as a burden to their relatives while the latter do not always have resource opportunities to take care of them. Nevertheless, in my opinion, it is the most significant dimension of life at any time, including retirement. Moreover, many, especially represent of other cultures, share this understanding and the idea of giving back the help and support to their parents when they become older. Meanwhile, other opportunities can satisfy a retiree’s life like retirement communities or special tours and camps thanks to civil society.
Furthermore, as it might have already become apparent, I understand retirement as another period of life that the ones lucky to face, have to go through honorably. It surely has some limitations – for example, the health condition typically degrades – but it is crucial to appreciate the opportunities given by this period. While elders themselves appear to share this understanding, there is a stigma of ageism to fight in our society (Ruggiano et al., 2017). This kind of perception that is shared by 24 % of the world population destructively affects the health of the elderly (Officer et al., 2020). It seems that this tendency is only possible as people lack knowledge of how retirement can be lifeful and joyful.
To conclude, retirement provides individuals with new opportunities, but it surely is a matter of personal choice. Noteworthy, retirement may negatively affect one’s health, so they need to carry on challenging themselves with volunteer projects or new kinds of activity. Communication appears to be another vital aspect that enriches one’s life, especially in retirement. Personally, I am looking forward to becoming a famous author when I retire and spending all the time possible with my family. Despite the widespread ageism, I stick to the idea that old age is not depressing or boring but another exciting adventure I, hopefully, will be lucky enough to experience.
References
Heller-Sahlgren, G. (2017). Retirement blues. Journal of Health Economics, 54, 66 – 78.
Officer, A., Thiyagarajan, J., Schneiders, M., Nash, P. and Fuente-Nunez, V. (2020). Ageism, healthy life expectancy and population ageing: How are they related? International Journal of Environmental Research and Public Health, 17(9), 1 – 11.
Retirement is all on you. 41 best retirement statistics and facts for 2020. Web.
Ruggiano, N., O’Droscoll, J., Lukic A. and Schotthoefer L. (2017). Work is like therapy that prevents aging: Perceptions of retirement, productivity, and health among minorities and immigrants. SAGE Open, 7(1), 1 – 11.
Evidence In Health And Social Care
Currently evidence based approaches have gained prominence in the fields of health and social care. A major motivation for the increased use of these approaches in the aforementioned areas is their ability to assist professionals in these disciplines make better and faster decisions in their every day practice. The inception of evidence-based practices in medicine is linked to a general practitioner named Archie Cochrane who was concerned that more often medical intervention is not based on the most current evidence.These approaches seek to reduce the gap between research and practice by emphasizing on the use of practical methods that make medical interventions to be efficacious. Advances in science, engineering, increasing technological advancements and social change due to globalization is likely to reinforce the use of evidence based approaches in health and social care practices now and in the near future.
The definition of evidence is contested because it’s meaning vary across the fields of health to social care. In health, the term is generally used to refer to findings from formal scientific research like randomized clinical trials (RCTs), perspectives assembled through the process of consulting with service providers, users and people who act as care givers and knowledge gained through experience. The term evidence is also frequently used to refer to theoretical frameworks used in different practice settings of health. In social care it is used to mean the impacts of particular social services in peoples’ well being or welfare (Shemmings, D&Shemmings, Y, 2003, p.111).
Lewis (2002, p.166-168) explains that the meaning of evidence in social care differs from that used in medicine because the concept of evidence –based practice was first used in medicine and particularly in drug testing and in the development of similar interventions.Because of the nature of the model in the health sectors, it becomes difficult to set up Randomized Clinical trials in social services provision. She further notes that research in social care is mostly based on individual professional judgment which is often determined under complex circumstances.Therefore what can be regarded as evidence in social care research is subjective to the people’s views or interpretation of the research findings. Experiential knowledge gained through practice (practice wisdom) and experience influences greatly on how people interpret research findings.Factoring all these aspects, evidence in social care can be said to be a constitution of the research findings, practice wisdom and the experience of the person doing the interpretation of research findings.
According to Upshur, VanDenkerkhof and Goel (2001, para 1), evidence based health care approaches are mainly based on clinical epidemiology and internal medicine. They identify that evidence used in evidence based healthcare can be classified into four main types which are closely related. These classes of evidence include; Qualitative personal, Qualitative general, Quantitative General and Quantitative personal. The use of qualitative methods in clinical and biomedical research is relatively new compared to experimental and observational quantative methods that have been traditionally used in clinical and biomedical research. However qualitative methods have come to be widely accepted in medicine in the past ten years (Pope& Mays, 2006, p.3-4) Qualitative research in health care mainly seeks to establish the meanings people attach to social experiences. Findings are then integrated in various medical interventions. Personal qualitative evidence is derived through the use of qualitative methods to obtain information from specific individuals while general qualities evidence is got by using qualitative research methods to capture desired data or information from diverse groups of people.
Qualitative evidence has made it possible to assess and evaluate health services and emerging medical technologies.Qualitative evidence can be realized in a short time span because the process of planning and carrying out the research is actually shorter compared to quantitative researches which are often carried out in phases. The main weaknesses linked to the use of qualitative evidence are that processing of qualitative data is often cumbersome and difficult. Qualitative evidence is also limited to a small number of respondents because qualitative researches of ten involve small number of participants; some argue that qualitative evidence does not meet the statistically significant threshold like evidence derived from quantitative research(Pope &Mays, 2006, p.82)
Quantitative evidence is mainly obtained through quantitative studies and the major emphasis is on data that can be analyzed by using conventional statistical processes. The advantages of using quantitative evidence is that it is possible to investigate relationships between two or more variables through correlation research, establish causal relationships, their nature and significance through Quasi experimental studies and also establish causality of phenomena through experimental ,randomized controlled clinical studies( Grove,2005, p.25). Quantitative evidence takes little time to analyze and is easy to understand the processed data. It is possible to obtain quantitative evidence that is statistically significant and one that can meet a specific threshold because it is possible to include many people in quantitative studies.The main weaknesses of quantitative evidence is that most of the studies used to generate the evidence are carried out in phases and this takes time. The cost involved in undertaking quantitative research on a large scale is enormous. A good example is studies involved in the development and clinical trials of new drugs.
Various concerns regarding the use of evidence based practice in health and social are ingrained in the meaning of evidence in relation to social and health care settings. Conceptual problems revolve around questions whether evidence to inform practice can be trusted, whether evidence will always be applicable and whether evidence gathered from a large population can be generalized to individuals. Another conceptual concern is the objectivity of the data and practitioners and the question whether researchers are biased or not. A common conceptual argument has been that the processes of establishing outcome measures and evaluation are highly politicized and therefore not wholly credible (Shemmings, D&Shemmings, Y, 2003, p.115).
Similarly pragmatic concerns regarding how evidence should inform practice have been raised. One of them is the question whether the evidence will always be available, the availability a lot of evidence has raised concern that maybe the evidence is of poor quality.some people have argued that using pieces of information regarded as right while discarding those assumed to be wrong does not necessarily result in changes in practice. Some point out that good intervention can be disregarded simply because they produce enough evidence; this can be seen as a limitation to promoting creativity and innovation in practice. Finally, a pressing concern is whether evidence based practice would always take into consideration the other forms of knowledge acquisition (regarded more as ‘unconventional’) like practice wisdom, use of theoretical paradigms and feedback form users (Shemmings, D&Shemmings, Y, 2003, p.115).
Despite these challenges that make evidence based practice in health and social care seem like impossible, evidence based practice is associated with numerous benefits. Shemmings, D&Shemmings, Y, 2003, p.115) for example outline that evidence based practices have resulted in numerous benefits in social care provision. These benefits are; evidence based practice provides a simple means of evaluating research evidence; it has resulted in identification of research that directly addresses the concerns of service users and workers as well. Through acknowledgment that there different form of evidence and that some are better than others, managers and supervisors are able to integrate their professional judgment and experiences in decision making. The result of this integration made possible through evidence-based experience is enhanced decision making. In addition to the above, the approach has made decision making more explicit and open to questioning and examination. All these advantages have in turn been condensed into better social care services to all welfare users.
On the other hand, evidence based practice in health care has its own benefits. Taylor(2000, p.135)explains that evidence based practice in health care brings great benefits to the health professional, the department providing health services and to the patients as well. He continues to explain that through evidence based practice, health professionals are able to upgrade their knowledge in the area of practice. Professionals also become well versed in research methods and in practices. Evidence based practices also helps in building professional competence among health practitioners through improving their computer literacy and data management skills and encouraging practitioners to improve on their reading habits. Similarly, practitioners improve their management skills and become more confident in their practice. Departments offering health services gain through increased participation by employees in departmental activities that require team effort. Evidence based practice also creates frame works that help in group problem solving and enhances teaching and learning within the groups.
Evidence based practice in medicine has made it easier to address emerging clinical questions by enabling professional bodies involved in the management of health matters to make good decisions.it has for example provided a decision making frameworks that are being commonly used to facilitate the making of complex decisions by conflicting groups such as academic clinicians, primary care physicians, and other experts. These kinds of frameworks also enable professional bodies to develop more transparent working processes and establish guide lines and standards that bring about efficiency in how such bodies go about in accomplishing their responsibilities. Patients benefit through receiving communication and explanations about the rationale behind particular medical interventions, this helps them in making decisions whether to accept one particular intervention or not. Evidence based approaches also promote the proper use of resources and this is beneficial to patients as it ensures that services are available whenever needed and that they are also reliable.
Since evidence based practice demands that physician continuously monitor and evaluate their own practice and the intervention they offer to their patients, patients can benefit through this because the physician is able to promptly change or adjust a treatment strategy that is not working for the patient. Evidence based practice is here to stay and since it involves everyone involved in the provision of health and social services , positive developments should be anticipated in the standards of care provision.
Reference List
Grove, S.K.2005.The practice of nursing research: conduct, critique, and utilization.5th Ed. Missouri: Elsevier Health Sciences.
Lewis, J.2002.The contributions of research findings to practice Change. In: Reynolds, J. Ed 2002. The managing care reader. London: Routledge.Ch.20.
Pope, C&Mays, N.2006. Qualitative research in health care.3rd ed. Massachusetts Wiley-Blackwell.
Shemmings, D& Shemmings, Y. 2003.Supporting evidence based practice and research-mindedness. In: Seden, J&Reynolds, J, Ed.2003. Managing care in practice.London:Routledge.Ch.5.
Taylor, M.C.2000. Evidence-based practice for occupational therapists. Massachusetts: Wiley-Blackwell
Upshur, R.E.G, VanDenkerkhof, E.G &Goel, V.2001. Meaning and measurement: an inclusive model of evidence in health care. Journal of Evaluation in Clinical Practice. [E-Journal]. Volume 7, Number 2, pp. 91-96(6), Abstract only. Web.