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Research Critique

Presenters:
Bishnu Mainali
Puspalata Ghimire
M.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.
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 used
Data 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 stated
o Implication for practice: Not mentioned
o Limitations: Mentioned

o 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.