1. Describe the relevance of the nursing research problem addressed in a SRR to practice. USE PROVIDED PAPER ATTACHED FOR THIS PAPER
2. Critique the levels of evidence of the studies used in the SRR, specifically the designs of the studies included. (CO 6)
3. Critique the clarity with which the studies are presented and critiqued. (CO 6)
4. Describe the overall findings of the studies, as summarized in the SRR. (CO 3, 6)
5. Critique the conclusions of the SRR, with implications for your current practice and future research. (CO 3, 6)
7. Paper length should be between 4-6 pages.
PREPARING THE PAPER
Consult your faculty member if you are uncertain about whether your article is a true SRR. If it is not, your grade will be affected because you will not be able to address all of the above objectives.
Critiquing a Systematic Research Review
The purpose of systematic research reviews (SRRs) is to ensure that clinical practice is based on reliable information (Gopalakrishnan, & Ganeshkumar, 2013, Pg. 9). They do so by summarizing multiple studies and integrating their findings in a comprehensive and a non-biased manner so that they can generate accurate accounts of previous studies. The conclusions made in systematic reviews often drive clinical practice, and therefore, it would be necessary to subject the reviews to critique to ensure that the performance of practices in clinical care is at its best (Uman, 2011, Pg. 57). Weller, Buchbinder, and Johnstone developed an SRR concerning interventions that would promote adherence to compression treatment among venous leg ulceration (VLU) patients (Weller, Buchbinder, & Johnstone, 2013). This paper appraises their research.
The Relevance of the Nursing Problem in the Review
The researchers indicated their research problem clearly and focused it on the improvement of patient outcomes. They narrowed their review to VLU, a condition whose treatment attracts the attention of nurses to an appreciable extent. The condition present with lesions on the skin surface between the ankle and knee joints. The lesions account for approximately 70% of leg ulcers reported in patients (Vasudevan, 2014). The condition impairs mobility in patients hence lowering their quality of life. The systematic review offers interventions that would promote treatment adherence and hence improve patient recovery and restoration of high-standard lives. The researchers noted that compressions were among the most reliable treatment strategies for the condition (Weller, Buchbinder, & Johnstone, 2013, Pg. 6). They gave a broad range of interventions that would promote patient adherence to compressions. The interventions ranged from educational, medical, nursing, as well as multidisciplinary types (Weller, Buchbinder, & Johnstone, 2013, Pg. 7). The researchers further indicated measurable outcomes that they were expecting from the application of their proposals. The ultimate goal of the intervention was to encourage people to adhere to compressions and promote healing while reducing the recurrence of the condition (Weller, Buchbinder, & Johnstone, 2013, Pg. 7). Nursing has the primary goal of achieving the best for the patient, and the SRR of interest was relevant in the pursuit of the objective.
Level of Evidence and the Design of Applied Sources
Use of electronic methods was the primary approach to obtaining studies to include in the review. The inclusion and exclusion criteria for articles were reasonable, and the researcher gave a clear diagrammatic representation of the process. However, the quality of evidence in the generated sources was mostly low as the researchers indicated. The first outcome in the researchers’ outline was the number of persons healed, and the quality score for the evidence that addressed it was low (Weller, Buchbinder, & Johnstone, 2013, Pg. 4). Recurrence of ulcers was the second outcome in the outline, and the researchers did not grade the evidence that addressed it since it was not measured. Other outcomes that were not measured were time of healing, adherence to compression therapy, and adverse events, and researchers could not grade the evidence concerning them (Weller, Buchbinder, & Johnstone, 2013, Pg. 4). Nevertheless, the researchers were able to grade evidence regarding quality of life and pain, and they described it as low for both outcomes (Weller, Buchbinder, & Johnstone, 2013, Pg. 4-5).
Clarity of the Presentation and Description of Studies
The review included an in-depth description of the studies to which it referred. Crucial concepts described included the methods that investigators used when performing the studies (Weller, Buchbinder, & Johnstone, 2013, Pg. 24). Other aspects described included the properties of the studied populations, investigated interventions, as well as the realized outcomes. The researchers gave the descriptions of both the included and excluded sources. Some of the excluded sources had no interventions purposed to improving patient compliance with treatment procedures including compressions (Weller, Buchbinder, & Johnstone, 2013, Pg. 29). Others were non-RCT while others did not address VLU patients as such. The exclusions ensured that the review was based on the most relevant and appropriate data rather than general information. Also, excluding such studies minimized the possibility of researcher manipulating the results by making deductions in studies that did not necessarily address the proposed intervention.
The researchers also described and critiqued studies that met the inclusion criteria. Among the aspects that the researchers described was the risk of bias (Weller, Buchbinder, & Johnstone, 2013, Pg. 28). The researchers indicated authors’ classifications of the risks that their studies bore. The studies had elevated risks to certain biases while they only had minimal of the same to others. To further facilitate the description of their sources, the researchers quoted authors so as to affirm the assertions that they gave.
The research indicated that various forms of interventions realize varied degrees of success in promoting compressions treatments and improving the outcome of care in VLU patients. Though the levels of evidence varied when linking interventions to success, researchers could establish and compare the effectiveness of different interventions. Emphasis on socialism and peer support was found to have almost the same degree of impact on improving treatment adherence when compared to visiting patients in their homes (Weller, Buchbinder, & Johnstone, 2013, Pg. 19). However, the two sets of interventions varied significantly in pain reduction. The trial that produced the evidence did not offer a comprehensive indication for certain crucial outcomes such as time of healing, reoccurrence, adherence to therapy, and occurrence of adverse events.
Attendance at outpatient wound clinics also had the same impact as the combination of nursing counseling, behavioral change, and engagement in exercises in some of the outcomes. Such outcomes included the rate of healing, adherence to compressions therapy, and recurrence (Weller, Buchbinder, & Johnstone, 2013, Pg. 19). Again, the trial indicating the relationship did not report on adverse events, healing time, pain, and the impact of the interventions on life quality (Weller, Buchbinder, & Johnstone, 2013, Pg. 19). The review did not offer reports on such as educational and healthcare interventions yet they probably had significant influence on improving adherence to compressions therapy.
Conclusions and their Implication to the Current as well as Future Nursing Practice
The researchers had a limited number of studies meeting their inclusion criteria. Again, the studies had their quality compromised to a significant extent, and as a result, the researchers could only derive a few conclusions. Events that compromised the quality of the studies include a high possibility for bias, inadequate reporting, and use of a small sample size (Weller, Buchbinder, & Johnstone, 2013, Pg. 20). Again, no studies reported on interventions that improved adherence to compression therapy. As such, the review had little impact on current nursing practice as it could neither recommend nor discourage nurse-led care in place of the standard type.
The researchers concluded that further research was necessary so as to determine the effectiveness of multifaceted interventions in improving patient adherence to compression adherence. Future studies would also be necessary for the innovation of treatment approaches that would encourage adherence to compression therapy and cause significant improvements in patient outcomes. Such studies should also report on outcomes such as recurrence, healing, adverse events, and reasons for non-adherence to the intervention (Weller, Buchbinder, & Johnstone, 2013, Pg. 20).
ReferencesGopalakrishnan, S., & Ganeshkumar, P. (2013). Systematic Reviews and Meta-analysis: Understanding the Best Evidence in Primary Healthcare. Journal of Family Medicine and Primary Care, 2(1), 9–14.
Uman, L. S. (2011). Systematic Reviews and Meta-Analyses. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 20(1), 57–59.
Vasudevan, B. (2014). Venous leg ulcers: Pathophysiology and Classification. Indian Dermatology Online Journal, 5(3), 366–370.
Weller, C. D., Buchbinder, R., & Johnstone, R. V. (2013). Interventions for helping people adhere to compression treatments for venous leg ulceration (Review). The Cochrane Library, 2013(9), 1-40.