Family presence during invasive procedures and resuscitation
Study problem
What problem was the study conducted to resolve?
A research problem identifies an area of concern when a gap exists in the knowledge needed for nursing practice (Burns & Grove, 2003, p 55).
Family presence (FP) during invasive procedures (IPs) and cardiopulmonary resuscitation (CPR) is considered a right, obligation, and natural event by some organizations, notably nursing (Blair, 2004).
According to a survey cosponsored by the American Association of Critical-Care Nurses (AACN) and the Emergency Nurses Association (ENA) only 5% of U.S. hospitals have written policies on FP during IPs and CPR (Aug 2003).
The problem that prompted this study was the need to determine if the presence of family was comforting to the client, distressing to the family members observing the procedure or resuscitation, or uncomfortable for the caregivers and would implementing family presence programs be justifiable (Myers et al., 2000).
The article clearly identified the problem that prompted the research.[Good]
Why is the problem an important one for nursing to study?
Nurses have the opportunity to preserve the wholeness, dignity, and integrity of the family unit from birth to death (Myers et al., 2000).
The benefits identified through research will guide nursing education and assist nurses with supporting FP during IPs and CPR. Through FP nurses are given the opportunity to educate families regarding clients’ conditions and the increased knowledge provide to families can help to lower the risk of potential lawsuits.
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Study Purpose
What is the purpose of the study?
The research purpose, derived from the research problem, identifies the goal or aim of the study (Burns & Grove, 2003, p 55).
The purpose of this study is the need to determine if the presence of family was comforting to the client, distressing to the family members observing the IP or CPR, or uncomfortable for the caregivers, and would implementing family presence programs be justifiable (Myers et al., 2000).
The authors identified the purpose of the study in an overview at the beginning of the article.[Good]
Research questions
What is the main research question?
Research questions are concise, probing statements that include one or more variables or concepts (Burns & Grove, 2003, p 87).
Research questions direct the flow of the study. There was one research question identified in this article. The question presented was, “Is the presence of family comforting to the patient, distressing to the family members observing procedures, or uncomfortable for the caregivers and would the benefits of FP justify implementing family presence programs” (Myers et al., 2000)? The benefits of FP are the concepts or variables explored in this question. The article indicated that clients’ families found the visitation was helpful to them and no psychological effects were suffered. The staff, 96% of nurses and 79% of attending physicians supported FP during IPs and CPR. The article posed the main research question in the overview and was easy to identify. .[Good]
Hypothesis
What is the study hypothesis?
A hypothesis is a formal statement used to predict the outcome of the study. The research findings will either support or reject the hypothesis (Burns & Grove, 2003, p 89).
The hypothesis was not stated in this study. This writer thinks an appropriate hypothesis would be, “Implementing family presence programs would be beneficial because family presence during IPs and CPR is comforting to the client, not distressful to family members, and is supported by the caregivers.” The components of a clear hypothesis include the study variables, the population indicated, and a proposed outcome for the study. This study identified the study variables and the population indicated, but did not clearly indicate the expected outcome of the study. With this hypothesis, the goal of the study would be to prove the above statement either true or false.
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The type of proposed hypothesis listed above is a causal hypothesis. Causal hypothesis suggest a cause-and-effect relationship between the variables in a study (Burns & Grove, 2003, p 91).
The suggestion is that the lack of education and training in the techniques of family presence by health care providers causes a difference in perception of possible benefits of FP during IPs and CPR. [Excellent]
Study variables
What are the independent and dependent study variables?
Variables are characteristics of the persons or objects in a study that may change or vary (Burns & Grove, 2003, p 104).
Burns and Grove identify two types of variables as independent and dependent. An independent variable is a treatment or stimulus manipulated by the researcher to cause a change or effect on the dependent variable. A dependent variable is the outcome or response the researcher is looking for. The independent variables in this study were investigator-developed family surveys (FS), health care provider surveys (HCPS), educating staff about the benefits of FP, and the availability of a family facilitator for. The dependent variable or outcome in this study was that the benefits of FP justify implementing family presence programs. By influencing the experiences of health care providers and families by addressing their concerns, the researchers would cause an effect on the dependent variable. The expected effect would be that implementation of family presence programs would be justified.
Conceptual model/Theoretical framework
In what way was this study guided by a conceptual model or theoretical framework?
A theoretical framework is a group of related concepts or theories (Blass, Hayes, Kozier, & Erb, 2002).
Nursing theories provide a systematic approach to nursing care. Guidelines developed by the Emergency Nurses Association’s (ENA) “Presenting the Option for Family Presence” guided this study, which focused on justification of implementing a family presence program. According to the ENA’s guidelines, the need for family support and facilitation of the grieving process is the motivation for FP protocol. This study uses the ENA guidelines to explain the need for facilitating the FP in order to fulfill the holistic framework of preserving the wholeness and integrity of the family unit. The study clearly identified the conceptual framework used to guide the research. .[Good]
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Review of related literature
In what ways does the literature review support the need for this study?
The review of literature section provides a background for the problem. The literature review identifies the current knowledge of practice problem and the gaps in that knowledge (Burns & Grove, 2003, p 112).
Sources listed in the literature review are either theoretical or empirical literature (Burns & Grove, p 110).
Theoretical literature reviews contain models, theories, concept analysis or conceptual frameworks that relates to the problem. An empirical literature review contains published or unpublished studies on the subject (Burns & Grove, p 111).
The literature review in this article contained empirical literature information. Three separate studies identified concepts that affected the need for implementing family presence programs. The literature review indicated that a need existed between health care workers and families in order to develop FP guidelines in implementing family presence programs (Myers et al., 2000).
The studies in the literature review section were relevant to the current study, and supported the need for the study. .[Good analysis. Might also mention the currency of the literature, recent 5yrs, etc]]
Study design
What study design is used?
This article used the correlational study design. A correlational study design examines the relationship between the variables in the study. Three types of correlational designs are descriptive, predictive, or model testing (Burns & Grove, 2003, pp 208-211).
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Descriptive designs describe the variables and examine their relationship. Predictive designs attempt to predict the value of one variable-based on the properties of another variable. The purpose is to examine causal relationship. Model testing requires large samples to evaluate accuracy of a model to determine whether the data collected is consistent with the model. The study design used in this article was the descriptive correlational design (Myers et al., 2000).
The researchers attempted to describe variables and examine relationships among these variables. This was an appropriate design to use because the aim of the study was to facilitate the identification of the many interrelationships in the situation.
Name and describe at least two threats to the internal validity of the study design.
Internal validity is the measure of the accurateness of a study considering the effects of unrelated variables. A threat to the validity of a study design would cause a false positive or false negative outcome (Burns & Grove, 2003, p 199).
One threat to the internal validity of this study design is failure of the participants to answer the questions on the survey truthfully. Another threat to the internal validity of the study is that those opposed to FP did not agree to family visitation and could not be surveyed
Name and describe at least two threats to the external validity of the study design.
External validity relates to the extent the result of the study generalizes the results beyond the sample used (Burns & Grove, 2003, p 200).
One threat to the external validity of the study was the study population. Employees and families from only one emergency department, of a university affiliated, regional, level-1 trauma center in the Southwest participated in the study. This excluded employees and families from other types of hospital settings. Another threat to the external validity of the study was the exclusion of women who did not speak English. Exclusion of these women from the study could skew the results. [Good points]
Sample and setting
In what way is the sample large enough?
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Sampling is the technique used to identify eligible participants for a study (Burns & Grove, 2003, p 31).
Quantitative research includes random or probability and non-random or non-probability sampling. The type of sampling plan used affects the validity of the research. This study used a nonrandomized sample of 39 family members and 96 health care providers. This sample was large enough to get an accurate picture of the attitudes and experiences of those interviewed.
In what way is the sample representative of the population?
The sample was not a fair representation of the population within the hospital because they only used nurses, doctors and family members in the emergency department. They did not use nurses or doctors from other units; participants had to be 18 years or older; and speak English.
In what way is the setting in which data were collected an appropriate one for this study?
The settings used for quantitative research are natural, partially controlled, or highly controlled. Natural settings are settings where the researcher does not manipulate the environment. The researcher makes some modifications in a partially controlled setting, and highly controlled settings are set up for the purpose of research (Myers et al., 2000, p 32).
The setting used in the study was a natural setting, not manipulated by the researcher. This was appropriate for the type of data collected. .[Good]
Identification and control of extraneous variables
What are the extraneous variables in this study?
Extraneous variables are variables that may have a negative effect on the outcome of the study (Burns & Grove, 2003, p 98).
Researchers try to identify and control or exclude these variables from the study. The extraneous variables in this study were nurses or doctors from other units, participants under age 18, and participants who could not speak English. The researchers identified and eliminated this population from the sample used for research. In order to control the influence of the extraneous variables, the researchers identified the criteria of the participants in the study, and used the nonrandomized sample method to eliminate those who did not meet the criteria.
Study Instruments
In what way is the support provided for the validity and reliability of the study instruments adequate for their use in this study?
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Validity refers to the accuracy of a claim made during a research study (Burns & Grove, 2003, p 274).
The researchers used a 4-point Likert scale to measure respondents’ agreement with statements about the problems and benefits of FP. Five nurse experts and two physician experts rated the individual relevance of each item and the overall relevance of the surveys to establish content validity of the instruments. Surveys were revised by three research team members prior to the start of the study. If the content experts did not have 70% agreement on the relevance of the item the item was deleted.
Reliability refers to the consistency of the results obtained (Burns & Grove, 2003, p 45).
The method used to test the reliability of the research was calculated by Cronbach’s alpha. This method revealed overall consistency indexes of 0.92 and 0.91 indicating high internal consistency. [Excellent]
Data collection methods
In what way was the data collection procedure appropriate for this study?
This study was looking for positive responses to FP that used a natural setting. Willing participants recruited from the sample population submit the information needed for the research. Within 72 hours of the FP event, healthcare providers were given the survey to complete and return. Approximately two months after the FP event, a trained investigator conducted follow-up audio taped interviews with families’ members using the survey.
In what way were appropriate steps taken to protect the right of the subjects?
The article did not indicate the steps taken to protect the rights of the participants.
Data analysis procedures
In what ways are the data analysis procedures appropriate for the data collected?
The article indicated the use of significant tests to analyze the data. Fisher’s exact or chi-square test for categorical survey items and the Student’s t-test or analysis of variance fro attitude scores was used for comparisons between respondents.
The audio taped family interviews and written healthcare provider responses were transcribed and compared again to the recordings or written responses to verify accuracy. Correlations were analyzed and four analyses were used to verify and isolate the criteria variables. These procedures were appropriate for the data collected, the research question, and the testing of the study hypotheses. .[Good]
Strengths and limitations
What are two major strengths of the scientific merit of this study?
This article did not identify any strengths but this writer thinks a strength of this study is the identification of practices healthcare providers can implement in order to assist clients and their family members with improving the outcomes of FP during IP’s and CPR. Another strength of the article was identifying the need of FP during IP’s and CPR. .[Good]
What are two major limitations of the scientific merit of this study?
One limitation of the study was that there were no non-English speaking participants in the study. The shortage of minority participants limits the generalization of the results across all groups of people. Another limitation of the study was a lack of representation of all age groups. A larger sampling including a large representation of people from all age groups would help to identify generational differences affecting the practice of FP during IP’s and CPR. .[Good]
References
(Aug 2003).
Peer pressure [Electronic version]. Nursing Management, 34(8), p 64. Retrieved May 4, 2006, from University of Phoenix, rEsource, NUR429, from http://www.apollolibrary.com/Library/journals1.aspx?sid=nursing%20management
Blair, P. (2004).
Is family presence practical during emergency resuscitation? [Electronic version]. Nursing Management, 35(6), pp 20-23. Retrieved May 4, 2006, from
http://www.apollolibrary.com/Library/journals1.aspx?sid=nursing%20management
Blass, K., Hayes, J., Kozier, B., & Erb, G. (2002).
Professional nursing practice: Concepts and perspectives (4th ed.).
New Jersey: Prentice Hall.
Burns, N., & Grove, S. (2003).
Understanding nursing research, 3rd ed. [Electronic version]. W.B. Saunders, an Elsevier Imprint. Retrieved April 10, 2006, from University of Phoenix, rEsource, NUR 429, from https://ecampus.phoenix.edu/secure/resource/resource.asp
Myers, T. A., Eichhorn, D. J., Guzzetta, C. E., Clark, A. P., Klein, J. D., & Taliaferro, E. et al. (2000).
Family presence during invasive procedures and resuscitation: the experience of family members, nurses, and physicians [Electronic version]. American Journal of Nursing, 100(2), pp 32-43. Retrieved May 4, 2006, from University of Phoenix, rEsource, NUR429, from, from http://www.apollolibrary.com/Library/journals1aspx?sid=american%20journal%20of20nursing
