Critical Appraisal of Research Essay

Critical Appraisal of Research Essay

 

Critical Appraisal Tool Worksheet Template

Evaluation Table

 

Use this document to complete the evaluation table requirement of the Module 4 Assessment, Evidence-Based Project, Part 3A: Critical Appraisal of Research

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Full APA formatted citation of the selected article.	Article #1	Article #2	Article #3	Article #4
	Hamdan, K. M. (2019). Nurses’ assessment practices of pain among Critically Ill patients. Pain Management Nursing: Official Journal of the American Society of Pain Management Nurses, 20(5), 489–496. https://doi.org/10.1016/j.pmn.2019.04.003	Korving, H., Sterkenburg, P. S., Barakova, E. I., & Feijs, L. M. G. (2020). Physiological measures of acute and chronic pain within different subject groups: A systematic review. Journal de La Societe Canadienne Pour Le Traitement de La Douleur [Pain Research & Management], 2020, 1–10. https://doi.org/10.1155/2020/9249465	Chan, A. Y., Ge, M., Harrop, E., Johnson, M., Oulton, K., Skene, S. S., Wong, I. C., Jamieson, L., Howard, R. F., & Liossi, C. (2022). Pain assessment tools in pediatric palliative care: A systematic review of psychometric properties and recommendations for clinical practice. Palliative Medicine, 36(1), 30–43. https://doi.org/10.1177/02692163211049309	Allen, E., Williams, A., Jennings, D., Stomski, N., Goucke, R., Toye, C., Slatyer, S., Clarke, T., & McCullough, K. (2018). Revisiting the pain resource nurse role in sustaining evidence-based practice changes for pain assessment and management. Worldviews on Evidence-Based Nursing, 15(5), 368–376. https://doi.org/10.1111/wvn.12318
Evidence Level * (I, II, or III)	Nonexperimental study – level III	A systematic review of other reviews – level II of evidence	A systematic review of previous studies including RCTs – level II evidence	Mixed method study with quantitative cross-sectional design and qualitative interviews, nonexperimental design – level III of evidence
Conceptual Framework Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here).**	No conceptual framework model o framework was provided	No conceptual framework was mentioned in the manuscript published	No conceptual framework was described in the published manuscript	No conceptual framework was provided in this article
Design/Method   Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria).	This study was a quantitative study that used a descriptive cross-sectional design. The researchers collected relevant data from nurses from different intensive care units using the Pain Assessment and Management for the Critically Ill survey	This was a systematic review of 29 other review studies. The studies were sourced from six international databases. The included studies had to include at least one physiological pain management method in humans. The researchers used the CASP checklist to check the quality of the studies	In this systematic review, literature was searched from PsycINFO, Web of Science Core, Medline, EMBASE, BIOSIS, and CINAHL using the COSMIN guidelines. Data was derived from these sources, appraised, and analyzed.	Documentation audits and a “Knowledge and Attitudes Survey Regarding Pain were used to collect quantitative data. Qualitative interviews and focus groups were used to collect data from participants. These assessments were done 8 years after the implementation of hospital-wide evidence-based practice changes using three key targets for pain assessment and assessments with one-year post-implementation recorded
Sample/Setting   The number and characteristics of patients, attrition rate, etc.	The researchers sampled 492 eligible participants were sampled through convenience sampling but only 300 nurses from 22 different ICU settings completed the study representing a 60.1% response rate	29 studies that met the inclusion criteria were reviewed. This number was derived from 543 studies that were returned from the literature search.	The search returned 1157 articles, 201 were available as full tests, but only 34 met the eligibility criteria.  Selected articles had to include infants and young people, involve pain assessment, and pain assessment tools.	The clinical audit was done from hospital records from data from approx. 420,000 patients per year. Data at T2 was from 177 records against the T1 records which were 220. Thirteen pain resource nurses were interviewed and participated in two focus groups.
Major Variables Studied   List and define dependent and independent variables	Dependent variables: pain behaviors, ICU experience   Independent: hospital type	Independent variables: types of physiological pain assessment methods Dependent variables: frequency of pain assessment method	Independent: pain assessment tools Dependent: psychometric properties of the pain assessment tool.	Independent: time Dependent: documentation of pain scores, the role of Pain Resource Nurses (PRNs), PRN pain knowledge and attitudes
Measurement   Identify primary statistics used to answer clinical questions (You need to list the actual tests done).	Frequency of pain behaviors, Spearman correlation tests X2 tests, Independent-samples T-test	Proportions of pain assessment per method Frequency of pain assessment per method	Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) assessment of the quality of each article; rating of psychometric properties of the tool per the strength of the evidence	Direct comparison of proportions and frequencies between T1 and T2; Qualitative themes
Data Analysis Statistical or Qualitative findings   (You need to enter the actual numbers determined by the statistical tests or qualitative data).	About 90% of nurses used pain assessment tools. The numeric rating scale was the most commonly used scale for verbal patients. The Adult Nonverbal Pain Scale was the most common among patients unable to communicate. Positive perception of pain was associated with the use of these tools (p < .01)	Most commonly used methods: MRI (193)>heart rate variability (184)>heart rate (169). Among children, heart and heart rate variability were the most commonly used methods among nonverbal children. Three (3) studies assessed pain in patients with intellectual disabilities.	The study evaluated 22 pain assessment tools from the 34 studies. The Faces Pain Scale-Revised (FPS-R) was found to have the highest psychometric properties The Faces, Legs, Activity, Cry and Consolability scale (FLACC)/FLACC-Revised and Pediatric Pain Profile (PPP) are two tools that are best for the observation of pain.	Improvement in daily observation charts from 47% in T1to 62% in T2 (p = .004). At T2 there was at least one record of pain score at admissions. Pain assessment documentation improved from 45.3% at T1 to 72.7% at T2; p = .0001. Themes: PRNs has a vital role in clinical settings; collaboration and support from PRNs was good, but ward staff were still unaware of PRN roles; ward nursing workload still problem with pain assessment,
Findings and Recommendations   General findings and recommendations of the research	The use of pain tools was more common in patients who can communicate. The importance of the use of these tools was given to the patients who can communicate. assessment tools and behavioral indicators of pain as a valid approach should be used by nurses in all critically ill patients	The least vulnerable population used more invasive methods. Limited research on physiological pain assessment for vulnerable populations such as the intellectually disabled. There is a need for more research on pain assessment methods’ reliability and viability among vulnerable populations	Most tools were operational tools. No pain assessment tool was validated for pediatric patients in palliative care stings. Most tools lacked valid evidence for use in infants and young children. Authors recommended robust clinical validation of pediatric palliative care pain assessment tools	Implementing and sustaining evidence-based practice change leads to improvement in the documentation of pain assessment scores. However, the process is challenging and requires collaboration and input from pain resource nurses. Addressing barriers, increasing awareness, and fostering collaboration can be effective mitigative interventions to improve pain management in nursing practice
Appraisal and Study Quality     Describe the general worth of this research to practice.   What are the strengths and limitations of the study?   What are the risks associated with the implementation of the suggested practices or processes detailed in the research?   What is the feasibility of use in your practice?	This study evaluated an actual practice issue that involves the critically ill. Its worth in practice is invaluable. This study is a powerful one because it involved nurses from different settings making its findings inferable to a variety of practice settings. However, being a cross-sectional study, the findings cannot be used to infer causality. This limitation is a key risk in the implementation of findings into practice. Nevertheless, the use of findings is feasible but with cautions	This study is relevant to my clinical issue. The clinical worth of this article in research practice is that it identifies research gaps regarding clinical assessment among vulnerable populations. The sample size in terms of the article used in this study is relatively small (29). Making conclusive findings and applying these findings in practice would require further research of similarly high-level evidence. Comparative analysis has yielded clinical outcomes that would shed more light on the need for evidence-based practice in pain assessment	This article provides a high level of evidence in answering my clinical question. However, there is a lack of comparison and deeper statistical analyses. A smaller sample of articles reviewed limits the reliability and feasibility of the application of its findings into practice. However, the findings are valid but need additional research evidence to back them up.	This study does not relate well to my clinical problem. However, its findings are worthy and can be useful in the implementation of outcomes of my clinical project. It provides both qualitative and quantitative findings that would guide project outcome implementations. However, this study was from a single site and this makes its findings less transferable to other settings of practice.
Key findings	Pain in patients who cannot communicate could be usually ignored. Pain assessment among the critically ill remains a challenge in ICU	Commonly used physiological pain assessment methods include muscle tension, MRI, respiratory assessment, hormonal analysis, and pupillometry. However, these methods are not adequately studied regarding their efficiencies in pain assessment.	Pediatric palliative care still lacks a valid pain assessment tool. Preexisting tools are good for pain observation and monitoring. FLACC-Revised and Pediatric Pain Profile (PPP) are better commendable pain observation tools among the appropriate pediatric age group.	Pain assessment requires the implementation and sustenance of an evidence-based practice change. An ongoing evaluation of pain assessment intervention implementation was emphasized. A collaborative approach to pain assessment from nurses cuts across the care for all patient populations
Outcomes	Need for improved pain assessment in critical care settings. Nurse perception of the need for pain should not dictate the use of pain scales and behavioral indicators of pain.	Need for more studies in physiologies pain management among intellectually disabled, preverbal children, and nonverbal patients such as those in the cortical care settings.	Scanty evidence on validity and reliability pain assessment tools among pediatrics in palliative care. need for a further research study on these tools.	Pain assessment and management roles, collaboration in pain assessment, and pain documentation for all patients at admission were key outcomes of this study
General Notes/Comments	An eye-opening study that provides various needs for more evidence to answer my clinical issue	A good article but does not address the outcomes of the interventions from my PICOT question	Addressed my study PICO population, clinical problem, and outcomes	This study has more qualitative into to my answering my clinical problem

 

Part 3B: Critical Appraisal of Research

Pain assessment among patients can take two forms: objective and self-reporting. Self-reporting of pain is usually considered the “gold standard” of pain assessment. This type of pain assessment can be verbal or nonverbal (Subramaniam et al., 2018). However, self-reporting of pain can be challenging in some populations such as preverbal children, critically ill patients, or comatose patients. Therefore, physiological and behavioral indicators can be used in these situations. My clinical project aimed at establishing through an evidence-based project the superiority of using behavioral strategies such as pain scales over physiological indicators of pain. In this project, 2 nonexperimental and 3 systematic reviews were critically appraised and best practices were deduced from these credible sources. These sources provided varying levels of evidence according to the evidence level hierarchy by Melnyk & Fineout-Overholt (2022). These sources provided answers to different components of a PICO question

Best Practices

Pain among pediatric patients, especially in the emergency department, sometimes do unassessed owing to different barriers to assessment. According to a study by Rybojad et al. (2022), pediatric patients reported nurses tended to under-assess their pain severity as compared to those of the parents. To mitigate this discrepancy and injustice to patient examination. Both behavioral and physiological indicators of pain can be used for objective pain assessment. The limited evidence available does not recommend the superiority of any of these pain assessment modalities.

The appraised evidence sources suggested that nonverbal and preverbal patients can be easily ignored leading to missed pain assessment (Hamdan, 2019). Therefore, commonly used physiological pain assessment methods such as muscle tension, MRI, respiratory assessment, hormonal analysis, and pupillometry can be used in the vulnerable group of patients aforementioned (Korving et al., 2020).  There are no valid pain assessment scales for preverbal patients. However, existing tools such as FLACC-Revised and Pediatric Pain Profile (PPP) can be used for the observation and monitoring of pain (Chan et al., 2022). Pediatric patients in palliative care and those who are preverbal can benefit from the use of these tools to ensure that pain management is effective and necessitate adjustments in management whenever progress deteriorates. From the organizational perspective, pain assessment and management can benefit from the implementation and sustenance of an evidence-based practice change. These change projects require the establishment of organizational culture that will ensure documentation of pain scores for every patient at admission, collaborative teams in pain management, tracking of progress in organization management of pain, and continuously addressing current and emerging barriers in pain assessment and management (Allen et al., 2018). These best practices are backed by current, relevant, authoritative, and reliable sources thus they are credible.

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References

Allen, E., Williams, A., Jennings, D., Stomski, N., Goucke, R., Toye, C., Slatyer, S., Clarke, T., & McCullough, K. (2018). Revisiting the pain resource nurse role in sustaining evidence‐based practice changes for pain assessment and management. Worldviews on Evidence-Based Nursing, 15(5), 368–376. https://doi.org/10.1111/wvn.12318

Chan, A. Y. L., Ge, M., Harrop, E., Johnson, M., Oulton, K., Skene, S. S., Wong, I. C. K., Jamieson, L., Howard, R. F., & Liossi, C. (2022). Pain assessment tools in pediatric palliative care: A systematic review of psychometric properties and recommendations for clinical practice. Palliative Medicine, 36(1), 30–43. https://doi.org/10.1177/02692163211049309

Hamdan, K. M. (2019). Nurses’ assessment practices of pain among critically ill patients. Pain Management Nursing: Official Journal of the American Society of Pain Management Nurses, 20(5), 489–496. https://doi.org/10.1016/j.pmn.2019.04.003

Korving, H., Sterkenburg, P. S., Barakova, E. I., & Feijs, L. M. G. (2020). Physiological measures of acute and chronic pain within different subject groups: A systematic review. Journal de La Societe Canadienne Pour Le Traitement de La Douleur [Pain Research & Management], 2020, 1–10. https://doi.org/10.1155/2020/9249465

Melnyk, B. M., & Fineout-Overholt, E. (2022). Evidence-based practice in nursing & healthcare: A guide to best practice (5th ed.). Wolters Kluwer Health.

Rybojad, B., Sieniawski, D., Rybojad, P., Samardakiewicz, M., & Aftyka, A. (2022). Pain evaluation in the pediatric emergency department: Differences in ratings by patients, parents, and nurses. International Journal of Environmental Research and Public Health, 19(4), 2489. https://doi.org/10.3390/ijerph19042489

Subramaniam, S. D., Doss, B., Chanderasekar, L. D., Madhavan, A., & Rosary, A. M. (2018). Scope of physiological and behavioral pain assessment techniques in children – a review. Healthcare Technology Letters, 5(4), 124–129. https://doi.org/10.1049/htl.2017.0108

Evidence-Based Project, Part 3: Critical Appraisal of Research
Realtors rely on detailed property appraisals—conducted using appraisal tools—to assign market values to houses and other properties. These values are then presented to buyers and sellers to set prices and initiate offers.

Research appraisal is not that different. The critical appraisal process utilizes formal appraisal tools to assess the results of research to determine value to the context at hand. Evidence-based practitioners often present these findings to make the case for specific courses of action.

In this Assignment, you will use an appraisal tool to conduct a critical appraisal of published research. You will then present the results of your efforts.

To Prepare:

Reflect on the four peer-reviewed articles you selected in Module 2 and the four systematic reviews (or other filtered high- level evidence) you selected in Module 3.
Reflect on the four peer-reviewed articles you selected in Module 2 and analyzed in Module 3.
Review and download the Critical Appraisal Tool Worksheet Template provided in the Resources.
The Assignment (Evidence-Based Project)

Part 3A: Critical Appraisal of Research

Conduct a critical appraisal of the four peer-reviewed articles you selected by completing the Evaluation Table within the Critical Appraisal Tool Worksheet Template. Choose a total of four peer- reviewed articles that you selected related to your clinical topic of interest in Module 2 and Module 3.

Note: You can choose any combination of articles from Modules 2 and 3 for your Critical Appraisal. For example, you may choose two unfiltered research articles from Module 2 and two filtered research articles (systematic reviews) from Module 3 or one article from Module 2 and three articles from Module 3. You can choose any combination of articles from the prior Module Assignments as long as both modules and types of studies are represented.

Part 3B: Critical Appraisal of Research

Based on your appraisal, in a 1-2-page critical appraisal, suggest a best practice that emerges from the research you reviewed. Briefly explain the best practice, justifying your proposal with APA citations of the research.

Submit Part 3A and 3B of your Evidence-Based Project.

The response fully integrates at least two outside resources and two or three course-specific resources that fully support the responses provided.