Essay Sample on Critique of a Critical Appraisal

The purpose of this critique is to conduct a critical appraisal of Durgun and Okumus (2017), a randomized control trial study. In the article, the authors sought to evaluate the effectiveness of the nursing care program based on Watson's "Theory of Human Caring" on anxiety and distress caused by coping when the treatment fails. They conducted the study with a single-blind, randomized controlled trial research method. The critique uses the rapid critical appraisal checklist for randomized clinical trials (RCT). Its questions can assist in quickly determining the study's value for practice.

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The first section of the checklist addresses the validity of the study to establish if the researchers used the sound scientific method to obtain their study results (Melnyk & Fineout-Overholt, 2015). Researchers must conduct the study in a way that minimizes bias or eliminates confounding variables. Durgun and Okumus (2017) used a single-blind, randomized controlled trial research method.

Were the subjects randomly assigned to the experimental and control groups?

Yes.

The study subjects were randomly assigned to the experimental and control groups.

Was random assignment concealed from the individuals who were first enrolling subjects into the study?

Yes.

Durgun and Okumus (2017) used the block randomization method that conceals the information concerning randomization. In this technique, a person not involved in the study determines the intervention and control groups in the study.

Were the subjects and providers blind to the study group?

Yes.

The women who participated in the study were blinded to their assignment either to the intervention or in the control group. Likewise, the staff working in the center where the study was conducted was not informed about the members of the intervention and control groups.

Were reasons given to explain why subjects did not complete the study?

No.

According to Melnyk and Fineout-Overholt (2015), sometimes respondents leave a study before the end. In their study, Durgun and Okumus (2017) had 50 subjects in the intervention group and 46 in the control group. Among these subjects, only data of 32 women in the intervention and 35 in the control groups were analyzed. However, the authors did not give reasons to explain why some subjects did not complete the study.

Were the follow-up assessments conducted long enough to fully study the effects of the intervention?

Yes.

Follow-up assessment in the study continued for four weeks, which should be adequate time to have an impact on the outcome of nursing care program. Moreover, the changes in anxiety levels occur before the treatment, during Oocyte Pick-up (OPU), ET, in the period of 12 days spent waiting for the pregnancy test result, and in the case of failure of the treatment. however, the follow-up assessment was not long enough for the women for whom caring was continued after treatment.

Were the subjects analyzed in the group to which they were randomly assigned?

Yes.

At the end of the one-month follow-up, Durgun and Okumus (2017) analyzed the 67 participants in the group to which they were randomly assigned.

Was the control group appropriate?

Yes

According to Melnyk and Fineout-Overholt (2015), it is challenging to establish an appropriate comparison or control group without an understanding of how the intervention will be executed. However, in this study, the women in the control group received the standard nursing care given in the IVF center. Additionally, the study process for the control group encompassed pre-treatment assessments (TI), assessments made just after the Embryo Transfer (ET) (T2), and one-month follow-up assessments (T3). The appropriateness of the control group is unquestionable based on this process.

Were the instruments used to measure the outcomes valid and reliable?

Yes.

The primary outcomes were anxiety, distress, and coping levels. The authors used the Spiel Berger's Sate-Trait Anxiety Scale, the Infertility Distress Scale, and the Ways of Coping Inventory to measure these outcomes respectively. Previous researchers have tested and ensured the validity and reliability of these instruments.

Were the subjects in each of the groups similar to demographic and baseline clinical variables?

Yes.

At the beginning of the treatment, so significant difference was established between the intervention and control groups regarding the demographic attributes, age, educational status, work activity, income, social security, accommodation place, the treatment applied, infertility diagnosis, and the duration of treatment (Durgun & Okumus, 2017). Clearly, the groups were homogeneous.

What are the results of the study and are they important?

How large is the intervention or treatment effect?

The researchers reported the study findings in various ways, but the bottom line is that the intervention and control groups differed significantly. In particular, the intervention group did better than the control group depending on the failure of the treatment. The significance level for this study was determined as P < 0.05.

In this study, the study findings in both groups before the intervention were statistically insignificant evidenced by their probability values, which were greater than 0.5. However, the findings, after the treatment, were statistically significant. This meant that they are not likely to be obtained by chance.

How precise is the intervention or treatment (CI)?

The sample size was calculated with an error margin of 0.05 in the reliability range of 80% and 95%. Based on the analysis conducted depending on the mean scores and the standard deviations, the effect size was 0.8, which is large effect size. Since the results were statistically significant, it shows the findings are reliable and can be put into practice confidently.

Will the results help me in caring for my patients?

This question addresses the applicability of the study, particularly, how clinicians can use the findings to help the patients they care for.

Were all clinically important outcomes measured?

Yes.

Notably, the infertility treatment process involves different treatment and intervention procedures, which result in anxiety, distress, and stress in women involved. Durgun and Okumus (2017) measured anxiety and infertility distress during this process, which are clinically important outcomes.

What are the risks and benefits of the treatment?

The intervention is beneficial because it provides infertile women whose infertility treatment results in failure with high-quality nursing care. Similarly, it provides nurses working in (In Vitro Fertilization) IVF centers with good guidance on how to care for these women.

Is the treatment feasible in my clinical setting?

Yes.

The nursing care program based on Watson's Theory of Human Caring is feasible because it moves away from treatment-centeredness and focuses on "caring", which can make nursing care more efficient and aware, and improve care outcomes.

What are my patient's/family's values and expectations for the outcome that is trying to be prevented and the treatment itself?

Infertility is a case of unexpected loss for the women (patients), their husbands, and their families. The situation requires adapting to a life without children and coping with difficulties. Individuals start searching for treatments such as Assisted Reproductive Technology (ART) to avoid the stress and life crisis of the situation. However, the treatments often fail, which leaves patients and their families devastated. Hence, patients and families expect that in the case treatment fails, the nursing care program can help the patients overcome the anxiety and infertility distress they experience.

References

Melnyk, B. M. & Fineout-Overholt, E. (2015). Evidence-based practice in nursing & healthcare: A guide to best practice. Wolters Kluwer Health: Philadelphia, PA.

Ozan, Y. D., & Okumus, H. (2017). Effects of nursing care based on Watson's theory of human caring on anxiety, distress, and coping, when infertility treatment fails: A randomized controlled trial. Journal of caring sciences, 6(2), 95. doi:10.15171/jcs.2017.010