Critical Appraisal of Research Paper

Introduction

According to Konow (2006, p.11), critical appraisal is usually a process that involves careful and systematically examining research in order to judge its trustworthiness, value, and relevance in a particular context. Critical appraisal is, therefore, an important element in evaluating evidence-based medicine research. Evidence-based practice, as described by Cluett (2006a, p.3), is the integration of individual clinical expertise with the involvement of best available external clinical evidence from a reputable systematic research. Additionally, it is a practice that improves individual clinical expertise in patient’s values and expectations.

Gerrish and Lacely (2010, p.91) refer to research as an essential element of midwifery that enables healthcare practitioners in providing evidence-based care. This is due to the fact that critically appraising or evaluating a research article helps in understanding midwives rules and standards. These rules and regulations point out the presence of a midwife and assistance in making decisions about woman’s care. One must need woman’s needs. This can be achieved by discussing healthcare matters with her. In the 2nd edition article, ‘Principles and Practice of Research in Midwifery,’ by Elizabeth Cluett and Rosalind Bluff, the two authors did not only increase the research awareness but have also helped develop the skills of critical appraisal of research evidence that are important for evidence-based practice(2006b). This is essential as they provide a framework for the appraisal of midwifery research evidence (Melnyk et al. 2006, p.47).

Therefore, the aim of this essay is to use critical appraisal framework provided by Cluett and Bluff to critically evaluate two research papers. The first is ‘Use of Pandemic preparedness drill to increase rate of influenza control & hospital epidemiology,’ by Kuntz et al. The second is , ‘Co-ordinated approach to healthcare worker influenza vaccination in an area of health service,’ by Ballestas, McEnvoy and Doyley.

As Cluett and Bluff (2006, p.36) observed, “evidence is forever changing in the light of new research, new technology, new ideas, as well as old ideas and opinions put together in new ways.” This indicates that providing appropriate advice and engaging interactively decision makers with an aim of realizing innovation and change require healthcare professionals to employ up-to-date best evidence-based practice. According to this, updating conceptual framework requires healthcare professionals to access various healthcare professional literatures with legislation, standards, and guidance information. However, they note that this can only be achieved if critical appraisal skill program (CASP) framework is used in depicting the relevance of the article towards evidence-based practice.

Kuntz et al. use the above framework in their article by using clear statements of aims within their abstracts. This is important as it assists readers, especially healthcare nursing students, in deciding whether the research is relevant and suits their particular interest (Rees, 2011, p. 22). The article seeks to “determine the effect of a pandemic influenza preparedness drill on the rate of influenza vaccination among health care workers (HCWs) (Kuntz et al, 2006, p.111). For this reason, having a qualitative approach to research as pointed out by Cluett and Bluff (2006, p. 38) is appropriate for the evaluation of such article. Researchers normally seek to understand rather than to quantify an experience that they gain during their practice (Rees, 2011, p.23).

Kuntz et al. (2006, p. 112) state that their research was conducted from post-positivistic perspective of the effect of pandemic influenza preparedness drill on increasing influenza vaccination among HCWs. This is an appropriate methodology towards qualitative approach of data collection. Based on logistic models of comparing vaccination rates that were achieved during the 2003 and 2005 vaccination drill campaign, they were able to gather adequate data that demonstrated how a drill could be used to improve vaccination rates among HCWs. Historically, influenza vaccine was not routinely available to HCWs outside employee health clinic (Kuntz, 2006, p. 112). In response to this, hospitals were directed to extensively mobilize their resources, administration, disaster, and emergency preparedness plan by ensuring that healthcare workers who directly provide patient care are immunized immediately.

The choice of research design and the type of data that was analyzed by Kuntz et al. article conforms to the critical appraisal framework given by Cluett and Bluff. It is essential to question the reliability, validity, and credibility of both quantitative and qualitative data collection methods used before accepting researcher’s interpretation of the results (Cluett & Bluff, 2006, p. 45). It is especially relevant to healthcare professional, as it encourages the use of evidence from individual papers in order to inform their practice and reference the evidence base within their reports. Additionally, it enables healthcare professional to utilize documented critical analysis of a research article to enhance and improve their continuing professional development (Karanfil et al. 2011, p.375).

For instance, Kuntz et al. cited data unreliability and incredible as the reason why they did not use influenza vaccination rates for vaccination campaign in 2004. Therefore, the results of 2004 influenza vaccine were affected by the fact that there was less vaccine supplied (Kuntz, 2006, p.113). Therefore, by randomizing the control trials in influenza vaccination among HCWs based on 2003 and 2005 results, the University of Iowa Hospital and Clinics (UIHC) was able to incorporate influenza preparedness drill within the vaccination component. In turn, it amounted to substantial increase in influenza vaccination among HCWs. In 2006, 4, 168 of 6, 438 and 5, 999 of 12, 191 translating to 64% and 49% of HCWs with direct patient contact and overall hospital employees were vaccinated (Kuntz et al, 2006, p.133). This was an increase compared to 54% of HCWs (2,034 of 5,467) who had direct contact with patients that were vaccinated in 2005.

The implication of this article is that healthcare professionals, especially HCWs, are motivated to implement new methods of patient care, because they realize that the older approaches were not effective (Hillman, 2011, p. 2091). Additionally, the drill enabled them to improve nursing practices as they were able to identify the logistical problems associated with tracking HCWs’ vaccination reports, and delivery.

One the other hand, the relevancy and reliability of “co-ordinate approach to healthcare worker influenza vaccination in an area health services,” article can be captured by critically appraising the research paper. According to Ballestas, McEvoy and Doyle (2009, p.111), the aim of the study which Cluett and Bluff (2006, p.36) point as essential to the reader, is to use co-ordinated approach. It is supposed to increase local influenza vaccination among HCWs. This is a purposive approach especially to recruitment. It was used in accordance with the fact that it enriches healthcare professionals or nursing students with a variety of deep and rich data to inform the data essential for their practical development.

What is more, this co-ordinated approach for influenza vaccination campaign was only undertaken in five hospitals of South Metropolitan Area Health Service of Perth, Western Australia. It relies heavily on healthcare professionals’ perception. This relies on the fact that participants who are involved in the process are representatives of the population. As pointed out by Cluett and Buff (2006, p.66), healthcare professionals normally respects a hierarchy of evidence that places both systematic reviews and meta-analyses at the top. In this respect, various source of evidences such as “Cochrane collaboration has been held among midwifery and researchers alike,” (p.68). Additionally, having systematic review of such evidence sources helps in drawing together the results associated with multiple, randomized and controlled trials that are incorporated to collect all empirical evidence. This is to fit in pre-specified eligible criteria that help in answering specific questions.

For instance, analyzing the denominator data that were obtained from WA Department of Health’s staff database enabled the researchers to calculate vaccination coverage rate among HCWs, thereby, helping in devising on programs to improve the process (Ballestas, McEvoy & Doyle, 2009, p.114). This assists in answering the questions regarding why the low influenza vaccination has continued among HCWs, the key elements which can be used to improve the process, and the number of HCWs that improved based on influenza vaccination, upon the engagement of a co-ordinated approach program. Quantitatively, 57.7% of allied health professionals showed highest coverage as compared to 51.9 %, 49.6% and 48.6% of doctors, nurses, and patient support staff respectively (Ballestas, McEvoy & Doyle, 2009, p.114). What is more important, 58.8% of HCWs were vaccinated because they saw themselves as susceptible to influenza. They, thus, noted that immunization is the only effective way of preventing them from being infected from such serious disease.

Additionally, Ballestas, McEvoy and Doyle used explicit systematic method in order to minimize the biasness. However, they provided more reliable findings that enabled healthcare professionals to come up with insightful conclusion essential for their decision making process. While their program included standardized marketing and data collection, they incorporated ethical standard in their research. This qualified their study as far as the reliability and validity are concerned. The component of this programme was actively engaged with a consent form completed by each recipient (Ballestas, McEvoy & Doyle, 2009, p.111). The reason for this is to reflect on the paper for the researcher to concede that valuable data may have not been missed in the study. In such a manner, they were able to support their conclusion by having regular party meetings, senior management support, consistent marketing, standardized data collection, and analysis. These are basic keys that enhance the attainment of goof vaccination coverage among HCWs.

Conclusion

In conclusion, critical appraisal framework that was devised by Cluett and Bluff provides an interactive research evaluation technique that helps in determining the validity, reliability and credibility of research papers towards evidence-base practice. It is important that drawing out insightful conclusion from research articles helps to improve healthcare professionals’ decision making process. One can emulate from interactively analyzing the related articles. In this case, the two articles have provided basis for which influenza vaccination can be improved among healthcare workers not only for their well-being, but that of their patients, as well.

Reference List

Ballestas, T, McEvoy, S & Doyle, J 2009, ‘Co-ordinated approach to healthcare worker influenza vaccination in area health service’, Journal of Hospital Infection, vol. 73, no.3, pp.203-209.

Cluett, E & Bluff, R 2006a, Evidence-based practice, Elsevier, Philadelphia.

Cluett, E & Bluff, R 2006b, Principles and practice of research in midwifery, Elsevier: Philadelphia.

Gerrish, K & Lacely, A 2010, The research process in nursing, John Wiley & Sons.

Hillman K, et al 2006, ‘Introduction of the medical emergency team (MET) system: a cluster-randomized controlled trial’, Lancet, vol.365, no.9477, pp. 2091-2097.

Karanfil, L, Bahner, J, Hovatter, J & Thomas, W 2011, ‘Championing patient safety through mandatory influenza vaccination for all healthcare personnel and affiliated physicians’, Infect Control Hospital Epidemiology, vol. 32, no.4, pp. 375-379.

Konow, F 2006, A critical appraisal of creativity techniques in the context of innovation, Grin Verlag.

Kuntz, JL, Holley, S, Helms, CM, Cavanaugh, JE, Vande Berg, J, Herwaldt, LA. & Polgreen, PM 2008, ‘Use of a pandemic preparedness drill to increase rates of influenza vaccination among healthcare workers’, Infection Control & Hospital Epidemiology, vol. 29, no.2, pp. 111-115.

Melnyk, B, Stillwell, S & Williamson, K 2006, ‘Evidence-based practice step by step: critical appraisal of the evidence: part I’, American Journal of Nursing, vol. 100, no. 7, pp.47-52.

Rees, C 2011, Introduction to research for midwives, Churchill Livingstone, Elsevier: Edinburgh.