Critical Appraisal of Research Paper

Introduction

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

Gerrish and Lacely (2010, p.91) refer to research as an essential element of midwifery that enables healthcare practitioners to provide evidence-based care. This is because critically appraising or evaluating a research article helps understand midwives' rules and standards. These rules and regulations point out the presence of a midwife and assistance in making decisions about a woman’s care. One must need a 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 not only increased the research awareness but 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 appraising midwifery research evidence (Melnyk et al. 2006, p.47).

Therefore, this essay aims to use the critical appraisal framework provided by Cluett and Bluff to 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.

Cluett and Bluff (2006, p.36) observed that “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 decision makers interactively to realize innovation and change require healthcare professionals to employ up-to-date, best, evidence-based practice. According to this, updating the conceptual framework requires healthcare professionals to access various healthcare professional literature with legislation, standards, and guidance information. However, they note that this can only be achieved if the critical appraisal skill program (CASP) framework is used to depict the article's relevance 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 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 research approach, as Cluett and Bluff pointed out (2006, p. 38), is appropriate for evaluating such an article. Researchers normally seek to understand rather than quantify an experience they gain during their practice (Rees, 2011, p.23).

Kuntz et al. (2006, p. 112) state that their research was conducted from a post-positivistic perspective of the effect of pandemic influenza preparedness drill on increasing influenza vaccination among HCWs. This is an appropriate methodology for the qualitative approach of data collection. Based on logistic models of comparing vaccination rates achieved during the 2003 and 2005 vaccination drill campaigns, they gathered adequate data demonstrating how a drill could be used to improve vaccination rates among HCWs. Historically, the influenza vaccine was not routinely available to HCWs outside the employee health clinic (Kuntz, 2006, p. 112). In response, 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 analyzed by the 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 quantitative and qualitative data collection methods before accepting the researcher’s interpretation of the results (Cluett & Bluff, 2006, p. 45). It is especially relevant to healthcare professionals, as it encourages using evidence from individual papers to inform their practice and reference the evidence base within their reports. Additionally, it enables healthcare professionals to utilize a research article's documented critical analysis 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 they did not use influenza vaccination rates for the vaccination campaign 2004. Therefore, the results of the 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) could incorporate an influenza preparedness drill within the vaccination component. In turn, it amounted to a 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 vaccinated patients in 2005.

This article implies that healthcare professionals, especially HCWs, are motivated to implement new patient care methods because they realize that the older approaches were ineffective (Hillman, 2011, p. 2091). Additionally, the drill enabled them to improve nursing practices as they identified the logistical problems associated with tracking HCWs’ vaccination reports and delivery.

One the other hand, the relevancy and reliability of the “coordinate 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 a coordinated approach. It is supposed to increase local influenza vaccination among HCWs. This is a purposive approach, especially to recruitment. It was used because it enriches healthcare professionals or nursing students with various deep and rich data to inform the data essential for their practical development.

Moreover, this coordinated approach for the influenza vaccination campaign was only undertaken in five South Metropolitan Area Health Service hospitals of Perth, Western Australia. It relies heavily on healthcare professionals’ perception. This relies on the fact that participants involved in the process are representatives of the population. As Cluett and Buff (2006, p.66) pointed out, healthcare professionals normally respect a hierarchy of evidence that places systematic reviews and meta-analyses at the top. In this respect, various sources of evidence, such as “Cochrane collaboration, have been held among midwifery and researchers alike” (p.68). Additionally, a systematic review of such evidence sources helps draw 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 answer specific questions.

For instance, analyzing the denominator data that were obtained from the WA Department of Health’s staff database enabled the researchers to calculate vaccination coverage rate among HCWs, thereby helping in devising 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 that can be used to improve the process, and the number of HCWs that improved based on influenza vaccination, upon the engagement of a coordinated approach program. Quantitatively, 57.7% of allied health professionals showed the highest coverage 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. Thus, they noted that immunization is the only effective way to prevent them from being infected with such a serious disease.

Additionally, Ballestas, McEvoy and Doyle used an explicit systematic method to minimize the bias. However, they provided more reliable findings that enabled healthcare professionals to come up with insightful conclusions essential for their decision-making process. While their program included standardized marketing and data collection, they incorporated ethical standards in their research. This qualified their study as far as 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). 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 supported their conclusion by having regular party meetings, senior management support, consistent marketing, and standardized data collection and analysis. These are basic keys that enhance goof vaccination coverage among HCWs.

Conclusion

In conclusion, Cluett and Bluff's critical appraisal framework provides an interactive research evaluation technique that helps determine research papers' validity, reliability, and credibility towards evidence-based practice. It is important that drawing out insightful conclusions 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 a basis for which influenza vaccination can be improved among healthcare workers for their well-being and that of their patients.

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 influenza vaccination rates 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.