Article Critique Paper

Article Critique Paper

Caregivers grapple with various challenges when safeguarding the safety of patients with dementia. In essence, dementia results in progressive deterioration of cognitive, psychological, and functional disabilities that compromise people’s quality of life and lead to disability-adjusted life years (DALYs) (Häikiö et al., 2019). Amidst these problems, care providers must incorporate the tenets of evidence-based practices, including the culture of using the best available evidence to improve care quality and improve safety. As a profound phase of the evidence-based practice (EBP) framework, evidence appraisal enables nursing researchers and care providers to assess sources’ credibility, reliability, relevance, currency, and authority in answering clinical questions and transforming decisions. During evidence source appraisal, researchers can critique scholarly articles to ascertain their strengths, weaknesses, and implications for clinical questions and practices. Consequently, this paper presents a critique of the article, Feasibility and potential effects of interdisciplinary home-based reablement program (I-HARP) for people with cognitive and functional decline: A pilot trial by Jeon et al. (2019).

An Overview of the Selected Study

In the article, Feasibility and potential effects of interdisciplinary home-based reablement program (I-HARP) for people with cognitive and functional decline: A pilot trial, Jeon et al. (2019) summarized the findings from a parallel-randomized controlled pilot trial conducted in Sydney, Australia targeting community-dwelling people with amnestic mild cognitive impairment or mild/moderate dementia and their care providers. The purpose of this study was to test the feasibility and potential effects of the interdisciplinary home-based reablement program (I-HARP) that entails evidence-based strategies and cognitive rehabilitation strategies into a dementia-specific, bio-behavioral-environmental intervention (Jeon et al., 2019, p. 1916). The researchers obtained inspiration from the overarching need to reduce the effects of dementia, including progressive cognitive and functional impairments and other co-existing health ramifications such as delirium, frailty, incontinence, and falls.

Although the researchers recognized comorbidities associated with dementia, they emphasized the need to focus on functional impairments resulting from comorbid conditions. Therefore, the I-HARP program encompassed multiple interventions, including cognitive rehabilitation, supported decision-making, and collaboration between patients and care providers. Also, the program focused on improving mobility by modifying cognitive functions, enhancing patients’ strength and balance, addressing depression, and transforming the home environment (Jeon et al., 2019). To test the effectiveness of I-HARP interventions, the researchers allocated 10 patients to the intervention group and 9 patients to the control group. They analyzed findings based on short and long-term outcomes. At 4 months, the intervention group showed a 0.78-point of improvement in functional independence while that of the control group declined by 4.78 points. At 12 months, the functional independence for the intervention group declined by 6.20 points while that of the control group declined by 12.06 points (Jeon et al., 2019, p. 1922). These findings justified the plausibility and feasibility of implementing the I-HARP program in improving safety for patients with dementia.

Strengths of the Study

The major strengths of this study rely massively upon the research design. For instance, the researchers applied a randomized clinical trial to examine the effectiveness of the I-HARP program in improving functional independence for patients with dementia. The ability to use a randomized clinical trial enhances the study’s validity by leading to two identifiable strengths; randomization and causation establishment. Firstly, the researchers used computer-assisted randomization to ensure equal allocation to groups. The randomization process acts as a strength since it eliminates accidental bias, including selection biases.

Also, it allows researchers to use the probability theory (Lim & In, 2019). Secondly, the study established causal inference and relationship between the intervention and control groups in response to the I-HARP program’s approaches. According to Deaton & Cartwright (2018), randomized controlled trials are profound research designs and ideal methodologies for establishing causal inference. This factor acts as a strength by enabling scholarly investigators to determine differences between intervention and control groups after subjecting the former group to interventions for a specific time. Consequently, the difference between the intervention and control groups informs conclusions and contributes to the study’s internal and external validity.

Weaknesses of the Study

Although the study exhibits various strengths owing to its design, it had two major weaknesses; a lack of blinding factor for participants and a relatively small sample size. Firstly, the researchers did not “blind” participants before group allocation. According to Jeon et al. (2019), the participants knew about group allocation through phone communication with researchers. The concept of blinding participants in research is essential in enhancing the study’s validity. According to Krauss (2021), blinding is profound when conducting a trial because it prevents biased decisions. Alongside randomization, blind trials maximize the results’ validity and promote the findings’ generalizability. Therefore, this study failed to capitalize on the importance of blinding participants.

Secondly, the study involved a relatively small sample size of 19 participants across the intervention and control groups (10 in the intervention group and 9 in the control group). In essence, the researchers recruited participants who fulfilled the following thresholds; be ≥60 years old, have amnestic mild cognitive impairment (aMCI) or mild/moderate stages of dementia, have difficulty with ≥1 basic activities of daily living (ADLs), and able to stand with or without assistance. Also, they considered participants living within 25 Km of central Sydney, people with conversational English, and patients with at least 4 days or 7 hours per week of contact with care providers (Jeon et al., 2019, p. 3). The strict inclusion criteria contributed to the recruitment of a small sample size.

Although it is time and resource-effective to manage fewer participants in randomized trials, involving a small sample size can compromise the findings’ validity and generalizability. Jenkins & Quintana-Ascencio (2020) argue that a small sample size is often problematic due to the likelihood of making inconclusive or contradictory results. In essence, this factor affects the study’s validity by reducing its statistical value and applicability in out-of-research contexts like clinical settings.

Proposed Changes and Recommendations

Undeniably, it is possible to enhance the study’s validity and generalizability by addressing weaknesses in the research design. As stated earlier, the study’s major weaknesses are a lack of participants’ “blinding” and a relatively small sample (19 participants). Therefore, it is valid to address these limitations by conducting a blinded trial and recruiting more participants to enhance the results’ credibility and statistical significance. Firstly, blinding is an essential concept in clinical trials. According to Monaghan et al. (2021), blinding is the process of withholding information that can potentially influence the study results until the completion of the intervention. In essence, different stakeholders in nursing research, including care providers, outcome assessors, data collectors, and trial managers can conceal information about an intervention or an initiative until its completion to reduce biased results and ensure effective randomization of group allocation.

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Secondly, it is essential to enhance the study’s validity and reliability by recruiting more participants through reviewing the inclusion criteria. Andrade (2020) argues that too large or too small samples are unscientific and unethical since they undermine studies’ statistical powers. However, a larger sample is necessary because it can effectively represent the population, providing more accurate results (Andrade, 2020). It is vital to note that the purpose of conducting a randomized clinical trial is to test an intervention’s generalizability and applicability in out-of-research contexts. As a result, maintaining a larger sample can enhance research findings and guide clinical practices. Also, a relatively larger research sample can address the problem of high participant drop-out that compromise a research’s statistical value.

Implications of the Study for Nursing Practice

Although the study exhibits limitations due to the small sample size and a lack of participants’ blinding, it provides profound insights into the importance of implementing an interdisciplinary home-based reablement program (I-HARP) in improving health and safety for patients with dementia. According to Jeon et al. (2019), the study examined how the I-HARP care model fits within existing hospital-based community programs and community aged care settings. Also, the scholarly article established the rationale for strengthening the individualized care support component of I-HARP by applying a more proactive approach to caregiver support and warranting further investigation into caregiver-patient-physician interactions in reablement care approaches. Therefore, the article provided for the need to implement a contingency plan and evidence-based patient-centered interventions for safeguarding the safety of patients with dementia.

Conclusion

Amidst the challenges facing care providers when caring for patients with dementia, healthcare professionals are responsible for embracing evidence-based practice (EBP) models that emphasize utilizing the best evidence in solving clinical questions and improving decisions. Since an article critique is a profound strategy for appraisal of scholarly evidence sources, it enables researchers to identify studies’ strengths and weaknesses, provide informed recommendations for changes, and establish articles’ implications for nursing practice. this paper presents a critique of the article, Feasibility and potential effects of interdisciplinary home-based reablement program (I-HARP) for people with cognitive and functional decline: A pilot trial by Jeon et al. (2019).

References

Andrade, C. (2020). Sample size and its importance in research. Indian Journal of Psychological Medicine, 42(1), 102–103. https://doi.org/10.4103/ijpsym.ijpsym_504_19

Deaton, A., & Cartwright, N. (2018). Understanding and misunderstanding randomized controlled trials. Social Science & Medicine, 210, 2–21. https://doi.org/10.1016/j.socscimed.2017.12.005

Häikiö, K., Sagbakken, M., & Rugkåsa, J. (2019). Dementia and patient safety in the community: A qualitative study of family carers’ protective practices and implications for services. BMC Health Services Research, 19(1), 1–13. https://doi.org/10.1186/s12913-019-4478-2

Jenkins, D. G., & Quintana-Ascencio, P. F. (2020). A solution to minimum sample size for regressions. PLOS ONE, 15(2), e0229345. https://doi.org/10.1371/journal.pone.0229345

Jeon, Y.-H., Krein, L., Simpson, J. M., Szanton, S. L., Clemson, L., Naismith, S. L., Low, L.-F., Mowszowski, L., Gonski, P., Norman, R., Gitlin, L. N., & Brodaty, H. (2019). Feasibility and potential effects of interdisciplinary home-based reablement program (I-HARP) for people with cognitive and functional decline: A pilot trial. Aging & Mental Health, 24(11), 1916–1925. https://doi.org/10.1080/13607863.2019.1642298

Krauss, A. (2021). Assessing the overall validity of randomized controlled trials. International Studies in the Philosophy of Science, 1–24. https://doi.org/10.1080/02698595.2021.2002676

Lim, C.-Y., & In, J. (2019). Randomization in clinical studies. Korean Journal of Anesthesiology, 72(3), 221–232. https://doi.org/10.4097/kja.19049

Monaghan, T. F., Agudelo, C. W., Rahman, S. N., Wein, A. J., Lazar, J. M., Everaert, K., & Dmochowski, R. R. (2021). Blinding in clinical trials: Seeing the big picture. Medicina, 57(7), 647. https://doi.org/10.3390/medicina57070647

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Assignment 7 Instructions

ARTICLE CRITIQUE:

DNP graduates are expected to apply research findings and integrate nursing science into evidence-based practice. To develop your skills in this high level of nursing practice, you will analyze the strengths and weaknesses of a research study over the next several weeks using the concepts presented throughout the course.
1. Use each bullet below as a “HEADER” in APA format…

• A brief, 1- to 2-paragraph overview of the study that you selected.
• An explanation of two to three strengths of the study and support for your selection (i.e., why is this a strength?). Be specific.
• An explanation of two to three weaknesses of the study and support for your selection (i.e., why is this a weakness?). Be specific.
Note: The strengths and weaknesses that you identified should be in relation to design, sampling, data collection, statistical analysis, results, and discussion of the study that you selected.
• An explanation of proposed changes that you would recommend improving the quality of the study, capitalizing on the strengths and improving on the weaknesses that you identified in the study. Be specific and provide examples.
• A final summary of the implications of this study for nursing practice.

The purpose of the analysis is to help you develop a deeper understanding of the research process, to inspire you to think critically and deeply about research on a specific topic, and to strengthen your ability to integrate research findings into evidence-based nursing practice. This Assignment also gives you practice in analyzing the research literature, which will support you when you begin your DNP project.

• Before you proceed, please review the rubric for this Assignment.
• Keep in mind that you will be working on your article critique throughout Weeks 8 through 10 with your critique due by Day 7 of Week 10.

The Assignment: (5–7 pages)

1. Select a research article from the body of literature that you have reviewed related to the practice gap you have identified and for which you will develop for your DNP Project.
2. Review the various quantitative research designs presented in the textbook readings and research articles.
3. Consider the research design used in your selected article. Ask yourself the following questions.
0. Is the design appropriate for the study? Why or why not?
1. Would a different design provide better results? Why or why not?

Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates/general#s-lg-box-20293632). All papers submitted must use this formatting.
Resources: Gray, J. R., & Grove, S. K. (2020). Burns and Grove’s the practice of nursing research: Appraisal, synthesis, and generation of evidence (9th ed.). Elsevier.
• Chapter 24, “Using Statistics to Predict” (pp. 675–686)
http://www.jhpr.ir/article_46507_d0ac0fb4948a39455baca303a79108c9.pdf
https://go.openathens.net/redirector/waldenu.edu?url=https://doi.org/10.1111/jonm.12452
https://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=103805630&site=ehost-live&scope=site&authtype=shib&custid=s6527200
https://go.openathens.net/redirector/waldenu.edu?url=https://doi.org/10.1111/jonm.12848