NURS 8201 Week 10: Assignment 2 Article Critique
NURS 8201 Week 7 Assignment
The identified practice gap for my practicum DNP project is the lack of peer support services for patients with traumatic experiences at my clinical practicum site. The proposed change is a quality improvement (QI) initiative incorporating peer support in trauma-informed care (TIC) to accelerate recovery. The project will be implemented at the Advantage Crisis Stabilization Unit, a Behavioral Health Crisis Center that provides crisis stabilization, temporary observation, and crisis walk-in services. Peer support entails having people from diverse backgrounds share common trauma experiences. Owing to their similar experiences and shared understanding, patients may create trust with their peer support worker and will be more ready to engage in treatment. The purpose of this paper is to critique a quantitative research article related to my topic, including the study’s strengths and weaknesses. In addition, I will recommend changes to improve the quality of the study and discuss the implications of the study for nursing practice.
Overview of the Quantitative Study
Asadzadeh et al. (2020) examined the impact of brief midwife-led counseling, founded on the Gamble and colleagues’ approach, in reducing post-traumatic stress disorder (PTSD), depression, and anxiety symptoms among women who had undergone a traumatic childbirth. The study employed a randomized control trial (RCT) on pregnant women attending three governmental antenatal clinics. The study sample included 90 women with a history of traumatic childbirth. The participants were randomly assigned into intervention and control groups with 45 women. The Gamble and colleagues’ approach entails a midwife-led brief counseling intervention for postpartum women exhibiting PTSD symptoms. It comprises two counseling sessions by midwives at 48–72 hours and four to 6 weeks post-delivery. This approach stresses the therapeutic relationship, acknowledgment of experiences, conveying emotions, reviewing labor management, increasing social support, and problem-solving.
In the study, the participants in the intervention group had a face-to-face counseling session within 72 hours post-delivery and a telephone counseling session four to 6 weeks postpartum. On the other hand, participants in the control group were only provided with postnatal routine care. The study’s outcome measures were PTSD, depression, and anxiety symptoms. The study’s findings revealed that at the three-month follow-up, the participants in the intervention group demonstrated markedly higher improvement in PTSD, depression, and anxiety symptoms than those in the control group. In addition, the PTSD, depression, and anxiety symptoms drastically reduced from 72 hours to four to 6 weeks and three months postpartum in the intervention group. However, the control group had no significant change during the same period.
Strengths of The Study
The strengths of the study by Asadzadeh et al. (2020) include having a relatively large sample size, employing a randomized control trial design, and using various screening tools for data collection. The study used a large sample size of 90 pregnant women. Andrade (2020) explains that a large sample size increases the generalizability of the findings as it provides the researchers with more statistical power. Besides, a large sample size provides more reliable and accurate results and enables the integration of information from a lot of people and data sources.
A randomized control trial design allowed for a direct comparison of implementing Gamble and colleagues’ intervention and routine care between the two groups. This provided a real representation of how the proposed approach impacts the mental health and well-being of women who have experienced a traumatic childbirth (Sharma et al., 2020). Moreover, employing an RCT trial helped to prevent bias, given that the participants were randomly selected into an intervention or control group, and the two groups were well-balanced with 45 women each. Therefore, it is highly likely that the only variables contributing to the differences in PTSD, anxiety, and depression symptoms between the groups are the effects of the interventions used for each group.
The study used a variety of screening tools to collect data on symptoms of anxiety, PTSD, and depression symptoms among the participants. Data was collected from both the intervention and control groups using Hamilton’s anxiety rating scale, Edinburgh postnatal depression scale, and PCL-5 within 72 hours, four to 6 weeks, and three months post-delivery. The psychometric properties of Hamilton’s anxiety rating and Edinburgh postnatal depression scales have been established in various populations, making them ideal for this study. Furthermore, the PCL-5 has acceptable validity and reliability and had an internal consistency of 0.76 in this study’s sample.
Weaknesses of the Study
Despite the strengths mentioned above, the study had some weaknesses. One of the weaknesses was that the study only used self-report questionnaires to measure the outcome variables. Dang et al. (2020) assert that self-report questionnaires are liable to several biases and limitations, which jeopardize the reliability and validity of the data collection measures. This data collection method could have created social desirability bias, which occurs when the participants are not honest in their answers, particularly on sensitive questions involving their mental health. In addition, it was subject to response bias, which is an inclination by a participant to respond in a particular manner despite the question. For instance, the participants may have been more likely to reply “yes” without considering the question.
Another limitation was that the researchers only employed double-blinding for the assessors and data analyzer but did not do the same for the participants and clinicians. A non-double-blinded clinical trial could have affected the participants’ behavior due to the knowledge of the assigned interventions. Subsequently, this would have affected the participants’ responses with respect to the subjective outcome measures. Bhatia et al. (2021) explain that one effect of revealing the study allocation includes creating potential distrust and confusion among the participants, particularly if they were randomized to the control group. Besides, the awareness that one received a placebo can lead to a loss of trust in the research team and their clinical relationships, particularly if the participants’ clinicians are involved in the study.
Proposed Changes to Improve the Quality of the Study
The study quality could have been improved by using participants from a larger setting, given that the participants were obtained from three governmental antenatal clinics. Using a larger setting, like five or more antenatal clinics, including private ones, can give a better representation of the population and more accurate results. Besides, I would recommend a longer follow-up period of six to 12 months in addition to the three months used in the study. Cuzick (2022) explains that linking long-term data to earlier clinical records can provide additional findings for an RCT and valuable new findings that are more reliable than non-randomized studies. Thus, having a long-term follow-up would have helped to assess the long-term impact of the intervention with respect to the outcome measures and provide more valuable information on its long-term impact on women with traumatic birth experiences.
The data collection method can be improved by integrating structured clinical interviews into the self-report questionnaires. I would recommend structured clinical interviews as they help the researchers assess the variables more objectively to establish the clinical significance of the intervention. Besides, structured research interviews are designed specifically for collecting facts, which would have prevented social desirability and response biases. The design and specific questions in the structured interviews provide a tool to standardize the interview style and ensure the collection of adequate data for accurate scoring. I would further recommend that the individual question items in the structured research interviews include fact-based and very concrete queries purpose to obtain exact clinical data to answer specific questions on patients’ PTSD, anxiety, and depression symptoms.
An RCT was the most suitable research design method for this study as the study outcomes can be linked with greater confidence in the intervention being investigated. Nonetheless, the design can be improved by double-blinding the participants to minimize bias. This is because there was a risk that knowledge of the intervention assignment may have influenced the participants’ and clinicians’ outcome ratings (Bhatia et al., 2021). Moreover, double-blinding can even out the placebo effect. Double-blinded trials have been attributed with smaller and more accurate estimates of intervention effect sizes than non-double-blinded RCTs.
Final Summary of the Implications of This Study for Nursing Practice
Asadzadeh et al. (2020) establish that Gamble and colleagues’ midwife-led brief counseling approach is effective in alleviating psychological distress in women with traumatic childbirth experiences. Midwives provide social support to women as most have experienced how traumatic childbirth affects a woman’s mental health. Traumatic childbirth is a major risk factor for developing PTSD, depression, and anxiety disorders in postpartum women. Thus, nurses and midwives should be impacted with knowledge and skills in screening postpartum women to identify those who have had a traumatic childbirth. The midwife-led brief counseling intervention can help accelerate recovery of depression, anxiety, and PTSD in postpartum women. It can also help prevent complications from these disorders and ensure women can raise their children optimally.
Conclusion
My DNP practicum QI project entails incorporating peer support in trauma-informed care to accelerate the recovery of patients who have experienced traumatic experiences. Asadzadeh et al. (2020) conducted an RCT to evaluate the impact of a brief midwife-led counseling approach in reducing PTSD, depression, and anxiety symptoms in women with traumatic childbirth experiences. The study’s strengths lay in the large sample size, study design, and data collection tools used. However, the study’s limitations included using only self-report questionnaires and employing a non-double-blinded clinical trial for the participants and clinicians. Nonetheless, this can be improved by using structured clinical interviews and double-blinding the participants to reduce bias. The study establishes the significance of peer support in reducing PTSD, anxiety, and depression symptoms in postpartum women after a traumatic birth experience.
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
Asadzadeh, L., Jafari, E., Kharaghani, R., & Taremian, F. (2020). Effectiveness of midwife-led brief counseling intervention on post-traumatic stress disorder, depression, and anxiety symptoms of women experiencing a traumatic childbirth: A randomized controlled trial. BMC Pregnancy and Childbirth, 20(1). https://doi.org/10.1186/s12884-020-2826-1
Bhatia, A., Appelbaum, P. S., & Wisner, K. L. (2021). Unblinding in Randomized Controlled Trials: A Research Ethics Case. Ethics & Human Research, 43(2), 28–34. https://doi.org/10.1002/eahr.500084
Cuzick, J. (2022). The importance of long-term follow-up of participants in clinical trials. British Journal of Cancer, 128(3), 432–438. https://doi.org/10.1038/s41416-022-02038-4
Dang, J., King, K. M., & Inzlicht, M. (2020). Why Are Self-Report and Behavioral Measures Weakly Correlated?. Trends in Cognitive Sciences, 24(4), 267–269. https://doi.org/10.1016/j.tics.2020.01.007
Sharma, N., Srivastav, A. K., & Samuel, A. J. (2020). Randomized clinical trial: Gold standard of experimental designs – importance, advantages, disadvantages, and prejudices. Revista Pesquisa em Fisioterapia, 10(3), 512-519. https://doi.org/10.17267/2238-2704rpf.v10i3.3039
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Week 10: Assignment 2 Article Critique
This is Assignment 2 for the course, but the first Assignment this week.
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. Your final analysis will be a 5- to 7-page paper that includes the following:
- A brief, 1- to 2-paragraph overview of the quantitative study that you selected. FOR THE PURPOSE OF THIS ASSIGNMENT THE ARTICLE CANNOT BE A SYSTEMATIC REVIEW. Review the Walden University library information on a systematic review https://academicanswers.waldenu.edu/faq/145443Links to an external site.
- 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 2–3 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 you would recommend to improve the quality of the this quantitative 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.
Resources
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
The Assignment: (5–7 pages)
- Select a quantitative research article from the body of literature that you have reviewed related to the practice gap that you have identified and for which you will develop for your DNP Project.
- Review the various quantitative research designs presented in the textbook readings and research articles.
- Consider the research design used in your selected article. Ask yourself the following questions:
- Is the design appropriate for the study? Why or why not?
- 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-20293632Links to an external site.). All papers submitted must use this formatting.
By Day 7
Submit your Assignment by Day 7 of Week 10.
submission information
Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the Turnitin Drafts from the Start Here area.
- To submit your completed assignment, save your Assignment as WK10Assgn2+last name+first initial.
- Then, click on Start Assignment near the top of the page.
- Next, click on Upload File and select Submit Assignment for review.
Rubric
NURS_8201_Week10_Assignment2_Rubric
| Criteria | Ratings | Pts | ||||
|---|---|---|---|---|---|---|
| This criterion is linked to a Learning OutcomeWrite a 1- to 2-paragraph overview of the study selected. |
|
25 pts | ||||
| This criterion is linked to a Learning OutcomeExplain two to three strengths of the study and support for your selection. Be specific.Explain two to three weaknesses of the study and support for your selection. Be specific. |
|
80 pts | ||||
| This criterion is linked to a Learning OutcomeExplain the proposed changes that you would recommend to improve the quality of the study. Capitalize on the strengths to improve on the weaknesses. Be specific and provide examples. |
|
100 pts | ||||
| This criterion is linked to a Learning OutcomeWrite a final summary of the implications of this study for nursing practice. |
|
50 pts | ||||
| This criterion is linked to a Learning OutcomeWritten Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction is provided which delineates all required criteria. |
|
15 pts | ||||
| This criterion is linked to a Learning OutcomeWritten Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation |
|
15 pts | ||||
| This criterion is linked to a Learning OutcomeWritten Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list. |
|
15 pts | ||||
| Total Points: 300 | ||||||
