research crituque shenna throop stephanie monroe ferris...

Running head: RESEARCH CRITUQUE 1

RESEARCH CRITUQUE

Shenna Throop

Stephanie Monroe

Ferris State University

RESEARCH CRITIQUE 2

Abstract

In an effort to determine the strengths, weaknesses, and validity of the research behind the

article, Impact of a Nurse-Driven Mobility Protocol on Functional Decline in Hospitalized Older

Adults, a critique of the evidence and research presented was completed. Using the book

Foundations of Nursing Research, by Rose Nieswiadomy, multiple aspects of the research study

are evaluated. Findings indicated the research was valid however, could have been strengthened

by using a larger population sample and taking co-morbidities into account. Overall the research

is valid, reliable, and provides strong evidence to the fact that use in a clinical setting should be

adapted.

Keywords: critique, research validity, mobility, nurse-driven

RESEARCH CRITIQUE 3

Research Critique

The following is a critique of the article, Impact of a Nurse-Driven Mobility Protocol on

Functional Decline in Hospitalized Older Adults. The article will be evaluated using

Foundations of Nursing Research, by Rose Nieswiadomy, in an effort to determine the strength

of the research process utilized. The critique will evaluate the internal and external validity of the

research completed in the article, as well as the strengths and weaknesses of the research process.

A determination will be made on whether or not the research is strong enough to be used as

evidence.

Purpose and Problem

Evidence

“The purpose of the study was to determine the impact of a nurse-driven mobility

protocol on functional decline” (Padula, Hughes & Baumhover, 2009, P.325). This is the

researcher’s purpose statement and is the first sentence of the abstract. The purpose statement is

written in declarative form. The second sentence of the abstract defined the independent and

dependent variables. The researcher introduced the problem statement to the reader at the end of

the introduction. The problem statement is also written in declarative form. The problem

statement is stated again in the section titled study purpose. In the abstract the researcher did not

state the population that is being studied but did include the population “hospitalized older

adults” (Padula, Hughes & Baumhover, 2009, p. 326) in the section titled study purpose.

Support

There are four parts to writing a correct problem statement these include; written in

integrative form, must be empirically testable, must include the population being tested and the

variable(s). When the statement is written in integrative form it is presented in question format.

RESEARCH CRITIQUE 4

This provokes the reader to seek an answer. The next criteria to be met of a problem statement

are that it is empirically testable. This means the data being tested by the researcher contains

variables that are measurable. The next two parts of a problem statement are the population and

the variables. Both the population that is being tested and the variable(s) need to be included in

the statement. The population should be narrowed down to an exact group being study

(Nieswiadomy, 2008).

Analysis

The purpose and problem statement of the research article met two of the three criteria’s

of a correctly written statement. The statement in the article correctly identified the variables

being tested; the mobility protocol and the functional decline. The variables being tested are

empirically tested by the researcher. “A demographic data collection sheet was developed

specifically for this research” (Padula, Hughes & Baumhover, 2009, p. 328). Information on the

collection sheet includes measureable data such as number of times out of bed, type of activity

and amount of oxygen used. The two criteria’s that were not met in the problem and purpose

statement were identifying the population and writing the statement in integrative form. The

population was not identified in the purpose statement but was in the problem statement later in

the article. The reader should be able to identify the population being studied early on in the

reading. The second part missing was that the statement was written in declarative form instead

of integrative form (Nieswiadomy, 2008). In conclusion the problem and purpose statement was

weak because it lacked two of the four areas to be considered correctly written.

RESEARCH CRITIQUE 5

Review of Literature

Evidence

The article Impact of a Nurse-Driven Mobility Protocol on Functional Decline in

Hospitalized Older Adults had a reference list of 28 sources, both classic and current. All

information that the authors presented from other sources was completed in paraphrase form.

The authors also listed, although limited, opposing data. The sources used by the authors were

mainly from primary sources; I noted one book reference and 27 references from various

journals (Padula, Hughes, & Baumhover, 2009).

Support

Foundations of Nursing Research, indicates that literature review is one of the most

difficult things to critique of a research article (Nieswiadomy, 2008). There are key components

that should be examined including; the presence of mainly primary sources, both supporting and

opposing viewpoints, the article should contain paraphrases in place of direct quotes, both classic

and current sources should comprehensive and concise, all sources that appear in the article

should also be found on the reference list, and sources should be relevant to the topic at

hand (Nieswiadomy, 2008). Primary sources should be used over secondary sources due to the

fact that “secondary sources may misinterpret information or leave out important information

that might me valuable to the reader” (Nieswiadomy, 2008. p.91). Journal articles have been

found to be a good indicator of primary source material and are usually critically appraised.

Literature review is of the utmost importance prior to any study, due to the fact that the

researcher should find out what is already known about the specific topic that they intent to

study.

RESEARCH CRITIQUE 6

Analysis

Overall, the Impact of a Nurse-Driven Mobility Protocol article, contained strong

research. The authors discussed opposing viewpoints stating, “Although functional decline

during hospitalization is well documented, Callen at al found little research to specific to

mobility changes during hospitalization” (Padula, Hughes, & Baumhover, 2009). Outside of this

one literature review, there was no evidence of any other possible opposing viewpoints or data;

this could have been stronger. One of the strengths found while evaluating the Nurse –Driven

Mobility Protocol article is the fact that the authors used only paraphrasing when referring to

their literary sources, there were no direct quotes, which as Nieswiadomy states, is an important

strength (2008). The reference list contained 28 sources; it appears that all of the sources used

throughout the article are found on the reference page. Nieswiadomy also indicated that the

reference list should be free of citation errors (2008). The article reference page has a few

grammatical errors, but otherwise appears complete. The authors of the article used primary

sources, outside of one book, and also utilized both current and classic sources; both indicated as

strengths by Nieswiadomy (2008).

Theoretical / Conceptual Model

Evidence

Evidence from a previous study provided the framework for this research study. The staff

at the hospital where the study took place had recently received training in a multicomponent

geriatric program called geriatric friendly environment through nursing evaluation and specific

interventions for successful healing (GENESIS). The training session took place over three days

and an additional four hour refresher course was taken before the study. Nurses and nurse

assistances received the GENESIS training. Incorporated into the GENESIS training is the

RESEARCH CRITIQUE 7

mobility protocol. The mobility protocol consists of having the registered nurse monitor activity

orders and to question orders that hinder ambulation. The nurse assistants are instructed to assist

the patients with ambulation three to four times a day and assist patients into the chair for meals.

The mobility protocol is what is being tested in this research study and acts as the framework.

Other than the mobility protocol there is not a nursing or non-nursing theory guiding the study

(Padula, Hughes & Baumhover, 2009).

Support

“A framework for a research study helps organize the study and provides a context for

the interpretation of the study findings” (Nieswiadomy, 2008. P. 111). There are two types of

frameworks used in quantitative studies theoretical and conceptual. Theoretical framework is

used when the researcher bases the study off one theory. Conceptual framework in contrast bases

the study of more than one theory. “A theory is a set of related statements that describe or

explains phenomena in a systematic way” (Nieswiadomy, 2008. P. 107). It is important that

research studies are based on theories because theories provide a foundation to the study. Once

the researcher has identified a theory to guide the study, knowledge is increased in a systemic

way. (Nieswiadomy, 2008).

Analysis

The Framework for this study was not guided by and existing theory or nursing theory

but rather an existing tool used in a previous study. The study was well organized and pertained

to the study. The researcher could strengthen the foundation of the study by incorporating an

existing theory or nursing theory (Nieswiadomy, 2008). The relationship between the functional

status and quality of life is clearly defined but lacks support. In conclusion the framework for

this study is weak because the study lacked the support of an existing theory.

RESEARCH CRITIQUE 8

Hypothesis and Research Questions

Evidence

The article Impact of a Nurse-driven Mobility Protocol on Functional Decline in Hospital

Older Adults contains two hypotheses. “Study hypothesis were as follows: (1) older adults who

participate in a mobility protocol will maintain or improve functional status from admission to

discharge and (2) older adults who participate in a mobility protocol will have a reduced LOS”

(Padula, Hughes, & Baumhover, 2009, p. 327). Both hypotheses are stated under the purpose

section of the article. Hypothesis one and two identified older adults as the population. Both

hypotheses contain two variables. Variables in hypothesis one are mobility protocol and

functional stasis. Variables in Hypothesis two are mobility protocol and length of stay (LOS).

There are no identified research questions. (Padula, Hughes, & Baumhover, 2009).

Support

In a research study there maybe more than one hypothesis and within each hypothesis

there must be at least two variables. The hypothesis should be worded clearly, be stated in

present time, and be in declarative form. The problem statement and the hypothesis are closely

related. The problem statement asks a question and the hypothesis provides an answer. The

variables in the hypothesis should be the same as the variable(s) in the problem or purpose

statement. Other aspects of a hypothesis are that it can be empirically testable and each

hypothesis contains only one prediction. (Nieswiadomy, 2008).

Analysis

The article meets most of the expectations of a quality hypothesis. The article contains

two hypotheses. Both hypotheses one and two are clear, in declarative form and are empirically

testable. The hypotheses are considered simple hypotheses because both include one independent

RESEARCH CRITIQUE 9

and one dependent variable (Nieswiadomy, 2008). The hypotheses reflect the purpose statement.

The variables in the hypotheses are those of the purpose statement. Both the hypotheses and the

purpose statement identified older adults as the target population. Another aspect met is that the

hypotheses are derived from the framework of the research study, the framework being previous

studies on mobility protocol. There are two aspects that were not met. The first aspect is that the

hypotheses are both written in future tense not present. The second aspect is that hypothesis one

contains two predictions instead of one. It states that the “mobility protocol will improve or

maintain” as predictions (Padula, Hughes, & Baumhover, 2009, p. 327). Overall this section of

the research article was well done. Adding the two missing aspects of the hypotheses would

strengthen the hypotheses.

Research (Study) Design

Evidence

The article Impact of a Nurse-Driven Mobility Protocol on Functional Decline in

Hospitalized Older Adults, stated that the “study used a nonequivalent control group

design” (2009, p. 327). This is evidenced by the fact that the researchers examined patients that

were 60 years of age and older, that were on one of two nursing floors, and having been admitted

with a medical diagnosis (Padula, Hughes, & Baumhover, 2009). The article also indicated that

the research nurse screened patient records for eligibility prior to enrollment into the study and

that they were not randomly selected. As part of the selection process, of the 84 patients selected

by the research nurse, 34 were removed from the trial for reasons that included; personal

withdrawal, transfer off of the unit, discharge before discharge data could be collected, and

occurrence of a disqualifying procedure or condition (Padula, Hughes, & Baumhover, 2009). The

RESEARCH CRITIQUE 10

researchers used the GENESIS as the test method for the treatment group with the control group

receiving no special ambulatory guidelines (Padula, Hughes, & Baumhover, 2009).

Support

When completing a research project, using an experimental design is essential when

looking for a cause-and-effect relationship (Nieswiadomy, 2008). Nonequivalent control group

design is one type of experimental design that falls under the Quasi-experimental design group

(Nieswiadomy, 2008). Factors that are indicative of this design group include, “no random

assignment of subjects to the experimental and comparison groups” (Nieswiadomy, 2008, p.

155), instead researches usually use groups that are already intact as their test and control groups.

Of the threats to internal validity often found with experimental design groups, the nonequivalent

control group design can control history, testing, maturation, and instrument change

(Nieswiadomy, 2008). “The biggest threat to internal validity is selection bias; the two groups

may not have been similar at the beginning of the study” (Nieswiadomy, 2008, p. 111). Testing

statistically for differences in the groups can be done in an effort to increase or decrease

confidence in the cause-and-effect relationship between variables (Nieswiadomy, 2008).

Analysis

The article lays out the type of research design used quite clearly, as well as the process

they used to screen participants, as well as withdrawal reasons. Both sample size and site were

discussed, indicating that a total of 50 patients are being used as test and control subjects and that

they are from two different floors within The Miriam Hospital (Padula, Hughes, & Baumhover,

2009). The authors of the article clearly stated what type of research design they used,

nonequivalent control group design, and then went on to explain that they screened their

participants prior to entry into the study, and that they were not chosen randomly, all elements of


the design group they stated they were using (Nieswiadomy, 2008). The authors also addressed

some of the threats to internal validity by using, SigmaStat statistical program, in an effort to

detect differences within the groups (Padula, Hughes, & Baumhover, 2009). According to

Nieswiadomy, quasi-experimental research design groups should have control over history,

testing, maturation and instrument change (Nieswiadomy, 2008). The article specifically states

their control over the instruments that they are using, the testing process, and participant’s

history; however maturation was not as well controlled as it should have been. This is indicated

by the researcher’s lack of mentioning whether or not participants were screened for changes that

occurred during their time in the hospital that could have made them ineligible. Overall, the

article had the majority of components required when stating a research design. The research

design was appropriate for testing the hypotheses however, additional elements, such as how

maturation was controlled would have added strength to this section.

Sample and Sampling Methods

Evidence

The article, Impact of a Nurse-Driven Mobility Protocol on Functional Decline in

Hospitalized Older Adults, clearly stated the sample population and who it consisted of. “The

researchers recruited a convenience sample of adults 60 years or older, who were admitted with

medical diagnoses to 1 of 2 nursing units” (Padula, Hughes, & Baumhover, 2009, p. 327). The

researchers listed inclusion criteria, cognitive status, and stated the reason they chose medical

patients was to, “avoid potential limitations in mobilization frequently associated with the

surgical experience” (Padula, Hughes, & Baumhover, 2009, p. 327). Out of 453 patient records

that were screened by an research nurse, the article stated that 84 were eligible for enrollment,

but that 34 were withdrawn from the study due to various reasons (Padula, Hughes, &


Baumhover, 2009). The article also stated reasons for withdrawal as well as the fact that sample

size statistics were conducted to determine adequate power (Padula, Hughes, & Baumhover,

2009).

Support

A sample is used more often in research studies than a population due to the inability to

gain access to an entire population. When a sample is used, it is meant to represent a certain

population (Nieswiadomy, 2008). Determining an accessible population is very important for

nursing research, and by stating the group from which the sample was chosen, the researcher is

allowing the readers to come to their own conclusion in regards to generalizability of the study

findings (Nieswiadomy, 2008). There are two different types of sampling methods; probability

and non-probability. Probability sampling involves the random selection of members from a

certain population, whereas non-probability sampling involves the selection of participants in a

non-random way (Nieswiadomy, 2008). The size of the sample group used for a research study is

important however, there is no pre-determined number. Large sample sizes may be more

indicative of the population of interest, whereas small sample sizes are useful if the population is

very alike on all variables other than the one being measured (Nieswiadomy, 2008).

Nieswiadomy stated, that one problem with non-random sampling is the opportunity for

sampling bias, which occurs when samples are not carefully selected (2008). Both the target

population and the accessible population should be clearly stated in a research

report (Nieswiadomy, 2008).

Analysis

The article appropriately indicated that the target population was hospitalized older adults

and that the sample was taken from two nurse units in one hospital. A strength of the article was


that it indicated they used non-probability sampling methods when choosing participants, by

stating exactly how they chose their test and control groups and why. Other strengths of this

article include, stating inclusion information and screening process. Sample size was stated,

which according to Nieswiadomy is essential however, the sample size used (25 patients in the

test group and 25 patients in the control group) was small. This is a weakness of this study due to

the fact that it is difficult to generalize the results from 25 test subjects onto the entire population

of hospitalized older adults. Although the researchers laid out their sample selection and process,

the fact that the sample size was so small is a hindrance to the quality of this report.

Data Collection Methods

Evidence

The functional method used for the study indicated in, Impact of a Nurse-Driven Mobility

Protocol on Functional Decline in Hospitalized Older Adults, was a “demographic data

collection sheet “ (2009, p. 328).

“The data collection sheet was developed specifically for this research and included such

information as age; gender; primary diagnosis; use of assistive devices; fall risk

assessment; presence of any restrictions to mobility (eg, bed rest order, foley, oxygen use,

restraints,); use of occupational or physical therapy; LOS; first and number of times out

of bed; and type of out of bed activity” (Padula, Hughes, & Baumhover, 2009, p. 328).

This study also used utilized a modified Barthal Index (BI) and the Get Up and Go test (Padula,

Hughes, & Baumhover, 2009). “The BI is a subjective measure that measures the capacity of an

individual to perform identified ADL’s” (Padula, Hughes, & Baumhover, 2009, p. 328). “The

Get Up and Go test is an objective assessment that measures subjects’ ability to stand from an

armchair, walk 3 m, turn around, return, and sit down in the chair again. Subjects were rated on


admission and again at discharge on a one to four scale, one being “able to rise in a single

movement” and four being unable “to rise without assistance” (Padula, Hughes, & Baumhover,

2009, p. 328). In addition to the data collection sheet, BI, and the Get Up and Go test, Padula,

Hughes, and Baumhover utilized a Mini-Mental state examination in an effort to routinely

evaluate subjects’ cognitive status (2009).

Support

“Observation research is concerned with gathering data through visual observation”

(Nieswiadomy, 2008, p. 245). In order for observations to be a reliable method of research, there

must be a carefully planned study with specific behaviors to be examined, specific people who

will do the observing, what observational procedures will be utilized, as well as the relationship

between the observer and the subjects (Nieswiadomy, 2008). The hypothesis or research question

of a study should clearly state what will be observed (Nieswiadomy, 2008). Should other people

be used to collect, or help to collect data, training sessions are necessary in an effort to increase

reliability of the observations (Nieswiadomy, 2008). “The researcher must determine how and

when observations will be made. The degree of structure of the observations and the period for

gathering data must be considered” (Nieswiadomy, 2008, p. 246). Most research studies are a

combination of structured and unstructured observations, as this combination provides both

quantitative and qualitative types of data (Nieswiadomy, 2008). An additional component to

observational research is the type of sampling; event or time sampling. “Event sampling involves

observation of an entire event whereas time sampling involves observations of events or

behaviors during certain specified times” (Nieswiadomy, 2008, p. 246). Finally, “there are four

ways to categorize observation research according to the relationship between the observer and


the subjects: (a) nonparticipant observer (overt), (b) nonparticipant observer (covert), (c)

participant observer (overt), and (d) participant observer (covert)” (Nieswiadomy, 2008, p. 247).

Analysis

The article, Impact of a Nurse-Driven Mobility Protocol, describes an observational

research method. This is indicated by the use of a demographic data sheet, the BI, and the Get

Up and Go test, which were all described in detail. The article, unfortunately did not state why

they chose these methods or if they had considered any other choices. An identified strength of

this article is that the data collector was described, as well as what type of training they went

through prior to the initiation of the research. It was also noted that patients were screened for

eligibility and then eligible patients were provided an informational letter prior to the beginning

the study (Padula, Hughes, & Baumhover, 2009). It is obvious based on information found in

the article that a time sampling was used as part of this observation method. Although the article

stated that an informational letter was handed out to all eligible participants, it was unclear what

information was divulged to them. Did participants know or interact with the data collector? Did

participants know which group they were a part of, the control or test group? Did the nurses who

had been trained in GENESIS inform patients of this fact? The article did an appropriate job at

describing the type of data collection method they used, what instruments were involved, the

notification of participants, and the training of the nurses and data collector.

Measurement and Collection of Data

Evidence

For this research study the data was collected by an advanced practice nurse who

specializes in gerontology and geriatrics and a nurse specialized in research nursing. Instruments

used were a demographic collection sheet, the modified BI, the Get Up and Go test, and a Mini-


Mental State Examination. The demographic data collection sheet organized information such as

age, gender, primary diagnosis, use of assistive devices, fall risk assessment and other general

information related to patient’s mobility. The BI was used to measure the patient’s ability to

perform activities of daily living (ADL). A five point rating scale was used. The patients were

tested at the time of admission and at discharge. “Researchers have proposed the BI as the

standard for clinical and research purposes” (Padula, Hughes & Baumhover, 2009, p. 328). The

Get Up and Go test is a measure of the patient’s ability to stand from a chair, walk 3 m then turn

around and sit down. “The get up and go test has been shown to be reliable and valid, and is

reported to correlate with the BI at r= -0.78” (Padula, Hughes & Baumhover, 2009, p. 328). The

Mini-Mental State Examination was completed multiple times throughout the study to evaluate

cognitive status. The nurses “practiced screening for eligibility and scoring using the study

instruments prior to data collection and continued until acceptable reliability was achieved”

(Padula, Hughes & Baumhover, 2009, p. 328).

Support

The measurement and the collection of data is a very important aspect to a research study.

The researcher must clearly state who is conducting the research, how it is being collected,

where and when it was conducted. It is also important that the researcher uses the appropriate

level of measurement to measure the variables. There are four levels of measurement that a

researcher can use, Nominal, ordinal, interval and ratio. The level of data chosen depends on the

precision of data that is needed to appropriately test and support the hypothesis. Research

instruments are the tools used to measure the data. The instruments used should be stated in the

study. The researcher may use existing instruments or develop a new one. Pilot studies should

take place prior to the study to examine different characteristics of the instruments; this is


especially important when a new instrument is used. Information confirming the reliability and

validity should be provided in the article (Nieswiadomy, 2008).

Analysis

Overall the research article was well done although there were few areas identified for

improvement. The article clearly stated who was collecting the data, what was collected, when it

was collected, and where and how it was collected. The researcher used a combination of three

levels of measurement. The majority of the measurements were nominal such as demographic

data that was described on the collection sheet. The measurements from the Get Up and Go test

and BI could be ordinal or nominal. Measurements such as vital signs were interval

(Nieswiadomy,2008). The chosen combination of levels of measurement was appropriate for

measuring the variables within the study. The instruments used in the study were clearly

described. All of the instruments used in the study were existing instruments. “The use of an

already tested instrument helps connect the present study with the existing body of knowledge on

the variables” (Nieswiadomy, 2008, p. 215-216). One area that adds strength to the study is that

pilot studies were done by the research nurses prior to using the instruments. The instruments

used were stated to be reliable and valid by previous researchers. Reliability was expressed in

correlation coefficients. The type of reliability used was stability. The researcher found these

instruments reliable because they have been found consistent and reliable over time by other

researchers. The type of validity used was content. The instruments used were found to be valid

in literature and by experts in the subject area such as the advanced practice nurse working who

was in charge of collecting the data. This section of the research study is strong and is well

written.


Descriptive Statistics

Evidence

The article Impact of a Nurse-driven Mobility Protocol on Functional Decline in

Hospitalized Older Adults uses a variety of descriptive statistics. The descriptive statistic most

frequently used throughout the article is percentage. Percentage was used in relationship to the

population in the study. There were two tables displayed in the article. The first one represented

the nursing staff on the unit and the second one represented Barthel scores. Another statistic that

was used is range. In the results section of the article the range was used to describe the ages of

the patients involved in the study. The relationship between the measurement tools was

represented by “r”. The Get Up and Go test correlates with the BI at r= -0.78 (Padula, Hughes &

Baumhover, 2009).

Support

“Descriptive statistics allow the researcher to examine the characteristics, behaviors, and

experiences of study participants” (Nieswiadomy, 2008, p. 269). There are four different

categories of descriptive statistics: measures to condense data, measures of central tendency,

measures of variability, and measures of relationships. Measures to condense data include

graphs, and percentages. A measure of central tendency is a way to describe an average of

common value. Examples of central tendency are mode, median and mean. Measures of

variability are used to describe how the values are distributed. Range and percentile are both

examples of ways to measure variability. Measures of relationships are used to determine the

correlation between variables; examples of this are contingency tables and correlation

coefficients (Nieswiadomy, 2008). “A correlation coefficient of -1.00 indicates a perfect negative

relationship, +1.00 indicates a perfect positive relationship, and 0 indicates the absence of any


relationship. Correlation coefficients are frequently symbolized by the letter r” (Nieswiadomy,

2008, p. 283).

Analysis

The descriptive statistics in the article were clearly displayed in the text and the two

tables. The information in the tables was in relation to the information in the text. The statistic

that was most used in the article was percentage. Percentage was used to give the reader a

condensed value in regards to the population (Padula, Hughes & Baumhover, 2009). It is easier

for the reader to understand what 40% means rather than a number alone. The article did not

include measures of central tendency. The article did include range which is a measure of

variability. The range described the variance in age among the patients in the study (Padula,

Hughes & Baumhover, 2009).This information was important to the reader because the study

focused on mobility of the patients, and mobility ranges dramatically among age groups. The

article included two measures of relationships; contingency tables and correlation coefficients.

There were two contingency tables. The first table displayed the amount of time nursing staff

spent with patients in both the control and treatment group each day. The table also included the

percent of registered nurses and nurse assistants who worked with each group on a daily basis.

The relationship among the two groups was equal. The second table compared Barthel scores

among the two groups at three different times in the study. (Padula, Hughes & Baumhover,

2009). The correlation coefficients used in the article of r=-0.78 “denotes a negative relationship

and indicates that as one variable increases, the other variable tends to decrease” (Nieswiadomy,

2008, p. 283). The descriptive statistics used in the article were an appropriate description of the

demographic data within the article and displayed the relationships among the variables.


Inferential Statistics

Evidence

The article, Impact of a Nurse-Driven Mobility Protocol on Functional decline in

Hospitalized Older Adults, stated that they used inferential statistics to calculate differences

between the treatment and control groups on the dependent variables (Padula, Hughes, &

Baumhover, 2009). These variables included, admission fall risk scores of both the control and

treatment groups, Barthel admission and discharge scores of both groups, admission and

discharge scores for the Up and Go test for both groups, and overall length of stay for both

groups. Based on statistical analysis of both groups upon admission to, and again on discharge

from the hospital, through inferential statistics, the following conclusions were obtained; fall risk

scores were lower for the treatment group, but the difference was said not to be significant (7.5

treatment vs. 9.5 control; P=.07), fall risk level of the treatment group was also lower which was

suggestive that the treatment group was at a lower fall risk on admission (1.86 treatment vs. 2.4

control; P=.04); Barthel scores at the time of discharge showed marked improvement for the

treatment group (P= .05) with control groups improvement proving not significant at discharge;

scores for the Up and Go test improved marginally for both groups but end results were not

significant (Padula, Hughes, & Baumhover, 2009). As for overall length of stay, it was proven

that the treatment group’s was significantly shorter (4.96 days treatment vs. 8.72 days control;

P= <.001) (Padula, Hughes, & Baumhover, 2009).

Support

“Inferential statistics are based on the laws of probability” (Nieswiadomy, 2008, p. 295).

The idea is that the researcher wishes to prove that chance is not the reason for the relationships

found in research (Nieswiadomy, 2008). “The larger the difference found between groups, the


lower the probability is that the difference occurred by chance” (Nieswiadomy, 2008, p. 295).

Statistical analysis can be used to test null hypotheses, not a research hypothesis. However, you

could, using statistical analysis, be able to prove that a null hypothesis is false, thereby providing

support for the research hypothesis (Nieswiadomy, 2008). “If small differences or low

correlations are found, chance is considered to be the reason, and the null hypothesis is not

rejected. If the results of the analysis show that the difference or correlation is too large to be the

result of chance, the null hypothesis is rejected” (Nieswiadomy, 2008, p. 300). Support of a

directional research hypothesis, what the researcher is hoping to prove, can be supported if the

null hypothesis is rejected. The p value that is obtained from collected data is compared to the set

level of significance (usually p= .05), if the obtained p value is less than the let level of

significance the null hypothesis can be rejected. Should the p value be larger than the set level of

significance, the researcher would be unable to fail the null hypothesis (Nieswiadomy, 2008).

Analysis

The authors of the article, Impact of a Nurse-Driven Mobility Protocol on Functional

decline in Hospitalized Older Adults, stated very clearly that they were in fact using inferential

statistics on their dependent variables. Sigmastat statistical program was used (Padula, Hughes,

& Baumhover, 2009). All calculated values were mentioned in the results portion of the article,

and appropriate conclusions were gathered however, it should be noted that the level of

significance was never mentioned. The researchers were able to make direct correlation between

the data and its significance. The results were discussed within the article as well as displayed in

a table. There was no discussion of a null hypothesis or chance being a factor however, the

researchers stated that the statistical analysis lead to supporting both original hypotheses. The

article could have been made stronger if the level of significance had been stated.


Study Findings

Evidence

The discussion section of the article impact of a Nurse-Driven Mobility Protocol on

Functional Decline in Hospitalized Older Adults clearly states the results of the study.

Hypothesis one and two are both addressed. The research study supported both hypothesis one

and two and was found to be consistent with the literature. The limitations of the study are also

addressed in the discussion section of the article. The author stated “limitations of the study

include the recognition that the lower functional level of the control group, though not

significant, could have contributed to increased LOS and/or later ambulation” (Padula, Hughes &

Baumhover, 2009, p. 330). The author suggested that further studies be done to address the

impact that disease has on the mobility and function decline due to the fact that many of the

patients had multiple comorbidities. The conclusion section of the article clearly states, “research

supports existing literature that identifies that functional decline actually begins in the

preadmission period. Finding suggest that early and ongoing ambulation in the hallway may be

an important contributor to maintaining functional status during hospitalization and to shortening

LOS” (Padula, Hughes & Baumhover, 2009, p. 330).

Support

In a research article the author should present the research finding objectively. The author

may “interject some subjective interpretation of the data” when discussing the findings

(Nieswiadomy, 2008, p. 330). The results from the study should be discussed in relation to the

hypothesis and the literature that was previously discussed in the article. If the study findings do

not support the hypothesis the author should state why this may have happened and give


suggestions for further research studies. All information stated in the discussion in findings

should be clear and concise (Nieswiadomy, 2008).

Analysis

The discussion of the research findings was clear and concise. The author separately

addressed both hypotheses one and two. The relationship between the hypothesis, literature, and

study findings were well stated. The author identified the study’s limitations and gave

suggestions for future research studies. In the conclusions section the author gave the suggestion

that “ambulation should be viewed as a priority and as a vital component of quality nursing care”

(Padula, Hughes & Baumhover, 2009, p. 330). The study’s findings were discussed objectivity.

The discussion and presentation of study findings was well done.

Utilization and communication

Evidence


Hospitalized Older Adults, indicated within a footnote that all research was funded by the Levy

Foundation, and was supported by the nursing staff at the Miriam Hospital (Padula, Hughes, &

Baumhover, 2009). Evidence was presented in the format of a journal article that was accepted

for publication on February 24th, 2009 (Padula, Hughes, & Baumhover, 2009). No other

information was provided in regards to other forms of communication or utilization of the study

results.

Support

According to Nieswiadomy, there are multiple ways to present study findings. These can

include, but are not limited to journal articles, presentation of results at a professional conference

by either an oral presentation or in a poster session, or a research report (Nieswiadomy, 2008).


Publishing results in a journal article can be a great way to communicate study findings to a large

population of people, who then, may be able to utilize the results. This can also serve as a means

of recognition for the researchers (Nieswiadomy, 2008). Generally, and due mainly to space

constraints within journals, journal articles provide shorter coverage of a research report

(Nieswiadomy, 2008). Prior to submitting an article to a specific journal, the authors may find it

prudent to determine if the journal or journals are interested in an article about their specific

topic. A good way to determine the amount of interest is to send query letters to multiple journals

to determine whether they would be interested or not (Nieswiadomy, 2008). Authors could then,

once interest is determined, proceed to submit the article to the journal for approval or rejection.

Utilization of nursing studies remains low. This is due in part to nurse’s lack of knowledge

regarding current study findings, their negative attitudes towards research, lack of institutional

support, and research findings not being ready for implementation at the nursing level

(Nieswiadomy, 2008).

Analysis


Hospitalized Older Adult, clearly indicates in the footnotes, whom it was supported by and when

it was chosen for publishing in the journal. Weaknesses in the article could be that there was no

discussion on whether or not the authors presented their findings in any other way besides the

journal article. Also not mentioned, was if there had been, or were any plans of utilization of the

research findings.

Conclusion

Overall the research article was found to be reliable, valid and provided strong evidence

in most sections of the article. Each section of the article was found to contain most aspects of a


good research article. Recommendations include; a larger sample size to be used and further

research on the effects of comorbidities on the mobility protocol. The study’s population sample

consisted of only fifty older adults, because this number is so small it may not be an accurate

representation of the total population (Padula, Hughes, & Baumhover, 2009). The comorbidities

of the patients should have been discussed in detail due to the fact that comorbidities could

further affect mobility. In conclusion further research on the effects of comorbidities on the

mobility protocol and expanding the population size would enhance the overall strength of the

research article.


References

Nieswiadomy, R. M. (2008). Foundations of nursing research (5th ed.). Upper Sadle River, NJ:

Pearson Education Inc.

Padula, C. A., Hughes, C., & Baumhover, L. (2009). Impact of a nurse-driven mobility protocol

on functional decline in hospitalized older adults. Journal of Nursing Care Quality, 325-

331.


Research Critique

Grading Criteria

APA Format: up to 30 points or 30% can be removed after the paper is graded for Title page, abstract, headers Margins, spacing, and headings, reference page, title page, abstract Sentence structure, spelling, grammar & punctuation.

Headings Possible Points

Points Earned

Comments

Abstract and Introduction: No heading

for intro, but there should be a introduction of the study and what your paper will

address, why you are doing the critique

10

10

Purpose & Problem Statement (Identify the problem & purpose and

analyze whether they are clear to the reader. Are there

clear objectives & goals? Analyze whether you can determine feasibility and significance of the study)

10

10

Review of the Literature and Theoretical

Framework (Analyze relevance of the sources; Identify a theoretical or

conceptual framework & appropriateness for study)

10

7

Hypothesis(es) or Research Question(s)

(Analyze whether clearly and concisely stated; discuss

whether directional, null, or nondirectional hypothesis[es])

10

9

Sample & Study Design (Describe sample & sampling method &

appropriateness for study; analyze appropriateness of design; discuss how ethical

issues addressed)

10

7


Data Collection Methods & Instruments (Describe & analyze the appropriateness

of the what, how, who, where and when; describe & analyze reliability and validity

of instrument)

10

9

Data Analysis (Describe descriptive & inferential

statistics & analyze whether results are presented

accurately & completely)

10

10

Discussion of Findings (Analyze whether results are

presented objectively & bound to the data, whether

there is a comparison to previous studies and

whether new literature is introduced that was not

included in the Literature Review

10

10

Conclusions, Implications, & Recommendations (Analyze whether the

conclusions are based on the data, whether

hypotheses were supported or not supported, whether implications are a result of

the findings, and recommendations consider

limitations

10

10

Your paper should end with a brief conclusion of your

critique

10

10

PAPER POINTS 100 92

Deductions for APA, grammar and Spelling

-5 Final GRADE 87

You had your headings without text.

research crituque shenna throop stephanie monroe ferris...

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