Research Appraisal Critique and Ethical Considerations
Research Appraisal Critique and Ethical Considerations
Background of Study
Article 1: Barreca, M., Renzi, C., Tankel, J., Shalhoub, J., & Sengupta, N. (2016). Is there a role for enhanced recovery after laparoscopic bariatric surgery? Preliminary results from a specialist obesity treatment center. Surgery for Obesity and Related Diseases, 12(1), 119-126.
Article 2: Van der Beek, E. S., Monpellier, V. M., Eland, I., Tromp, E., & van Ramshorst, B. (2015). Nutritional deficiencies in gastric bypass patients; incidence, time of occurrence and implications for postoperative surveillance. Obesity surgery, 25(5), 818-823.
Article 3: Cooley, M. (2017). Preventing Long-term Poor Outcomes in the Bariatric Patient Postoperatively. Dimensions of Critical Care Nursing, 30-35.
Article4: Dogan, K., Kraaij, L., Aarts, E. O., Koehestanie, P., Hammink, E., van Laarhoven, C. J., Aufenacker, T. J., Janssen, I. M. C., & Berends, F. J. (2015). Fast-track bariatric surgery improves perioperative care and logistics compared to conventional care. Obesity surgery, 25(1), 28-35.
The first article written by Barreca, Renzi, Tankel, Shalhoub, & Sengupta (2016) investigates the recovery process of bariatric patients during post-surgery. The scholars of this article focused on determining the impact of the application of Enhanced Recovery After Surgery procedure and its effects in the post-surgery recovery duration of hospital stay. The problem statement of the research article involves the investigating the impact of applying ERAS to bariatric surgery patients and the length of hospital stay. The study is significance to the field of nursing because it brings out the impact brought by the role of nurses during pre and post-surgery. The research question in study involves whether the application of ERAS program reduces the length of hospital admission during post-surgery.
The second article by Van der Beek et al. (2015) investigates the key challenges that are known to lead poor health outcome post bariatric surgery. The study emphasizes on lack of the nurses playing their roles such as following up on the patient during the recovery process and lack of adequate nurse assessment before the patient is operated. Therefore, this shows the significant role of the nurses and the impact of their services to patient recovery. The research for this study includes the post-surgery effect such as nutritional deficiencies in gastric bypass patients.
The third article by Cooley (2017) investigates the willingness of the patient to escalate issues during hospitalization. The study takes an in-depth analysis of the qualities of the different services offered by the nurses which might make the patients have confidence in escalating issues or shy away from escalating the issue. The study is significance to the nurse practice because it shows s how the relationship between the nurses and the patients affect the healthcare delivery. The research question for this study includes whether the preoperative care improves the overall health outcome of the bariatric patients.
The fourth article by Dogan, Kraaij, Aarts, Koehestanie, Hammink, van Laarhoven, Aufenacker, Janssen, & Berends, (2015) investigates the application of Fastrack program and its impact in quick recovery of the obesity surgical patients. The study problem statements includes the different constituent of the fast track program such as the role of nurses in perioperative surgery and how the different roles affect the recovery of the patients. The research question of this study involves the investigation of whether the application of fast truck program lead to improved surgical outcome.
How the Article Supports the Nurse Issue Chosen
PICOT Question
Do the role and the challenges experienced by the pre- and post-operative nurses affect the recovery process of obese patients undergoing surgical treatment.
How the Article Relates to the PICOT Question
The above article will assist in finding insights to the following components of the PICOT question.
P: Patient– The patient undergoing through the survey
I: Intervention -My intervention includes investigating the different nurse behavior during the pre and post surgeries and analyzing the impact of the behavior on the patent’s recovery process
C: Comparison-The comparison group will involve comparing the intervention such as use of Fastrack and ERAS and nurse qualities vs the health outcome of the surgical patient without the application on enhanced program care.
I: Improve– My goal for the intervention includes finding the best pre and post-operative surgical nurse practices that can facilitate quick recovery of bariatric patients.
O: Objective: The objective of my study entails investigating how the role of the nurses lead to improve or worsen the recovery process.
T: Time– I will study the control and intervention group for a period of 3 months in order to determine the changes in the recovery process with certainty.
How the Intervention and Comparison Group Identifies the PICOT Question
The first article written by Barreca et al. (2016) investigate the recovery process of the patient wo have undergone through surgery and the impact of the role played by pre and post nurse care in the quick recovery of the patients. The article provides an insight on how the role played by nurses can affect health intervention. This is directly related to the PICOT question.
The second article by Van der Beek et al. (2015) assesses the lack of nurse intervention such as following up in the patients and the health outcome such as nutritional deficiencies. This relates to the PIOT question because it investigates the contribution of nurses and the resulting health outcome.
The third article by Cooley (2017) establishes different nurse patient relationship during the surgery that can affect the health outcome. This implies that depending on how the nurse responds to the patients, the patient might shy away from escalating matters to the nurses or senior medical practitioners. The article relates to the PICOT question because it investigates how nurse behavior affect the health intervention given.
The fourth article by Dogan, Kraaij, Aarts, Koehestanie, Hammink, van Laarhoven, Aufenacker, Janssen, & Berends, (2015) establishes how the application of fast track health care delivery affect health outcome. Nurses plays a big role in fast truck health care delivery method. Hence, the article endorses fact that nurses’ contribution affects health care intervention to a large extent.
Study Method
Research Methodology
The first research article, Barreca et al. (2016) entailed a quality study that compares the recovery process of bariatric surgical patients who underwent through ERAS treatment vs those who did not. The study makes a comparison of the patient recovery process using the 30-day readmission period analysis. The study investigates 288 patients and use the result to form a conclusion. This reach study applies multivariate analysis in analyzing the data insights. On the other hand, the second research article by Van der Beek et al. (2015) utilizes both qualitative and quantitative study. The study conducts an observational analysis on 427 gastric bypass patients. Unlike the first article, this study utilizes cluster analysis in analyzing and visualizing the data. The third article by Cooley (2017), the article uses case study purely to determine the poor health outcome of post-surgery obese patients. The study utilizes secondary data. The fourth article by Dogan, Kraaij, Aarts, Koehestanie, Hammink, van Laarhoven, Aufenacker, Janssen, & Berends, (2015) applies observational study to the 75 patients who underwent the Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) which is a fast track program and compare the result with the patients who underwent through conventional perioperative care
Benefits and Limitations of the Cluster and Multivariate Analysis
Multivariate research methods give room for the researchers to make a comparison between more than two variables and relate to the findings. However, multivariate analysis can be complicated especially when the analysis involves more than one variable. On the other hand, one merit of cluster involves the ability to collect data from homogenous group. However, it is significance for the researchers to be careful when utilizing the cluster method because it can result to biasness and skewed data. One advantage of observation as a data collection method involves the ability to easily use the result from observation in creating a viable hypothesis. However, observational studies can be unreliable and hence needs to be handled objectively.
Results of the Study
Key Findings
According to result from the fist article by Barreca et al. (2016) the application of the ERAS process can be said to result to 96.5% chances of earlier discharged compared to normal operative process. The study also shows that there is a 3.5% chance of surgical patients experiencing complication irrespective of the applied process. The results from Van der Beek et al. (2015) indicates that post-surgery health complications are likely to occur if there is no sufficient nurse follow up of the patients. The result from the third article by Cooley (2017) indicates that nurse contribution lowers the probability of poor health outcome of bariatric patients. Lastly, the result from the fourth article by Dogan, Kraaij, Aarts, Koehestanie, Hammink, van Laarhoven, Aufenacker, Janssen, & Berends, (2015) shows the application of fast truck method in surgery reduces the recovery time by and also the surgical time used in operating the patients.
Implications
Generally, the 4 studies show the vital role of nurse during the surgery of bariatric patients with respect to health outcome. For instance, the studies show that application of method such as ERAS and Fast track where the nurse role in enhance reduces recovery time and readmission of the patient. Furthermore. the four articles show that post-operative follow up of patients reduces the chance of the patients developing a health complication. These article highlights the significance of nurse contribution on the general health outcome.
Ethical Considerations
Two Ethical Considerations When Conducting Research
Informed consent is an ethical consideration which mandates the researchers to have the consent of the patient before conducting any research. Any research that is done without the patient knowledge or through coercion is believed to have gone against the research principles and the patients’ rights and can lead to legal measures taken on the researchers. On the other hand, the beneficences refer to the principle of do not harm. This implies that the any activity carried out by the researcher should be at the best interest of the patient.
Relating the Ethical Considerations to The Study
It is evidence that the researchers in all the four studies ensured that there is patient consent before conduction the research. The researchers worked with various health institutions which were the enablers of the patients. In addition, there was no harm of any patient during study process. Therefore, it can be concluded that the researchers had the patients’ best interest.
Outcome Comparison
Anticipated Outcome
My anticipated outcome for the PICOT Question includes validating the role and contrition of nurses on how its is directly linked to health outcome.
How the Outcome of the Four Articles Compares to Anticipated Outcome
From the four articles, it is evident that the enhance role of nurses leads to improve health outcome compared to application of conventional nurse responsibilities. For instance, the application of ERAS and Fast track (enhanced nurse role) method during the operation resulted in decreased operative and recovery time. These outcome from the article directly relate to my anticipated outcome on the PICOT question
Reference
Barreca, M., Renzi, C., Tankel, J., Shalhoub, J., & Sengupta, N. (2016). Is there a role for enhanced recovery after laparoscopic bariatric surgery? Preliminary results from a specialist obesity treatment center. Surgery for Obesity and Related Diseases, 12(1), 119-126.
Cooley, M. (2017). Preventing Long-term Poor Outcomes in the Bariatric Patient Postoperatively. Dimensions of Critical Care Nursing, 30-35.
Dogan, K., Kraaij, L., Aarts, E. O., Koehestanie, P., Hammink, E., van Laarhoven, C. J., Aufenacker, T. J., Janssen, I. M. C., & Berends, F. J. (2015). Fast-track bariatric surgery improves perioperative care and logistics compared to conventional care. Obesity surgery, 25(1), 28-35.
Van der Beek, E. S., Monpellier, V. M., Eland, I., Tromp, E., & van Ramshorst, B. (2015). Nutritional deficiencies in gastric bypass patients; incidence, time of occurrence and implications for postoperative surveillance. Obesity Surgery, 25(5), 818-823.