NRS 433V RS3 Rough Draft Quantitative Research Critique and Ethical Considerations

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NRS 433V RS3

Write a critical appraisal that demonstrates comprehension of two quantitative research studies. Use the “Research Critique Guidelines – Part II” document to organize your essay. Successful completion of this assignment requires that you provide a rationale, include examples, and reference content from the study in your responses.

Use the practice problem and two quantitative, peer-reviewed research articles you identified in the Topic 1 assignment to complete this assignment.

In a 1,000–1,250 word essay, summarize two quantitative studies, explain the ways in which the findings might be used in nursing practice, and address ethical considerations associated with the conduct of the study.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.

An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

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A solution to NRS 433V RS3 Rough Draft Quantitative Research Critique and Ethical Considerations

Quantitative Research Critique

Background of Study

Both Jung e al. (2016) and Al-Omari et al. (2019) conducted quantitative studies that addressed rapid response teams’ impact in inpatient settings. The study by Jung e al. (2016) was influenced by evidence that RRTs reduced in-hospital cardiac arrest episodes. The effect of the RRTs on mortality rates was unconvincing. The researchers opted to conduct the study to evaluate the outcomes of implementing an RRT program on mortality rate in patients admitted to the hospitals. The hypothesis was that implementing a RRT in the hospital would lead to hospital mortality rate. The increased incidences of cardiopulmonary arrest in hospitalized patients that have led to mortality and morbidity influenced Al-Omari et al., (2019) to conduct the study. The researchers hypothesized that implementing a rapid response team can help to manage emergencies resulting from cardiopulmonary arrests. Al-Omari et al. (2019) noted that RRTs are highly effective in providing emergency care to prevent further deterioration of patients’ clinical status in hospital settings.

How do these two articles support the nurse practice issue you chose?

The nursing practice issue of concern is the ability of RRTs to improve inpatient-nursing care by addressing care emergencies promptly to improve outcomes. The PICOT question is that: “In a hospital setting with patients (P), does a code blue or rapid response teams (I) compared to not having a team at all (C) impact mortality rate (O) during three months (T)?” The expected outcome is that the use of RRTs will reduce the deaths in hospitalized patients during the study period.

Jung et al. (2016) noted that RRTs are valuable in improving population-based performance in inpatient settings. The articles not that RRTs have not been utilized widely. However, based on the two studies, engaging RRTs can improve patient care outcomes. With that said, the two articles provide an essential foundation for RRTs as tools for reducing mortality rates in inpatient care settings. Al-Omari et al. (2019) also support the implementation of RRTs by relying on epidemiologically data to reveal that the teams can reduce the ICU admissions, hospital occupancy, and mortality rate significantly.

Method of Study

In both studies, the researchers used a quantitative research design to collect data regarding the outcomes of implementing RRTs. Jung e al. (2016) investigated RRTs’ implementation in one hospital- Montpellier University Hospital, France. The researchers also compared the information with retrospective data from other hospitals. The study involved three cohorts followed for three years. The researchers excluded patients admitted to the geriatric facilities, maternity and rehabilitation daycare facility. The reporting of data in this study flows the STROBE guidelines and RECORD statement. Before the RRT phase, all ICU teams addressed triage calls and codes by use of their conventional setup.

RRT implemented the intervention by initiating plan-do-study-act projects. A dedicated phone number was available for the care providers to contact the RRT directly. The researcher defined a code blue as a patient with respiratory or cardiac arrest that requires resuscitation. RRT team consisted of ICU nurses, residents or physicians, and a crash cart with resuscitation equipment and drugs. When the called, the RRT would be informed about the situation, background, assessment data and recommend drugs or procedures before arrival. Deaths occurring from non-DNR (Don Not Resuscitate order) were reported. The data collected was compared with that from control hospitals- those without RRTs. Data from non-RRT hospitals were analyzed retrospectively (Jung et al., 2016). A potential benefit of a cohort study is the ability to study exposure and outcomes and measure interest variables. However, the susceptibility to loss of follow-up poses a significant limitation to the study method.

Al-Omari et al., (2019) employed a quasi-experimental method, which used pre-trial and post-trial strategies to compare the RRT’s epidemiological performance before and after implementation. The study included 154,869 patients admitted to the hospital. The researcher collected data from the pre-RRT period of 36 months and compared to that from post-RRT/implementation period of 30 months. Four private hospitals provided general and tertiary health services to the participants of this study. The researcher implemented RRT interventions through plan-do-study-act project steps. Data was obtained from records of the CPR committee, the hospital information system and ICU databases. The researchers presented the outcomes in counts RRT population outcomes and percentages before and after implementing (Al-Omari et al., 2019).

One of the benefits of a quasi-experimental method is that the researcher can transfer and generalize outcomes to a large population. With that said, the rapid response team’s performance, as reported in their hospital, can match the performance of other teams reported in other hospital settings under similar conditions. However, one of the limitations is that the sampled population may not represent all large populations. Besides, cultural influence can invalidate the study outcomes. For instance, (Al-Omari et al., 2019) conducted the study in Saudi Arabia- cultural differences may alter the same practice results in other settings.

Results of Study

Jung e al. (2016) revealed a significant decrease in mortality rate from 21.9 – 17.4 per 1000 discharges. The decrease occurred between the time before implementation and post-RRT. The observed reduction in the number of hospitalized patients would mean that the RRT implementation in a hospital was responsible for saving 1.5 lives per week. The researchers did not report significant changes in mortality rates in the three control hospitals that did not implement RRTs. Unexpected hospital mortality occurring in general wards and ICU following sepsis reduced in the hospital with RRT from (4.2 %) before RRTs implementation to (3.1 %) after implementation at p = 0.03. However, this decrease did not occur in the three control hospitals with no RRT. Mortality decreased significantly from 39.6 – 34.6/1000 discharges.   The researchers observed an insignificant cardiac arrest decrease during the RRT period.

Based on Al-Omari et al. (2019) findings, nurses activate RRTs more times than the physicians.

The commonest triggers are respiratory and cardiovascular abnormalities. The RRT roles included the provision of diagnostic and therapeutic interventions. The RRTs influenced a marked drop in mortality rates from 7.8 – 2.8 deaths/1000 hospital admission. Besides, there was also a significant drop in cardiopulmonary arrest rates from 10.53 – 2.58 per 1000 admissions. Al-Omari et al. (2019) also noted that RRTs were very practical in establishing and enabling dialogue about patient care during terminal illnesses. The care incorporated discussions on end-of-life issues. Generally, the study findings show that RRTs effectively decreased mortality, hospital occupancy, and total admissions.

The two studies imply that RRTs could be a valuable tool that can be implemented in the hospital to improve nursing practice, particularly in inpatient settings, where most emergencies occur. The RRTs can respond promptly to address emergencies occurring in the inpatient and reduce mortality rates.

Outcomes Comparison:

Based on the results from Jung e al. (2016) and Al-Omari et al. (2019), it is anticipated that the RRTs implementation will reduce the deaths as intended by the PICOT question. Precisely, the RRTs will be a resource to assist nurses in addressing emergencies. The help from RRTs complements nurse’s services by providing prompt interventions. The study findings presented in the two articles are congruent with the expected outcomes by demonstrating that RRTs are useful tools for addressing emergencies and improving patient outcomes.

 

References

Al-Omari, A., Al Mutair, A., & Aljamaan, F. (2019). Outcomes of rapid response team implementation in tertiary private hospitals: a prospective cohort study. International Journal of Emergency Journal, 12, 31. DOI: 10.1186/s12245-019-0248-5

Jung, B., Daurat, A., De Jong, A., Chanques, G., Mahul, M., Monnin, M., … & Jaber, S. (2016). Rapid response team and hospital mortality in hospitalized patients. Intensive care medicine42(4), 494-504.

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