Epidemiological and Statistical Terminology †MyAssignmenthelp

Question: Discuss about the Epidemiological and Statistical Terminology. Answer: Introduction: Medications are the most commonly used treatment measure in the healthcare that contributes to the significant improvement in healthcare setting when used effectively (ACSQHC, 2013). However, the use of medication may also be linked with certain harm and hence the nurses should adapt varied techniques to prevent medication and non medication-related errors while caring patients in practice area (emergencies, medical/surgical ward) (Douglas, 2017, Athanasakis, 2012). In this report, two articles were systematically analyzed to evaluate the extent to which the research methods applied are trustworthy, appropriate and relevant (Steen, 2011). In a critique, assessment of the study-title gives valuable information about the study. Moreover, a title should be concise, clear and should portray the fundamental nature of the study; which is evident in both articles (Polit, 2016). The abstract of both articles gives valuable insight into the studys complexity (Iverson, 2014). Literature review involves critical summary of the studies related to the topic of interest which is prepared to contextualise the study problem as evidenced in both articles that focuses on medication-related and non medication-related error studies. In a research-study, identifying the study problem and formulating the study steps as per hypothesis is critical (Fink 2013). It is evident that both articles have appropriately identified their problem based on the PICO (Problem/population, Intervention/experimentation, Comparison/control and Outcome) framework. Both studies have provided an appropriate, accurate and understandable purpose to assess the effectiveness of interventions in minimizing the medication and non-MAEs as advised by Iverson (2014). Objectives are the specific accomplishments that are framed to achieve what the researchers have decided to enquire (Polit, 2016). Both have presented concise, adequate and achievable objectives. Hypothesis that is a predicted/expected relationship between study-variables were not found in these articles (Moule, 2013). Research methodology is defined as the techniques that are utilized to structure a study as well as to gather and analyze data in a systematic manner (Polit, 2016). It is evident in both articles from their structural fashion by utilizing adequate research methods along with sequential discussion in the study-text (Panneerselvam, 2014). Research design is considered as the integral part of methodology as it is the overall plan for research study that addresses the research question; including specifications for improving the studys integrity (LoBiondo-Wood, 2014). In both articles, quantitative design is used that enables comparison of two treatments (Yartsev, 2017). In Article-A, non-randomized design with one-group comparing pre- as well as post-outcome variables was used which is a quasi-experimental design that is used to draw causal impact of intervention on target population without randomization (THS, 2015). While, cluster randomized control-trails (RCT) was adopted in Article-B which is a true experimental design with manipulation; control and randomization. They have selected cluster design to reduce contamination during the implementation of intervention and hence Article-Bs design is better than A (LoBiondo-Wood, 2014). Data collection is the process by which data is gathered to address the research problem and the device used to collect data is called as instrument (LoBiondo-Wood 2014). In Article-A, the use of pre- and post-tests, survey (Likert scale) and identifying the no. of MAEs through chart reviewing and safety reports (voluntary) is appropriate. Similarly, in Article-B, the use of structured survey, Likert scales and structured direct-observations is adequate. Target population is defined as an entire group of population; the researcher is interested to propose study as well as generalize the study-findings (THS, 2015). The target population of the nurses working in the ED of a tertiary-care centre, U.S in Article-A and nurses working in 4 medical 4 surgical wards of Adelaide hospital, Australia in Article-B is adequate. Fink (2013) emphasises that samples are the part of the population that represents the entire population. Selection of 95 nurses in pretest while 84 in both tests; 81 in pre-survey while 73 in post-survey; 299 pre-charts while 295 post-charts in Article-A indicate possible 10% attrition. They used convenience sampling that involves selecting the volunteering participants but it may cause self-selection bias. They have given a educational flip-chart along with slide-show titled Preventing medication intravenous administrational errors to reduce MAEs. In Article-B, the selection of 70 nurses in control and 77 nurses in experimental group is adequate for a RCT. They used stratified random sampling by stratifying the wards (clusters) by area (medical/ surgical) in 1:1 ratio among which 2 wards of each area were randomly allocated to receive the intervention as advised by Polit (2016). The experimental group nurses were trained to wear a vest during administration of medication with educational intervention while control group was blinded to the intervention. . Validity is the degree to which the inferences made in the research-study are accurate. Internal validity is defined as the extent to which the intervention (independent variable) has inferred, rather than confounding variables causing observer effect (Polit, 2016). In both articles, the researchers have quoted varied studies to specify the existence of causal relationship between intervention and outcome. They have tried to prove the internal-validity by finding statistical-difference between pre-test and post-test group in Article-A while control and interventional group in Article-B. But, no statistical difference was found in Article-A which underestimates the studys validity. External validity is the extent to which the inferences regarding the relationships that are observed about the setting variations, subjects and study-duration and/or study-outcomes has to be accounted (Houser, 2011). Both studies were conducted in the same setting, while in Article-B, nurses working in varied type were analysed which may question external validity in Article-B. Measurement validity is the extent to which the measurement-instrument measures what it is subjected to measure (Fink, 2013). There are no evidence of validity and reliability assessment of the study-instruments in both articles. In Article-A, only face validity was taken which questions the study-validity whereas in Article-B, structured survey was conducted but no evidence of reliability. Blinding is the technique used to prevent the subjects participating in the study from obtaining information about study-participants, intervention and/or researchers/investigators in-order to reduce possible bias (LoBiondo-Wood, 2014). In Article-B, control nurses were blinded to the studys aim as well as to the intervention at the baseline which suggests that Article-B findings are more trustworthy than Article-A. The statistical analysis that involves the organization as well as analysis of information by utilizing statistical measures as descriptive and inferential measures were employed (NewCombe, 2012). In Article-A, Knowledge test (n=84) showing 92% with perfect scores in post-test while 69% in the pre-test (P=0.0001, p0.05) indicates that the difference is statistically significant. In behavior-survey, the post-survey response is higher than pre-survey response (P=0.98) which is statistically insignificant and in-regard to chart review, little difference was noted between number and percentage of MAEs in pre (n=287) with 25% vs 24% in post (n=296) at P=0.78 which is also statistically insignificant while the number of voluntarily-reported MAEs has fallen from 1.28 to 0.99/1000 ED-patients. The finding of Article-B indicates that the baseline interruptions are 57/100 administrations with 87.9% of non-MAEs and the unrelated medication interruptions was significantly reduced in interventional ward from 50/100 administrations (CI-95%:45-55) to 34/100 (CI-95%:30-38) as evidenced in Kliger (2012). Controlling for clustering shows that the drug interruption was significantly-reduced to 15/100 administrations than in control wards. Among interventional nurses, only 48% have supported to implement this intervention as a hospital policy as using vests consumes time; cumbersome as well as hot. The analysis in both articles suggests that the researchers have done an in-depth scrutinizing of informations as per their study-outcomes and have also tested hypothesis. The aim of conducting any study is to find-out appropriate solutions for the selected problem and also to disseminate the trustworthy findings (Polit, 2016). Article-As findings indicate that the intervention implemented has enhanced the knowledge of improved medication administration but hasnt been translated into practice. Use of instruments without validity assessment; single ED setting; convenience sampling method (causing self-selection bias) with chances for 10% attrition in post-survey (absence of 8 nurses in post-survey) questions the studys applicability. In-spite of disadvantages, the educational intervention can be employed in nursing practice to enhance medication safety to some extent (with basic ideas) by minimizing MAEs. Article-Bs findings show that the intervention has statistically reduced the number of non-MAEs which is similar to Keers (2013). But, the study was conducted in single setting which questions applicability in other settings. In-spite of blinding, about 30% of control nurses have informed that they were aware of the use of vest by the interventional wards which could affect the nurses behavior. Further, observation of participant-nurses could have increased consciousness of interruptions. Additionally, the influence of interruptions on MAEs and patient harms was not assessed. Despite these limitations, Article-B findings can be utilized in wards as it is an RCT. However, the intervention technique could be little modified as only 40% of nurses has accepted it to be their hospital policy. In conclusion, all the major findings that are related to the study aims should be discussed by relating to the hypothesis (Polit, 2016). The conclusions of both articles are found to relate to the findings logically. No distortions were attempted in fitting their pre-conceived ideas. They have mentioned about the advantages as well as disadvantages of these studies as given by Boswell (n. d.). They have given their recommendations for future studies along with its applicability in nursing practice. Thus, conclusions given in these studies are appropriate. To conclude, both Articles A B have utilized experimental design to rule out the effectiveness of their intervention in reducing MAEs and non-MAEs. Though their attempt to promote medication safety had equivocal results, their findings have inculcated in-depth insight about medication process. Despite certain demerits that are evident in these studies, their findings can be utilized in future studies. Reference Blank, F. S. J., Tobin, J., Macomber, S., Jaouen, M., Dinoia, M., Visintainer, P. (2011). A Back to Basics Approach to Reduce ED Medication Errors. JEN: Journal of Emergency Nursing, 37(2), 141-147. doi:10.1016/j.jen.2009.11.026 Article B Westbrook, J. I., Ling, L., Hooper, T. D., Raban, M. Z., Middleton, S., Lehnbom, E. C. (2017). Effectiveness of a 'Do not interrupt' bundled intervention to reduce interruptions during medication administration: a cluster randomised controlled feasibility study. BMJ Quality Safety, 26(9), 734-742. doi:10.1136/bmjqs***********3 . ACSQHC- Australian Commission on Safety and Quality in Health Care (2013), Literature Review: Medication Safety in Australia. ACSQHC, Sydney. Athanasakis, E. (2012). Prevention of medication errors made by nurses in clinical practice. Health Science Journal, 6(4), 773-783. Boswell, C. (n. d). Chapter14: The research critique process and the evidence based appraisal process. Retrieved from https://samples.jbpub.com/9781284079654/9781284108958_CH14_Pass03.pdf Douglas, H. E. (2017), Improving our understanding of multi-tasking in healthcare: drawing together the cognitive psychology and healthcare literature. App Ergon, 59, 4555. Fink, A. (2013). Conducting Research Literature Reviews: From the Internet to Paper. Retrieved from https://books.google.co.in/books?isbn=1483301036 Houser, J. (2011). Nursing Research. Retrieved from https://books.google.co.in/books?isbn=1449677444 Iverson, K.M. (2014). 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Research Methodology. Retrieved from https://books.google.co.in/books?isbn=8120349466 Polit, D.F Beck, C.T. (2016). Nursing Research: Generating and assessing evidence for nursing practice. Lippincott Williams Wilkins: New Delhi. Steen, M. Roberts, T. (2011).The handbook of midwifery research. Wiley-Blackwell: West Sussex. THS. (2015). Epidemiology- Glossary of Epidemiological and Statistical Terminology: Tropical Health Solutions. Retrieved from https://www.tropicalhealthsolutions.com/statsglossary Yartsev, A. (2017).Advantages and disadvantages of RCT. Retrieved from https://www.derangedphysiology.com/main/cicm-primary-exam/required-eading/research -methods -and-statistics/Chapter%202.0.2/advantages-and-disadvantages-randomised-control-study-design