A critical appraisal team for nurses

Research findings are essential to the progress of the profession, but they are not always relevant or easily accessible. Literature searches can also be off-putting because of the sheer volume of material available. The critical appraisal team is a nurse-led initiative set up to tackle these problems. It responds directly to the research needs of nurses in the workplace, supplying staff with concise, reliable research that can be used to benefit practice.     

Searching the biomedical literature: research study designs and critical appraisal.

Two essential issues to consider when assessing the validity of research studies are the strengths and weaknesses of the study design and quality of methodology. This paper reviews study designs commonly used in clinical research, including case reports, cross-sectional studies, case-control studies, cohort studies, randomized controlled trials, reviews, and meta-analyses. It concludes with an outline for assessing study quality.     

Lumbar functional instability: a critical appraisal of the literature.

The goals of this paper were to define the concept of instability, to describe the way it can be assessed, to report on impairments of the spine stabilization system in patients with low back pain (LBP), to cite the recommended exercises and, lastly, to examine the results of programs based on lumbar stabilization. Patients suffering from lumbar instability appear to belong to a particular subgroup of subjects with LBP. In the literature, several definitions of lumbar instability have been proposed. Radiological instability, for instance, differs from functional instability. Diagnosis remains difficult: the relevance of static and dynamic radiographs appears limited whereas several signs and clinical instability tests have been described in the literature but remain controversial. The functional stability system of the spine consists of three interdependent components: the passive, the active and the neuromuscular subsystems. The benefits of lumbar stabilization programs for LBP patients have been underlined. Lumbar stabilization exercises are aimed at sensorimotor reprogrammation of spine stabilizer muscles intended to improve their motor control skill and delay of response and consequently to compensate for weakness of the passive stabilization system.     

Professional development and appraisal system for school nurses.

Dissatisfied with current school nurse evaluation instruments, school nurse administrators sought to develop an appraisal system that would emphasize the professional role of the school nurse and provide a means to enhance individual practice. The newly revised Standards of Professional School Nursing Practice and the creation of a state teacher evaluation model presented the opportunity to produce an instrument that could be adapted within the educational setting for school nursing practice. The appraisal system included not only the methods to evaluate practice, but the means to involve the individual school nurse through goal setting. The process also included a structured intervention plan that facilitated remediation. This article describes the development of the appraisal system, the components, and the implementation of an evaluation system for school nurses.     

A critical appraisal of the research literature investigating fatigue in the individual with cancer

Fatigue is a commonly experienced symptom, which may be a component of virtually any disease and can have a psychological, physical, or mixed origin. Nurses need to understand the onset, duration, and progression of fatigue to intervene successfully with the cancer patient adapting to diagnosis and treatment. While the literature is an important source of information, results of research studies must be critically interpreted before proceeding with practice guidelines based on research findings. A critical appraisal of the research literature investigating the problem of fatigue in individuals with cancer was conducted. There is strong evidence to suggest that fatigue is a prevalent problem among cancer patients receiving chemotherapy and radiation therapy. However past research has been limited by methodological problems. Typically, studies fail to include a control group, do not control for possible confounding variables, and have restricted measurement to unidimensional scales with limited reliability and validity. While several correlates of fatigue have been postulated, research to date has found no consistent relationships among such correlates as weight loss, anemia, or psychological distress. This article reviews what is currently known about fatigue in the cancer patient and how future research could be designed to improve on past measurement and sampling problems.     

Substance use and its implications for the critical care nurses: a literature review.

BACKGROUND: Illicit drug use in Australia has been increasing and studies indicate that illicit drug users have a higher risk of accidents which may result in the user needing critical care. However, there is a significant gap in the literature specifically pertaining to the implications of drug use in critical care. AIMS: The primary objective was to examine the literature for the physiological effects of methylenedioxymethamphetamine (MDMA), cocaine and amphetamines in critically ill patients. METHODS: A comprehensive literature review was undertaken and a body systems framework was used to categorise the effects of these illicit drugs. RESULTS: The illicit substances addressed have potentially fatal and long-term side effects. For those users involved in accidents or trauma requiring intensive or critical care nursing, the mortality and co-morbidity risks are increased significantly. It is, therefore, important that nurses are able to recognise the specific physiological effects and possible complications that can occur with the use of each illicit drug. CONCLUSION: Both nursing and medical staff need to have a thorough understanding of how illicit substances work and how they can affect the critical care patient and the care they are given.     

Steroid treatment in ARDS: a critical appraisal of the ARDS network trial and the recent literature

Objectives To compare the design and results of randomized trials investigating prolonged glucocorticoid treatment (≥ 7 days) in patients with acute lung injury–acute respiratory distress syndrome (ALI–ARDS), and review factors affecting response to therapy, including the role of secondary prevention. Design Trials were retrieved from the Cochrane Central Register of Controlled Trials (CENTRAL). Two investigators collected data on study characteristics, treatment intervention, and outcomes. The methodological quality of trials was determined and data were analyzed with Review Manager 4.2.3. Measurements and results Five selected trials (n = 518) consistently reported significant improvement in gas exchange, reduction in markers of inflammation, and decreased duration of mechanical ventilation and intensive care unit stay (all p < 0.05). Two early small clinical trials showed marked reductions in the relative risk (RR) of death with glucocorticoid therapy (RR = 0.14, 95% CI 0.04–0.53; p = 0.004, I² = 0%). Three subsequent larger trials, when combined, although nominally beneficial, did not reproduce the marked reductions observed in the earlier trials (RR = 0.84; 95% CI 0.68–1.03; p = 0.09, I² = 9.1%), but achieved a distinct reduction in the RR of death in the larger subgroup of patients (n = 400) treated before day 14 of ARDS [82/214 (38%) vs. 98/186 (52.5%), RR = 0.78; 95% CI 0.64–0.96; p = 0.02, I² = 0%]. Conclusions Prolonged glucocorticoid treatment substantially and significantly improves meaningful patient-centered outcome variables, and has a distinct survival benefit when initiated before day 14 of ARDS.     

Stereotyping by nurses and nursing students: a critical review of research

Thirty-eight empirical studies of stereotyping by nurses and nursing students were critically examined and discussed. The review was conducted and reported as though it were primary research. Subjects were the studies examined, methods were the reviewing procedure, data were attributes of the studies, and results were the conclusions drawn. The research on nurses' stereotypes has been characterized by: the use of one method of data collection, usually questionnaires; the measurement of the presence or absence of specific stereotypes; and nonprobability sampling techniques. There is some evidence that nurses stereotype other people based on age, sex, attractiveness, personality, diagnosis, social class, and family structure. Suggestions for adding to this body of knowledge are made.     

Teaching critical appraisal during critical care fellowship training: a foundation for evidence-based critical care medicine

OBJECTIVE: To determine whether fellowship training in critical care medicine with critical appraisal exercises improves the ability and confidence of fellows to evaluate the medical literature. DESIGN: Prospective, interventional pilot study. SETTING: Multidisciplinary critical care medicine training program at a large university hospital. INTERVENTION: Fellows were given three didactic sessions covering study design, analysis, and critical appraisal techniques. During the course of the year, each fellow was required to review one article from the literature and present a critique of this article to the group and faculty (Journal Club). Fellows were guided in the preparation of this presentation by one of the critical care medicine faculty. Finally, a written analysis and critique of the article was performed by each fellow. MEASUREMENTS AND MAIN RESULTS: A test was given to each fellow at the beginning and end of the academic year. This test consisted of two pairs of articles on therapy for acute lung injury. For the pretest, each fellow was assigned, at random, one pair of articles. Fellows were given 1 hr to review both articles and to fill out a six-point test to assess their ability and confidence to appraise each article. At the end of the year, each fellow was tested on the opposite pair, the tests were graded in a blinded fashion and the results of each test were compared. Six fellows completed both pre- and posttests. These paired results were analyzed separately, whereas results for another six fellows were conducted as an unpaired analysis. Mean scores increased both for the paired analysis (4.1+/-0.7 vs. 5.1+/-0.5; p = .015) and for the unpaired analysis (4.3+/-0.6 vs. 5.0+/-0.5; p = .012). Self-reported confidence in critical appraisal also increased (2.5+/-0.5 vs. 3.9+/-0.7; p = .004 and 2.6+/-0.5 vs. 3.9+/-0.6; p < .001, respectively). CONCLUSION: Critical appraisal exercises used in the training of critical care medicine fellows appear to improve both ability and confidence to appraise relevant medical literature.