Critical Appraisal Is An Important Aspect Nursing Essay
The first paper will use the example of the article Deconstructing delusions: A qualitative study, examining the relationship between religious beliefs and religious delusions (Drinnan, A & Lavender, T 2006). According to Paul Gill (2008), qualitative research is subjective and uses different methods of collecting data. These methods include interviews and the use of small numbers of participants, which meets the description of this paper. The researchers of this study subjectively explored the relationship between religious beliefs and religious delusions by conducting semi-structured interviews. Semi-structured interviews include several key questions that help interpret information and allow the interviewer to investigate an idea or response in more detail (Gill, P et al. 2008). The article interprets information from a small sample group to try and assist in the understanding of the topic.
The second paper will use the example of the article 'Randomized, Double-Blind, Placebo controlled Trial of Herbal Therapy for children with asthma' (Wong et al 2009). The second paper objectively analyses the data to generalize its findings to the whole population, making it a quantitative paper (Muijs, D 2011). According to Lisa Givens (2008) quantitative research is a systematic evidence based investigation of social phenomena with the use of statistical, mathematical or computer aid. This paper decreased the chance of bias by conducting a randomized control trial. The statistical method associated with quantitative research was useful in this study to help produce factual or reliable data, which can be generalized to the wider population (Coughlan, M et al. 2007). This study aimed for a p value less than 5% to determine whether the study results are likely to have occurred simply through chance (Beth, L 2005).
Key Findings and Sample Groups
Qualitative research aims to collect a detailed understanding of human behavior and the reasons that control certain behavior (Williams, R 2007). Qualitative research usually uses smaller focused sample groups to help develop a more personal understanding of the phenomena. In the first paper 7 participants were recruited from the Community Mental Health Team and an Assertive Outreach Team for this study. The authors explained the decision to use self-report in this study, by stating the fact that they where focusing on individuals perception and beliefs and not on religion itself. Individuals were included in this study if they considered themselves religious and if they had experienced beliefs that had been diagnosed as delusional. The key findings of the first paper suggested that mental health and religious beliefs lead to the individual's identity being compromised.
The second paper randomly selected 85 children between the ages of 7-15 years from two pediatric clinics of two major government hospitals. Participants were included if they were between the ages of 7-15 years, had persistent mild to moderate asthma according to the Global Initiative for Asthma Guidelines, were on regular inhaled steroid therapy and where able to perform a spirometer test. Participants where excluded if they had taken specific medications or had difficulty swallowing tablets. The authors justified their sample size by stating that to detect a 33% difference in results, 36 patients from each study group were required. They also allowed for a 10% loss of follow up participants. The results showed the CUF2 group scored 298 for the PEFR whilst the placebo group scored 272. Both groups scored the same on the FEV1 and FEV1/FVC predicted. This showed that there was no significant difference between the two groups. This study had a null hypothesis and was unable to support the effectiveness of herbal therapy in children with asthma (Beth, L 2005).
Funding Source, Ethics Permission and Conflicts of Interest
The first paper does not state who funded the study, instead it thanks participants for sharing their stories and thanks the assertive outreach team and the Heights CMHT for their help in recruiting participants. The article stated that the lead researcher does not have religious beliefs, however that she does believe that religious beliefs have a potential to cause distress. Additionally the article suggested that the themes relating to her preconceived ideas did emerge in the data, but positive themes of religious beliefs also occurred removing bias from the analysis. This article does not mention ethics permission or if participants gave any form of consent.
The second paper is funded by the University Grants Committee of the Hong Kong special Administrative Region, to help support the project 'Chinese Medicine Research and Further Development.' This study was approved by the Ethics Committee of Clinical Research in the Chinese University of Hong Kong and also by the Ethics committee of the Western New Territories Hospital Cluster. This study maintained a high standard of professional conduct by receiving written consent from parents and verbal consent from the participants (Muijs, D 2011). They also achieved this by describing the studies purpose, details and rights, to the participants and their parents. The authors do not specify that there were no conflicts of interest in this study, but they do state that there was no competing financial interest involved (Wong et al 2009).
Style of Research
The first paper used a qualitative phenomenology research method. This method attempts to understand the participant's perceptions, understandings and outlook of a particular situation or phenomenon (Lester, S 2005). The researchers did this by conducting semi-structured interviews. Semi-structured interviews are performed with an open framework, which allows for a more focused and conversational interview (Cohen, D, Crabtree, B 2006). The interviews lasted 50-90 minutes and focused on four main areas, background information, family history, developing unusual beliefs and recovery. The interviews were tape-recorded and transcribed afterwards.
The second paper is a randomized blinded controlled trial, which is the preferred design for a quantitative clinical trial (O'Brien, N et al. 2006). Randomized control trials are often used to test the efficacy of various types of intervention within a patient population (O'Brien, N et al. 2006). The researchers used a pre and post design to help the researchers measure the degree of change occurring as a result of the treatment (Stolberg et al. 2006). An asthma baseline score was taken prior to the therapeutic treatments and another score was taken at 24 weeks post placebo or therapeutic treatment.
Evaluation of studies
The first paper was well structured and included a clear description of the problem, aim, method, results and conclusion. This study utilized literature review's that related to the study, in particular ones that examined factors that influenced the development of religious delusions. The importance of this study was supported by a literature review, which stated that more research and evidence is needed to explain and understand religious beliefs and religious delusions (Sheridan, M et al 1992). The overall aim of this study was explored through 3 main points. The author's stated they chose an exploratory method to investigate how participants make sense of their lives at a level of inquiry that is more detailed than the quantitative method (Drinnan, A & Lavender, T 2006). The use of coding for analysis was explained as well as the use of an 'analyse trail', which allowed the reader to judge the sensitivity of the methodology. The authors acknowledged the limitations relating to their study, which were the sample size and style of research. The sample size of this study was limited due to the similar ethnicity and age of participants. This meant that results of the study could not be generalized to the wider population (Coughlan, M et al 2007). As previously mentioned, there was no discussion of ethical approval or if voluntary or informed consent was obtained from participants.
The second paper has a clear title and a concise and informative abstract. The introduction clearly states the aims and objectives of the paper and includes key literature reviews to support the study (Coughlan, M et al. 2007). Several referenced articles supported the use of CAM and one in particular reported that treatment with Chinese formulas resulted in lung improvement and a decrease in airway hyper activity (Huntley, A & Ernest, E 2004). These articles stated that this medicine was used in different countries so this enables the authors to generalise their findings to a wider population. This paper was of high quantitative standard due to attrition rate, high compliance levels, and broad sample source (Coughlan, M et al. 2007). The authors acknowledge the two limitations of the study. These limitations included only recruiting mild asthma sufferers and using children as participants who where already on inhaled steroids. The authors clearly justified their sample size and reported it statistically and the length of time the participants were a part of the study is indicated. Participant drop out from the study was also explained. The results of this study supported the author's null hypothesis (Beth, L 2005).
Relevance to nursing practice and Findings
The first paper concluded that the results suggested that participants' early experiences provide a base for the development of their personal identity and religious beliefs (Drinnan, A & Lavender, T 2006). Results of the study found that the participant's religious background influenced the nature of their delusions, but their delusional beliefs were also influenced by family factors. From these results it was hypothesized that delusional beliefs and religious beliefs are similar in that they both offer a way for the individual to cope with anxiety and insecurity (Drinnan, A & Lavender, T 2006). The findings were structured into four sub headings and quotes were illustrated to discuss the themes that appeared in the interviews. The authors stated that further quantitative research with a larger sample group, could build on this study to help investigate the relationship between particular experiences and religious beliefs. It is important for nurses to understand how religious beliefs impact on the individuals over all mental health and how to treat appropriately (Huntley, A & Ernest, E 2004).
The second paper concluded by stating that there is evidence supporting the benefits of CUF2 in certain studies, how ever this study was unable to support this hypothesis in children with asthma. The treatment of CUF2 has not been completely ruled out, it could be a beneficial option for specific individuals or different levels of asthma. The results didn't show a significant difference between the treatment of CUF2 and the placebo, therefore it was suggested that parent's should consult their health care providers before relying on this treatment option. This study used the placebo effect to demonstrate how patients who are given a placebo treatment often have improvement in their medical condition. The placebo effect can often have physiological effects that have a positive or negative impact on health (Gunver, S & HelmutÂ K 2004). Therefore, it is important that nurses are aware of the implications involved in this method and can help provide a safe and healthy environment for the individual.
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