In today’s world, research and it implications to nursing practice is paramount to positive patient results. The following critique of the quantitative research article entitled “Nurse-Patient Interactions Related to Diabetes Foot Care” written by Lisa Sue Flood. This is a critique of her research study dated November of 2009 Oakland University, Rochester Michigan.
Problem Statement, Study Purpose, and Research Question
Diabetic foot care is becoming an ever increasing concern as diabetes has reached epidemic proportion. This has increased the associated diabetic problems such as amputations and non-healing ulcerations. The increase in education in this area is of extreme importance in order to control this epidemic from affecting increasingly more patients. It is through updated research and education of this issue that we as nurses will be able to serve our diabetic patients in the way that is needed so they can maintain as close to a normal life as possible. This recent research study gives diabetic patients this opportunity. The main question in this paper is there a relationship between nurse variables (age, gender, level of nursing education, and years of nursing experience) and reported nurse patient interactions related to diabetic foot care?
Hypotheses and Study Variables
Although the intended hypothesis was not determined by the researcher in this study, I would determine it to be a null hypothesis as nurse-patient interactions (independent variable) have no effect on diabetes related outcomes (dependent variable). The alternative hypothesis would then reject the null hypothesis by stating that nurse-patient interactions do affect diabetic related outcomes. We use the nurse-patient interaction as the independent variable because the degree of interaction can be manipulated while the diabetic related outcomes is the dependent variable as that is what is being witnessed to gauge the results of the interaction.
The Interaction Model of Client Health Behavior (Cox, 1982) was used as a framework for this study because of its focus on identifying nurse factors and elements of nursing interactions with potential impact on client health outcomes. The inception of the study indicated an importance of nurse-patient interaction in regards to diabetic foot care. At each juncture in the study it reiterates this importance, finally concluding by keeping nurse-patient interactions the center of nursing practice (Shattell, 2004); nurses may be able to have a positive impact on foot health of patients with diabetes. This was all in keeping with the health model.
Review of Related Literature
The literature review as it pertained to this study was pertinent from the inception of the research all the way through to the results and conclusion. It was used to keep the researcher focused toward completion of this quantitative study. This was seen by her comparison of her study to several articles that were used for review.
A descriptive correlational design was used during this study. The correlation design is proper in this situation as they are trying to find the correlation between nurse-patient interactions to diabetic foot care. The correlation between the two is evident throughout the study as a direct comparison was continually made between them.
There are possible internal validity threats in all research, in this case the degree of education and understanding of the patient along with the skill of the nurse to teach. Another point of validity to consider is the attitude of the nurse toward diabetic foot care. There was also only 1 male in the research group.
Along with internal validity you have to watch for external validity. This could consist of having the study done in an area that has more diverse health conditions as opposed to having a high occurrence of diabetic health issues. Another is the work load of the nurse; the nurse that has a hectic schedule will not be able to have as much interaction as the nurse that has a simple assignment.
Sample and Setting
The sample size of this study was 42 registered nurses was sufficient as there was only 89 possible giving a 47.2% participation rate. This gave a sufficient number to determine a result on a local or regional level. It allowed for acute care nurses and home health nurses aged 28-68, and experience ranging from 1 to 36 years which increased the variability thus lowering internal and external threats. (2) The sample is representative of the target population by encompassing a wide variety of staff RN’s while excluding nursing in managerial roles with no patient contact. (3) The setting for data collection allowed for the nursing profession to determine if proper interaction was being made between nursing and patients.
Control of Extraneous Variables
The extraneous variables of this research would include the use of different facilities. One was an acute setting the other was home care nurses. Other extraneous variables would include years of RN experience, age, and number of diabetic patients on averaged seen per week amongst others that were found by using a demographic data form. Controls were developed such as a Pearson product moment correlation was used to examine the relationship among NPIQ total score, nurses’ age, and years of nursing experience. The results indicated nurse-patient interactions were not related to age or years of nursing experience (Flood, 2009).
The researcher modified the Client Encounter form to reflect patients with diabetic foot care with permission from the forms creator. A panel of six experts (advanced practice nurses and certified diabetes educators) reviewed items on the Nurse-Patient Interaction Questionnaire (NPIQ) to ensure they were representative. The results were analyzed with the Statistical Package for Social Sciences version 15.0.
Data Collection Methods
The resultant research as seen in this study was understandable and thorough in design. The use of the NPIQ was advantageous to obtaining an unbiased result while procuring necessary information. All participants signed consent and permission was obtained from the facilities administration.
Data Analysis Procedures
The results were analyzed with the Statistical Package for Social Sciences version 15.0 using descriptive statistics, chi-square, t-tests, and Pearson’s product moment correlations. Cronbach’s alpha coefficients also were used to examine instrument reliability. This was suitable and consistent with the results.
Two major strengths of scientific merit for this study are approval by Oakland University Institutional Review Board and the health care system where the study was conducted and approval by a panel of 6 experts in this area of practice. Major limitations were that Type 1 diabetes was under represented and the sample size was not reflective of a larger geographic area.
The set-up, methodology, and analysis were well done. It was done with no observable bias and suitable to the resultant findings of the study. The final results are concise and complete the study question appropriately.
Implications and Conclusion
The study shows that despite the nursing assessments being done on our patients we still do not have the degree of interaction that is needed to affect a higher degree of successful patient outcomes and nursing need to put in the extra effort to attain this standard. The study also shows that nurses must have current, evidenced based diabetes knowledge and follow the recommended clinical practice standards for diabetic foot care to obtain positive patient outcomes. Further research should include a larger sample to determine regional trends and deficits and a study that concentrates on Type 1 diabetes should also be done to determine differences in interactions for this group. Research into diabetes and associated care is paramount to alleviating one of the quietest epidemics of modern times with 8.3 % of the population and 25.4% with pre-diabetes.
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