Critical Appraisal of Two Nursing Articles on Wound Care

importance of clearly stating the title and aims of a study is emphasized by Cormack et al (2006). Doing so directs the reader's attention to the specific area being investigated. The article's aim is recognized to employ a phenomenological approach, which is a type of qualitative study. This approach seeks to understand phenomena in terms of the meaning individuals assign to them. It involves conducting in-depth investigations with a small number of subjects (Lincoln, 2000). Unlike quantitative approaches, qualitative methods do not focus on measuring frequency or testing hypotheses (Burn, 2004).

The article compares qualitative and quantitative research methods, noting that qualitative research does not require random participant selection while quantitative research does. It also discusses the use of qualitative research to understand participants' experiences with pressure ulcers. Another article mentions a randomized clinical trial (RCT), a type of quantitative research that aims to compare different approaches. The RCT follows scientific methods and focuses on measuring facts.

The objective of this study is to compare two dressings through clinical testing. The Randomized Controlled Trial (RCT) is considered the highest form of evidence, as it provides the most accurate results (Parahoo, 2006). At the beginning of a study, researchers formulate a hypothesis or prediction which explores the relationship between an independent variable and a dependent variable. In this case, the abstract's summary stated the null hypothesis that no difference was found between the two dressings. Cormack et al (2006) recommend that hypotheses should be testable and use an experimental approach.

The study presents testable hypotheses. Although the methodologies used in both articles appear appropriate, Streubert and Carpenter (1999) suggest that the choice of

methods should be based on the research questions. However, both articles have realistic goals that are relevant to the topic being investigated. Using SPICE to research the literature for the qualitative study helped narrow down the focus of the research question (Beecroft, 2006) and resulted in the identification of 11 articles on CINAHL, as opposed to 7916, when using the Boolean phrase "pressure ulcer".

Applying the same PICO method for article two's quantitative research yielded only one result. However, upon conducting a peer review search for both articles, it was discovered that article two did not undergo peer review. Traynor & Rafferty (2000) mention that peer review practices contribute to maintaining the credibility of journals and help assess the trustworthiness of published material (Parahoo, 2006). In conclusion, the database confirmed the findings of the searches, and the relevant keywords in the abstract proved helpful for the literature research.

The text discusses the significance and accuracy of information in two articles. Both articles utilized current journals and primary sources to conduct their literature review and substantiate their findings. Primary sources, which are defined as original research articles authored by the researchers themselves that present novel ideas, reports, or information (Paterson, 1993), were employed. However, it is noted that not all journals publish original research, according to Cormark et al (2006). The subsequent section offers a critical evaluation of the literature review.

A literature review is essential for new research as it examines previous work and provides a rationale for further study. It helps readers grasp the current knowledge on the subject being investigated and assesses whether sufficient background information exists. The significance of

a thorough literature review is highlighted in articles by Beck and Pilot (2012), Smith (1997), and Munhall (2006). However, these sources do not extensively discuss the topic or have a dedicated section specifically focused on literature reviews.

Both articles presented arguments to justify the need for their respective studies. Article one provided an overview of the existing evidence on the addressed problem and critically reviewed the quality of life for patients living with pressure ulcers. However, it failed to highlight any gaps that would justify undertaking further research, as it did not introduce any new information. On the other hand, article two compared alginate and hydrofiber dressings, filling the gap of a previous lack of testing on these dressings following post-hip replacement surgery.

The need for this research arises from the gaps that the reader sees, which require filling since there is no existing information on the subject. Culham (1998) highlights that the assessment of literature review is an essential part of evidence-based practice. The determination of sampling size is based on the participation of individuals in a study (Crookes and Davies, 1998). Both articles discuss the selection of participants. Article one explains the recruitment process of clinical nurses who participated in the study, consisting of 23 individuals. This demonstrates the researchers' determination of the adequate number of participants for the research (Beck, 2008).

Instead of using a sampling technique, the researchers focused on gaining a thorough understanding of how pressure ulcers affect patients' quality of life. The small sample size was not considered an issue because purposive sampling was used to select individuals based on their specific experience with

pressure ulcers. The participants in the study had pressure ulcers ranging from grade 2-5 and were located in various parts of the body. Additionally, the researchers took variables such as age, sex, and reason for admission into account.

In order to accurately depict the overall population, researchers chose not to document the research rate. This lack of documentation presents difficulties in comparing participants and those who declined. Moreover, the sampling strategy used was non-random, thereby restricting the applicability of the results to a broader population. In contrast, patients in the second article were randomly assigned to the dressing group.

The total sample consisted of 200 participants, with each comparison group having 100 participants. Random allocation ensures that participants have an equal chance of being assigned to a study group, which helps obtain a statistically significant difference between the dressings of the comparison group. Proper randomization reduces the impact of confounding variables, both known and unknown, that may affect the study outcomes.

To conclude that the difference in effectiveness between the dressings is unlikely to be due to chance, a probability or power calculation is necessary. If the sample size is too large, it can lead to a type 1 error known as 'false positive results', which weakens external validity. On the other hand, a small sample size can result in a type 2 error or 'false negative results', weakening internal validity. In this study, the sample selection technique aligned with the methods used in RCT and the approach to sampling size and selection (Cormark, 2000).

The clinical trial had a low chance of selection bias as participants in the alginate

and hydrofiber control group were allocated randomly. Single blinding was used to blind the participants, which may have helped to overcome bias since nurses could differentiate the two dressings in appearance. According to Jadad (1998), randomization and double blinding are gold standards for randomized control trials. Data collection is a method used to gather research information.

The credibility of the research findings is determined by the validity and reliability of the collected data (Hek et al, 2002). In article one, a semi-structured interview served as the method for collecting data. According to Barriball and While (1994), semi-structured interviews enable patients to convey their experiences and offer a thorough explanation of how pressure ulcers affect their quality of life. Moreover, encouraging participants to clarify their understanding of the questions during the interviews enhances the trustworthiness of the findings.

The credibility of the findings was enhanced by recording the interviews, as mentioned by the researchers. The use of semi-structured interviews and recording method were considered appropriate for this study. Two distinct data collection methods were employed to ensure a comprehensive investigation of the findings. However, the article did not include the specific questions asked by interviewers. The relationship between patients and researchers/interviewers was clearly established.

According to Burn and Groove (2008), the way a person is listened to, eye contact, initiating topics, determining responses, and interrupting can influence the interviewee. The authors state that providing a thorough explanation of the data procedure can limit biased possibilities. However, the article does not mention the duration of the interviews or the number of times participants were interviewed. If the interviews were short, this could result in

obtaining less information. In article two, it specifies how wounds were measured and which tools were used.

In order to improve credibility and ensure accuracy and dependability of the data collected, the researchers chose tools from an international classification of diseases. They also carried out daily observations using an evaluation form and took pictures before and after applying dressings. While visual evidence is useful in providing solid proof of skin damage, it becomes difficult to determine the specific cause because there are both primary and secondary dressings present.

Both articles stress the significance of conducting interviews in a comfortable environment to minimize disruptions and ensure accurate data collection. According to Guerrish and Lacey (2010), if comfort is lacking, it can impact data collection and potentially influence research findings. It should be noted that neither article discusses any challenges or issues associated with this matter. The first article mentions that the study obtained approval from three Ethical Committees, with all participants giving their consent. Additionally, participants were informed about the study's objectives and reassured that they had the right to terminate the interview at any time without providing a reason.

To summarize, participants were reassured that discontinuing their involvement would not impact their treatment and their privacy would be upheld. Ethical considerations are crucial in article 2, as it mandates ethical committee approval prior to conducting clinical trials. This encompasses obtaining consent, safeguarding participant confidentiality, and ensuring privacy. The data analysis process involves condensing, arranging, and interpreting the data. In article 1, the researchers outline the transcription and analysis of the data. Detailed information about the analyzed data can be found in Table

4 of the report.

According to Burn and Groove (2008), the presentation of data is considered clear and helpful in understanding the results, which enhances the credibility of the findings. The article notes that two nurses analyzed the data to ensure rigor in the report. However, because there are only a limited number of themes and subheadings in the table, it is too short to assess the quality of analysis. Therefore, it is important to provide comprehensive information on what patients said and how that information was selected in order to properly evaluate patient experience.

The researcher did not mention data saturation. In the second article, it was stated that all data were analyzed using a statistical program package. According to Carmak (2000), the analysis method should match the collected data. Both articles lack sufficient details for evaluating the quality or impartiality of the researcher's analysis, which raises concerns about its potential impact on the final outcomes.

The researchers in article one presented and discussed their findings. They provided evidence of participants' statements and used a coding system to identify each patient's statement. However, the small sample size prevents generalization of the findings. The researchers also note that they did not obtain ethics clearance to access patient medical records, which limits certainty regarding participant morbidity (Spilsbury et al. 2006).

The study findings are considered trustworthy and believable, although no new concepts emerged. In the second article, the results showed a p-value of 0.02 for the alginate dressing and a p-value of 0.05 for the Hyfrofiber, which indicates statistical significance. The Alginate dressing had fewer occurrences of blisters on patients' skin compared

to the Hyfrofiber, which caused more extensive damage.

The statistical significance of p-value can be uncertain, which highlights the need for confident interval estimation to establish a more solid claim. Without this estimation, the validity of the results becomes questionable. Additionally, the report suggests that both dressings have a p-value of 1 and there is 'no difference' between them. This inconsistency in accuracy raises doubts about the reliability of the findings.

Finally, it states in the same section that no skin damage was found under any of the dressings, and almost all skin damage occurred at 92.3% of the film dressing and steri-drap covering the skin's edge. This indicates that the blisters were caused by factors other than the dressings. Considering these facts and the recommendation statement that supports the selection of one dressing, the reader questions the report's subjectivity and motives.