Mobility Protocol Article Critique 1

MOBILITY PROTOCOL ARTICLE CRITIQUE 1

Mobility Protocol Article Critique

Katrina Lampman, Tina Palmer, Shelly Parker, and Carol Zinn

Ferris State University

NURS 350
Abstract

This paper is designed to read and critique the article “Impact of Nurse-Driven Mobility Protocol on Functional Decline in Hospitalized Older Adults” by Padula, HughesBaumbover(2009) by using Nieswiadomy’s (2010) book titled “Foundations of Nursing Research” as a guide. This article was broken down into the steps of the nursing research process and critiqued accordingly.

Keywords: mobility, functional decline, protocol, internal validity, external validity

Mobility Protocol Article Critique

The purpose of this paper is to establish students’ skills at critiquing research work as a group. The article critiqued was “Impact of a Nurse-Driven Mobility Protocol on Functional Decline in Hospitalized Older Adults” by Padula, HughesBaumbover(2009). Nieswiadomy (2010) was used as a resource for evidence-based practice and critique models.

According to Nieswiadomy (2010), a nursing researcher article should include a purpose and problem statement, review of literature and theoretical framework, a hypothesis or hypotheses, sample and study design, data collection methods and instruments, data analysis, discussion of findings, and conclusions, implications, and recommendations. This paper shows the evidence, support, and analysis of each of these sections of the article critiqued.

Purpose

Evidence

According to Nieswiadomy (2012, p. 34), the purpose of an article can be determined by why the study was done. In this article, the purpose was clearly stated as it had the words “the purpose of the study” in the sentence. Padula, Hughes & Baumbover (2009, p. 326) state “the purpose of the study was to determine the impact of a nurse-driven mobility protocol on functional decline in hospitalized older adults”. In a review of the text book materials, the book described the purpose statement and noted the difference between a purpose and a problem, avoiding any possibility of confusion.

Support

The purpose of the study should be written in the article in such a way that it will leave no doubt to the reader what it is (Nieswiadomy, 2012, p. 300). Before the study even begins, the reasons for the study should be determined. The purpose statement is usually written in the abstract and again in the introductory section of the article(Nieswiadomy, 2012, p. 34). The text does also state that the purpose statement should be in the form of a study purpose (Nieswiadomy, 2012, p. 300). It is also noted that the broad purpose of the study may be more specific in the form of objectives or goals.

Analysis

The purpose of the mobility article is pretty strong in this section as it is well defined and the reader is able to understand what is going to happen, but the conclusion in the article included the length of stay which was not mentioned in the purpose statement. According to Nieswiadomy (2012, p.303), the conclusion of the study answers the purpose of the study. There was no abstract with a purpose statement attached to this article.

Problem Statement

Evidence

The problem statement is not clearly defined in this article; however, it can be found at the end of the introductory paragraph, which is the correct placement according to Nieswiadomy(2012, p. 300). The writers make the problem statement difficult to single out.

The problem in the article is “the goal of this study was to determine the impact of the mobility protocol on the functional decline in hospitalized patients” (Padula, Hughes, and Baumhover, 2009, p. 325).

Support

According to Nieswiadomy (2012, pp. 33-34), the reader should be able to identify the problem statement at the beginning of the introductory paragraph. The text indicates that the problem of the study should be clearly identified. It further indicates that early in the report there should be a mention of the broad problem of the study. The more specific statement of the problem can be found in the abstract and at the end of the introductory section of the report. The text also states that the problem statement can be in the form of a declarative problem statement, a purpose statement, or a research question. The problem statement should contain the population and major variables and indicate the data may be gathered empirically. The feasibility and significance of the study should be apparent. In many reports the purpose may be more easily identified than the problem (Nieswiadomy, 2012, p. 300).

This research article, “Impact of a Nurse-Driven Mobility Protocol on Functional Decline in Hospitalized Older Adults” (Padula, Hughes & Baumhover, 2009) is of quantitative design. Therefore, there should be a clear problem statement at the beginning of the article. The goal of this article is feasible so it is capable of being carried out successfully as the costs are low, data can be easily gathered, assessed, and the subjects are easily accessible. This study is also beneficial to healthcare workers, physicians, and patients.

Analysis

Since the reader is unable to clearly define the problem statement at the beginning of the article, it is weak. The reader may have to read the manuscript very closely to identify what the problem is. The purpose statement is clear, however. The study is ethical as the patients were informed by a letter approved by a review board and then gave consent. There was no harm done to the patients. The study was low in costs as it did not require any additional staff or expensive equipment. The subjects were readily available, which enabled the studied to be completed.

There are benefits to all the healthcare professionals and the patients as patient satisfaction and level of functioning improve with this intervention. Although the subjects were carefully screened for functional mobility and cognitive ability prior to the study, there were still a lot of variables. For example, the fall risk factors were higher in the control group than the treatment group, meaning that there were already some weaknesses or decreases in mobility. Further, there was a wide age range and some varying levels of independence as some came from home, some from assisted living, and some from a nursing home. It is not clear how the data was gathered or exactly what the data is, therefore the reader is not sure how the authors support their conclusion.

Review of Literature

Evidence

The beginning of the review of literature (ROL) is at the end of the first paragraph in the article after the problem statement. The article goes right from its introduction into the ROL. It cites several articles with statistics to indicate there is an ongoing problem with functional decline in activities of daily living (ADL’s) and ambulation in hospitalized patients. It goes on to discuss how this decline is associated with poor outcomes and prolonged length of stay.

The article then presents its findings associated with increased mobility while hospitalized and how this increased mobility yielded positive outcomes for the patients. The article then concludes its ROL with a short statement regarding maintenance of mobility in critically ill people and how this is crucial in the achievement of positive outcomes. There was some critiquing of the articles, but nothing substantial.

Support

Nieswiadomyindicates in the text that the ROL should be all-inclusive and to the point. It should have a nice flow and be easy to understand. All sources should be relevant to the study topic and should be critically appraised. The research should be critiqued in the article such that the reader knows if the findings are weak or strong(Nieswiadomy 2012, pp. 78-79).

ROL should include classic sources as well as current sources. Most references should not be more than 5 years old. The ROL should be mostly paraphrases and not direct quotes, but both should be cited when referencing the writings of others. One should be able to determine if the researcher is using primary sources or secondary sources (Nieswiadomy 2012, p. 71).

However, this is not always clear in the writings. To distinguish between the two it may be necessary to look at the reference list for hints. It is to be expected that research journals are primary sources, while secondary sources are items like book chapters and literature reviews. The only way to know for certain would be to review each reference personally but this is unlikely to be an option. Supporting and opposing theory and research should be presented in the ROL section.

All sources should be cited on the reference list and should be without errors (Nieswiadomy,2012, pp. 78-79). The ROL can be found toward the beginning of the article or toward the end of the article, depending on the design. The ROL should “provide an adequate summary of the existing body of knowledge on the phenomenon of interest” (Nieswiadomy,2012, p. 306). The ROL should end “with a sentence or two that indicates how the present study will contribute to the existing body of knowledge in that subject area” (Nieswiadomy2012, p. 300).

Analysis

The ROL is not clearly marked but it is distinguishablebecause it flowed from the purpose statement as indicated it should according to (Nieswiadomy, 2012, p. 79). It is easy to tell when the article moves into discussing the ROL as it starts to give statistics and cites where these statistics come from. The information is to the point, but not convincing that it is all-inclusive and the flow of the information seemed a little off. It is not clear by reading the article whether the sources used are primary or secondary. When reviewing the citations at the end of the article, it is apparent that they are mostly primary sources, but some of them were difficult to determine. There are some book references which could be secondary sources as these could be considered classic sources and the articles as current sources. Some of the resources used in the article were more than five years old so the ROL is a weak section. While the article does not indicate direct quotes, specific statistics cannot be paraphrased which is what Nieswiadomy states should be (Nieswiadomy,2012, p. 300). The researchers also did not critique the articles that they used to determine if the resources are appropriate. According to Nieswiadomy (2012, pp. 78-79), this is part of the ROL process.

This ROL is at the beginning of the article as Nieswiadomy indicates it should be. The article does provide some opposing information but not much. Nieswiadomy(2010, p. 79) states that both supporting and opposing theory should be represented, which makes this section of the article weak as well.

Theoretical Framework

Evidence

Under the Intervention heading, the researcher does mention that education had been provided to nurses on the GENESIS model (Geriatric Friendly Environment through Nursing Evaluation and Specific Interventions for Successful Healing)(Padula, HughesBaumbover, 2009, pp. 327-328). However, there was no information provided on the theories of the GENESIS program. It would be more beneficial to the readers of this study to know what GENESIS is. The framework is not clearly defined in this article.

Support

The theoretical framework provides a general explanation of the relationships between concepts of interest in the study, and is based on one existing theory. The conceptual framework explains the relationships between concepts and can link the concepts from several theories. The theories are based on previous results or from the experience of the researcher. The concepts should flow in a logical manner and are less well developed than a theoretical framework(Nieswiadomy, 2012, p. 88).

Conceptual frameworks can act like maps. According to Nieswiadomy, theoretical or conceptual framework assists in the selection of the study variables and in defining them. The conceptual framework should define the terms, propositions, and assumptions of the researchers (Nieswiadomy, 2012, pp.87-88). The framework also directs the hypothesis and the interpretation of the findings (Nieswiadomy, 2012, p. 35).

Analysis

The article is weak in showing the conceptual framework clearly. The framework is not clearly defined and there is no conceptual framework heading to point the reader in locating the information. There is reference to the educational program provided to the nursing staff called GENESIS, but there is not much information about what GENESIS is, or the theories related to the program.

The researcher attempted to provide definitions of the variables, especially as noted in describing the instruments used. However, when the researcher used the term functional status, the term was not clearly defined which made it difficult to determine that functional status had actually improved. Finally, the type of hospital used for the research study was not clearly defined.

Hypothesis

Evidence

According to the article by Padula, HughesBaumhover(2009,p. 327), there are two hypotheses stated. The first hypothesis states “older adults who participate in a mobility protocol will maintain or improve functional status from admission to discharge” (Padula, HughesBaumhover, 2009,p. 327). This means that the research will prove that elderly patients, that are part of the mobility study, will improve their functional level of mobility or at least maintain it.

The other hypothesis states “older adults who participate in a mobility protocol will have a reduced LOS” (Padula, HughesBaumhover, 2009,p. 327). This means that the length of stay will be decreased for those who participate in the mobility exercise. The independent variable, or cause, is the mobility protocol. There are two dependent variables, or effects, and they are the functional status and length of stay. The population in this study is elderly adults and it was plainly identified that the elderly patients were over the age of 60(Padula, HughesBaumhover, 2009,p. 327).

Support

According to Nieswiadomy(2012, p. 36), a hypothesis should be written in the present tense. The goal of the hypothesis is to be specific in identifying the part of the theory being tested. The hypothesis should answer the research question. The knowledge that is gained through the study is used to either support or reject the hypothesis or theory. Both positive and negative findings are important to the research. The hypothesis predicts the relationship between one or more variables. A variable is something that is different among the population being studied (Nieswiadomy, 2012, pp.36, 41,100).

In the text by Nieswiadomy (2012, pp. 101-104), there exist different hypotheses; simple, complex, research, null, directional, and nondirectional. A simple hypothesis looks at the relationship between one independent variable, or cause, and one dependent variable, or effect. A complex hypothesis looks at the relationship of two or more independent or dependent variables or both. A null hypothesis states that there will be no relationship between the variables. The researcher’s goal is to disprove the null hypothesis. The research hypothesis expects that there will be a relationship between the variables. Hopefully, the outcome of the research supports the research hypothesis and rejects the null hypothesis. A nondirectional hypothesis is one where a research predicts that there is a relationship between the variables. The expectation of the researcher may not be clear. In a directional hypothesis the relationship between the variables is clear, as are the expectations of the study (Nieswiadomy, 2012, pp.101-104).

A hypothesis is used in a quantitative research design because it contains the researcher’s expectation about the results of the research. A hypothesis must also predict the answer to the research question, contain the population, variables, and be able to be tested in an empirical fashion, which means one should be able to validate the findings of the research by realistic means such as using the senses (Nieswiadomy,2012, pp.105-106).

Analysis

This article did contain two clearly stated hypotheses which are written in the present tense. The dependent variable, the functional status, and length of stay are clearly stated as well as the independent variable, and the mobility protocol. The hypothesis is a directional hypothesis as the relationship between the variables is clear. It uses two dependent variables, and one independent variable; the results of the study support the research hypothesis. The null hypothesis is not clearly defined, but may be assumed in this study. The population is addressed in the hypothesis, and it can be empirically tested. One can see the results and hear about the results.

More positive findings were addressed in the study than negative. There was a direct correlation between the research question and the hypothesis. The article is strong in clearly stating what the hypotheses are and that the LOS decreased and that mobility had increased and the hypothesis are easily identified within the article. The article was weak in stating what the null hypothesis is.

Research Design

Evidence

In the article by Padula, Hughes & Baumbover(2009, p. 327), they clearly state that the study used the “nonequivalent control group design”. It is clearly stated under the headings “Research Methods” and “Design” what control group design was used as their research method. In addition, it is clearly stated under this heading what the independent and dependent variables are. The independent variable is “mobility protocol” and the dependent variables are “functional status and LOS” (Padula, Hughes & Baumbover, 2009, p. 327).