EBP Critique Essay PDF

Preview

Summary

My essay is an Evidence Based Practice critique. I had to critique this EBP article "Evaluating the effectiveness of gel pillows for reducing bilateral head flattening in preterm infants: a randomized controlled pilot study"
My Professor is Peterson....

Description

1

EBP Critique: Evaluating the effectiveness of gel pillows for reducing bilateral head flattening in preterm infants: a randomized controlled piloto study Alyce A. Schultz et al. Professor Peterson, 11/4/2020 Shaniyah Thompson

2

Abstract

The following paper provides a critique of the article “Evaluating the effectiveness of gel pillows for reducing bilateral head flattening and preterm infant; is a randomized controlled pilot study” authored by Alice Schultz et al. This study looks at the findings of how using a gel pillow in preterm infants will decrease bilateral head molding. This article gives insight on how bilateral head molding has caused a negative perception of the beauty of the infant primarily too the parents. This article provides comparison of how other studies that were previously conducted help layout the foundation to this research. This paper would go over how effectively this article was written, the type of framework was used, and how it can help nurses in the future. As well as what kind of exogenous factors that could have effects on accuracy of the data obtained.

3

Authors Alyce A Schultz et al(2006) of The article “ Evaluating the effectiveness of gel pillows reducing bilateral head flattening in preterm infants: a randomized controlled study” are qualified to do this research because more than one of the authors work in the Neonatal Intensive Care Unit(NICU) which enables credibility and therefore has an understanding of dealing with bilateral head molding. Secondly, at least one of the authors has credibility in the practice of Evidence-Based Practice. The authors did look at the literature at the expense of what can decrease bilateral head molding and how the previous studies were able to collect data. “The most common measurement for comparison across the studies is the Cephalic Index(CI), (Schultz et al.,2016, p.192)”. However, the authors did not thoroughly take into account how the study design affects the outcome of the data. Such as the length of the study, the gestation age of the infants, and the number of subjects. Two of the studies mentioned in the literature section of the article were inappropriate to use as a reference because the gestational age of the infants was younger than the infants in this article, therefore, inhibiting subjects who are over 32 weeks gestational but younger than 36 weeks. Secondly, another inappropriate literature that should not be present is the research conducted by Marsden on the water pillows because of the lack amount of participants “ Marsden reported that the use of a standard mattress for reducing head molding in preterm nonidentical female twins,(Marsden,1980, p.192)”. The title can be more direct with the study. The title can be rewritten as “ Evaluating the effectiveness of gel pillows for reducing bilateral head flattening in preterm infants in tertiary

4

level of nice”. This gives a precise overview to the reader on what type of preterm infants is being observed. The abstract gives insight into the focal point of the study, and lets the reader know how measurements are taken, and whether the results were favorable to the hypothesis or not. The problem statement has easily been defined in the introduction. “Heald molding has been identified as a contributor to negative perception of the cuteness of infants by nonparents, parents and caregivers, suggesting that these premature infants may be at greater risk for the negative physical and psychosocial effects of a dissociated bonding process and lack of caregiver attachment, (Schultz et al,2006,p.191)”. Secondly, the study object is not clearly stated but rather suddenly mentioned in the literature. For best understanding, the study object should be placed in the introduction. The hypothesis is that infants in the experimental group would demonstrate significantly less head molding over time than those in the control group by 5 weeks post-birth. The hypothesis is clearly stated and well structured. More so it was not expressed in the introduction but rather at the end of the literature review which was inappropriate. It should be stated in the introduction so the reader can have a sense of what the focal point is of the research so when analyzing the literature part it helps with understanding. This is considered a simple hypothesis because it involves 2 variables which are the standard mattress and the gel pillow. There no theoretical framework used but rather used a conceptual framework because of the use of other sources of research with similar concepts but different variables such as water pillows, water bed therapy, positioning protocols, and foam mattress. This was appropriate however, the authors should have looked at the subjects and what kind of level NICU the infants reside in. As well as the number of subjects involved in the study.

5

The population is selected by eligibility if they are under 1500g which equivalents to 3.3 pounds and are under 34 weeks of age. However, infants were excluded if they had any cranial deformities and abnormalities. “Exclusion criteria included hydrocephalus, microcephaly, cranial deformities or central nervous system, abnormalities,(Schultz et al.,2006,p.194)”. This was a nonprobability sample because they were randomizing the selection of infants. The important extra variables are the nurses who are taking care of the infants while they reside in the hospital. The researcher attempts to control them by educating the nurses. “All registered nurses in the NICU received education on the rights of subjects participating in research and information on the inclusion criteria to assist in identifying potential infants for the study,(Schultz,2007,p.192)”. The data was being collected through the use of the NICU nurse measurement. The instrument that was instructed by the researchers. The instrument that was instructed to use by the researchers is a 6-inch digimatic. “The AP and BP were measured using a 6-in digimatic caliper manufactured by Mitutoya,(Schultz et al.2006.p.195)”. Instead of using the caliper, the researchers could have opted out for a ribbon measuring tape which would be more resourceful and appropriate for the use of infants, the staff to use and the parents observing. The difference between the control and experimental group is that most values stayed within range. The difference in the 15-week mark is the mean CI difference between the control and experimental group was .001. “The mean CI for subjects in the control group was 1.41, as compared to the mean CI of 1.40 for subjects in the experimental group, (Schultz et al.,2006,p.196)”. More upon entry the correlation birth weight between and CI had little to no difference. “There was no statistically significant difference between the CI of infants weighing 1000g(Shultz et al,2006,p.196)”. There was a

6

point in the study where the subjects had reversed effects using the gel pillow. “At week 7, the degree of head molding began a downward trend for those infants placed on pillows, (Schultz et al,2006,p.196)”. It was appropriate to use a T-Test to collect data because they're looking for the mean values of a single variable into groups. However, it was inappropriate to do the Anova test because the researchers are only working with two groups and they're only comparing two samples which are with the gel pillow and without the gel pillow. The appropriate measure would be is the correlation coefficient because they are measuring how much the gel pillow decreases bilateral molding compared to the standard mattress. What were used to show the data as line graphs. The line graphs allow the reader to see the difference between the groups. There was a risk in external validity within the discussion pointed out about the nurses not being able to fully attend to the infants the way the researcher wants. The author mentioned one of the NICU nurses interfering with the experiment itself and the information being projected. As the reader this invention poses its benefits to the infant's however, it is not responsible for the difference but rather the turning of infants “The repositioning standard was defined as “met” if repoositioning was documented six times duringt the day,(Schultz et al.,2006,p.196)”. This allowed for the infant to have rotation rather than laying in a supine position in which the pressure builds up. The author discusses the limitations present in the study of the blinding of research assistants. Also, the constant reduction of participants for the study made it difficult for accurate data collection. There is only one study that the findings were consistent with however the others were different whereas they had positive feedback to their hypothesis. This study compared the Hemingway and Oliver water bed study presented with the same limitations such as size “Only 5 infants remained in the study at 11 weeks. (Schultz et al,2006,p.193)”.

7

This article is relevant to nurses because it allows the nurse to see the effects of the use of a gel pillow and other inventions that may help decrease bilateral molding. Not only will it help with appearance but it may even prevent health issues that may be associated with bilateral head molding that may not have been researched. It can also create a foundation of interest in nureses to develop more research and hypotheses based on what was presented in this quantitative paper.

8

References

Schultz, A. A., Goodwin, P. A., Jesseman, C., Toews, H. G., Lane, M., & Smith, C. (2008). evaluating the effectiveness of gel pillows for reducing bilateral head flattening in preterm infants: a randomized controlled pilot study. Applied Nursing Research, 21(4), 191–198. https://doi.org/10.1016/j.apnr.2006.11.003...