Doppler Assessment Critique Essay

The purpose of this assignment is to critique two research studies that I have identified from my practice. I am currently working as a community staff nurse within a District Nursing team (DN). Leg ulcers have a huge impact on the DNs workload, Moffat; Franks & Oldroyd (1992) evidenced that time spent by DNs caring for people with leg ulcers ranged from 9-22% of the total workload.

Douglas (2001) informs us that leg ulceration affects around 1% of the population. This evidence has provided the author with a rationale to review the literature regarding the contemporise issue of Doppler assessmenDts with an aim to measure the reliability and validity of this type of clinical procedure. Learning outcomes to be met will be indicated in bold lettering at the end of each appropriate paragraph. In order to practice competently nurses must possess the knowledge, skills and abilities required for lawful, safe and effective practice (Nursing and Midwifery Council NMC 2004). Evidence based practice therefore is the integration of best research evidence with clinical expertise and patient values (Sackett, Strauss & Richardson 200). Having identified the topic area, a structured approach to the literature review was undertaken as recommended by Polit & Beck (2006).The search involved identifying literature related to the chosen topic.

A computerised literature search was carried out using the following databases; Cinahl, Cochrane, Internurse, Journal of Wound Care and Pubmed (see Appendix.1.). McShay & Haddock (1999) & Polit & Beck (2006) believe that in order to develop evidence based practice it is necessary to identify areas of practice that can be clinically questioned, identify relevant evidence from available information, critically appraise the evidence for validity and usefulness and then implement the findings into clinical practice (LOC 1, 2 &3).

For the purpose of this assignment, the critique framework by Cormack (2000), (appendices. 2.), has been selected as it provides a comprehensive series of questions that are presented in a clear and concise manner, which allows for thorough critical analysis of the chosen research studies. However it must be noted that not all aspects of Cormack’s (2000) framework will be critiqued, due to the type of research articles being critiqued, not all questions need to be answered. The two research articles chosen are1) Community nurse uses of Doppler ultrasound in leg ulcer assessment byLorraine French (2005) see (Appendices. 3.).

2) Pulse oximetry index: a simple arterial assessment for patients with venous disease, by Bianchi et al (2008) see (Appendices. 4.).Title.Polit & Beck (2006), Bond (2000) and Tierney (1996) state that the title of an article should clarify the topic of research and to give an indication of the content, all research articles should have a meaningful and unambiguous title. The title of both French’s (2005) article and Bianchi et al (2008) are concise, informative and clearly indicates the contents of the article. However, they both fail to outline the research approach used by the author.

Polit & Beck (2006) advocate that in quantitative studies the title usually indicates the independent and dependent variables and the population, again, French’s (2005) article does not, however Bond (2000) feels that too much complexity regarding the title may deter the reader from pursuing further reading.Author.When critically reviewing research articles it is important that there is information provided relating to the relevance and appropriateness of the authors academic and professional qualifications, and their experience to perform such research (Cormack 2000).

French (2005) appears adequately qualified both academically and professionally to perform the study as she is a qualified nurse and clinical specialist and possesses a higher degree in Vascular Nursing. Bianchi et al (2008) also all appear adequately qualified; between them on paper they hold both academic and professional qualifications. However their capacity in the research study is unclear. Knapp (1998) comments that it is common practice to list individuals as authors although in fact their role may have been no more than providing access to the research subject.

Abstract.Parahoo (2006) believes that abstract information should be concise and succinct, including the aim, methods, samples and findings. The chosen research articles abstracts does contain the afore mentioned criteria. Therefore the abstracts did provide sufficient details regarding the nature of the study and the relevance to the reader.Introduction.After reading the introduction the reader should be clear about the exact nature of the research, its background and context (Tierney 1996). Cormack’s (2000) framework questions whether the introduction to the study clearly identifies the problem, the rationale, and the limitations of the work. French (2005) clearly identifies the problem within the introduction by outlining the influential variables evident in assessing Doppler readings.

The observation that such variables can cause significant inaccuracies was considered adequate rationale for conducting the study (Russell 1999). However French (2005) failed to identify the studies limitations within the introduction, which could be perceived as a weakness (Polit & Beck 2006). Bianchi et al’s (2008) also clearly identify the problem area and give a rationale for the study. They go on to inform the reader of what they hope to accomplish by conducting the study, Bianchi et al (2008) also have documented limitations of the study which can only increase its validity.Literature Review.Cormack (2000) suggests that the review should incorporate up-to-date publications and should draw upon a wide range of resources. Porter & Carter (2000) propose that a literature review is essential to the research as it provides the reader with the relevant knowledge regarding the identified subject, which may then aid to identify shortfalls in the subject that needs addressing.

Oermann et al (2006) claim that most clinicians are not interested in a lengthy background of previous research or any gaps in the literature that led to this study. Polit & Beck (2006) disagree, they argue that the aim of a research literature review is to summarise the existing knowledge related to the research problem. Benton & Cormack (1996) suggest the review should also create a structure upon which further research can be based, by identifying gaps as well as strengths and weaknesses.French’s (2005) article does not give the literature review its own heading. Her literature does include a wide variety of sources that originate from the 1970’s, however, it could be argued that, although there appears to be no omission of references, none are dated post 2002. French (2005) failed to identify whether this was due to an insufficiency of relevant, recent studies, therefore provided cause for a weakness within the review. The review doesn’t critically appraise and compare key studies and it doesn’t present a balanced evaluation of supporting and challenging material.

Draper (2004) points out that literature reviews are often insufficiently critical, the reasons for the selection and inclusion of material is not clear and bias is often shown towards studies demonstrating positive findings. Although French’s (2005) identifies the need for such research she fails to state what additional contributions to the body of knowledge her work will contribute.Operational Definitions.Cormack (2000) suggests that the research report should include operational definitions of the terms utilised within the research problem. French (2005) has defined the terms used within the confines of the study, such as educational issues and sharing of knowledge amongst Primary Care Trusts (PCTs), but fails to identify them clearly as operational definitions.

Bianchi et al (2008) also define the terms used in the question within the confines of the study, such as, searching for alternative methods of measuring pressures in the lower leg, and making testing much simpler and effective enabling ease for the operator with greater healing rates for the patient. Again Bianchi et al (2008) fail to identify them clearly within the literature as operational definitions.Methodology.

Holloway & Wheeler (2003), and Parahoo (1997) state that methodology is a term used to describe the thoughts and principles researchers base their procedures and strategies. The methodology for both French’s (2005) and Bianchi et al (2008) articles is quantative. Quantitative researchers believe that the scientific approach provides the appropriate methodology to study the social world in which their opinion has parallels with the natural world (Kelly & Long 2005). This positivistic approach emphasises objectivity and impartiality. Quantative research data therefore must be reliable, verifiable and representative. French (2005) clearly stated that the research was an exploratory survey and included a table of assessment showing the method used and how data was collected.

The approach chosen by Bianchi et al (2008) is described as a prospective approach. The method chosen would appear to be suitable for the research problem, but the article would have benefited from a discussion by the authors of the strengths and weaknesses of their chosen approach. (LOC4).

Subjects.Cormack’s (2000) framework questions whether the subjects of the study are clearly identified. In both French’s (2005) and Bianchi et al’s (2008) studies the subjects are clearly identified and described within the study. Both authors also added inclusion criteria, a positive aspect of the study as it illustrates the characteristics of the subjects and that the sample did represent what the author intended it to do (Burns & Grove 1997).

Data Collection.The data collection methods for a quantitative study must be predetermined, structured and standardised (Parahoo 1997). There are a number of ways available to collect data; the success of a study depends heavily on the quality of the methods chosen and employed (Whittmore & Grey, 2006). All tools used must be reliable and valid to ensure the validity of any study (Haber & Loiondo- Wood 2006). French (2005) attempts to describe the data collection procedures but fails to provide any adequate information. She also mentions briefly that alterations were made to the original questionnaires as a result of the pilot, however French (2005) does not include any evidence of this, therefore this is a weakness of the data collection instrument, therefore reducing the tools validity (Burns & Grove 1997). Bianchi et al (2008) describe the data collection procedures at great length, they also document the strengths and weaknesses of their chosen collections, thus increasing validity and reliability of the results. Bianchi et al (2008) also analysed their chosen data collection methods, again improving the studies validity.

Ethical Consideration.Cormack’s (20000) framework to analysing literature includes analysis of the attention paid to ethical consideration within a study. Both studies do not go into any depth regarding ethical issues and it does not suggest that confidentiality or anonymity was assured.

Therefore the researchers did not appear to follow a quantitative model of ethical consideration when applying the research (LOC.3).Results and Data Analysis.

Cormack’s (2000) framework asks if the results are presented clearly. French’s (2005) results are described in detail, however, not necessarily within the results section of the article, making interpretation fairly difficult. French (2005) displayed some of her findings in graphs and tables, enhancing the clarity of the results being presented. Polit & Beck (2006) claim that this allows for a considerable amount of information to be displayed in a limited space. Although the findings identified a number of important factors little depth was explored, therefore the confidence of the study is debatable, as if the trial was repeated would it disclose similar findings? Was the study reliable? (LOC.5).Discussion.

Cormack (2000) suggests that the discussion will enable speculation about the meaning of the findings, recognition of the limitations of the study and suggestions for future research in that specific subject area. French (2005) acknowledges the study’s weaknesses; she discusses time limitation, sample size and variations in practice, therefore limiting the validity of the findings. The discussion should according to Polit & Beck (2006) suggest implications and meanings of the findings, pose alternative implications, relate the findings to previous work and suggest the use of research results. French’s (2005) discussion section is very disjointed and lengthy.

It does however present a balanced discussion and links the findings to previous research in order to confirm the authors own findings with some success. French (2005) acknowledges the studies weaknesses; she discusses time limitation, sample size and variations in practice therefore limiting the validity of the findings.Conclusion.Cormack (2000) suggests the conclusion should be supported by the results, identifying the implications and recommend further actions.

The conclusion that French (2005) study reached was that there seems to be an unacceptable level of variation in the application and interpretation of Doppler assessments within the community setting. French (2005) identified implications for practice, for instance, ensuring nurses undertaking Doppler assessments need to ensure that they have received formal training, she fails however to suggest any practical suggestions as to how this will be achieved.Recommendations.There is no specific section within French’s (2005) study; she appears to have incorporated various recommendation elements throughout the discussion section. There are no suggestions for future/further research, which limits the value of this particular article.

She also fails to suggest any alternative methodology which could be implemented to further expand the body of nursing knowledge relating to this subject.