Why Is Critical Appraisal Needed? Discuss The Role Of Critic ✓ Solved

Why is critical appraisal needed? Discuss the role of critic

Why is critical appraisal needed? Discuss the role of critical appraisal in literature searches using databases like Medline or EMBASE, outline key questions and checklists used in appraisal, and apply critical appraisal to the study 'Effects of Nursing Care Based on Watson's Theory of Human Caring on Anxiety, Distress, and Coping When Infertility Treatment Fails' (Durgun & Okumus, 2017), evaluating its design, methodology, results, feasibility, clinical applicability, limitations, and conclusions.

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Introduction

Critical appraisal is essential in modern healthcare because literature searches in databases such as Medline and EMBASE often return large volumes of heterogeneous studies that vary widely in methodological quality and clinical relevance (Fineout-Overholt et al., 2010). Appraisal helps clinicians and researchers separate robust evidence from opinion, bias, and flawed methods, allowing prioritized focus on studies that reliably inform practice and policy (Higgins & Green, 2011). This paper summarizes key appraisal questions and applies them to an RCT by Durgun and Okumus (2017) evaluating nursing care guided by Watson's Human Caring Theory in women experiencing infertility treatment failure.

Key appraisal domains and questions

Critical appraisal typically examines: relevance and novelty (Does the study address a meaningful clinical question?), study design appropriateness (is an RCT, cohort, or qualitative design appropriate?), internal validity (randomization, allocation concealment, blinding, attrition), measurement validity (use of validated instruments), statistical analysis (correct tests, handling of missing data, effect sizes and confidence intervals), reporting transparency (adherence to CONSORT or other standards), conflict of interest, and external validity or applicability to local practice (Fineout-Overholt et al., 2010; Schulz et al., 2010).

Useful checklists include CONSORT for randomized trials, the Cochrane Risk of Bias tool, and discipline-specific appraisal checklists that probe population, intervention, comparison, outcomes, timing, and setting (PICOS) (Schulz et al., 2010; Higgins & Green, 2011).

Summary of the Durgun & Okumus (2017) study

Durgun and Okumus conducted a randomized controlled trial at a Turkish infertility clinic (n=86) comparing a nursing intervention based on Watson's Human Caring Theory to standard nursing care among women undergoing infertility treatment. The primary outcomes were anxiety, distress, and coping, assessed with validated measures (Spielberger State-Trait Anxiety Inventory, Infertility Distress Scale, and a Coping Methods Inventory). Block randomization, blinding of staff scheduling and allocation concealment elements were reported; no participant dropouts were recorded. Analysis used SPSS v13, and follow-up included sessions across treatment and after failed cycles (Durgun & Okumus, 2017).

Appraisal of internal validity

Strengths: The RCT design is appropriate to test the causal effect of the nursing intervention (Polit & Beck, 2017). Use of block randomization and separation of appointment times reduces selection and contamination bias; staff blinding to allocation is a tangible strength. Use of validated psychometric tools (Spielberger, Infertility Distress Scale) supports measurement validity (Spielberger, 1983).

Limitations: Complete participant blinding is unlikely given the interpersonal nature of the intervention, raising the possibility of performance and detection bias. The paper's description suggests analysis was performed "in the group to which participants were designated," but it is unclear whether a prespecified intention-to-treat (ITT) analysis was used; absence of explicit ITT reporting can overestimate effect sizes if protocol deviations existed (Schulz et al., 2010). The small sample size (n=86) raises concerns about statistical power and precision, particularly for subgroup or secondary outcomes (Higgins & Green, 2011). The reported results emphasize change scores but the summary here lacks explicit p-values, confidence intervals, or effect sizes that are crucial for interpreting clinical significance (Guyatt et al., 2008).

Appraisal of methodology and analysis

The study followed CONSORT principles in design stages, which increases confidence in reporting completeness (Schulz et al., 2010). Use of SPSS v13 is standard, but transparency about missing data handling, assumptions of parametric tests, and multiplicity adjustments was not fully described in the summary provided; these elements are vital for assessing the robustness of findings (Higgins & Green, 2011). The follow-up schedule was adequate to capture immediate psychological effects; however, longer-term outcomes (e.g., subsequent mental health, relationship impact, treatment adherence) were not measured, limiting conclusions about sustained benefit.

Clinical applicability and external validity

The intervention appears feasible and acceptable in the study setting and yielded clinically meaningful reductions in anxiety and distress and improvements in adaptive coping strategies (Durgun & Okumus, 2017). However, participants were women attending a single infertility clinic in Turkey; applicability to other cultural contexts, to couples rather than women alone, or to different healthcare systems remains uncertain (Greil et al., 2010). The intervention’s resource implications (nurse training time, session frequency) were not quantified, which is important for implementation decisions in routine care.

Bias, conflicts, and ethical considerations

No conflicts of interest or funding biases were indicated in the summary provided; full appraisal requires checking declarations in the article. The absence of dropouts is notable but warrants verification (unexpected zero attrition can signal selective reporting). The study's ethical approach—voluntary participation and informed consent—was described, aligning with best practice for trials involving psychosocial interventions (Polit & Beck, 2017).

Conclusions and recommendations

Overall, Durgun and Okumus (2017) present encouraging evidence that nursing care grounded in Watson’s Human Caring Theory can reduce anxiety and distress and improve coping after infertility treatment failure. Methodological strengths (RCT design, validated measures, protective allocation procedures) support cautious confidence. Key limitations—small sample, limited generalizability, uncertain handling of missing data, and incomplete reporting of effect sizes—mean the findings should be considered promising but preliminary. Future studies should preregister protocols, use larger multicenter samples including couples, report ITT analyses with confidence intervals and effect sizes, and include cost-effectiveness and longer-term follow-up to support implementation (Guyatt et al., 2008; Schulz et al., 2010).

For clinicians and librarians conducting literature searches, the study illustrates why critical appraisal is needed: appraisal identifies both strengths that justify clinical consideration and weaknesses that temper immediate adoption into practice (Fineout-Overholt et al., 2010). Using structured checklists (CONSORT, Cochrane Risk of Bias) and focusing on applicability will ensure evidence synthesis leads to safer, more effective patient care decisions.

References

1. Durgun, O. Y., & Okumus, H. (2017). Effects of nursing care based on Watson's theory of human caring on anxiety, distress, and coping, when infertility treatment fails: a randomized controlled trial. Journal of Caring Sciences, 6(2), 95–109.
2. Watson, J. (2012). Human Caring Science: A Theory of Nursing (2nd ed.). Jones & Bartlett Learning.
3. Fineout-Overholt, E., Melnyk, B. M., Stillwell, S. B., & Williamson, K. M. (2010). Critical appraisal of the evidence: Part II. American Journal of Nursing, 110(9), 41–49.
4. Schulz, K. F., Altman, D. G., Moher, D.; CONSORT Group. (2010). CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. BMJ, 340, c332.
5. Higgins, J. P. T., & Green, S. (Eds.). (2011). Cochrane Handbook for Systematic Reviews of Interventions. The Cochrane Collaboration.
6. Spielberger, C. D. (1983). Manual for the State-Trait Anxiety Inventory (STAI). Consulting Psychologists Press.
7. IBM Corp. (2004). IBM SPSS Statistics for Windows, Version 13.0. IBM Corp.
8. Guyatt, G., Oxman, A. D., Vist, G., et al. (2008). GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ, 336(7650), 924–926.
9. Polit, D. F., & Beck, C. T. (2017). Nursing Research: Generating and Assessing Evidence for Nursing Practice (10th ed.). Wolters Kluwer.
10. Greil, A. L., Slauson-Blevins, K., & McQuillan, J. (2010). The experience of infertility: a review of recent literature. Sociology of Health & Illness, 32(1), 140–162.