Nurses are expected to deliver high quality care with the latest techniques and information available. In order to do this nurses are required to actively participate to nursing research and critique them. Nursing research has increased greatly in the past three decades exposing nurses to latest knowledge, to provide quality care to the patients (Polit & Beck, 2004). Further more, to provide evidence based practice, nurses must be able to assess and critique research to evaluate and to judge whether the research is useful, good quality, current and safe to apply in their practice (Fink,2005). This essay critiques a quantitative original research article, which is relevance to nursing.
The research article “Cardiovascular risk of essential hypertension: Influence of class, number, and treatment-time regimen of hypertension medication” by authors Ramon c. Hermida, Diana E. Ayala, Aetemio Mojon and Jose R. Fernandez was published in 2013 by Informa health care USA in Chronobiology international journal volume 30. This essay will critique the above research paper using the systematic frame work provided by Schneider, Whitehead, Lobiondo-Wood & Haber(2013 p 15) including the title, abstract, method, literature review, results, discussion and conclusion of the research paper.
Title of a research article should describe and focus on the research conducted (Cormack, 2000). The title of the research paper by Hermida et al, 2013, clearly describes the purpose of the research and indicates the relevant area of study and the target population. However, by reading the title alone it is difficult to identify the nature of study and requires the reader to continue reading the abstract. It could be argued that it is better to describe this in the title thus it will help the reader to identify whether the research is useful to their practice (Cormack, 2000). Authors’ qualifications are not provided, however it is indicated that the research was conducted by Bioengineering and chronobiology laboratory in a university in Spain. Therefore, it is unable to decide whether the authors have sufficient research skills and expertise to carry out the study.
According to Schneider et al (2013) abstract of an article is a brief summary of the study at the start of an article. Abstract focuses on the important points of the study. It states the purpose, the method, the results and the conclusion of the study ( Schneider et al, 2013). The abstract by Hermida et al (2013 ) clearly describe the purpose of the study and the method and sample used. It also gives a brief description of the data collected and analyzed to provide a conclusion of the study. It is easy for the reader to identify that the research method is quantitative by reading the abstract.
Introduction and Literature review
According to LoBiondo-Wood, G., & Laber, J. (2014) a good literature review provide an introduction, which include the keywords and a description of the databases used to conduct the study. In this article introduction and literature review is included as one subheading, and the authors have clearly identified the keywords of the study, which will again allow the reader to assess the relevance of the study. In this article authors have started the literature review from the introduction part and provided the related previous study findings in order to build the hypothesis of the current study. They clearly describe the need and the rational for the conduction of the study, as the lack of study conducted considering the ingestion time of the blood pressure lowering medication (Hermida et al, 2013).
They have used recent research within the last 10 years to support their research study. However, the research does not specify the search strategies used to locate the previous research used, which questions whether the research used are biased or unbiased (Fink, 2005). As the study is accepted in 2012, most of the research articles cited in the review are current. As mentioned in Fink (2005) articles’ cited within the last 10 years from the year the study is accepted are considered as current research.
In the article, the authors acknowledge that there are several studies conducted to measure the efficiency of blood pressure (BP) lowering medication, disregarding the time of the blood pressure medication taken during the day (Hermida, 2013) This study is conducted using the Ambulation blood pressure monitoring for prediction of cardiovascular event (ABPM) to monitor the effect on better BP control and cardio vascular risk with the bedtime ingestion of one medication rather than all the medications taken in the morning (Hermida, 2103). Authors support the ABPM design that is used for the study by citing previous research studies that have used the same design, in order to improve the credibility of the research (Cormack, 2000).
Aim and Hypothesis
Aim and hypothesis have been clearly stated in this article by Hermida et al(2013). Unlike qualitative research, quantitative research has an hypothesis provided by the researchers to compare the relationship between variables (Polit & Beck, 2004). The aim of the research is to examine the administration time effect on the CVD risk and lowering BP of each class of antihypertensive medication and the number of medication used for therapy (Hermida et al, 2013). Authors have conducted the study based on the hypothesis that “bedtime therapy with one or more BP lowering medications exerts better BP control plus greater CVD risk reduction than the conventional morning only schedule of all therapy” (Hermida et al, 2013 p 324). This hypothesis can be categorized as directional as it predicts the expected outcome of the study conducted (Polit & Beck, 2004). According to Polit & Beck(2008), directional hypothesis may results in biased outcomes due to the intellectual commitment to the desired hypothesis.
Quantitative research approach provides a better state of evidence and increase ability to replicate the study (Schneider, 2013). This study by Hermida et al (2013) provides clear information about the methodology, sample and the technique of the data analysis used.
Authors have chosen samples for this research based on inclusion and exclusion criteria, providing very clear and specific information of the target population group that can be used for the study. The sample group were from a population of Spanish subjects > 18 years of age then carefully screened using the inclusion and exclusion criteria (Hermida etal, 2013). Sample size was clearly stated, which will allow the reader to decide whether the sample size for the study was adequate, however they have failed to mention how the sample size was determined. Sample size was adequate and included both male and female population without gender discrimination.
Therefore, the study can be considered as useful and good quality as there are no gender limitations (Fink, 2005). It has been well described how the samples were recruited for the process and the samples have been chosen from different hospitals to reduce sample bias. According to Hermida et al (2013) the study method was approved by the State ethic committee of clinical research as ethical medical research. And all participants have given written informed consent to participate in research (Hermida et al, 2013).
The design used by the authors for the study was a prospective randomized open label, blinded end point (PROBE) (Hermida et al, 2013). This design can be compared to the double blind design, which commonly used in quantitative research. In contrast to the double-blinded method, the participants/assessors have the ability to know the nature of the treatment. Major advantages of this design are lower cost, higher similarity to clinical practice and the ability to replicate the study easily in order to apply the results into medical care (Polit & Beck, 2004). In addition, even though it is an open labeled design, due to the blinded end point the results will not be subjected to any bias (Cormack, 2000).
The randomized study method used, reduces the sample bias (Cormack, 2000) which is done by a computerized random number generator in this study (Hermida et al, 2013). However, the authors have failed to mention the name of the computerized random number generator program used, which makes it difficult for the reader to replicate and evaluate the credibility of the study (Fink, 2005). Further more, in order to ensure the internal validity of the study the authors have adhered to their exclusion and inclusion criteria and have recruited a large sample group (Polit & Beck, 2008).
Data collection and analysis
Data was collected at the start and at every scheduled visit during the follow up appointment. BP of each recruit was automatically measured at specific times for 48hrs. Authors have used 48hrs observation periods rather than standard 24hrs observation periods (Hermida et al, 2013) to improve the reproducibility and accuracy of the results (Fink, 2005). An actigraph was given to all participants to wear and measure the physical activity during the 48hrs, which is then synchronized to a computer. During the follow up data was collected and necessary test were performed to gather more data and the yearly appointments were organized (Hermida et al, 2013).
More over, data collection procedures are adequately described in the study which will make it easy to replicate (Cormack, 2000) The use of multiple data collection instruments can be identified as a strength of the study and citations of previous research have been provided to support the data collection instruments, hence will improve the validity and quality of the study (Cormack, 2000) There were no ethical issues identified as the participants provided informed consent prior to the study (Fink, 2005).
The results of the study are given in great detail using one table and 7 graphs within the paper. They have used subheading within the results section to clearly present the results for different variables of the study. Findings are accessible and p values are clearly stated, which is important in a quantitative study (Hermida et al, 2013). The consistency of the results, logical link between the data analysis and findings of the study presented in text and in numbers are similar which outlines the correctness of the findings and the findings can be used in clinical practice (Polit & Beck, 2008). The table and graphs used to interpret data are very clear and easy to understand by the reader.
Discussion and conclusion
Discussion and conclusion are presented under the same subheading in this research paper. The discussion appeared well balanced and very well detailed, making it easy for the reader to understand and analyze the paper (Cormack, 2000). Authors have discussed and compared the findings with the previous credited research, which are mentioned in the literature review. Authors argue the accuracy of the research findings in a logical manner summarizing relevant previous research findings.
They challenge the past research stating how this study method of BP lowering is more effective than the traditional way of treatment using their findings. Even though, the authors have not used a separate section for the conclusion, they have strongly supported the hypothesis in the last paragraph of the paper by using the results obtained (Hermida et al, 2013). In addition, the authors do not mention strength and limitations of the study. Limitations and strengths of a study is useful when assessing the validity of the study or to improve the research method ( Cormack, 2000).
Reference list is complete and accurate and include all the cited literature, which includes 72 references, most within the last 10 years of the year the study was accepted (Hermida, 2013).
In conclusion this study was conducted very well with a strong hypothesis, relevant literature review, appropriate samples, well-organized research design and statistical analysis. This essay has critically analyzed each component of the study by Hermida et al(2013) adhering to a systemic framework in order to assess the quality, credibility and validity of the research study.
Cormack, D. F. S. (2000). The Research Process in Nursing (3rd ed.): Blackwell Science Ltd. Fink, A. (2005). Conducting Resaerch Literature Reviews: From the Internet to Paper (2nd ed.): SAGE Publications.
Hermida, R., Ayala, D., Mojón, A., & Fernández, J. (2013). Cardiovascular risk of essential hypertension: influence of class, number, and treatment-time regimen of hypertension medications. Chronobiology International, 30(1-2), 315-327. doi:10.3109/07420528.2012.701534 LoBiondo-Wood, G., & Laber, J. (2014). Nursing Resarch: Methods and Critical Appraisal for Evidence-Based Practice Retrieved from http://books.google.com.au/books?id=3tTsAwAAQBAJ&printsec=frontcover&source=gbs_ge_summary_r&cad=0#v=onepage&q&f=false Polit, D. F., & Beck, C. T. (2008). Nursing Research: Generating and Assessing Evidence for Nursing Practice Retrieved from http://books.google.com.au/books?id=Ej3wstotgkQC&printsec=frontcover&source=gbs_ge_summary_r&cad=0#v=onepage&q&f=false Polit, D. F., & Beck, C. T. (2004). Nursing Research: Principles and Methods Retrieved from http://books.google.com.au/books?id=5g6VttYWnjUC&printsec=frontcover#v=onepage&q&f=false
Schneider, Z., Whithead, D., Lobiondo-Wood, G., & Haber, J. (2013). Nursing and Midwifery Research: Methods and appraisal for evidence based practice (4th ed.).