Write a critical appraisal that demonstrates comprehension of two quantitative research studies. Use the \”Research Critique Guidelines – Part II\” document to organize your essay. Successful completion of this assignment requires that you provide a rationale, include examples, and reference content from the study in your responses.

Use the practice problem and two quantitative, peer-reviewed research articles you identified in the Topic 1 assignment to complete this assignment.

In a 1,000–1,250 word essay, summarize two quantitative studies, explain the ways in which the findings might be used in nursing practice, and address ethical considerations associated with the conduct of the study.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

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 Quantitative Research Critique  

The selected topic is ventilator-associated pneumonia (VAP), a common nursing practice problem in healthcare organizations. VAP is a respiratory infection that affects patients under mechanical ventilation and occurs approximately 48 hours after mechanical ventilation. Just like other hospital-acquired infections (HAIs), VAP is associated with increased healthcare costs, prolonged length of hospital stay, and increased morbidity and mortality. VAP affects about 28% of inpatients in the ICU and therefore this is a nursing issue that needs to be addressed. Among the interventions shown to be effective in lowering the prevalence of VAP is repositioning of patients by elevating their head bed angles to 30 – 45 degrees. Thus, there is a need to conduct more research regarding the efficacy of repositioning of patients by elevating their head bed angles to 30 – 45 degrees in preventing VAP.

Title and Author(s) of Article 1

Ghezeljeh, T. N., Kalhor, L., Moghadam, O. M., Lahiji, M. N., & Haghani, H. (2017). The Comparison of the Effect of the Head of Bed Elevation (HOB) to 30 and 45 Degrees on the Incidence of Ventilator-Associated Pneumonia and the Risk for Pressure Ulcers: A Controlled Randomized Clinical Trial. Iranian Red Crescent Medical Journal, 19(7).

Background Article 1

According to Ghezeljeh et al (2017), VAP is a common HAI that affects a high number of patients within the ICU and are under mechanical ventilation. VAP risk factors include sedatives, proton pump inhibitors’ drugs, increased blood transfusion, mechanical ventilation, neuromuscular paralyzing agents, feeding tubes, and endotracheal intubation. Factors like endotracheal intubation significantly interrupt the mechanism of airway protection and lead to the local inflammation. Thus, preventing VAP should be a key priority when providing care to critically ill patients. The aim of Ghezeljeh et al (2017) is to compare the efficacy of elevating HOB to 30 and 45 degrees on VAP.  The research question in this article is “what is the link between pneumonia, and varying degrees of HOB among patients under mechanical ventilation?”

Title and Author(s) of Article 2

Martinez, B. P., Marques, T. I., Santos, D. R., Salgado, V. S., Nepomuceno Júnior, B. R., Alves, G. A., Gomes Neto, M., & Forgiarini Junior, L. A. (2015). Influence of different degrees of head elevation on respiratory mechanics in mechanically ventilated patients. Revista Brasileira de Terapia intensiva, 27(4), 347–352.

Background Article 2

According to Martinez et al (2015), the position of mechanically ventilated patients in bed has a direct impact on their respiratory function. This is because the posture increases the mechanical load and thus outweighing the respiratory system airflow. Studies suggest that the head of patients who are mechanically ventilated ought to be maintained between 30 and 45 degrees to reduce the risk of broncho-aspiration and VAP. The patient’s position can have a direct impact on the respiratory mechanics of the patient and thus this study aimed to examine the respiratory mechanics of patients under mechanical ventilation and positioned at different head angles. The research in this article is “how does the positioning in bed for patients who are mechanically ventilated impact their respiratory mechanics”?

Relationship to Nursing Practice

The article by Martinez et al (2015) provides that in patients under mechanical ventilation, the head angles affect their respiratory mechanics. Therefore, this article supports the EBP project by providing evidence regarding the impact of the position of the head on the risk of VAP by impacting the respiratory mechanics. According to Ghezeljeh et al (2017), the elevation of the patient’s head bed to 45 degrees lowers the rate of VAPs when compared to head-bed elevation at 30 degrees. This study supports the EBP project by demonstrating the efficacy of head-bed elevation in lowering the rate of VAP.

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Method of Study- Article 1

Ghezeljeh et al (2017) used adopted a quantitative research design and used a randomized controlled trial as the methodology. The study was conducted in the ICU and the study sample included mechanically ventilated patients (n= 120). The study sample should be selected based on the primary endpoints of the study and thus as per the study aim, the sample was appropriate (Grand Canyon University, 2018). Data was collected using various instruments including the Braden scale, clinical pulmonary infection score, and APACHE II. Data analysis was conducted using Scheffe ad hoc tests and ANOVA. The cited studies are current because it is recommended that nursing research should be the latest. Quantitative Research Critique Essay

Method of Study- Article 2

Martinez et al (2015) employed a quantitative research design and used a prospective physiological design. The study’s setting was an ICU at Hospital Santo Antônio and the sample included ventilated adult patients. Data was collected by obtained the values of respiratory mechanics od the patients from the mechanical ventilators. Data analysis was performed using the Friedman analysis tool and ANOVA tool. The cited studies are current because it is recommended that nursing research should be the latest.

Combined Results of the Studies

Findings from Ghezeljeh et al (2017) show that elevation of the head-bed to 45 degrees has a higher efficacy in lowering the rate of VAP in patients who are mechanically ventilated in comparison to an elevation of 30 degrees. Findings by Martinez et al (2015) indicated that resistive airways pressures reduced in patients positioned at higher angels. The findings from both studies show the positioning of the head angle for patients under mechanical ventilation has an impact on the respiratory mechanics and therefore the position of the head-bed can influence the risk of VAP in this patient population.

The implication to practice from the two studies is that appropriate elevating/positioning the head-angles form patients who are mechanically ventilated may reduce their risk of acquiring VAP.

Ethical Considerations

It is essential to obtain informed consent from the potential study participants before engaging them in any research. This ensures that the study participants make informed decisions before taking part in the study (Dankar et al., 2019). The approval should be sought from the appropriate research ethics committee before starting any research study involving humans. Additionally, the confidentiality and privacy of the study participants ought to be respected and maintained. In the two study articles, informed consent was obtained from all study participants, and also the privacy and confidentiality of the patients were maintained (Grand Canyon University, 2018). Moreover, researchers obtained approval from the appropriate research ethics committees before starting the research.

References

Dankar, F. K., Gergely, M., & Dankar, S. K. (2019). Informed Consent in Biomedical Research. Computational and structural biotechnology journal, 17, 463–474. https://doi.org/10.1016/j.csbj.2019.03.010.

Ghezeljeh, T. N., Kalhor, L., Moghadam, O. M., Lahiji, M. N., & Haghani, H. (2017). The Comparison of the Effect of the Head of Bed Elevation to 30 and 45 Degrees on the Incidence of Ventilator-Associated Pneumonia and the Risk for Pressure Ulcers: A Controlled Randomized Clinical Trial. Iranian Red Crescent Medical Journal, 19(7).

Grand Canyon University (Ed). (2018). Nursing research: Understanding methods for best practice. Retrieved from https://lc.gcumedia.com/nrs433v/nursing-research-understanding-methods-for-best-practice/v1.1.

Martinez, B. P., Marques, T. I., Santos, D. R., Salgado, V. S., Nepomuceno Júnior, B. R., Alves, G. A., Gomes Neto, M., & Forgiarini Junior, L. A. (2015). Influence of different degrees of head elevation on respiratory mechanics in mechanically ventilated patients. Revista Brasileira de Terapia Intensiva, 27(4), 347–352.

Quantitative Research Critique Essay