NUR 319 Nursing Assignment Hermanson and Åstrandb
What is meant by evidence-based practice?
Evidence-based practice (EBP) is the use of the best available evidence in combination with clinical expertise and patient values to guide healthcare decision-making. EBP involves critically appraising research evidence to identify the most relevant and reliable findings, which can then be integrated with clinical expertise and patient preferences to inform healthcare decisions.
Why is it important that we use evidence-based practice?
There are several reasons why healthcare professionals should use evidence-based practice:
- Improved patient outcomes: Evidence-based practice is associated with better patient outcomes, as it involves using interventions that have been shown to be effective in research studies.
- More efficient use of resources: By using evidence-based practice, healthcare professionals can avoid using interventions that have not been shown to be effective, thereby reducing waste and unnecessary expenditure.
- Greater consistency of care: Evidence-based practice helps to ensure that patients receive consistent, high-quality care, regardless of the healthcare professional they see.
- Enhances clinical decision-making: Using evidence-based practice ensures that healthcare decisions are informed by the best available research evidence, leading to more informed and effective clinical decision-making.
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Hermanson and Åstrandb (2020) Study Critique Questions
The study by Hermanson and Åstrandb (2020) investigated the effects of early pacifier use on breastfeeding outcomes. The following questions are related to the study design:
Did the research address a clearly focused research question?
A focused research question is a clear and concise statement of the problem being studied. The research question was clearly identified as “What are the effects of early pacifier use on breastfeeding?” This question is focused and specific and helps to guide the study design and analysis.
Were the participants clearly identified? Why is this important?
Clear identification of study participants is important to ensure that the study results are applicable to the population of interest. In the study by Hermanson and Åstrandb, participants were clearly identified as primiparous women who planned to breastfeed and had given birth to a healthy term infant. Participants were recruited from a single hospital in Sweden, which may limit the generalizability of the study results.
Was the intervention clearly described? Why is this important?
A clear description of study interventions is important to ensure that the intervention can be replicated by other researchers and healthcare providers. In the study by Hermanson and Åstrandb, the intervention (early pacifier use) was clearly described as offering a pacifier within 2 hours of birth and allowing unrestricted pacifier use. However, it is unclear whether the control group received any pacifier use, which may limit the interpretation of study results.
Was the assignment of participants to interventions randomized?
Randomization is the process of assigning study participants to treatment or control groups randomly, to minimize the risk of bias. In the study by Hermanson and Åstrandb, participants were randomized to either the intervention group (early pacifier use) or the control group (no pacifier use). The authors used computer-generated randomization, which is a commonly used and adequate method of randomization.
How was randomization carried out, and was it sufficient to eliminate systematic bias?
Randomization was carried out using a computer-generated randomization list. This method of randomization is sufficient to eliminate systematic bias and ensures that participants are assigned to study groups in a way that is not influenced by the researcher.
Was the aim of the research clearly identified, and why is this important?
Yes, the aim of the research was clearly identified. The aim of the study was to determine the effects of early pacifier use on breastfeeding outcomes among newborn infants. Clearly identifying the aim of the research helps to ensure that the study is conducted in a focused and systematic manner.
Discuss the reasons why observational studies have found associations between pacifier use and shorter breastfeeding duration, while results from randomized controlled trials (RCTs) did not reveal any difference in breastfeeding outcomes.
Observational studies have found associations between pacifier use and shorter breastfeeding duration, while RCTs have not consistently shown a difference in breastfeeding outcomes. One possible explanation for this discrepancy is that observational studies are prone to bias, including selection bias, confounding bias, and information bias. Observational studies often involve non-randomized samples and may be subject to a range of confounding variables that cannot be controlled for, such as maternal breastfeeding attitudes, maternal education, and socioeconomic status. In contrast, RCTs involve the randomization of participants, which can help to reduce bias and increase the internal validity of the study.
Another explanation for the discrepancy between observational studies and RCTs is that observational studies may be influenced by reverse causation. For example, mothers who are having difficulty breastfeeding may be more likely to use pacifiers to soothe their infants, rather than the other way around. In contrast, RCTs are less prone to this type of bias because they involve the random allocation of participants to interventions, which reduces the likelihood of reverse causation.
Were all participants who entered the study accounted for at its conclusion?
Yes, all participants who entered the study were accounted for at its conclusion. The researchers reported a 100% follow-up rate, which means that all participants who were enrolled in the study were included in the final analysis. Accounting for all study participants is important to ensure that the study results accurately reflect the study population and minimize the risk of bias.
Methodological Considerations
Were the participants ‘blind’ to the intervention they were given? Consider the benefits of using a ‘blind’ design.
The study does not explicitly state whether the participants were blinded to the intervention they were given. However, blinding is an important aspect of RCTs because it helps to eliminate bias and ensure that the groups are comparable. In this study, blinding could have been achieved by providing all participants with a pacifier, but only activating it in the intervention group. This would help to ensure that any differences in breastfeeding outcomes were due to the use of the pacifier and not to other factors, such as the psychological effect of receiving a pacifier.
Were the baseline characteristics of each study group (intervention group and control group) clearly identified?
Yes, the baseline characteristics of each study group were clearly identified. The study reports that the two groups were similar in terms of demographic and obstetric characteristics, including age, parity, gestational age, birth weight, and mode of delivery.
Prior to collecting data why is important that the questionnaires used, were validated?
It is important to validate questionnaires prior to collecting data because it helps to ensure that they measure what they are intended to measure. If a questionnaire is not validated, it may not accurately reflect the construct of interest, which can lead to inaccurate results. Validating questionnaires involves testing their reliability and validity, which involves assessing their internal consistency, test-retest reliability, and construct validity. In this study, the researchers used a validated questionnaire to assess breastfeeding outcomes, which helps to ensure that the results are accurate and reliable.
Apart from the experimental intervention, did each study group receive the same level of care (that is, were they treated equally)? Why is this important?
It is important to ensure that each study group receives the same level of care, as this helps to control for any extraneous factors that may influence the outcome of the study. If one group receives more attention, support or care than the other group, it can confound the results and make it difficult to determine the true effect of the intervention being studied. In this study, the researchers did not explicitly state whether both groups received the same level of care, but they did state that both groups received standard postnatal care according to hospital guidelines.
Conclusion
In conclusion, the study conducted by Hermanson and Åstrand (2020) was a well-designed RCT that addressed a focused research question related to the effects of early pacifier use on breastfeeding. The study was adequately powered and had a good sample size, and the participants were clearly identified. The intervention was also clearly described, and the assignment of participants to interventions was randomized. The aim of the research was clearly identified and the results were analyzed using appropriate statistical methods. The study also had some limitations, such as the fact that it was conducted in a single hospital and may not be generalizable to other settings. Overall, the study provides important evidence to inform clinical practice in relation to the use of pacifiers and their potential impact on breastfeeding.
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