SOLUTION

Critical Appraisal of an RCT

Introduction

            The basis of nursing, the very nature of the profession, is defined by caring. In the best possible way, the role of the nurse is to put their patients in a position in which they will be able to self-heal. This is the vision that Watson (1997) reiterates in her Theory of Human Caring. In the theory, Watson (1997) explicates that “humans cannot be treated as objects and that humans cannot be separated from self, other, nature, and the larger workforce” (pg 49). This theory emphasizes the interpersonal process between nurse and the patient – recognizing the healing potential for both the one who is caring as well as the one who is being cared for. Inspired by Watson, Ozan and Okumuş (2017) take a similar approach in their bid to understand whether the theory can be used in patients with infertility treatment in order to decrease levels of anxiety and distress. Their research paper represents one of the many Randomized Controlled Trials that seek to answer questions relating to the theory. This paper, therefore, will critically analyze Ozan and Okumuş’ (2017) paper using a Rapid Critical Appraisal Checklist developed by Melnyk and Fineout-Overholt (2011).

Summary

            Infertility is one of medical problems that does not only affect the individual but also cause familial and social problems. On this perspective, Ozan and Okumuş (2017) evaluates the effectiveness of the nursing care program based on Watson’s Theory of Human Caring. In their paper, they seek to analyze how effective the program is when infertility treatments fail. The study, conducted from April to November of 2012, encompassed 86 Turkish women with infertility; 45 of whom were the intervention group while the others were the control group. After a follow-up for at eight months, data was collected through Distress scale, a questionnaire on ways of coping, and Spiel Berger’s State. The data was later analyzed using SPSS. As per their analysis, their results showed a significant difference between the intervention group and the control group in terms of anxiety, distress, and coping levels for women with infertility. For this reason, they concluded that Watson’s theory of human caring is recommended as a guide to nursing patients with infertility treatments in order to decrease levels of anxiety and distress while also increasing positive coping styles among the same women.

Rapid Critical Appraisal

            The first criteria for critique are the validity of the results conducted. The first question seeks to understand whether the participants were randomly assigned their groups. In the Ozan and Okumuş (2017) study, the participants were, as a matter of fact, blind from their assignment to either the intervention or the control group. As long as the women fit the criteria for both groups, they were randomly assigned to either groups without their knowledge. However, the providers knew where each woman fall within the study groups. For the reason, the participants were blind of their assignment but the providers were not. 77.9% of the original participants went all the way with their assignments, indicating that the study was fully conducted with a majority of participants. The study was also designated to be conducted over a period of eight months, which is far more sufficient for this type of study. Furthermore, the study followed up 32 women from the intervention group and 35 women from the control group four weeks after the study. This insinuates that the study fully studied the effects of the intervention. The participants were also analyzed in the groups to which they were assigned, with valid and reliable instruments. Considering the participants from each group were similar in demographic and baseline clinical variables, it can be safely concluded that study was valid.

            The second criteria to be analyzed is the reliability of the results. Perhaps, one of the biggest issues with any clinical trial is whether the results can be relied upon to be used in actual care practice. For this reason, the results of this study will therefore be analyzed to ascertain their reliability. As per the authors, the effect of the intervention was large and quite significant when compared with the control group. The intervention’s group anxiety was recorded to have decreased (from the initial level before the study) by thirteen points and distress by fourteen points. On the other hand, a negative increase was recorded in the control group’s distress and anxiety levels depending on the failure of the treatment. Furthermore, the coping style score for the control group drastically reduced, insinuating that the intervention group did far better than the control group. In that regard, the study is reliable.

            Similarly, a study is only viable if it is applicable in an actual clinical scenario. A randomized clinical trial will also, therefore, be analyzed by its applicability in the field of nursing care. Having have read and gone through the study a couple number of times, one thing is clear, the authors largely advocate for the theory to be used in all nursing cares even though this study mostly focuses on infertility cases. Considering the results and the analysis of this critical appraisal, all clinically important outcomes were measured in this study. However, the study majorly focuses on the effect of the intervention style on the patient only. While the theory insinuates that a similar outcome would be experienced by the care nurse, this is completely not measured. Furthermore, there might be the risk of developing feeling in the process of interpersonally creating a connection with a patient. Nonetheless, the treatment is feasible in my clinical setting and can be used to ensure better outcome with my patients. For this reason, I would use this study results in my practice to make a difference in patient outcome. This is because this method provides the nurse with a good guidance that will also result in high quality nursing care. Furthermore, I can accomplish this not by the medicine approach but by the improvement of human character and love. I can do this by focusing on the individual, being respectful, honest, sensitive, and providing care with love as if providing to my own child or sibling; thus, reducing anxiety in the patient.