Running head: QUANTITATIVE RESEARCH CRITIQUE

Quantitative Research Critique Impact of a Nurse-Driven Mobility Protocol on Functional Decline in Hospitalized Older Adults, by Padula, Hughes and Baumhover (2009) Amber Gall Suzette Ploughman Tamara Putney Ferris State University

Quantitative Research Critique Abstract

Understanding and utilizing nursing research is imperative to building a superior evidence based nursing practice. A crucial step in establishing the validity and reliability of any research study is the critical appraisal process. This quantitative research critique appraises all aspects of the Padula, Hughes and Baumhover (2009) nursing research study, Impact of a Nurse-Driven Mobility Protocol on Functional Decline in Hospitalized Older Adults. The purpose and problem statement, review of literature, theoretical framework, hypothesis, sample, study design, data collection methods, instruments and analysis, as well as findings, implications and author recommendations is examined and scrutinized for validity and reliability. Results of this analysis reveal this study presents relatively weak evidence for the hypotheses being tested. However, this research study is considered extremely valuable and encourages more research on this important aspect of utilizing mobility to promote optimal patient outcomes. Keywords: nursing research, critical appraisal, functional decline, evidence-based practice

Quantitative Research Critique Quantitative Research Critique A large percentage of nursing research studies are done using quantitative research. Quantitative research is a formal, objective, systematic process in which numerical data are

used to obtain information about the world (Burns & Grove, 2011, p. 20). Quantitative Research is an important step in building the best evidence-based practice (EBP). Evidence has shown that research studies help to promote the best quality, cost-effective outcomes to patients and families (Burns & Grove, 2011). Making sure that the researcher is using the most current, well-designed and beneficial information available, helps to ensure that the study is going to be of good quality and aide in EBP. All researchers must critique any article to decide if it meets the requirements of a good research tool for their own study. Doing a critical appraisal of an article is done through a process of steps and guidelines (2011). In this paper, a critical appraisal of the article Impact of a Nurse-Driven Mobility Protocol on Functional Decline in Hospitalized Older Adults, by Padula, Hughes and Baumhover (2009) is done using the recommended critique process. Evidence is shown from the article that supports the guided step in the critique process. Support is shown from approved references to explain what should make it an appropriate resource to be used. An overall analysis is completed after each step to explain if the findings were strong or weak and if that section should be used as a reliable source of information or avenue for further research. Purpose Evidence Many past studies have shown a very clear relationship to hospitalization and the loss of functional decline in older adults (Padula, Hughes & Baumhover, 2009). Although the authors discuss and include in the hypothesis how the study affected length of stay in hospitalized

Quantitative Research Critique patients, the main purpose or goal of the study was to determine the impact of a nurse-driven mobility protocol on functional decline in older adults, (Padula et al., 2009, p. 326). Padula, Hughes and Baumhover (2009) focused the nursing intervention of mobility in this study on whether functional decline levels of older adult patients would stay the same, decrease, or improve. Support The purpose of any research study should be clearly stated with precise goals and/or

objectives (Burns & Grove, 2011). According to Burns and Grove (2011) the stated purpose of a research study should allow the reader to clearly understand the relationships between interventions and problems, as well as why the study is of significance and what the researchers hope to solve, produce or prove. In nursing research the purpose is derived from the problem list and should be applicable to nursing practice or patient outcomes (2011). Analysis As Burns and Grove (2011) describe, the purpose of a study is to identify what the specific goal of a study is, and examine the relationships of the interventions, variables and causal relationships contained in the study. The Padula, Hughes and Baumhover (2009) Impact of a Nurse-Driven Mobility Protocol on Functional Decline in Hospitalized Older Adults, study does state a very specific purpose and goal based on problems identified. In interrogatory fashion this study sets out to discover if implementing certain nurse driven mobility protocols on hospitalized older patients will affect functional decline, therefore decreasing length of stay and improving the patient outcome. The population being affected, the location, and variables are evident.

Quantitative Research Critique Problem Statement Evidence

Padula, Hughes, and Baumhover (2009) states a very clear, direct link between functional status, independence and performance of activities of daily living in the very specific population of older adults. If the level of functioning declines, the ability to remain as independent as possible and perform optimal daily living skills is affected (Padula, Hughes & Baumhover, 2009). During hospitalization, research has demonstrated that low mobility and bed rest are common (Padula et al., 2009, p. 325). This study discusses many previous research results and reports that functioning can suffer up to a 50% loss due to a hospitalization (2009). Padula et al., (2009) indicates that several studies have thoroughly documented the fact that functional decline occurs in hospital stays, but some have found little research specific to mobility changes during hospitalization (p. 326). The authors indicate the hopes of the study outcome will be directly affected by the interventions from the nursing staff and pave the way for future studies to utilize nursing interventions to improve patient outcomes (2009). Support The statement of problems in a research study should provide clear identification of a lack of knowledge or understanding, and indicate if a need for further research is recommended or required (Burns & Grove, 2011). The statement of the problem can be a single declarative sentence or imply that actions will determine and affect outcomes (2011). Burns and Grove (2011) also state that identification and implication links to populations, the research scope, assessment of settings, and identification of variables are also important considerations when stating and identifying problem statements in research studies. Problem statements should address feasibility and stress the significance of the study being performed (2011). Problem

Quantitative Research Critique

statements should also indicate whether empirical data is available, and address how the result of the study can impact the nursing profession, as well as, provide enough background information to guide the impending research in the direction of the intended purpose (2011). Analysis Simply and clearly stated, the study sets out to assess whether adding a nurse intervention of increased mobility to an older patients daily hospital stay regime will decrease the decline of functional loss (Padula, Hughes, & Baumhover, 2009). The study problem statement briefly discussed variables, but did not clearly state the relationship to functional decline to specific lengths of hospital stay. However, the authors did allude to the fact that there were numerous opportunities for more data collection and future research (Padula, et al., 2009). In an attempt to gain new insight, building upon previous research and data, the authors expressed the hope that the study would lay the foundation for the development of standards of care for mobility in hospitalized older adults this indicates that the study is ethical and can have a major impact on patients and health care overall, if favorable results are found (p. 325, 2009). The authors convey that positive study results clearly indicate that a knowledge base can be developed and implications for nursing is focused on improving patient outcomes because, impairment in functional status is a strong predictor of poor outcomes (p 325). The purpose and problem statement did address the feasibility of the study, but did not directly relate the ongoing feasibility of results to the nursing profession in regards to staffing and increased workload. More interventions and tasks for nurses could require more staff; benefits and net outcomes would need further review. Conclusion of Purpose and Problem Statement The purpose and problem statements are very important in any research study. Having

Quantitative Research Critique the reader understand what is guiding the author and the research work will spark interest and

may enable the reader to more easily understand how and why the results could impact their area of expertise or patient population, especially in the case of nursing research. The study carried out by Padula, Hughes, and Baumhover (2009) Impact of a Nurse-Driven Mobility Protocol on Functional Decline in Hospitalized Older Adults, announces a clear purpose and justifies why the study is both important and relevant, not only to the healthcare system as a whole, but to the profession of nursing and the patients that are served. Review of Literature Evidence The review of literature for the study Impact of a Nurse-Driven Mobility Protocol on Functional Decline in Hospitalized Older Adults by Padula, Hughes and Baumhover (2009) used 28 prior sources. Twelve sources were less than 5 years and 16 were greater than 5 years, the dates ranged over a 22-year span. The majority of sources that were used came from journals but it is unknown if they were primary sources. There were no direct quotes and some paraphrasing was used. According to Padula et al. (2009), there has not been much research related to changes in mobility during a hospital stay. Support The review of literature in a research article should give the reader a broad enough review of the research to give a thorough overview of what is known about a problem, and contain the most relevant research information (Burns & Grove, 2011). According to review guidelines a research program should start with what is known, review prior research, and build on that knowledge (2011). The information should relate to the purpose of the desired research and use classic and new sources can help balance out the information; opposing sources of

Quantitative Research Critique research should also be mentioned (2011). Burns and Grove (2011) explains that a review of literature should identify the current, most relevant research, but also needs to discuss and identify any gaps in the review. When doing a review of the literature it is important use quotes

only if absolutely necessary; paraphrasing is preferred for the best understanding of the literature (2011). Analysis The review of literature section in this study is weak; it is unknown if the authors used primary or secondary sources. The research was limited in describing how the sample sizes were selected. The instruments used to determine and rate progress were not thoroughly explained. The review mentioned GENESIS as a tool but did no further explanation of what it was. All sources were cited appropriately, however no opposing studies were provided. The study was able to prove one of hypothesis; length of stay was shorter, but the author was not able to prove any effects on maintaining, meeting or improving mobility from preadmission (Padula, Hughes, & Baumhover, 2009). The article does point out factors that may have influenced the study results to conclude in a certain way when it could have gone another. Conclusion It is important to do a review of the literature for any research that is going to be preformed. The researcher must make sure that the information is relevant and reliable for accurate results. In the study, Impact of a Nurse-Driven Mobility Protocol on Functional Decline in Older Adults, by Padula, Hughes and Baumhover (2009) the review of literature needed to be better stated and explained better for the reader. There is a lot of room for error in interpretation of the literature that could be improved upon.

Quantitative Research Critique Theoretical Framework Evidence

This study does not clearly identify the framework that is being used. There is no section of this article that explains or describes what model the researcher implemented, but there is researcher-formulated statements that support the use of a theoretical framework. Even though this is not clearly stated it is apparent that a physiological framework model was utilized to drive the research methods of this study. Padula, Hughes, and Baumhover (2009) state, The purpose of this study was to examine a nurse-driven mobility protocol on functional status and LOS of hospitalized older adults (p. 325). The results were achieved by studying two variables, implementing early ambulation in the treatment group, and comparing results to the control group, which continued to use current practices for mobility during hospitalization. This study focused on nurse driven implementations that are hoped to achieve higher functional mobility for an elderly patient than compared to current practices used during hospitalization. The methods and ways of collecting research are clearly identified for the reader. A stay in the hospital often results in complications that lead to functional decline in older adults, which occurs in 34% to 50% of hospitalized older adults (Padula, Hughes, & Baumhover, 2009, p. 325). In this particular study the functional status at question is the elderly patients mobility while hospitalized. Maintaining mobility is paramount in preserving independence in activities of daily living (Padula et al., 2009, p. 325). Support A framework is an abstract, logical structure of meaning, such as a portion of a theory, which guides the development of the study and enables the researcher to link the findings to nursings body of knowledge (Burns & Grove, 2011, p. 238). In a research study the theoretical

Quantitative Research Critique 10 framework needs to be clearly identified and supported throughout the text so the reader and consumer of research can understand the testing methods and results (2011). Developing a framework to clearly express the logic on which the study is based is helpful both to the researcher and readers of the published study (p. 242, 2011). It is important that the researcher clearly identify the framework from which the study is being derived so that the reader can fully understand the results and knowledge that can be obtained from the researchers efforts (2011). Burns and Grove (2011) state that terms such as cardiac output, dyspnea, wound healing, blood pressure, tissue hypoxia, and metabolism, and functional status are concepts researched in physiological studies. The functional status of mobility fits under this physiological framework. Analysis The theoretical framework in this article is weak. There is no section in this article identified as theoretical framework and the authors do not clearly identify what framework is used for the reader. From the article it can be derived that the appropriate framework is a physiological one because the variable being implemented is one of mobility. As Burns and Grove (2011) discuss, every quantitative study has a framework, this is true whether the study has a physiological, psychological, social, or cultural focus (Burns & Grove, 2011, p. 239). The article being discussed clearly identifies in its opening statement that the functional status of mobility is the issue being studied and the goal is to improve the level of this functional status to the elderly community after discharge from hospitalization (Padula, Hughes & Baumhover, 2009). The interventions such as early ambulation during the patients hospitalization and increased amount of ambulation out of the room are ways in which the physiological concept of mobility was implemented. The process for obtaining the study subjects, explanation of the study, and the way in which informed consent was obtained is clearly identified and easy for the

Quantitative Research Critique 11 reader to understand. The physiological framework is appropriate for the study of improving the elderly patients ability to perform activities of daily living successfully. Two hypotheses were clearly stated and easily identified. Hypothesis one: that older adults who participate in a mobility protocol will maintain or improve functional status from admission to discharge was supported. Hypothesis two: older adults who participate in a mobility protocol will have a reduced LOS, was also supported (Padula et al., 2009, p. 330). Conclusion The theoretical framework in this study, although not precisely stated, is easily identifiable and well fitting for the study of mobility during hospitalization of elderly adults and the long term effects of the patients ability to perform activities of daily living after discharge. The variables being tested are strongly identified. While only a couple of studies previous to this one have been done it is mentioned that there has been limited information collected on this topic, but the purpose of this study was to create more knowledge about the impact of increased mobility during hospitalization. This study however was performed on a small amount of subjects and only on one nursing unit. To provide strength to the mentioned hypotheses the same methods should be used and expanded to a larger amount of subjects and multiple nursing units so that the results can be proven or disproven on a more broad level. Research Objectives, Research Questions, and Hypothesis Evidence The Padula, Hughes and Baumhover (2009) Impact of a Nurse-Driven Mobility Protocol on Functional Decline in Hospitalized Older Adults, quantitative research study does identify two clear declarative research hypotheses. The first hypothesis states: Older adults who participate in a mobility protocol will maintain or improve functional status from admission to

Quantitative Research Critique 12 discharge (Padula, Hughes & Baumhover, 2009, p. 327). The second hypothesis states: Older adults who participate in a mobility protocol will have a reduced LOS, referring to length of hospital stay (Padula et al., 2009, p.327). The study problem and review of literature presented in this research basically suggests that the longer a patient is immobile, the greater the functional decline which in turn has been correlated to an increased length of hospital stay (2009). The hypothesis is directly related to the problems presented in the study, that is, functional decline and length of hospital stay. The hypotheses of the research study clearly identify the population being studied as older adults, and at least two variables for each are identified. The independent variable of a mobility protocol and the dependent variables of improved functional status and decreased length of stay are undoubtedly identified in the Padula et al., (2009) study. Applying a mobility protocol to an older adult during a hospital admission would hopefully result in no decline, or possibly an increase in functional status, referring to the ability to perform activities of daily living, as well as decreased length of hospital stay (2009). Also to note, this study is designed in a way to allow the hypotheses to be easily tested in the hospital environment by specially trained GENESIS nurses (2009). Support Study objectives, research questions, or hypothesis are a key part of any research study (Burns & Grove, 2011). Usually preceding the method section of a study these very important statements act as guides for the remainder of the study (2011). Study objectives are usually in the form of a declarative sentence(s) and define an aim or goal of a study; this type of statement is generally found in descriptive or correlational studies (2011). Simply put, the research question(s) of a study is presented in the form of a question, is very clear, and asks for a relationship outcome of, or differences between variables (2011).

Quantitative Research Critique 13 Burns and Grove (2011) state the hypothesis of a research article is a formal statement of the expected relationship between two or more variable in a specified population (p.167). The hypothesis should basically predict the outcome of the research problem being presented and if possible, be derived from the framework used in the study (Burns & Grove, 2011). Obvious variables, the identification of the population to be measured, as well as a predicted outcome of the study, are all components of a clear hypothesis (2011). Also, it is very important to understand the term variables. Two important variables to understand when critiquing the quality of a hypothesis are: independent and dependent variables (2011). The actual treatment or intervention being carried out in the study is the independent variable, the independent variable is used to induce an expected outcome, that outcome is considered the dependent variable (2011). As Burns and Grove (2011) explains, several types of hypothesis exist: Associative versus causal, simple versus complex, non-direct versus directional and null versus research (p.167). The type of hypothesis used in a research study is determined by the kind of study and the purpose of the study (Burns & Grove, 2011). Burns and Grove (2011) also indicate that the critique of a research study hypothesis should indicate if it is testable or not, that is, can it be supported in the real world. Analysis The Padula, Hughes and Baumhover (2009) Impact of a Nurse-Driven Mobility Protocol on Functional Decline in Hospitalized Older Adults, quantitative research study demonstrates a clear purpose and utilizes hypotheses and not research questions to guide the research objectives. The hypotheses are clearly stated in a declarative format and concise. The Padula, Hughes, and Baumhover (2009) research study does not contain a specific framework therefore the hypothesis

Quantitative Research Critique 14 relates more to the variables than a framework. A weakness is noted in this study in that, although the hypotheses can be tested in the real world, specialized GENESIS training by the nurses are needed (Padula, et al., 2009). According to Burns and Grove, (2011), there should be at lease two variables and both the population and the variables should be very clearly defined in the hypotheses. Padula, Hughes and Baumhover, (2009) does clearly define the variables and the population. Although examination of the variables in hypothesis number one indicates that two outcomes may be seen, the population still remains defined as does the main variables as a mobility program and a decrease in functional decline. The only possible weakness in hypothesis number one relates to the definition of the term older adult, this should be more specifically detailed. The Padula et al., (2009) research study clearly defines the types of hypotheses presented. The hypotheses presented are strong, they are both: simple, causal, directional, and research type hypotheses. A simple hypothesis merely states the relationship between two variables, (Burns and Grove, 2011, p.172). In addition, Burns and Grove, (2011) define a causal hypothesis as demonstrating cause and effect. Padula et al., (2009) identifies that applying a mobility program on older adults will have an effect of decreasing the amount of functional decline, as well as decreasing the length of hospital stay. This research study is considered directional because Padula et al., (2009) is predicting that the nature of the outcome and stating that it will be positive. Had these predictions been designed as non-directional hypotheses, relationships would have been demonstrated but no attempt to predict the nature of the outcome would be seen (2011). Last, Padula et al., (2009) is using research versus null type hypotheses design as evidenced by the direct statement that a positive relationship between the variables does in fact exist. One of the reasons a null hypothesis is used in a research study is when the researcher believes there is no relationship between two variables, (p.172, 2011).

Quantitative Research Critique 15 Conclusion The identification of a clear hypothesis in a research study is imperative. It is important to realize that the study design, sampling method, collection of the data, analysis process and interpretation of the findings can all be affected by the determination of the hypothesis (Burns & Grove, 2011). Ideally, a hypothesis in a research study should be clearly and formally stated, the relationships of the variables must be clearly identified, and the outcome of the study must be clearly predicted (2011). Padula, Hughes and Baumhover (2009) accomplishes this with the presentation of a strong, clearly stated hypothesis. Sample Evidence In the Impact of a Nurse-Driven Mobility Protocol on Functional Decline in Hospitalized Older Adults study performed by Padula, Hughes, and Baumhover (2009) the sample selection used was of the nonprobability and convenience sampling type. Padula et al. (2009) state A convenience sample (N=50) of adults 60 years or older, who were admitted with medical diagnoses to 1 of 2 nursing units (n=25 each) were selected for the study (p. 327). The study subject was required to understand English, have no physical impairments that limit mobility, be cognitively intact, and have a length of stay equal to or longer than three days (Padula, Hughes & Baumhover, 2009). A research nurse chose the study sample and 453 patient records were examined for eligibility to be included in the study (Padula et al., 2009). Originally 84 subjects were enrolled to be included in the research sample, but of those 84, 34 had to be withdrawn due to uncontrollable circumstances such as early discharge, transfers to other nursing units, personal reasons, and occurrence of a disqualifying procedure (2009). The research nurse reviewed the data for eligibility criteria within 48 hours of admission (2009).

Quantitative Research Critique 16 Support Burns and Grove (2011) state that a sample consists of a group of people selected to represent a population. Sampling involves selecting a group of people, events, behaviors or other elements with which to conduct a study (Burns & Grove, 2011, p. 290). It would be impossible for a researcher to have the access or abilities to study an entire population. The process of sampling is used so that a smaller group of people can be studied and evaluated by the researcher and then the results if appropriate can be generalized to the larger population (2011). According to Burns and Grove (2011) there are two main types of sampling: probability and nonprobability. In probability sampling the population is represented on a greater whole and samples are achieved randomly (Burns & Grove, 2011). Nonprobability sampling includes choosing a sample of subjects in a way that is not random; this decreases the representativeness of the population (2011). Convenience sampling is a type of nonprobability sampling where subjects are chosen and included in the study to be performed because they are in the right place at the right time (2011). Burns and Grove (2011) state that convenience sampling groups are made of patients hospitalized on the same unit or with similar medical diagnosis or a group of people who attend the same seminar or class. This type is the most commonly used in healthcare studies, inexpensive, and the least time consuming the weakest approach to research (2011). Frequently, quasi-experimental and clinical trials in nursing are being conducted and require the use of convenience sampling (Burns & Grove, 2011). As Burns and Grove (2011) explain, convenience sampling can be called a weak approach because it provides little opportunity to control the biases of the subjects. In convenience sampling the researcher picks subjects that are in the right place at the right time, like patients admitted on the same unit or having the same or similar medical diagnosis until the desired sample size is reached (2011).

Quantitative Research Critique 17 One of the most troublesome questions that arise during the critical appraisal of a study is whether the sample size was adequate (p. 308, 2011). If the study was designed to make comparisons and significant differences were found, the sample size, or number of subjects participating in the study was adequate (p. 308). Burns and Grove (2011) explain that currently, the effectiveness of the sample size in the study being examined is evaluated and examined using a power analysis. This type of analysis detects the differences between the subjects; this information is usually included in the sample section of the researchers work (2011). Type of study, sample size, number of variables, sensitivity of the measurement tools, and data analysis techniques also influence the adequacy of the sample size (p. 308). Analysis For the purpose of this study the method of convenience sampling was used as is clearly explained and identified in the sample section of the article. As Burns and Grove (2011) state, this method of sample selection is often used in the healthcare setting and is ample in its findings when used with reasonable knowledge. There is the possibility of biases when using convenience sampling, which can affect whether the characteristics of the sample discussed are representative in the entire population. Padula, Hughes, and Baumhover (2009) used the nonprobability convenience method of sample selection because the population of patients in the two nursing units was easily accessible and the desired variables were easily studied here. Padula et al., (2009) explain the final target population consisted of 50 participants of 60 years and older who were admitted to one of the two selected nursing units and fit all inclusion criteria. Inclusion criteria required that the patient had no cognitive impairments, had to be without physical impairments that would limit mobility, be of age 60 years or older, have a length of stay three days or longer, and understand English (Padula, Hughes, & Baumhover,

Quantitative Research Critique 18 2009). Padula, Hughes and Baumhover (2009) also explain that sample size statistics were conducted to determine adequate power and supported a total number equal to 50 (p. 327). Convenience sampling is an acceptable way of performing research when reasonable knowledge and care is used during implementation of a study (Burns and Grove, 2011). The type of sampling and selection used by Padula et al., (2009) was adequate and appropriate for the study that was performed. The sample section in the article clearly lays out the sample method, inclusion criteria, sample size, and use of power analysis. According to Burns and Grove (2011) the authors correctly identified and explained all the details needed to appropriately select the sample population of a research study. Although convenience sampling as explained by Burns and Grove (2011) is frequently used in nursing research, it can be a weak approach because of the uncontrolled biases that can exist in the sample population, so results of studies are not always entirely representative of the larger population. Padula, Hughes, and Baumhover (2009) seem to appropriately use the methods of convenience sampling, and prove its adequacy of power. Conclusion Proper sample size and selection is a fundamental step when performing research. The reliability of an entire research study could be questioned if a valid sample is not used. The authors of this study properly justify the sample they chose to use, and prove its adequacy. Research Design Evidence In the article Impact of A Nurse-Driven Mobility Protocol on Functional Decline in Hospitalized Older Adults by Padula, Hughes and Baumhover (2009) it is clearly stated that the research design that was chosen is a non-equivalent control group design also known as the

Quantitative Research Critique 19 pretest-posttest design. This is an experimental type quantitative study. The article also clearly states that the independent variable is mobility protocol and the dependent variable is functional status and length of stay (LOS) (Padula, Hughes, & Baumhover, 2009, p. 327). The design was chosen to test the hypotheses 1) Older adults who participate in a mobility protocol will maintain or improve functional status from admission to discharge and 2) Older adults who participate in a mobility protocol will have a reduced LOS (Padula, Hughes & Baumhover, 2009, p. 330). The research article states, no attempt was made to influence clinical initiatives on the unit (Padula et al., 2009, p. 330). However, Padula et al., (2009) admits that having an advanced practice nurse on the control unit may have affected the control outcomes. The research design does allow the researcher to draw a cause-and-effect relationship between the two variables. The mobility protocol that was enforced in the experimental group did prove to have a decreased LOS and had a higher functional status at discharge when compared to preadmission functional status than when compared to the control group (Padula, Hughes & Baumhover, 2009). Support According to Grove & Burns (2011), A research design is a blue print for conducting a study (p. 253). There are several different designs available to help a researcher; such as the descriptive design, which includes comparative and case study (Burns & Grove, 2011). There is also the correlational design that includes the descriptive correlational, predictive and model testing design (2011). The quasi-experimental design is an experimental design that includes the pretest-posttest design and randomized clinical trials (2011). According to Burns & Grove (2011) the most common experimental design is the pretest-posttest design with experimental

Quantitative Research Critique 20 and control groups (p. 276). Burns & Grove (2011) states that multiple experimental and control groups can be used. The pretest measures the dependent variable between groups in the beginning then adds in the manipulation of the independent variable (treatment). The posttest then re-measures the dependent variable after treatment between the experimental and control groups (2011). Uncontrolled threats to an experimental study can be the testing itself, the instrumentation, disease burden or size of sample groups (2011). Analysis This study has a strong clear research design stated for the mobility and functional status of the experimental and control groups. The design chosen was not the best choice, but does show that the mobility protocol put in place had better final outcomes than the control group did. This was not a well-controlled study in that it did have threats to its validity. The internal validity is compromised because each group was not of equal comparison as the researchers took whatever admissions met their criteria. Because the two groups were unequal it makes the results and statistics weak. There was a lack of a strong control group and they did not pick their subjects randomly, making this study more of a quasi-experimental type design not experimental. Padula, Hughes, and Baumhover, (2009) does discuss the possibility that further studies could be done. Also, Padula et al., (2009) suggests that a larger sample size with several different units would be beneficial to the outcome. Conclusion Picking the right type of research design is crucial to having the best outcome on what is being studied. If the author of a research study clearly states the design they are using, then the process involved must match the design being used.

Quantitative Research Critique 21 Data Collection Evidence Padula, Hughes and Baumhover, (2009) state the data collected and included in this study consisted of: Demographic information of patients including data such as age, gender, primary diagnosis, use of assistive devices, fall risk assessment, presence of any restrictions to mobility, use of occupational or physical therapy, LOS, first and number of times out of bed, and type of out of bed activity (p. 328). Functional status and the ability to stand from an armchair were also data that was collected during the study (Padula, Hughes & Baumhover, 2009). Cognitive status, length of stay, and being without physical impairments were also data collected and included in the study to screen for eligibility of the patients (Padula et al., 2009). According to Padula, Hughes, and Baumhover (2009) data was collected a couple of different ways including Mini-Mental status examinations, modified Barthel Index (BI), and the Get Up and Go test. The Mini-Mental status examination was implemented in the screening process to determine eligibility and select subjects for participation in the study. The patients

score of this exam was collected and only those patients who scored a 24 or above were eligible for the study (Padula, Hughes & Baumhover, 2009). Things included in the eligibility screening were events such as early discharge, transfer to another nursing unit, personal reasons, and occurrence of disqualifying procedure (Padula et al., 2009). Padula et al., (2009) used the modified BI test and the Get Up and Go test as measurements of ability of individuals to perform activities of daily living (ADLS) and ability to stand from armchair and ambulate.

Quantitative Research Critique 22 Data was collected by advanced practice nurses with gerontology and geriatric expertise, the nurses were hired and trained by the geriatric nurse practitioner to collect data during the course of the study (Padula, Hughes, & Baumhover, 2009). According to the authors these registered nurses on the involved nursing units were already knowledgeable about treating geriatric patients and integrating Geriatric Friendly Environment through Nursing Evaluation and Specific Interventions for Successful Healing (GENESIS). GENESIS education included a formal, intensive 3-day continuing education units program related to principles of geriatric nursing care (Padula et al., 2009, p.328). Eligibility data of patients in this study was collected and screened by the hired research nurse. Padula, Hughes and Baumhover (2009) collected data on inpatients that stayed 3 or more days and completed their hospital stay on 1 of 2 nursing units at the Miriam Hospital in Providence, Rhode Island. The two nursing units used for the study were equivalent to each other in size and served similar patient populations. This hospital is a teaching facility affiliated with Brown Medical School and the first Magnet hospital in Rhode Island (Padula, Hughes & Baumhover, 2009). The two nursing units used for the study were equivalent to each other in size and served similar patient populations. Data for eligibility was collected within 48 hours of admission for eligible subjects (Padula, Hughes, and Baumhover, 2009, p. 327). Mobility status data was collected throughout the patients length of stay in the involved nursing units. Support Data collection is the process of acquiring the subjects and collecting data for the study (Burns & Grove, 2011, p. 361). The collection of data varies and is unique and specific to each study (2011). A good research report explains the way in which a researcher collected their data

Quantitative Research Critique 23 so that it is easily accessible to the reader (2011). According to Burns and Grove, (2011) details that need to be included about data collection include how subjects were chosen, what was the sampling criteria, the amount of subjects who declined the study, and approaches to measurement. The result is a step-by-step description of exactly how, where, and in what sequence the researchers collected the data (Burns and Grove, 2011, p. 361). The author of the study needs to make the data collection process they used clear to the reader so the results of the study can be fully understood. Burns and Grove (2011) state that recruiting subjects, consistent collection of data, maintaining controls, protecting the integrity of the study, and solving issues that could potentially disrupt the study are all steps that need to be taken by the researcher during the data collection process. Subject selection is based on the design of the study and needs to take place during the initiation phase of data collection (2011). The authors state that consistent data collection is a key step to any research design and helps maintain the validity of the study (2011). Minimizing the influence and interference of outside forces on the study is also a necessary part of the data collection process (2011). If the controls cannot be maintained than there is no validity of the results. Last, Burns and Grove (2011) state that researchers need to protect the integrity of their study and look at the data collection as a whole piece. Analysis Although there is no section clearly labeled data collection, the information can be found throughout the design, sample, site, intervention, procedures, and instrument sections. The data collected by Padula, Hughes, and Baumhover (2009) in the Impact of a Nurse-Driven Mobility Protocol on Functional Decline in Hospitalized Older Adults research study is strong and easily identified and understood by the reader. Burns and Grove (2011) state that authors of good

Quantitative Research Critique 24 research identify and lay out the data collection process for the reader. Padula et al. (2009) clearly describe their data collection process walking the reader through the steps of subject selection, eligibility screening, methods used for mobility testing, and who and where the research was performed. The only thing that is not clearly found is how long of a period the researchers performed their study over. This would be helpful information to the reader so that the results can be regarded as short term or long term. Padula et al., (2009) clearly identify the use of advanced practice nurses, and research nurses for data collection and screening for eligibility of subjects. The recruitment and selection process for obtaining subjects was identified by the authors. Padula, Hughes, and Baumhover (2009) state that a research nurse collected data within 48 hours of admission for eligibility in the study. The inclusion criteria consisted of the ability to speak English, having no physical impairments, and receiving a score of 24 or higher on a mental status examination (Padula, Hughes & Baumhover, 2009). Advanced practice nurses collected the data with expertise in geriatrics. Padula et al., (2009) state The geriatric clinical nurse specialist and research nurse practiced screening for eligibility and scoring using the study instruments prior to data collection and continued until acceptable reliability was achieved (p. 328). The data from this study were collected in a consistent and concise manner. Two standardized tests were used to assess the ability of subjects to complete ADLs and mobility. The Get Up and Go Test and the BI tests have been proven reliable and valid when assessing mobility (Padula et al., 2009). Burns and Grove (2011) explain intervention designs need to be implemented consistently throughout the research process. The authors achieved this by having nurses educated with GENESIS and certified nurse assistants walked the study participants 3-4

Quantitative Research Critique 25 times per day (2009). Padula et al. (2009) did an excellent job of laying out there data clearly for the reader to understand. Conclusion In conclusion, the data collection is specific to each study (Burns & Grove, 2011). The researcher must thoroughly describe these methods to the reader to support the validity of the research findings (2011). Although not placed in one location, the data collection methods performed by the researcher are clearly explained and the researchers prove that their data collection methods were sufficient for this study. Data Measurements Evidence The article, Impact of a Nurse-Driven Mobility Protocol on Functional Decline in Hospitalized Older Adults by Padula, Hughes and Baumhover, (2009) uses several different measuring instruments for their research. They used a demographic data collection sheet, a modified Barthel Index (BI), a Get Up and Go test, a rail elderly functional assessment and a Mini-Mental State examination (Padula, Hughes, & Baumhover, 2009). The average age of the patients was 80.4 and per Padula et al., 2009 there were closely equal number of patients on both units and no real differences were found according to the demographic data sheet. They measured the fall-risk score of both the treatment and control group before and during hospitalization and found a difference in scores from 7.5 and 9.5 on the control floor and 1.86 to 2.4 in the treatment group Padula et al., (2009). The modified BI measured a patients ability to perform activities of daily living (ADLs). The scores were measured in both the control and treatment groups on admission, at discharge and also what the patients perception of where they were at 2 weeks prior to

Quantitative Research Critique 26 admission. The end results showed the treatment group went from 69.1 on admission to 80.6 at discharge. The control group only went from 64.2 to 71.08 (Padula, Hughes & Baumhover, 2009). According to Padula, Hughes and Baumhover (2009) the Get Up and Go test measured a patients ability to get up out of a chair, walk 3 minutes and return to the chair in both groups. The control group was 1.35 on admission and 1.17 on discharge. The treatment group went from 1.16 to 1.04 on discharge (Padula, Hughes & Baumhover, 2009). The researchers also measured how often and how long each group was out of bed and ambulating. The results showed the treatment group was out of bed less often and for shorter times. However, the treatment group was out of bed sooner post-op 2.7 days as opposed to the control group at 4.9 days. The results showed the treatment group had a significant shorter length of stay at 4.96 days compared to the control group at 8.72 days (Padula, Hughes & Baumhover, 2009). Support According to Burns & Grove (2011), When quality measurement methods are used in a study it improves the accuracy and validity of study outcomes or findings (p.327). Burns & Grove (2011) also state measurement is the process of assigning numbers or values to individuals health status, objects, events or situations using a set of rules (p. 327). The researcher must evaluate and study the measurement tools that are to be used. The measurement tools must be trustworthy and the most reliable to get accurate data (Burns & Grove, 2011). Strict guidelines and or rules must be followed so that if someone else was to use it, it would produce similar results.

Quantitative Research Critique 27 According to Burns and Grove (2011) when measuring something that is not concrete such as pain, stress, or coping the researcher must use indirect measures to capture the abstract concept like mobility function. Often several different measurement tools are needed and used to measure the whole concept (Burns & Grove, 2011). According to Burns & Grove (2011), many scales used in nursing research are ordinal levels of measurement (p.330). This can be used to rank different levels of mobility on a numeric scale such as 0-5 (Burns & Grove, 2011). As Burns and Grove, (2011) state, errors in measurement can occur when using indirect measuring because what is being measured cannot be seen directly. It is with the combination of measuring tools that reliability and validity increases (Burns & Grove, 2011). Analysis Overall, the measurement is weak because the groups were not equal. In the beginning of the study, the treatment group had a lower fall-risk measurement than the control group. Because the groups were not equal this makes the measurements nearly negligible and not justifiable to the research. The research does not explain any other factors that may have gone into the measurements such as differences in socioeconomics, disease process, etc. Therefore is an unreliable and invalid measurement of research. Conclusion To have accurate, reliable and valid results in any research there must either be equal groups to compare, or calculated statistics to support or make up for the difference. It is not valid research when the groups cannot be compared on equal ground.

Quantitative Research Critique 28 Instrument Evidence The Padula, Hughes and Baumhover, (2009) Impact of a Nurse-Driven Mobility Protocol on Functional Decline in Hospitalized Older Adults, quantitative research study state a demographic data collection sheet was developed specifically for this research and included detailed information on each patient (p.328). The Padula et al., (2009) study demographic sheet collected various kinds of information on each patient, from age, any assistive device used, to level of activity the patient could tolerate. Some of this data was recorded on the sheets live, as the study progressed, while other data was collected via chart reviews before, during and after the study (Padula, Hughes & Baumhover, 2009). Padula, Hughes and Baumhover (2009) also utilized a modified Barthel Index (BI) to operationalize functional status (p.328). The Barthel Index was used to measure the subjects level of current functioning in various areas of everyday living, according to what the patient perceived (Padula, Hughes & Baumhover, 2009). The modification made to this index included the addition of a rating scale that, as the authors report, would increase the sensitivity of the tool so changes after the study might be apparent (Padula et al., 2009). The BI instrument was used to measure status prior to admission, at admission and after discharge (2009). This instrument was also compared to the Frail Elderly Functional Assessment to assess for reliability and precision (2009). Padula, Hughes and Baumhover (2009) also utilized an instrument called the Get Up and Go test (p. 328). This measurement was very objective, found to be reliable and valid by external researchers and was administered to assess physical functioning at admission and at discharge (Padula, Hughes & Baumhover, 2009).

Quantitative Research Critique 29 The last instrument utilized by Padula, Hughes and Baumhover (2009) was the Mini-Mental State Examination (p.329). This measurement was used to gather a baseline of the patients ability to state their own functional level; if the patient did not score a sufficient number to be a reliable indicator of their own functional status, then the significant other was asked the exam questions (Padula, Hughes & Baumhover, 2009). Support Concerning research studies, Burns and Grove (2011) explain, an instrument is selected to measure a specific variable in a study (p.51). Also, it is important to note that usually each instrument will have a different level of measurement and serve a specific purpose in the study, be clearly identified, stated and explained (Burns & Grove, 2011). Instruments used in a research study should also have been tested for reliability, and validity must be proven (2011). Reliability in measurement is concerned with the consistency of the measurement technique and reliability testing focuses on equivalence, stability and homogeneity (2011, p. 332). Burns and Grove, (2011) also state the validity of an instrument is a determination of the extent to which the instrument reflects the abstract concept being examined. Also, construct validity includes content-related validity and evidence validity from examining contrasting groups, convergence and divergence (p. 367). How instruments and measuring tools are developed should be described, as well as the techniques used to administer and score the results should be clearly outlined in the study (2011). Analysis Instruments must be both reliable and valid; although no tool can be 100% reliable and valid all attempts must be made to prove as much as possible (Burns and Grove, 2011). Although many instruments of measure were used in this study, this section seems weak for many reasons.

Quantitative Research Critique 30 Padula, Hughes, and Baumhover (2009) utilize many instruments for data collection and measurement and although the researchers claim the instruments are valid and have been tested for reliability, there is little actual proof or evidence provided. Even though the results of the tests were statistically significant and are supported by analytical data, the author did not extensively describe any instrument utilized and did not mention if the instruments had previously used in any other significant study. The name of the demographic data collection sheet was misleading because it contained more than just demographical information. In other words, activities of daily living and even some functional status information was included on this measurement tool. It would have been interesting to examine the out of bed information on this sheet and compare those results to the Get Up and Go objective test results and the subjective Barthel Index (BI) results (Padula, Hughes & Baumhover, 2009, p. 328). The authors do not discuss whether this information was conflicting or if it was adjusted to be consistent as each subject was measured. Also, the authors mention the BI instrument in relation to the Frail Elderly Functional Assessment, but no other information is offered as to what the Frail Elderly Functional Assessment test is and there is no mention of validity or reliability information of either (Padula, Hughes & Baumhover, 2009, p.328). The Get Up and Go test also seems like a very weak measure because although the test has seemingly objective measures, the conductor of the test would need to be the same person for each subject, in order to ensure consistency of the measure. Last, the Mini Mental Exam was utilized, but very little explanation of what and how it was measured, or where it came from was offered (Padula et al., 2009, p.329). Conclusion In conclusion, instruments used in any study must be well controlled, described, proven

Quantitative Research Critique 31 reliable and valid (Burns and Grove, 2011). Padula, Hughes and Baumhover, (2009) do not describe the instruments in enough detail to make the reader feel confident that all tools utilized to measure the subjects in the study are reliable and valid. Instruments are very important in any study and can have a major impact on the results and establish the need for further research. Data Analysis-Descriptive Statistics Evidence The article Impact of a Nurse-Driven Mobility Protocol on Functional Decline in Hospitalized Older Adults by Padula, Hughes and Baumhover, (2009) states the mean age of participants was 80.4 and the mean number of diagnosis for each patient was 6.7. There were 23 men and 27 women with fairly equal numbers in the treatment and the control group. Eighty percent (40) of the patients came from home, 7 came from assisted living and 3 from a nursing home. Eight percent (4) had dementia and 62% used assistive devices. Twenty patients had a physical therapy consult and 8 had an occupational therapy consult. No significant difference was found between demographic variables (Padula, Hughes, & Baumhover, 2009). Padula, Hughes, and Baumhover (2009) reported the treatment group was out of bed less often than the control group 5.9 vs. 8.7, p=. 05, ambulated less often 5.54 vs. 7.19, not significant, but ambulated earlier 2.7 days vs. 4.9 days, P=.007. This gave the treatment group a shorter length of stay 4.96 days vs. 8.72; p < .001 (Padula, Hughes & Baumhover, 2009). Support Descriptive statistics is research that provides an accurate portrayal or account of characteristics of a particular person, event or group in real-life situations; research that is conducted to discover new meaning, describe what exists, determine the frequency distributions and measures of central tendency and dispersion (Burns & Grove, 2011, p. 536).

Quantitative Research Critique 32 According to Burns and Grove, (2011) there are two types of frequency distributions: grouped and ungrouped. Ungrouped usually uses discrete data such as gender, ethnicity, marital status, etc., while grouped frequencies represent continuous variables such as age and level of functioning (Burns & Grove, 2011). There must be at least 5 groups, but no more than 20. Each variable must fit into only one grouping and cannot overlap (2011). Measures of central tendency cover the mode, medium and the mean of the acquired data. The mode is the value that appears in the data most often, the medium is the exact center value of all the data and the mean is the average score after adding all the values and dividing it by the number of scores obtained (Burns & Grove, 2011). Measures of dispersion use 3 types of measurement range, variance and standard of deviation (Burns & Grove, 2011). This measures the differences in subjects of the study that is not covered in the central tendency (2011). According to Burns and Grove, (2011) dispersion shows if the variability is small (homogenous) or wide (heterogeneous). As Burns and Grove, (2011) explain, range subtracts the lowest score from the highest score to measure the dispersion. Variance requires an equation to show dispersion, it has no absolute value and can be compared only with data obtained using similar measures (Burns & Grove, 2011, p.388). Standard deviation is the average difference in values and measures the degree of error in data (2011). Analysis The Padula, Hughes, and Baumhover, (2009) study did display discussion of frequency distributions, grouped and ungrouped. The ungrouped discussed gender, physical therapy and occupational therapy involvement, and if assistive devices were used by study participants. The grouped frequency measured how often patients were out of bed, how long and how soon after

Quantitative Research Critique 33 surgery between the treatment and control groups. The grouping statistics measured the means of the overall treatment and control groups and not the individuals. The data was not presented in a clear manner and was difficult to comprehend. The Padula, Hughes and Baumhover (2009) research study was weak in showing enough statistical evidence to validate the results reported. Not enough background information was given on the individuals in the groups to believe that the information is factual and relevant. Demographic information is presented, but no discussion on differences in baseline variables is examined. Calculations and statistical measures of significance are not discussed and although two tables are used to show staff and group characteristics, no attempt is made to correlate the two. Conclusion Descriptive statistics are usually represented in the results section of a study. They often relate to the sample and/or a value, central tendency and dispersion of the variable (Burns & Grove, 2011). Statistical analysis is often described by using tables or graphs and must present enough evidence to show reliability and validity (2011). Descriptive statistics often measure and describe the difference between groups and the variables (2011). The information and data obtained through descriptive statistics helps to better understand where differences lie between the treatment and control groups and how the variables are adjusted to show significance in the results presented. Data Analysis-Inferential Statistics Evidence The Impact of a Nurse-Driven Mobility Protocol on Functional Decline in Hospitalized Older Adults, article by Padula, Hughes, and Baumhover (2009) gave careful attention to ensure

Quantitative Research Critique 34 an adequate sample size was used for the study. Adults admitted to one of two selected nursing units, 60 years and older, and who met inclusion criteria for the study were selected through convenience sampling (Padula, Hughes, & Baumhover, 2009). Padula et al., (2009) report that utilizing statistical measures ensured adequate power, for the sample size. Both of the nursing units the research was performed on were of the same size and had similar populations and nursing staff (2009). Selected candidates on both floors were subjected to the same inclusion criteria in order to determine eligibility (2009). Differences between the treatment and control group on the dependent variables were calculated using inferential statistics (Padula et al., 2009, p. 329). The differences examined included demographic variables and fall-risk scores, none of which showed any significant difference (2009). Support A researcher must explain and describe the study sample to the reader (Burns & Grove, 2011). According to Burns and Grove (2011) when there is more than one group included in a study, variables such as demographics are compared to show whether the two test groups are similar. When there are significant differences between the test group and control group the statistical results of the study are not justifiable (2011). Researchers use confirmatory analysis to confirm expectations regarding data that are expressed as hypotheses, questions, or objectives (Burns & Grove, 2011, p. 375). According to Burns and Grove (2011) these analyses are used to generalize findings of the sample to target populations and justify generalization of the study results. It is assumed that all of the groups being included in the study are of the same population (2011). The null hypothesis states there is no difference between groups in a study in terms of variables included in the hypothesis (p. 377).

Quantitative Research Critique 35 The sample of the study must show statistical significance. The level of statistical significance is used to explain the probability of which statistical analysis are judged and indicate differences between the groups (Burns & Grove, 2011). The majority of nursing studies use p values of 0.05 or less meaning that if the result of the statistical analysis is found to be p=0.05, or less, significant differences between the two study group exist (2011). Whenever performing a study there is a risk of a type I error and the researchers must use a probability (p) value to reveal any risk of this error (2011). If p = 0.05, the probability that the groups belong to the same population is 5 in 100 (p. 377). Burns and Grove (2011) state that when researchers are deciding what the results of their statistical testing means, a Type I or Type II error can occur. These errors occur when one of two things happen, either the null hypothesis is rejected when it is really true, or the null hypothesis is regarded as true when in all reality it is indeed false (Burns & Grove, 2011). The risk of type II errors in nursing studies are high, because of the use of small samples, the use of imprecise instruments, and interaction of variables (2011). Analysis Inferential statistics were used to analyze the data in this article. Padula, Hughes, and Baumhover (2009) state that inferential statistics were used to calculate the differences between the control group and dependent variables. However, this section is very weak because there is only one sentence in the entire article that mentions the use of inferential statistics and not enough evidence is presented to determine if the appropriate tests were used. The reader is not provided with the calculated value, degrees of freedom, or level of significance. Neither are the results of these tests discussed in any detail. Burns and Grove (2011) explain that researchers can use tests such as chi-square test of independence, t-tests, and analysis of variance (ANOVA) to

Quantitative Research Critique 36 test for differences between sample groups. There is absolutely no mention of any of these tests mentioned in the discussed article. The authors do use p values when explaining their testing scores, but there is no mention of these statistics when looking at the sample groups. Burns and Grove (2011) state the level of statistical significance needs to be evaluated before data is collected to improve justification of the study results. It is not clearly explained to the reader what tests were used or how the author validated the validity of the test groups and variables. In order to strengthen the results of this study these methods should have been explained in detail to the reader. Conclusion In conclusion statistics in a research study are used to examine the data gathered in the study and obtain a clear image of the sample (Burns & Grove, 2011). Using statistics to prove the implications of the study is imperative when discussing evidence-based research. Padula, Hughes, and Baumhover (2009) explain that inferential statistics were used, but poorly demonstrate this to the reader. By doing this the validity and reliability of their research decreases significantly. Findings, Conclusions, Implications and Recommendations Evidence The Padula, Hughes and Baumhover (2009) Impact of a Nurse-Driven Mobility Protocol on Functional Decline in Hospitalized Older Adults, quantitative research study states that the majority of participants in this study were from home, had nearly equal demographic variables, displayed a mean age of 80.4 years and the sample was nearly divided according to gender. More than 6 comorbidities were present with each patient and most of the patients used an assistive device prior to admission (Padula, Hughes & Baumhover, 2009). The treatment group had a

Quantitative Research Critique 37 lower fall risk score at the beginning of the study than the control group (Padula et al., 2009). Both the treatment group and the control groups reported higher perceptions of functioning (Barthel Index score) two weeks before being admitted as compared to the level of function they felt they had on admission (2009). By discharge both groups displayed a lower perceived functional status score to both pre admission and admission, but the score in both groups did increase at discharge from the actual admission score (2009). The Padula et al. (2009) study results report the scores for the objective Get Up and Go Test were slightly improved in both the treatment and the control groups from admission to discharge, but these results were deemed not significant (p. 329). The study finding also showed while the treatment group got out of bed less and walked in the room less than the control group, they did ambulate in the hall more often and earlier (2009). The treatment group also displayed a decrease in length of stay from 8.72 days to 4.96 days (2009). The purpose of the Padula, Hughes and Baumhover (2009) study was to determine if adding a mobility protocol to a hospitalized adult patients daily routine would maintain or decrease level of functioning and decrease the length of hospital stay. The results in this study did support these hypotheses and was consistent with previous literature (Padula, Hughes & Baumhover, 2009). Limitations identified in the Padula et al. (2009) study were the lower beginning functional level of the control group, and the fact that multiple comorbidities and uncontrollable existing disease states could have had an impact on the results. Further research is needed to investigate how certain diseases can individually impact functional level. More testing and validation is recommended for the instruments used, specifically the Barthel Index and Get Up and Go test (2009). Another possible limitation to this study was the effects of the presence of an advanced practice nurse on the control unit. Since this nurse was responsible for patient

Quantitative Research Critique 38 outcomes, it is not known what patient care initiatives were ongoing and how this could affect results (2009). Padula, Hughes and Baumhover (2009) concluded that it is well supported that hospitalized patients do lose a certain level of functioning, and that consistent ambulation in the hallway early in the adult hospitalized patients stay, is pivotal to the length of stay and functional status at discharge. More research is needed and nursing should view ambulation as a priority and as a vital component of quality nursing care (Padula, Hughes & Baumhover, 2009, p.330). Support According to Burns and Grove, (2011) the results in a study are translated and interpreted to become study findings, which are a consequence of evaluating evidence from a study (Burns & Grove, 2011, p. 410). Any information in the findings section of a research study should be presented in a clear, precise, objective manner (2011). Not only should nursing research study findings address the significance of the results, but this section should also discuss any non-significant findings and relate both to the profession of nursing (2011). Statistical evidence should be presented and the findings in a nursing research study should discuss if the results are clinically significant, and what that means as far as implications, to the nursing profession (2011). The hypothesis or research questions presented in the research study should be discussed in the findings section and if possible relate to the framework of the study itself (2011). The findings section of a nursing research study should correlate all aspects of the study, this section should discuss the findings related to past or proven previous literature and research, as well as any limitations that are known and how those limitations may have influenced the outcome of the study (2011).

Quantitative Research Critique 39 The conclusion section of a research study is a synthesis of the findings (Burns & Grove, 2011, p.412). The conclusion should be stated clearly and be directly related to the stated findings and results of evidence presented in the study (2011). It is important to note if generalizations in the conclusion of a research study apply to the population as a whole or to just a certain subset of a population as described in the specific research (2011). Implications for nursing practice are a very important component to any nursing research study (Burns & Grove, 2011). The implications in study results should be identifiable, clear, and address what body of knowledge pertaining to nursing or nursing practice could be affected (2011). When at all possible, theory in nursing should also be discussed and if additional research is needed or required, that too, should be stated, as well as the specific reasons why the research should take place (2011). Recommendations in a research study should be discussed and, if possible, correlated to any limitations that might be encountered. Analysis The Padula, Hughes and Baumhover (2009) study findings were presented objectively, basic statistics and numbers were provided, but strong statistical test evidence seemed to be lacking to truly support the significance of the outcomes. In addition, several limitations existed. The study findings did present a review of both hypotheses and stated the results did show support. However, hypothesis number one that older adults who participate in a mobility protocol will maintain or improve functional status from admission to discharge, had a p value equal to 0.05, although this value is accepted in nursing research as significant, there were multiple limitations suggesting the validity of the very subjective BI measure, as well as other measures may not be completely reliable (Padula, Hughes & Baumhover, 2009, p.330). This section seems moderately weak because further investigation into the instruments used is

Quantitative Research Critique 40 necessary to completely state that this hypothesis was supported, even though limitations were noted later in the discussion section. Hypothesis number two, older adults who participate in a mobility protocol will have a reduced LOS, was supported and displayed significance, however, there seemed to be many limiting factors concerning disease states that could have affected these scores (Padula et al., 2009, p.330). Again, although the findings section provided many numbers and values, the significance and specific statistical calculations were not discussed in detail, only touched upon without significant evidence to make reader feel that the findings are reliable (2009). Padula, Hughes and Baumhover (2009) did mention how the supported findings of this study would have important implications to both the nursing profession and the lay community but did not offer any details and no nursing framework or theory was presented or discussed. Limitations were discussed in moderate detail and revealed the instruments used, disease states and comorbidities present, baseline functional status of both groups on admission, and specific unknown protocols (that may have been ongoing in the control unit) could have had a major impact on the outcomes of this study. A lot of weight seemed to be given to a subjective measure (BI) of perception of functional status. Also, the time of baseline data collection should be questioned, as it was not discussed in detail, only stated that this collection occurred within 48 hours of admission. A lot can happen to a patient in 48 hours that could seriously affect the results of a persons perception of functional status. Also, there is no statistical evidence correlating the BI measure to the Get Up and Go test results. Since there is such a significant change in BI scores, yet very insignificant change in Get Up and Go scores, this seems like unreliable evidence without knowing how the two tests might statistically relate to each other. Another questionable part of the findings section in this study are the numbers relating to the

Quantitative Research Critique 41 amount and times the patients were up ambulating and to the chair. Also, no mention is given to the amount of minutes or ambulated distance with regard to the mobility interventions. This does correlate with the limitation suggested by Padula et al. (2009) that the presence of an advanced practice nurse could have affected the patient care in the control group, thus skewing results as related to the real world results that might occur. One last consideration is a possible Hawthorne Effect on the control group, which is not discussed. For these reasons, the reader must demand more research, as suggested by the author, to draw a firm conclusion that indeed the conclusions presented are significant and reliable. Although there are many questions to be answered with regard to the design and delivery of this study Padula, Hughes and Baumhover (2009) does repeatedly suggest that more research should be done and effects of disease states on level of functioning should be explored. Overall, the findings and implications of this study discussed a lot of basic information and presented basic statistical numbers but did not specifically correlate outcomes with the nursing profession, theory or framework. This section seems moderately weak because the reader is never told exactly how this could change the profession of nursing or increase quality of patient care. The limitation, conclusion, and recommendations of this study is strong and displays relatively detailed information, and reiterates the need for adoption of more ambulation and more research, but seems to make the overall results (findings) of the study moderately weak with regard to how this particular study can impact nursing care. However, this study could be seen as an important bridge to demanding more research in many areas. This study did support results of previously reviewed and existing literature which does suggest that outcomes are accurate, just that methodology may be slightly unreliable because of such heavy subjective measures and

Quantitative Research Critique 42 perceptions, as well as the multiple limitations and variations in disease states of patients. Conclusion The findings, conclusions, implications and recommendation sections of a nursing research study are imperative, must be organized, and tie all aspects of the study to the practice of nursing, its body of knowledge and how patient care and outcomes will be affected. The reader should be presented with reliable evidence that is compared to existing research and correlated with the nursing profession, in order to make a determination on the value of the research and the need for continuing exploration on the topic being presented. Quantitative Research Critique Conclusion The nursing profession is one that evolves on a daily basis and continually strives to implement evidence-based practice (Burns & Grove, 2011). The purpose of a research critique is to examine the quality and credibility of the study being reviewed (2011). In the study being reviewed Padula, Hughes, and Baumhover (2009) are trying to find evidence to support nursing based interventions and increased functional status of hospitalized older adults after hospital admission. The aim of these interventions was to help develop standards of care for mobility that could be implemented in the hospital setting (Padula, Hughes & Baumhover, 2009). The critique of this article has shown some strengths, but shows numerous weaknesses. The article was thoroughly critiqued and all areas including: purpose, problem statement, review of literature, theoretical framework, research objectives, research hypothesis, research question, sample, research design, data collection, data measurements, instruments, data analysis of descriptive statistics, data analysis of inferential statistics, findings, and conclusions. Although there was strength found in areas such as purpose, problem statement, and hypothesis many other areas are lacking and show weakness on the authors part. The authors do recognize that there is

Quantitative Research Critique 43 a need for interventions of mobility in older adults, but do not provide the findings necessary for these changes to be implemented or considered evidence based. Small sample size, inconclusive data findings, and poor validity of instruments are a few of the things that demonstrate the weakness of the discussed research. Overall, this study provides little validity to its findings and more research needs to be done in this area in order to make any significant changes to current nursing practices.

Quantitative Research Critique 44 References Burns, N., & Grove, S.K. (2011). Understanding nursing research: Building and evidencedbased practice (5th ed.). Maryland Heights, MO: Elsevier Saunders. Padula, C. A., Hughes, C., & Baumhover, L. (2009). Impact of a nurse-driven mobility protocol on functional decline in hospitalized older adults. Journal of Critical Care Quality, 24(4), pp. 325-331.

Quantitative Research Critique 45 Research Critique Grading Criteria APA Format: up to 3. points or 30% can be removed after the paper is graded for Title page, abstract, headers Margins, spacing, and headings, reference page, title page, abstract Sentence structure, spelling, grammar & punctuation. Headings Possible Points Comments Points Earned Abstract and 10 Fantasitic job throughout the 10 Introduction: No heading paper. Demonstrates great for intro, but there should be thought and critical thinking. a introduction of the study This was so easy to read (a and what your paper will bit long) but so logical, address, why you are doing ordered and it just flowed.
the critique Purpose & Problem Statement (Identify the problem & purpose and analyze whether they are clear to the reader. Are there clear objectives & goals? Analyze whether you can determine feasibility and significance of the study) Review of the Literature and Theoretical Framework (Analyze relevance of the sources; Identify a theoretical or conceptual framework & appropriateness for study) Hypothesis(es) or Research Question(s) (Analyze whether clearly and concisely stated; discuss whether directional, null, or nondirectional hypothesis[es]) Sample & Study Design (Describe sample & sampling method & appropriateness for study; analyze appropriateness of design; discuss how ethical issues addressed) Data Collection Methods & Instruments (Describe & analyze the appropriateness of the what, how, who, where and when; describe &
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analyze reliability and validity of instrument) Data Analysis (Describe descriptive & inferential statistics & analyze whether results are presented accurately & completely) Discussion of Findings (Analyze whether results are presented objectively & bound to the data, whether there is a comparison to previous studies and whether new literature is introduced that was not included in the Literature Review Conclusions, Implications, & Recommendations (Analyze whether the conclusions are based on the data, whether hypotheses were supported or not supported, whether implications are a result of the findings, and recommendations consider limitations Your paper should end with a brief conclusion of your critique

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10 100 Final GRADE

PAPER POINTS Deductions for APA, grammar and Spelling

30 % of final paper score can be deducted for APA, grammar and spelling.