Critique of Research Study
Tiffany Kilhoffer
Simmons College
Critique of Research Study
The purpose of this paper will be to conduct a comprehensive and concise critique of a research study aimed at studying the correlation of nurse and physician collaboration in the adult critical care setting in Athens, Greece. Nurse and physician collaboration may involve activities such as making care plans together, sharing responsibility and problem solving.
Description and Critique of the Research Purpose, Objective, and/or Questions
The descriptive and correlational study by Mpouzika, Haikali, Giannakopoulou, Karanikola, Lemonidou, Patriraki, & Papathanassoglou (2017) was designed to evaluate the collaboration of nurses and physicians in the adult intensive care unit (ICU) setting in Athens, Greece. The study investigated nurse-physician collaboration through “levels of nurse-physician collaboration and associations with workforce characteristics including: gender, professional experience, and education” (Mpouzika et al., 2017, p.65-66). Key words are listed below the authors enabling ease for the reader to distinguish important topics included in the article. Listed key words include collaboration, critical care, nurse-physician communication, and work satisfaction. Effective nurse-physician collaboration has shown positive outcomes with patients such as “lower mortality, lower rates of intensive care unit (ICU) readmission, ventilator associated pneumonia, central catheter-associated bloodstream infections and pressure ulcers” (Mpouzika et al., 2017, p. 65). The study suggested that strong collaboration between nursing and the physicians can also lead to retention among nurses staffed in the ICU setting and barriers in these settings can contribute to less than optimal patient outcomes. The title of the article succinctly reflected the content of the study and is easy to stimulate a potential reader’s attention.
Description and Critique of the Research Design
A “descriptive, correlational, cross-sectional design” was employed in the study (Mpouzika et al, 2017, p.66). An important limitation within the study is obtained directly from the lack of respondents. The sample also was limited to the Athen’s metropolitan area and public-sector intensive care units. The study listed the observed levels of collaboration in the “low” category; although, there were no established norms. A strength of this study is the descriptive snapshot into the population of nursing with regard to nursing and physician collaboration. The study is well written and concise. The summary provides an organized view detailing the major objectives and results included in the study. Jargon is avoided throughout the study allowing ease for non-medical readers to comprehend.
Another limitation with the study is the contraindicated studies mentioned. The study lists considerably lower scores in a recent Italian and an earlier US study. While the references for the study appear relevant by only reading the title, the dates range from 1992 to 2017. This equates to the study including information from up to twenty-five years before the study was produced.
Description and Critique of the Sampling including Size Determination, Sampling Type, and Sampling Technique/Frame
The study adequately described how the sample was obtained and the target population is clearly identified. Random and direct element sampling was implemented to obtain a sample of nurses in the ICU setting located in Athens, Greece. Inclusion and exclusion criteria are also supplied within the study. Thirty-four intensive care units from fifteen hospitals were selected randomly with the mean age of respondents being 34.1. Exclusion criteria included any neonatal or pediatric ICUs that housed less than 6 beds. The study stated these were excluded due to the opinion of these type of settings not proving typical of an adult ICU setting (Mpouzika et al., 2017).
Six hundred and seven questionnaires were distributed to respondents with background data including: nursing experience, type of ICU, and educational. Nursing experience was broken into years. The position of the nurse in the ICU was included and broken into 3 categories: nurse assistant, staff nurse, and head nurse. Four different types of ICUs were involved in the study: medical/surgical, coronary, cardiac surgery, and neurosurgical. The educational background for the responding nurses included degrees ranging from Associate Degree to PhD. The background data is included in the study and is condensed into an easy to comprehend table. The average for nursing experience for participant’s in the study was 6.5 years.
Description and Critique of the Data Collection
Ten 7-point Likert scale items addressing nurse’s perceptions of the level of collaboration were used in the data collection for the study. This collection is known as the Collaboration and Satisfaction About Care Decisions Scale (CSACD). The scale has a range ten to seventy with the higher score correlating to higher satisfaction regarding nurse-physician collaboration. An exception to the scale is 10. 10 relates to “I have considered seeking other employment outside this unit or hospital related to an incident that occurred while collaborating with a physician” (Mpouzika et al., 2017, p.66). Implied consent for the study was obtained through return of the questionnaire anonymously and in sealed envelopes. This assisted in the protection of the participants from any harm. Over half of the nursing personnel responded with a response rate of 58.5%. The units participating in the study were frequently visited. The majority of the data was collected with recent origin, and books and journals incorporated into the study are adequately referenced.
The questionnaire was evaluated on the following ten statements and questions:
• Nurses and physicians plan together to make decisions about care for the patients in this unit.
• Open communication between physicians and nurses about patient care decisions takes place.
• Decision-making responsibilities for patients are shared between nurses and physicians.
• Physicians and nurses cooperate in making decisions about patient care.
• In making decisions, both nursing and medical concerns about patients’ needs are considered.
• Decision-making for patients is coordinated between physician and nurses.
• How much collaboration between nurses and physicians occurs when making patient care decisions?
• How satisfied are you with the overall collaboration between physicians and nurses at this unit?
• How satisfied are you with collaboration in the hospital overall?
• I have considered seeking other employment outside of this unit or hospital related to an incident that occurred while collaborating with a physician. (Mpouzike et al, 2017, p.67).
Description and Critique of Data Analysis Plan and Results
Data were analyzed through the Statistical Package for Social Sciences (SPSS). Statistical testing used in the study included “comparisons assessed through the students t or Mann Whitney U test and analysis of variance (ANOVA), as appropriate. Pearson’s r (r) correlation coefficients were also explored” (Mpouzike et al., 2017, p.66). ANOVA is frequently used to test the equality of population means. The Mann-Whitney U is an alternative commonly used instead of the standard t-test. (Wall Emerson, 2017). Step-wise regression analysis was also used in investigating significant variables.
The CSACD scores were not affected by factors such as age, gender, education and experience in the nursing profession. The study did demonstrate a strong correlation between the number of years a nurse has been staffed in the ICU with regard to CSACD scores with head nurses providing higher than staff nurses. Control variables did not show any significance with CSACD scores. Employee characteristics played a low role in the study in regard to the collaboration of nurse-physician relationships in the ICU setting in Athens, Greece (Mpouzike et al., 2017).
Important findings resulting from this study showed low collaboration and satisfaction in regard to care decision scores and decision making. Highest scores were shown in relation to nurse-physician communication. The most significant determinant of collaboration was the type of post. The study does suggest interventions in the hospital setting for improved levels of empowerment amongst nursing staff and for the initiative to begin from nursing staff (Mpouzike et al., 2017). As all of the authors are registered nurses (RN), the study is presented without any obvious bias.
Overall Critique of the Rigor and Validity of the Study
Rigor can be defined as the strength of the design and the appropriateness as to which the questions are answers to the presented method. It can be a synonym for trustworthiness. For rigor to be valid, validity and reliability must be strong (Cypress, 2017). The study is precise and the design is strong. Overall, the study shows excellent validity and soundness with the evidence. The study is random, unbiased, and well grounded. The study by Mpouzike et al. (2017) measures what it has aimed for and intended to measure. Another important concept in rigor, transferability, is seen throughout the study. The study is reliable and can easily be applied to nursing/physician collaboration practices and interventions to improve treatments and better outcomes in practice. There is confirmability displayed by the use of the finding’s collected through the respondent’s questionnaire responses rather than potential researcher biases. In order to reduce threats to internal validity, the respondents returned the questionnaires anonymously and in a sealed envelope.
Conclusion
In conclusion, maximizing nurse-physician collaboration in the ICU setting is beneficial for not only the patient, but also the nurse and physician involved in the care. In the always evolving world of medicine, it is vital that topics such as nurse-physician collaboration and the effect it may or not have on patient care and various other aspects should be visited regularly. Staff members in the medical field will always be leaving and joining different settings of the hospital. It is important to maintain communication amongst the new and seasoned staff.
References
Cypress, B. S. (2017). Rigor or reliability and validity in qualitative research: perspectives, strategies, reconceptualization, and recommendations. Dimensions Of Critical Care Nursing: DCCN, 36(4), 253-263. doi:10.1097/DCC.0000000000000253
Mpouzika, M. A., Haikali, S., Giannakopoulou, M., Karanikola, M. K., Lemonidou, C., Patiraki,
E., & Papathanassoglou, E. E. (2017). A descriptive correlational study of nurse- physician collaboration in adult critical care in Greece. CONNECT: The World Of Critical Care Nursing, 11(3), 65-68.
Wall Emerson, R. (2017). ANOVA and t-tests. Journal Of Visual Impairment & Blindness, 111(2), 193-196.