Critical Appraisal of The Article

Introduction

The critical appraisal involves careful examination and evaluation of presented facts and information to identify the effectiveness and limitations of the data provided in the study. The critical appraisal of the paper is to be executed by nurses before deciding to implement the evidence learned in their practices. The aim of the paper is to critically appraise the article “Patient perceptions and experiences with falls during hospitalization and after discharge”. The critical appraisal of the topic is important for the field of nursing because understanding of the perception of falls during hospitalisation and after discharge among the elderly patients would lead the nurses to develop strategies and care service intervention to avoid falls. This is because falls for the elderly patients is common as with age and impact of diseases they are unable to manage proper body balance and the falls often lead them to face bruises, accidents and others which adversely affect their health (Clayton et al. 2016). The information developed from the appraisal would help in executing evidence-based practice in relation that the nurses would have evidence for the understandings the patients have regarding falls according to which the nurses are to arrange care for them (Cathala and Moorely, 2018). In this appraisal, the strength and limitation of the study in relation to robustness and believability are to be presented by using the critiquing tool mentioned by Cathala and Moorely.

Writing Style, Title, Keywords

The paper has been written in the proper writing style which is evident as the structure is well maintained and all information is clearly written in English. This is strength of the paper as the data and facts can be easily understood by all without hindrance in developing evidence to be put into practice to arrange proper nursing services for the elderly patients. The information about the authors who have presented the paper is required so that the competence of them in presenting the topic can be understood. This, in turn, helps the reader to determine the effectiveness of the information of the research paper to be put into practice (Salmond and Porter, 2016). The keywords in the paper are properly mentioned and listed which is strength of the article as the highlighting of keywords in the paper helps the readers to identify whether or not the paper is has information related to topic selected for studying. The keywords mentioned in the paper are falls, fall prevention, discharge instructions, older adults and perceptions (Clayton et al. 2016).

In this paper, proper information about all the authors is presented which shows that the authors are effectively qualified to present adequate and authenticated facts regarding the topic through qualitative analysis. It is evident as all the authors are mentioned to belong from the nursing backgrounds who are teaching in universities. This is strength of the study as it can be determined that by developing evidence from the paper it can be put into practice to arrange better care services. The study of Cathala and Moorely (2018) mention that title of the research paper is to be written within 15 words and be able to attract the reader. This is because the title of the highlights the information that can be retrieved from the study. In this paper, the title is seen to be written within 11 words and is effective to draw attention from the readers as the title clearly mentions the facts that can be retrieved from by studying the presented facts easily.

Abstract

A clear abstract of the paper acts as the resume to let readers understand whether or not the mentioned information is relevant to their area of study (LoBiondo-Wood and Haber, 2017). In this paper, it is seen that a clear abstract is mentioned in the beginning by maintaining proper structure such as introduction followed by methods, results and conclusion of the paper. This ensures that the abstract provides a true reflection of the paper. Thus, it acts as strength as the reader through the abstract can be able to understand whether or not the paper can be used as evidence for working in the field or nature of study being planned. It indicates that the abstract in this paper is going to give the reader a good inclination to understand what is expected to be understood by reading the article.

Robustness

Introduction

In this paper, a well-structured introduction is being mentioned where the aim of the study along with overview of the topic is explained (Jin et al. 2016). This is evident as the introduction mentions that the specific aim of the paper is use exploratory study design for describing the perception of the hospitalised older adults who are above 60 years regarding fall risk while hospitalisation, intervention received by them for preventing falls in the hospital and instruction received on discharge to prevent falls at home afterwards (Shuman et al. 2016). This act as strength for the paper as a clear aim in the introduction would help the reader for critically reviewing the article in a thorough manner. As commented by Al-Ghareeb et al. (2016), literature review of the paper is essential to understand the facts that are already known regarding the topic. This is because it provides indication to the researcher to avoid creating duplication of the facts and understand the way the topic is to be progressed so that new knowledge regarding the subject can be developed to contribute in the field of research.

Literature Review

A good literature review assists the reader to properly contextualise the problem in the research and understand the reason behind the execution of the study (Preshaw et al. 2016). In this paper, a clear literature review is already presented which focus on known information regarding the topic. This is evident as the context regarding falls among elderly patients and the understanding of perception is clearly explained in the paper. Moreover, the literature review of the paper mentioned that in 2009 in the study of Roe et al. and Boyd & Stevens older patients perceive that falls are embarrassing and fear to fall. It also mentioned that in the study of Host et al. (2011) older people perceive that falling is a part of ageing process and in the stud of Roe et al. (2009) it is mentioned that older people perceive falling is to be restricted as it interferes with their normal activities (Shuman et al. 2016). This indicates that the literature review has taken information from the most current paper published within 10 years to present the background information regarding the topic to educate the reader about the facts that have already been developed. The literature review in the paper also mentioned that there is less study regarding perception of falls among older patients in and after hospitalisation (Shuman et al. 2016). Thus, the facts in the literature review act as strength for the study as it provided scope to understand that there is not much data collected regarding the topic in hospital settings indicating the part to be focussed in the study to develop evidence for support effective in nursing.

Methodology

The methodology section of the study has clearly informed the nature of study design, sample, data collection and data analysis procedure to be used. The paper is seen to have used qualitative research method which is evident as they have used interview process for collecting data and thematic analysis for data analysis that are the methods specifically used in executing a qualitative study. The strength of qualitative research method is that it helps to execute in-depth analysis and implement examination of individual experiences of participants to develop information for solving the research problem (Bengtsson, 2016). Thus, it avoids executing pre-judgements as qualitative research provides explanation regarding any particular response to reach conclusion. However, the weakness experienced by the article as a result of using qualitative study method is that the researchers were able to study few people and had less scope to generalise results. The prospective exploratory research design by using qualitative methods is being implemented in the study to meet the aim of the research (Shuman et al. 2016). As asserted by Goldsmith et al. (2017), prospective exploratory study design helps the researcher to improve understanding regarding any topic by testing any concept. This is because this design leads the researchers to understand why and how things happen that raises the issues identified in the study. Thus, use of the design is strength for the study as it would provide assistance to the researcher to test accuracy of the perception of older patients regarding falls during and after hospitalisation and intervention being offered to them to prevent falls.

The advantage of exploratory research is that it helps the researchers to draw better conclusion in meeting the objectives of the study (Bramer et al. 2017). Thus, in this respect, it acts as strength for the researchers to properly reach the aim identified in the study. As argued by Boaden et al. (2017), prospective exploratory design generates qualitative information that is interpreted by the researcher. This may create biased development and presentation of evidence in the study which would act as a weakness for the paper as authenticated evidence cannot be retrieved by analysing the study. The other weakness to be experienced by the paper by using this design is that the findings developed may not be useful for decision making in the practical field. Moreover, in explanatory research design smaller sample size is used which leads the researchers to face issues in interpreting the results for the generalised population (Varndell et al. 2016). Thus, in this respect, the data received from this study may not be used effectively in executing evidence-based practice in practical field. The article has mentioned that the total number sample participants being used is 15 out of 18 patients who are above 60 years of age and are at risk of fall during hospitalisation or after discharge from the hospital (Shuman et al. 2016). The strength of using sample size for the study is that it helps to quickly conduct the study within lower cost. Moreover, smaller sample size helps to minimise the margin of error experienced while analysing the data.

However, the weakness is that it affects the reliability of the facts developed due to high variability which often leads to bias (Malterud et al. 2016). Thus, using smaller sample size may cause negative impact on the presentation of the facts in the paper in the sense that they may be biased and cannot be relied to be used as evidence in nursing practice. The selection of the sample is being done by using Confusion Assessment Method (CAM) screening tool which helped to avoid including any participants in the sample who are acutely confused about the topic (Shuman et al. 2016). This act as strength for the study as proper sample could be used in executing the study those can provide related information to be analysed to explore the subject properly.

In this study, the data is being collected by using interviewing method. As commented by Norlyk et al. (2016), interview data collection method helps to investigate the raised issue in the study in depth. This is because the expression and feelings of the participants regarding the topic in the interview process can be understood to execute in-depth study. The other advantage of interview is that queries can be asked by the researchers in structured way which allows the candidates to answer properly helping the researcher to develop a clear perception as well as opinion about the actual data being wished to be informed by the sample participants. Further, clarification regarding any confusion experienced while collecting data in the interview process can be resolved by the researchers which assist to ensure validity and reliability of the study (Flick, 2017). Thus, using interview method helped the researcher in the study to discover the feeling and perception of the older patients regarding falls during or after hospitalisation and the effectiveness of the intervention provided to them. The weakness of using interview data collection method in the study is that it may lead the researcher to take increased amount of time in collecting data. Moreover, it been criticised that different interviewers transcribe and understand facts gained from the interview which may lead to biases (Forsgren et al. 2016). However, in this study, it is been mentioned that the researchers used comparative methods of Glaser and Strauss for analysing the transcribed interviews and reviewed them to ensure accuracy and avoid any biases (Shuman et al. 2016).

The thematic analysis method is being used in the study of analysing the data. The strength of using thematic analysis for the paper is that it allowed the researchers to increase the range of their study by passing individual experience. As asserted by Stewart et al. (2015), thematic analysis is useful where multiple researchers are involved. In this study, there are multiple researchers involved and therefore it is justified to use this method of data analysis. As criticised by Braun et al. (2019), thematic analysis raises reliability concern as a wide number of interpretations are offered in the process for a single data. Thus, using this data analysis method for the paper may act to create biases in results and cause reliability issues. Moreover, the flexibility of the thematic analysis may result to create confusion among the researchers in this study regarding which aspect of the data is to be focused on analysing the information properly according to developed themes.

Reliability and Validity

In order to ensure the data analysis is valid and reliable, three members who belong to the investigation team having expertise in analysis of qualitative data individually executed coding and formation of mini themes for the paper (Shuman et al. 2016). This evidence in the paper entails the trust in the executed work as well as assures the robustness as well as validity and reliability of the study.

Ethical Consideration

During the collection of data from the sample, the ethical considerations are effectively abided by in the article by the researchers. This is evident as the participants are provided informed consent regarding the way the data being informed them are used. It was seen that no participants were forced to include in the study and were allowed to freely inform the data during the interview. Moreover, to ensure confidently of the patients no personal data was shared in the study. The participants were also interviewed in closed surroundings without the intervention of the service providers so that they inform data without hesitation or interruption from others.

Results and Discussion

In this paper, the results are clearly mentioned under proper themes. This is evident as the paper clearly mentioned under results section that qualitative data analysis helped to develop eight major themes for the study. The eight key themes are also mentioned in the paper which is overall perception regarding falling by the patients, overall patient perception regarding intervention to prevent fall while being hospitalised, communicating fall prevention, effectiveness of the strategies for fall prevention, executing fall prevention, personal strategies to prevent fall, instruction while discharged from hospital to prevent fall and most effective instruction for fall prevention (Shuman et al. 2016). The results in the paper are presented by highlighting the key interview transcripts received by the researchers from the participants (Shuman et al. 2016). This act as strength for the paper as it can be understood from the transcripts that the findings are not manipulated as well as offer advantage to the readers for free analysis to ensure authenticity of the findings. The results or findings developed under each theme are clearly mentioned under different sub-themes so that better clarifications of the findings can be provided. In the paper, under the theme overall perceptions regarding falling by the patients, three sub-themes are created which are previous fall experiences, fall risks and fear of injuries from the fall (Shuman et al. 2016). This acts as strength of the paper as it helped the researchers to mention different perception of the patients under different category or condition that leads to their fall. The discussion section of the paper is also clearly mentioned by the researchers by linking the findings with other studies. There is a logical flow of information mentioned in the discussion section of the paper where the context of the study is appropriately linked by the researchers with the literature review. This is evident as the researchers mentioned that the reasons behind fall identified are similar to contributing factors related to fall they identified in previous studies. The gap in the study is that it did not highlight the intervention to be taken by the patients who are living alone after hospitalisation and are at risk to fall. Further, the results did not share the instructions to be followed in case a patients experiences fall even after implementing fall prevention strategies due to accident. A proper conclusion is being mentioned in the paper. This is strength for the study as all the information developed by the researchers are summarised for the readers to understand the facts they could develop by analysing the article.

Conclusion, Limitation, Implication of the study

The paper has properly highlighted the limitation experienced in executing the study. This is evident as the paper has mentioned under the limitation section that the single hospital setting involved in drawing sample to execute the study was one of its weaknesses. This is because the single settings result them to face hindrance in generalising the results due to which the evidence presented cannot be made sure whether or not they can act effectively to prevent fall in all other surroundings. The article has also highlighted the way in which at the future the study is to be executed to further enrich the findings. This is effective for the readers to understand the way they can use the present findings in the study to extent the work in future for presenting it in an enriched way. The paper has also highlighted in a proper manner the implications of the findings can be done in clinical practice. This is evident as the study has mentioned that as per their research the nurses working in the hospital settings are to impart information through conversation rather than only communicating the information to the patients and their families regarding the way to prevent fall (Shuman et al. 2016).

The study in relation to clinical implication has mentioned that repeated conversation with the family and patients are to be made to ensure prevention of the patients from falling. The paper also informed that the nurses are to inform patients and families that fall prevention activity is a collaborative task (Shuman et al. 2016). These explanations regarding clinical implication of the information developed in the study are going to help the nurses to understand the way they are to interact the fall prevention strategies to the patients and the families to avoid injury. In the study, no recommendations for future practice are provided that the nurses need to develop to prevent fall among the elderly patients. This is weakness for the study as the lack of recommendation would make the nurses remain in dilemma regarding the way issues encountered in fall prevention strategies that are avoid them to resolve fall risk among elderly patients can be mitigated.

Conclusion

The above discussion informs that the paper has the key aim to identify the perception the patients have regarding fall risk and intervention to prevent fall during or after hospitalisation. The study has a well-develop title, abstract, introduction along with aim and literature review which helps the readers to have clear overview regarding the topic. The paper has used prospective exploratory research design which is effective draw better conclusion from the data gathered but the design used may have lead the paper to show bias in interpreting data due to personal involvement of perception of researchers. The ethics are properly maintained within the paper and they have use interview method in collecting data. The results are clearly mentioned by highlighting themes and sub-themes and a logical discussion is also found to be mentioned for the article. The limitations of the study along with the clinical implication of the findings are mentioned in the paper but future recommendations for the practice are not mentioned in the article.

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References

• Al-Ghareeb, A.Z. and Cooper, S.J., 2016. Barriers and enablers to the use of high-fidelity patient simulation manikins in nurse education: an integrative review. Nurse education today, 36, pp.281-286.
• Boaden, E., Lyons, M., Singhrao, S.K., Dickinson, H., Leathley, M., Lightbody, C.E., McLoughlin, A., Khan, Z., Crean, S., Smith, C. and Higham, S., 2017. Oral flora in acute stroke patients: A prospective exploratory observational study. Gerodontology, 34(3), pp.343-356.
• Bramer, W.M., Rethlefsen, M.L., Kleijnen, J. and Franco, O.H., 2017. Optimal database combinations for literature searches in systematic reviews: a prospective exploratory study. Systematic reviews, 6(1), p.245.
• Braun, V., Clarke, V., Hayfield, N. and Terry, G., 2019. Thematic analysis. Handbook of Research Methods in Health Social Sciences, pp.843-860.
• Bengtsson, M., 2016. How to plan and perform a qualitative study using content analysis. NursingPlus Open, 2, pp.8-14. Flick, U. ed., 2017. The Sage handbook of qualitative data collection. Sage. Forsgren, E., Skott, C., Hartelius, L. and Saldert, C., 2016. Communicative barriers and resources in nursing homes from the enrolled nurses’ perspective: A qualitative interview study. International journal of nursing studies, 54, pp.112-121.
• Goldsmith, H., Curtis, K. and McCloughen, A., 2017. Effective pain management in recently discharged adult trauma patients: Identifying patient and system barriers, a prospective exploratory study. Journal of clinical nursing, 26(23-24), pp.4548-4557.
• Jin, Y.H., Wang, G.H., Sun, Y.R., Li, Q., Zhao, C., Li, G., Si, J.H., Li, Y., Lu, C. and Shang, H.C., 2016. A critical appraisal of the methodology and quality of evidence of systematic reviews and meta-analyses of traditional Chinese medical nursing interventions: a systematic review of reviews. BMJ open, 6(11), p.e011514.
• LoBiondo-Wood, G. and Haber, J., 2017. Nursing research: Methods and critical appraisal for evidence-based practice. UK: Elsevier Health Sciences. Malterud, K., Siersma, V.D. and Guassora, A.D., 2016. Sample size in qualitative interview studies: guided by information power. Qualitative health research, 26(13), pp.1753-1760.
• Moorley, C. and Cathala, X., 2019. How to appraise qualitative research.pp.10-13. Norlyk, A., Haahr, A. and Hall, E., 2016. Interviewing with or without the partner present?–an underexposed dilemma between ethics and methodology in nursing research. Journal of advanced nursing, 72(4), pp.936-945.
• Preshaw, D.H., Brazil, K., McLaughlin, D. and Frolic, A., 2016. Ethical issues experienced by healthcare workers in nursing homes: literature review. Nursing ethics, 23(5), pp.490-506. Salmond, S. and Porter, S., 2016. Critical Appraisal. Comprehensive Systematic Review for Advanced Practice Nursing, p.173.
• Shuman, C., Liu, J., Montie, M., Galinato, J.G., Todd, M.A., Hegstad, M. and Titler, M., 2016. Patient perceptions and experiences with falls during hospitalization and after discharge. Applied nursing research, 31, pp.79-85.
• Stewart, D., Burrow, H., Duckworth, A., Dhillon, J., Fife, S., Kelly, S., Marsh‐Picksley, S., Massey, E., O'sullivan, J., Qureshi, M. and Wright, S., 2015. Thematic analysis of psychiatric patients' perceptions of nursing staff. International Journal of Mental Health Nursing, 24(1), pp.82-90.
• Varndell, W., Ryan, E., Jeffers, A. and Marquez-Hunt, N., 2016. Emergency nursing workload and patient dependency in the ambulance bay: a prospective study. Australasian Emergency Nursing Journal, 19(4), pp.210-216.