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Comparative Critical Appraisal of Two Research Articles on Head Injur

  • 11 Pages
  • Published On: 02-12-2023

The critical appraisal of the articles involves the process of making systematic and careful assessment of scientific outcome of the research for evaluating its value, trustworthiness and relevant regarding particular context (Dempsey et al., 2018). In this essay, the main aim is to make comparative analysis through critical appraisal of two articles that are Confidence and willingness among laypersons in the UK to act in a head injury situation: a qualitative focus group study” by (Kulnik et al., 2019) and “Delayed Sequelae Related to Mild Traumatic Brain Injury in Children” by (Chendrasekhar et al., 2020). In creating argument in the essay, one key element that is sampling is to be focused for critical appraisal and comparative analysis. In addition, the validity, reliability and credibility of the two studies are to be discussed by referring secondary literature. The critical appraisal framework by Moule (2018) will be implemented in critiquing the two research articles. Moreover, the hierarchy of evidence in the two research articles is to be discussed to inform where they are in the hierarchical level and the use of the articles in professional practice is also to be discussed.

The critical appraisal framework of Moule (2018) mentions that clarified purpose or aim of the study is to be present in all articles. This is because they direct the readers to understand the key focus of the study and determine at the initial stage if the studies are relevant to their area of interest or topic of interest. In both the studies of Chendrasekhar et al. (2020) Kulnik et al. (2019), it is seen that clarified aim or purpose of the study is specifically highlighted. In the study by Chendrasekhar et al. (2020), the key aim is to examine the effect of persisted delayed-squealed on the children after longer time of mild traumatic brain injury (TBI) in children who are less than 15 years of age. The study to fulfil the aim is seen to have organised a quantitative survey in which questionnaires are used to gather responses from recruited participants in the study. In contrast, the study by Kulnik et al. (2019) focussed in exploring the factors affecting the willingness as well as confident attitude of the laypersons of the UK to take actions in a situation of head injury of an individual. This is to get informed regarding their participation in the first aid education provided by the British Red Crisis. The study implemented qualitative focus group design in gathering relevant data in the research.


In comparing both these studies, the dissimilarity identified is the nature of research design used by them as Chendrasekhar et al. (2020) used qualitative research design whereas Kulnik et al. (2019) used quantitative research design. The purpose of the qualitative research is to gain a deeper understanding regarding specific topic compared to developing a surface description of a larger sample regarding the study topic. This design aims to inform an explicit structure, broad patterns and order to be identified among group of sample participants (Flemming et al., 2019). This is evident as Chendrasekhar et al. (2020) used focus group study to gain deeper insight into the selected participants regarding their reaction to delayed-sequalae impact on mild TBI in children. In contrast, the quantitative research aims to generate knolwdege and develop understanding regarding the social world by allowing observation of occurrences or phenomenon and communicating with the affected individual for gathering numeric data regarding the phenomenon (Bloomfield and Fisher, 2019). It is evident as in the study of Kulnik et al. (2019), the researchers are seen to focus on forming survey questionnaires to gather insight of the attitude and thoughts of the participants regarding taking action for mild TBI in children. However, on comparison, the similarity identified in the articles of Chendrasekhar et al. (2020) and Kulnik et al. (2019) is that both of them have focused their work on similar topic that is mild traumatic brain injury (TBI) in children.

The research design influences the sampling technique and strategy to be used in the research. This is because based on the design the specific sampling ways are used so that related data are gathered to be measured and interpreted in the study in meeting the aim and objectives of the research (Elfil and Negida, 2017). Thus, in this study, the element to be focussed for critical appraisal and comparison of the two articles is sampling method. The use of effective sampling method is important in the study because they allow to recruit relevant study participants from the population in drawing conclusions in the research (Diener et al. 2017). Moreover, effective sampling method allows researchers to execute the study within time and helps in organisation of convenience for the researcher in gathering intensive and exhaustible data (Diener et al. 2017). Thus, the sampling element is to be key focus for critical appraisal of both studies.

The presence of evidence-based research helps the nurses to makes enhanced health outcome for the patients. This is because in evidence-based practise (EBP), the available scientific evidence is the guidance used by clinical nurses and healthcare staffs in developing thoughts and knolwdege of appropriate care and its ways of delivery to the patient for the patient’s enhanced health condition (Skela-Savič et al., 2020). In the healthcare field, it is seen that nurses have responsibility to work in diverse settings such as hospital, school, community healthcare centres and others. In each of these setting, the nurses have different responsibilities to be performed but one of the primary roles of nurses in all diverse settings is to advocate the care of the patients based on best available evidence and deliver the patients care in their best interest (Swito et al., 2021). The EBP is seen to holistically support the nurses in fulfilling their primary role. This is because the evidence used in practices are often well-defined care guidance for the nurses that helps them to deliver the right care to the patient that is in their best interest and effective to enhance their health (Kim et al., 2019).

The evidence-based practise (EBP) in nursing is also supported by the “Practise effectively” guidelines in the Code of Conduct mentioned by the NMC. It is evident as the Code mentions the nurses to always practise by following potential available evidence regarding care (NMC, 2018). Moreover, the NMC Code inform the nurses that they have the duty to be updated about the technological and methodological changes occurring within the care environment. It is to help the nurses deliver appropriate and enhanced quality care with use of advanced support in meeting the changing demand and needs of the service users or patients (NMC, 2018). The EBP is responsible for making nurses feel empowered in delivering appropriate care as the evidence acts as support for them to develop knolwdege and skills in identifying gaps and risks in any care that is hindering the nurses to provide the care in true potential (Horntvedt et al., 2018). However, the lack of EBP in nursing would create nurses to have less knolwdege and skills about advanced care and make them deliver outdated and possible outdated care support top the patient that would further deteriorate their health (Saunders and Vehviläinen‐Julkunen, 2017).

In nursing, the EBP helps the patients to be experience less costly care from the healthcare intuitions. This is because evidence for care in EBP is used by the nurses in determining most economic support available for the patients which are beneficial for their health and within their financial limit to avail (Lam and Schubert, 2019). Moreover, EBP allows the nurses to avoid making unnecessary error in care that raises the overall cost of care for the patient due to their longer stay in the hospital and additional care required out of the error in care (Kim et al., 2019). Thus, the EBP is also beneficial for the patient to help them with lost cost care as well as assist the nurses in the delivery of error-free care to the patient for enhancing their health. Therefore, the understanding of the evidence presented in the Kulnik et al. (2019) and Chendrasekhar et al. (2020) is important for the nurses as it would act as evidence for them to determine the way people react in case of mild traumatic brain injury in children and according actions to be taken to enhance the care condition regarding the health situation.

The validity, credibility and reliability of the two studies are to be critically analysed by using the critical appraisal tool mentioned by Moule (2018). According to Moule (2018), the reliability in study mentions that overall consistency in the research is maintained. The research study that meets the reliability and validity standards are capable of producing accurate as well as consistent data in the study (Moule, 2018). However, the credibility of the research is important as it informs to what extent the stud can be delivered and used as evidence in the future exploration of the topic (Beccaria et al., 2018). According to Moule (2018), the presence of enhanced reliability and validity standards on the study ensures the study is credible and can be used as evidential reference in the practical field of focus.

The researchers of the study of Kulnik et al. (2019) are seen to involve representatives of the British Red Cross (BRC), clinicians in emergency services in the National Health Services (NHS) and individuals who are layperson regarding mild traumatic brain injury in children. This sample ensure reliability of the study because the key person to be focused mentioned in the aim is the selected subjects in the study. Moreover, the sample selected ensures validity of the study because the key measure in the study was to evaluate the confidence and willingness attitude of the laypersons to inform it to the BRC and the sample are representatives of the mentioned groups. It also proves credibility of the study because the selected participants are appropriate in informing credible information required in the study to meet its aim (Moule, 2018). In the study by Chendrasekhar et al. (2020), the reliability can be ensured as the sample selected are children who expressed long-delayed sequalae of traumatic brain injury who are the focus of the research. Moreover, the study is valid because it allows measuring the percentage impact of different effects as a result of delayed sequalae in traumatic brain injury in children through the elected sample. According to Moule, the presence of validity and reliability ensures the study is credible. Therefore, the study by Chendrasekhar et al. (2020) is credible as it meets the standards of validity and reliability.

The Moule (2018) mentions to determine if appropriate sampling strategy is used for critically appraising any article. In the study of Kulnik et al. (2019), the snowball sampling strategy is been used. The use of snowball sampling is advantageous for the study of Kulnik et al. (2019) because it allowed to create a chain referral process by the researcher in recruiting determined population (laypersons about brain injury) that is difficult to the found in the population. Moreover, snowball sampling leads the researchers to require fewer workforce in gathering subjects (Ghaljaie et al., 2017). Thus, the use of snowball sampling is effective for Kulnik et al. (2019) because it allowed the study to executed in economical and simple way without requirement of extended workforce. However, the limitation of using snowball sampling is that leads the researcher to have less control on recruitment of subjects that at times create error in recruitment and the sample generated through the strategy is no representative of the population (Kurimoto et al., 2017). Thus, the use of the snowball sampling strategy creates limitation for the study of Kulnik et al. (2019) to experience fear of developing bias in sample selected and recruitment.

In contrast, the study of Chendrasekhar et al. (2020) used simple random sampling to recruit subjects for the study. The advantage of using simple random sampling by Chendrasekhar et al. (2020) was that it allowed the researcher to recruit participants who are representative of the entire population of children with prolonged mild traumatic brain injury (TBI). Thus, comparison of Chendrasekhar et al. (2020) and Kulnik et al. (2019) in respect to sampling strategy is that the initial study ensures all relevant nature of people from the population is included in the study to ensure its greater validity. However, the later study failed to ensure it as right mix of people was not allowed to be recruited through snowball sampling. The use of simple random sampling is that it is cheaper and easy to be used as its implementation does not require any special training (Ahmed and Mohammed, 2019). Thus, the similarity between the sampling strategy of Chendrasekhar et al. (2020) and Kulnik et al. (2019) found on comparing them is that both use sampling strategy that are economic and easier to be used ensuring to avoid creating hardship for the researcher in recruiting potential subjects in the study. However, simple random sampling is time-consuming and can create bias (Taghizadeh et al., 2021). Thus, the biasness in sampling is one of the limitations that may have been faced by Kulnik et al. (2019) on using the specific sampling strategy.

In order to critically appraise articles, the Moule (2018) mentions that biases in the sample group are to be identified and ensure the target population, as well as its size, is well-informed. The studies by Chendrasekhar et al. (2020) and Kulnik et al. (2019) no bias regarding sampling collection or method is mentioned. Thus, it cannot be ensured if any error was faced during sample recruitment in the studies. However, in both the studies, the target population and sample size is well-informed. In the study of Chendrasekhar et al. (2020), the target sample were boys and girls who have suffered mild traumatic brain injury along with their parents. The study recruited 66 boys and 34 girls of 1-14 years of age in executing the survey with their parent acting as support. The study of Kulnik et al. (2019) included 37 women and 7 men in the study from the general population. The target population were parents of young child (8), young adults (9), school staff (7), sport coaches (2), informal carers for elderly (7) and other adults (11). The mean age of the participants in the study was between 25-34 years.

The critical appraisal framework of Moule (2018) informs that clear account of the way participants is recruited is to be mentioned in the study. This is to develop insight into the technique and methods used by the researchers in gathering potential participants for the research. The study by Kulnik et al. (2019) mentioned recruitment of participants through use of survey questionnaire and Chendrasekhar et al. (2020) informed participants are recruited by reviewing 168 charts of patients at the hospital in Glasglow. The Moule (2018) informs that clear evidence regarding informed consent received from the participants is to be mentioned and way vulnerable participant is tackled is to be thoroughly informed in the study. This is to ensure ethical consideration of taking approval to share information and safety of the participants area ensured (Sari et al., 2018). In both the studies of Chendrasekhar et al. (2020) and Kulnik et al. (2019), it is seen that effective informed consent through consent forms are taken from each participant ensuring ethical aspects are followed in both the studies.

In critically appraising the articles, their level in the hierarchy of evidence is to be determined (Moule, 2018). This is because the hierarchy of evidence provides guidance to determine the quality of the evidence been discussed along with its appropriateness and feasibility of use (Abraham and Scaria, 2017). According to the hierarchy of evidence suggested by Noyes (2010), qualitative studies (Kulnik et al., 2019) are placed third while quantitative studies (Chendrasekhar et al., 2020) are placed fourth in the hierarchy. In comparison, according to hierarchy of evidence mentioned by Polit and Beck (2008), the qualitative study of Kulnik et al. (2019) is to be placed sixth out of seventh place in the hierarchy. The hierarchy suggested by Petticrew and Roberts (2003) also places quantitative studies like Chendrasekhar et al. (2020) in the sixth level out of seventh in the hierarchy. The comparison of the hierarchries suggested by the authories mentioned that none of them has the ability to truly measure the hierarchy of evidence of the two articles. This is because while one hierarchy is presenting qualitative and quantitative studies at alternate level the other two hierarchies are presenting both qualitative and quantitative articles at the same level.

In nursing, the hierarchy of evidence is used to define the articles so that the nurses can understand which of them evidence superior over another to be considered for implementation in practice in providing better health outcome to the patients (Horntvedt et al., 2018). The findings of Chendrasekhar et al. (2020) mentions that during the survey 33% reported suffering residual issues with concussion out of delayed neurological sequelae. Among them, 15% reported sleep disturbances, 14% have memory loss and 21% expressed having depression and anxiety issues. The findings contribute to my area of practice by allowing me as a nurse to understand the negative effects of delayed neurological sequelae in children and aware of the importance of immediate actions to be taken. The findings of Kulnik et al. (2019) informs that previous knowledge and experience related to health injury influences effect of willingness and confidence in person to act for the cause both positively and negatively. In addition, the study concludes the local and environment of head injury influences laypersons to become confident to take care of head injury. These findings allow me as a nurse to understand in what situation laypersons may act to take care of head injury.

The qualitative evidence of Kulnik et al. (2019) informs my area of practice that is nursing to understand the importance of detailed knowledge of feelings and opinions of participants in a clinical study. However, the quantitative evidence of Chendrasekhar et al. (2020) inform in my area of practise that is nursing regarding the way to gather numeric data about any health condition. The findings contribute to my nursing field to led me realise as a nurse the factors to be focused in raising awareness about head injury in children and people in the UK so that they are willing to take actions with immediate effect for the health issue.

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The critical appraisal of the articles leads to conclude that Chendrasekhar et al. (2020) used quantitative research design and followed simple random sampling method to recruit participants in the study. However, Kulnik et al. (2019) used qualitative research design and implemented snowball sampling method in recruiting participants in the study. The initial study focused to inform the impact of delayed action in brain trauma whereas the later study focused to inform the factor that are responsible for making layperson act to avoid acting in taking care for brain trauma. The identified hierarchy of evidence could not effective place any of the two articles in higher position of the hierarchy. The evidence-based practice is effective as it helps nurses to provide error-free treatment with greater efficiency.


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