Health care workers have a responsibility to provide their patients with high-quality care. The nurses rely on evidence-based practice while providing this assistance (EBP). This paradigm has three basic components: employing professional knowledge and best judgment, addressing the needs of patients and their relatives, and applying the best available evidence of treatment for the scenario under discussion (DiCenso, Guyatt, & Ciliska, 2014). Evaluating primary research aids in determining whether the study meets the quality standards for inclusion in evidence. The purpose of this essay is to conduct a critical assessment of “Effects of the use of the provider resilience mobile application in reducing compassion fatigue in oncology nursing” (Jakel et al., 2016.) The study was published in the clinical journal of nursing. The article acknowledges that the nurses working in the oncology unit are exposed to tragedy, loss, chronic illness, and untimely death of the patients under their care. This exposure puts them under an increased risk of developing compassion fatigue (Jakel et al., 2016). The study, therefore, sought to establish if the use of the Provider resilience mobile application will lead to enhanced quality of life among the oncology nurses. The study made use of a quasi experimental design where the outcome of an intervention was evaluated on the professional quality of life (ProQOL) led by 2 non-randomized groupings of RNs working in an oncology unit. Pre-test and post-tests was conducted in a specified sample of nurses working in an oncology department.
Elements that Enhance the Believability of the Study
According to Coughlan, Cronin, and Ryan (2007), some of the factors that influence the believability of a study include the writing format, the author, the title of the report and the abstract. The authors argue that a well written report should be concise, adhere to the correct use of grammar, avoid jargon and be well structured. The current study has met this criteria in the structuring of the format, use of proper grammar sentence structure.
The qualifications and positions of the authors are crucial components that define the believability of the study. These qualities indicate the authors’ degree of knowledge to design a research, ask appropriate questions and analyze the findings (Coughlan, Cronin, & Ryan, (2007). The authors’ qualifications have been included in the study. It is evident that the study has used experienced researcher who have the ability to design the study appropriately. Another factor to be considered is the title of the report which should be clear, accurate and communicate the purpose of the study. It should neither be too long or too short. Using 16 words, the length of the article is slightly outside that proposed by Coughlan, Cronin, and Ryan, (2007) of between 10 to 15 words. However, it is considered as an appropriate title that meets the expectations. The final aspect, the abstract, should offer a summary of the research including the problem, the methods, findings and recommendations. The article by Jakel et al. (2016) defines these aspects and it is easy to understand the summary of the article.
While it is evident that this is a quasi experimental design, the authors have not explicitly stated the independent and dependent variables. They have also not stated the conceptual framework that guided the study. However, the inferred independent variable of the study is the intervention that was used (PRMA) while the dependent variable is the quality of life of the nurses.
As opposed to presenting a hypothesis, the authors chose to present a research question by proclaiming “this study explores the effect of a convenient, low-cost, and accessible mobile application on professional quality of life of oncology nurses at risk for CF” (Jakel et al., 2016). The use of a research question as opposed to a hypothesis further shows that the study is not a purely experimental, but a quasi-experimental.
Review of Literature on the Topic
A review of literature is a crucial step in conducting quasi-experiments as it allows proper definition of a research question and identification of an appropriate method of study. The section also helps in highlighting the gaps that have been identified in the problem in addition to suggesting the means by which those gaps can be filled (Coughlan, Cronin, & Ryan, 2007). the sources that should be used in the literature review should not be older than 10 years with 5 years old published primary studies given a priority. The authors have used the sources within this range of years of publication and as such, the information contained is recent and relevant.
The purpose of reviewing literature was to provide the descriptions of compassion fatigue among health care providers (Jakel et al., 2016). Various studies (Mendes, 2014; Smart et al., 2014; Carson, 2016) attempting to give the meaning of CF acknowledge that a universally agreed upon definition has not been arrived at. The review, however, states that many of the descriptions share common characteristics such as feeling emotionally distressed and physically exhausted as a result of interacting with patients and their relatives. The continued occurrence of this state makes the nurses internalize the suffering and when this is coupled with the lack of ability to stop it, it leads to judgments of self-blame (Jakel et al., 2016). When these situations are repeated without appropriate attention or efforts to improve it, the nurses begin to be emotionally detached from the clients and harbor feelings of apathy to the families and the patient (Jakel et al., 2016).
The review further highlights the findings of other studies regarding professional burnout and CF and established that while there has been progress in educating the nurses on the risks associated with CF, there is limited data that supports increased quality of life of the nurses (Jakel et al., 2016). Jakel et al. (2016) further argue that the previous studies in this topic were relatively insignificant and used sampling techniques that limit generalization of findings. The review acknowledges that no published research had focused on technology as an intervention in combating CF (Jakel et al., 2016). This then gives the reason for the current study.
Analysis and Discussion of the Research Report
The study by Jakel et al. (2016) made use of a prospective quasi-experimental design to perform the research. The ProQOL among a sample of oncology nurses was evaluated using a longitudinal approach that used an intervention program, PRMA. Two nonrandomized groups, the treatment and control, were used to record the effects. Members from both groups were given CF education at baseline before the intervention. The treatment group was then exposed to the PRMA for 6 weeks. At the completion of the intervention, the two groups were evaluated at baseline (Jakel et al., 2016). The study is an example of a controlled observational study which is placed in the second level of evidence on the hierarchy of evidence beginning from the least evidentially significant sources. The highest and golden level of evidence is the systematic reviews, followed by RCTs, then the controlled observational studies and lowest level is the uncontrolled observational studies (DiCenso, Guyatt, & Ciliska, 2014).
Sampling is a crucial aspect of quantitative studies as it helps in determining the adequacy of representation. The research that uses small samples risks the study of sampling error bias (Campbell, & Stanley, 2015). To allow generalization of results, the participants should be recruited by a probability method (Coughlan, Cronin, & Ryan, 2007). The authors used advertisements to recruit the subjects. To participate, the subjects must have been 18 years and older, in fulltime employment as an oncology nurse, fluent in English and in possession of a smartphone. A total expediency sample of 25 RNs was used with non-random allocation placing 16 subjects into the treatment group and 9 in the control category (Jakel et al., 2016).
Internal validity refers to the extent to which a research establishes the cause-effect association between an intervention and on observed effect (Hoe & Hoare, 2012). For this study, the logical framework, which forms the basis for determining the internal validity, has been provided (Campbell & Stanley, 2015). The methods section has given the procedures to be followed while the results section provides the relevant information. The influence of bias has also been highlighted in the discussion section. Some examples of internal validity include history, maturation, and instrumentation among others (Campbell & Stanley, 2015). Because of the small sample size and the nonrandomized placement of subjects into the two groups, the internal validity of the research is likely to have been compromised. External validity describes the degree to which the findings of a research can be applied to other groups and places other than those that participated in the research (Polit & Beck, 2010). Some threats to external validity include the effects of experimental arrangements, specificity of the variables and experimenter effects.
The analysis of quantitative research presents challenges among the analysts and readers in understanding the sophisticated language and the statistical tests performed (Campbell & Stanley, 2015). The researchers have a duty to explain the different tests that were performed, why they were conducted and the meaning of the results (Coughlan, Cronin, & Ryan, 2007). The article under review analyzed statistics using the chi-square and Fisher’s exact test to determine the sample characteristics of each group and the level of ProQOL subscales for different categories (Jakel et al., 2016). The ProQOL scale uses a 5-point Likert-type scale to measure the negative and positive quality of life elements faced by the people in helping professions (Jakel et al., 2016). The article has given the analysis and explained its meaning sufficiently.
The reliability of a study is calculated by checking the extent to which a given instrument used to collect data can accurately and consistently measure the concept or item being considered. The ProQOL was the chosen instrument that could measure the concepts including the STS, burnout and compassion satisfaction. The reliability (Cronbach alpha) of the instrument range between 0.75 to 0.9 in all of the three subsets (Jakel et al., 2016). The provided values present a high degree of reliability of the tool.
Results and Discussion
The results of the study were presented in tables, figures and the text. The key demographic data is given in table 2 showing the age, experience and gender distributions. Using a bivariate analysis, both nurses in the two groups were found to be of comparable age, gender, levels of education, experience on oncology, certification and the number of years practiced as an RN (Jakel et al., 2016). During pre-test, 14 subjects had average STS, 15 indicated low burnout and 17 recorded high compassion satisfaction. At post-test, 8 subjects recorded low STS, 12 low burnout and 14 had high compassion satisfaction. Table 3 indicates that there were no statistically significant differences in the levels of STS, burnout and compassion satisfaction between the intervention and control group (Jakel et al., 2016). Besides, there were non-significant variances between the intervention groups of the STS subscale between pre-test and post-test for the treatment group.
The results, therefore, indicate that no statistically significant correlations exist between the control and treatment group on the three subscales in the oncology nurses. However, there was a hypothesized inverse association in the treatment group for the STS scores of the pre-test and post-test. This relationship may be indicative of the effectiveness of the PRMA in decreasing the levels of the nurses’ stress (Jakel et al., 2016).
The (Jakel et al., 2016) study discusses the implication of the findings to the nursing practice. A primary inference is that the research will inform a larger study since the current attempted to go into an area that had not been researched before (Jakel et al., 2016). For a thorough analysis of the effectiveness of PRMA, a larger study with a bigger sample and more data f may be required. The study concludes that further studies investigating the use of technology to prevent CF are needed. The summary related back to the review of literature, regarding the use of mobile phone applications (Coughlan, Cronin, & Ryan, 2007).
Conclusion
To summarize, while the research attempted to highlight some critical issues concerning CF, by the admission of the authors, the study was limited in its use of a small sample size and hence the collection of insufficient data for analysis. The use of nonrandomized method to group the participants into the classes further adds to the loss of internal validity and hence the lack of generalizability of the findings. However, the evidence provided can be used to inform future studies into the use of mobile devices to manage CF. The review of literature by Jakel et al. (2016) clearly shows that CF is a serious problem that needs to be attended to. Health care facilities with nurses that are free of stress and disruptions caused by CF will offer focused care with positive patient health outcomes. Currently, the nurses may not fully integrate the findings of this research into their practice, but with further research, it may form part of the evidence based practice. There is a strong need for further studies into the use of technology as an intervention for CF management among nurses to ascertain whether the findings of the Jakel et al. (2016) can be generalized.
References
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