Critical Appraisal of Randomized Controlled Trial, Article Critique Example

Was the research question clear? Was the need for the study adequately substantiated? Explain

The research question was clear. As well, the need for the study was adequately substantiated. The aim of the study was to rigorously evaluate a brief stress management intervention for nurse leaders. The author describes the work environment under which the modern nurse leaders operate and lays out the need for an interventional program to prevent and control stress. The author also describes the outcomes related with stress and the need for it to be controlled.

What was the design (experimental or quasi-experimental)? Was it an appropriate fit for the research question? Explain.

The design was experimental which is an appropriate fit for the research question since this was a cause-effect process. Experimental design is the best fitted for such a causal process.

Describe the sample. How was the sample selected? Identify the threats to external validity.

The sample was selected from a number of nurse leaders (n=33) from a healthcare system in the southwest of the united states exclusive to those in leadership positions those who belonged to a formal leadership council and able to read and write English. The exclusion criterion was those with a clinical condition or those who had undergone such a program before.

The Mindful Meditation Course (n=16) and the control group (n=17).

Threats to external validity: other nurses who are not in leadership positions and those outside the Southwest medical care facility in the US.

Was a power analysis performed? Was the sample size large enough to statistically detect a clinically important difference?

A power analysis was performed and the sample size was large enough to statistically detect a clinically important difference.

How was the study subjects assigned to treatment groups? Were the groups comparable at baseline? If not, how did they differ? Identify the treats to internal validity.

By random placement method.

The groups were comparable at baseline.

Threats to internal validity: compensatory rivalry, experimental bias, history and instrument change.

Describe the intervention or experimental manipulation.

The experimental was under the direct control of the investigator and attempted to control extraneous factors in this case by random assignment to the study condition

Did the investigators report the extent to the intervention was followed (adhered to)? If so, what did they report?

No

How was /were the outcome(s) measured? Describe the reliability and validity of the measures. Are the measures appropriate for the population or the variable being studied? If not, why?

The outcome was measured by observing the performance of the MMC group against the control groups in terms depression, anxiety, PSDI, and caring efficacy. The measures are appropriate for the sample being measured.

Was an-intention-to treat approach used when the outcomes were analyzed?

Yes

Were the correct statistical tests used according to the type of data analyzed and the questions asked? Explain the rationale for your answer.

Yes. The statistical tests employed included t tests, power deviation methods etc

What were the findings?

The intensity and prevalence of stress experienced by the leaders (combined treatment and comparison groups) were much greater than originally anticipated which indicated that the level of stress for this leaders was higher at baseline than would be expected in the general population. Self-nurturing interventions can positively influence leadership.

How were the data distributed? Were statistical tests results given in detail?(descriptive statistics and p value or confidence interval) did they find statistical significance? Did they find clinical significance?

The results were given in detail which included descriptive statistics, p value, and confidence interval which all well documented and aptly described.

The results found both clinical and statistical significance.

Was the interpretation of the findings correct? If there were negative (non-significant) results, were power and sample size discussed? Were the conclusions stated appropriate – not stated beyond what the data support? Who sponsored the study (drug companies, etc)? Is there potential for bias based on the sponsor?

The interpretations of the findings were correct. As well, the power and sample size were discussed. The conclusion was also appropriate since it was well supported by the data. There is no potential for bias from the sponsor. However, the sponsors for this research have not been explicitly brought out.

Did the authors put their findings in the context of the broader literature on this topic? How are these findings convergent or divergent from other findings?

Yes. The study converges with other findings, which had found MBSR effective for successfully reducing stress and its symptoms with people with cancer, cardiovascular disease and other conditions.

Section III: How can I apply the results/ findings?

What relevance do the findings have to nursing practice and how can the findings be applied to nursing practice.

The findings of the study are relevant to the nursing profession since they would help the nursing practice to;

Acknowledge the intense the intense and chronic nature of stress and its impact on one self, employees and students. As well, to explore the feasible ways of translating stress management techniques into moment-by-moment living and to exert leadership influence to create organizational environments supporting healthy stress management.

Using pico identify

P (=POPULATION): those in the nursing profession

I (=INTERVENTION): the Nurse Leader Mindfulness Meditation Program

C (=COMPARISON GROUPS): those undergoing other leadership programs

O (=OUTCOME): lowering of stress levels for those undergoing the mindfulness meditation program

a. chronologically

a. observation with intervention

Research design is experimental

t-test, descriptive statistics

Interpreting and appraising quantitative research reports

Aim(s) of research question(s) in the study

To rigorously evaluate a brief stress management intervention for nurse leaders

Independent variables and their levels of measurement: stress, stress management intervention for nurse leaders.

Dependent variables and the levels of measurement: the nurses’ performance at work

Inferential tests used to address the aim(s). Were they appropriate? Why or why not?

Nurse leaders randomly assigned to brief mindfulness meditation course or leadership course (control). The test employed was appropriate since it helped achieve the intended objective of determining stress management the best stress management intervention for nurse leaders.

What were the findings in relation to each aim/question?

The results showed a lot of improvement in self-reported stress symptoms among MMC participants compared to the control group.

Limitations of this study are: limited ability to closely monitor frequency and duration of meditation practice, restricted generalizability due to selection bias, relatively small sample, and no long term comparison to assess the assess the durability of observed differences between groups.