Project #76128 - wk 6 two responses to discussion

 Make a response to these two discussions.Only needs to be about 300 words.

1st one: Response to Julie:

 

Eletha,

You did a very nice job breaking down the components of the study. I had a hard time with this and have read the article a few times to gain additional clarity. You and I both discuss the inequity of sample populations among groups.That was the most obvious problem to me as well. The positive aspect is they were able to implement two new interventions that could reduce aspiration and pneumonia. However, it would be a stronger study if they would have had similarly sized groups as the results favored the AARP group. To me this would be a problem with statistical significance. Statistics should be used to lend strength to a study. As you state these study results helps guide practice change in order to improve the care of patients. The other component that was interesting is that from my own standpoint I thought that elevating the head of the bed was a common intervention to avoid apiration and did not realize that it was something that needed to be studied further. The researcher did make a piont to elude to idea that  small bowel tube feeding could decrease the incidenc of aspiration in patients with feeding tubes ( Metheny, Davis-Jackoson & stuart, 2010) . Perhaps the researchers could have foused more on developing interventions for patients with feeding tubes only. And leave out the patients on mechanicsl ventialtion. I only say that becuse it is common for patients to aquire ventilator associate pnumonia. This is pretty well know. If we were to evluate true risk for aspiration in pnuemonia I would sutdy s population who had a similar disease process with the presecen of a feeding tube and then I would randomize the two groups. What do you think? Do you think the resaercher were trying to accomplish too much?

 

Julie

 

References

Metheny, N. A., Davis-Jackson, J., & Stewart, B. J. (2010). Effectiveness of an aspiration risk-reduction protocol. Nursing Research, 59(1), 18–25.

 

2nd one: Response to Julie P.

 

 Effectiveness of an Aspiration Risk-Reduction Protocol

Purpose and Methods:  The study was quasi experimental design, three pronged study, conducted to measure the prevalence of aspiration and pneumonia among mechanically ventilated patients receiving tube feedings: The groups were a normal care group and a high risk for aspiration group. The second group received the Aspiration Risk –Reduction Protocol (ARRP) (Metheney, Davis-Jackson & Stewart, 2010).

Concerns about the Studies Internal Validity

The threat to internal validity is the study is non -randomized. The other concern is the patients were not of similar prognosis or disease process. The inclusion data was participants were to be on mechanical ventilated ventilation and have a feeding tube present. The research used two comparison groups for the study. The first group was a 329 sample population study was conducted between the years 2002-2004 and the ARRP group was comprised of 145 between the years 2007 to 2008 (Metheny at al., 2010). Several ideas give rise from this study information. This time gap among group studies could pose a problem. Medical advances and improvement in technology could certainly influence the outcome of the study. I do not see how the information obtained from this group could still be considered a valid representation. The other problem is the sample size. The sample size is quite dissimilar between groups. This could be a type of experimental mortality even though I understand this to normally occur at the end of a study when participants fall out of the study (Slack & Drugalis, 2001). The inclusion was the patients who were at high aspiration risk and a normal aspiration risk group. However, the diversity among the high aspiration group could certainly impact results. Not to say the outcome of the study was bad, they describe three effective interventions to reduce the risks of aspiration.

How to Strengthen the Validity

 Threats to validity can be avoided by including design characteristics that will give the study evidence weight and merit (Polit and Beck, 2012). By not considering research design a researcher could end up with a flawed study that is not supported by evidence. Choosing the right design can help to strengthen study validity. In fact, true experimental designs that incorporate randomization are strongest. Experimental studies that include randomization are better able to control the confounding variable which can decrease the threats to internal validity (Slack & Drugalis, 2001).

Failure to consider Validity in Research

 The researchers chose to use quasi- experimental design which leaves the reasons or the outcomes less definable and more open to interpretation. They wouldn’t be able to say for sure that utilizing the aspiration protocol actually led to a reduction in aspiration and pneumonia for their study population. There are independent variables like the clinical pulmonary infection score. The other independent variables to consider would be the tube feedings and if factors like residual volume of feeding or vomiting had any influence on the participants.

References

Metheny, N. A., Davis-Jackson, J., & Stewart, B. J. (2010). Effectiveness of an aspiration risk-reduction protocol. Nursing Research, 59(1), 18–25.

Polit, D. F., & Beck, C. T. (2012).  Nursing research: Generating and assessing evidence for nursing practice (Laureate Education, Inc., custom ed.). Philadelphia, PA: Lippincott Williams & Wilkins.

Slack, M.K. & Drugalis, J.R. (2001). Establishing the Internal and External Validity of Experimental Studies.American Journal of Health System Pharmacy, 1(58), 22. Retrieved fromm http://www.medscape.com/viewarticle/414875_3

 

Subject Medicine
Due By (Pacific Time) 07/11/2015 12:00 pm
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