Removal of Urinary Catheters - Midnight vs 06-00 Hours - Essay Example

CRITIQUE OF A RESEARCH PAPER ENTITLED “REMOVAL OF URINARY CATHETERS: MIDNIGHT VS 0600 HOURS” BY M. M. KELLEHER (2002) 1.0 Context of the paper The paper on the “Removal of Urinary Catheters: Midnight VS 0600 Hours” which was written by M.M, Kelleher in 2002 was published in the British Journal of Nursing, volume 11, number 2, pages 84-90. It sets out to analyze whether midnight removal of Indwelling Urinary Catheter (IDCs) in patients’ resuming normal voiding patterns. The paper was also centered on the determination if midnight removal of catheters increases the possibility that the patients would be released earlier from the hospital. The conclusion reached is that there is benefit from midnight removal of the indwelling urethral catheter. The evidence also suggests shorter hospital stay after early rather than delayed catheter removal but the effects on other outcomes are unclear. A number of arguments used in reaching this conclusion are critically examined. The discussion leads the reviewer to a conclusion that there are implications but the magnitude of these is not clear from the study. 1.1 Is the title appropriate? Why/why not? Yes, the title is appropriate because it directly tells what the research is all about. Similar titles are used in other studies. These research titles usually attract attention to the readers. Good examples of appropriate titles are that of the study by Inelmen, Meral, Enzi and Sergi. The title of the study is “When are indwelling urinary catheters appropriate in elderly patients?” published by the Geriatrics in 2007. Another example is the “Urinary catheters: a one-point restraint?” by Munasinghe RL. which was showcased by the Annual for Internal Medicine in 2003. Research titles such as these are simple, yet attractive and appropriate for the study. 1.2 Does the abstract summarizes that main features of the paper? Yes, the abstract was able to summarize the main features of the paper. The introduction, the purpose, the methodology used, the results and the conclusion were all mentioned in the abstract. This abstract which makes use of the inverted pyramid style in presenting the summary of the paper was efficiently presented by the author. There is no relevant information or part of the paper that is not mentioned in the Abstract of the paper. 1.3 What was the question that the research was designed to answer? The paper was done in order to determine if midnight removal of indwelling catheters in patients’ resuming normal voiding patterns and to determine if midnight removal of catheters increases the possibility that the patients would be released earlier from the hospital. This is the question that the research was designed to answer. Indwelling catheters are commonly used in elderly patients with urinary retention as well indwelling catheters is also use for the patient's comfort. Aside from these, there are still a lot of uses of the indwelling catheters. One important benefit from using this on patients is the ease that it bring to nurses. When these are used in patients, a big bulk of the job and responsibilities of nurses are addressed. 2.0 Research method The method that was used by Kelleher in the study is randomized controlled trial and the method of allocation used random numbers table. The randomized controlled trial is usually associated with Sir Austin Bradford Hill (1952). It was Hill (1952) who made use of the randomized controlled trials on the use of streptomycin from Streptococcus sp. His study was very successful in that it sets modernization of the random numbers table research method to assess the streptomycin produced by the bacteria for pulmonary tuberculosis. This was published through the Medical Research Council. The random numbers table are being used in previous experiments such as that in the examination of the reproducibility of items on the questionnaire which was designed to assessed a sample (random number table) of fifteen (15) trials published in Obstetrics and Gynecology Journals by Schulz, Chalmers, Grimes and Altman (1994). 2.1 What research design did the researchers use? Was this appropriate? Why/Why not? Prospective clinical trial was conducted in order to determine the impact midnight removal of the urinary catheters would have on the patients' voiding pattern, and subsequent discharge from hospital. The patients were allocated at random to have their urinary catheter removed either at midnight or at 0600 hours. The method used was not appropriate. This is because it is not appropriate to let the patients choose between 0600 hours and midnight. It must be up to them when they will be having the removal of their catheters, not merely allocated by the researchers. Most often than not, quantitative research is the most appropriate approach is scientific research. This is because quantitative research design assures precision. 2.2 What is the independent variable? The independent variable in the study was the time in removing the catheters. In the study, An independent variable is a hypothesized cause or influence on a dependent variable (Variables in Your Science Fair Project. Science Buddies, 2008). 2.3 What is the dependent variable? The dependent variable is the amount of urines that may be produced by the patients after the removal of their urinary catheters and the number of early discharged patients relative to what time they had their removal. The researcher the new value of the dependent variable is caused by and depends on the value of the independent variable (Variables in Your Science Fair Project. Science Buddies, 2008). 2.4 Name two potential extraneous variables? The number of early discharged patients relative to what time they had their removal of catheters is one of the extraneous variables (Experimental Designs. 2008). In this case, the extraneous variable is any other factor that might affect the dependent variable. Another variable that is potentially extraneous is the reduced in patient’s anxiety due to midnight removal of catheters. 2.5 Are the measurement strategies adequately described? Why/why not? Yes, the measurement strategies are adequately described. This is because there is ample amount of descriptions / illustrations given in the paper. Adequate description of the measurement strategies will help ensure clear understanding of the measurement strategies employed in the research/ 3.0 External validity of the study The approximate truth of conclusions is evident in the generalizations made in the study. There is a high degree to which the conclusions in this study would hold for other persons in other places and at other times. Generalizability of the research is important in every research. 3.1 Who were the study participants? The study participants are the patients having urinary removal. They are the one hundred sixty (160) patients who are admitted to urology or renal unit which comprises of seventy-five per cent (75%) male patients. These study participants efficiently represent the population of patients with urinary removal. These patients who undergo urinary removal are those who have their uterus remove who now are more prone to the risk of urinary incontinence. 3.2 How was the sample selected? Was this appropriate? Why/why not? The samples were selected from the one hundred sixty (160) study participants who are the patients having urinary removal. This was appropriate since they are the right participants of this study. The data that will be gathered from them will be very relevant in determining if midnight removal of IDCs in patients’ resuming normal voiding patterns and if midnight removal of catheters increases the possibility that the patients would be released earlier from the hospital. 3.3 How many participants were in the study sample? How was this determined? Was this adequate? Why/why not? The participants in the study samples consist of one hundred sixty (160) participants, seventy-five per cent (75 %) of which are male patients. This was determined by choosing the participants who are patients having urinary removal. This is adequate since it is relatively a large sample size already which efficiently represents the population. 3.4 What (if any) information is given about non-responders/dropouts that would help the reader to decide if they were in some way different to those who remained in the study? No information is given about non-responders or dropouts that would help the reader to decide whether they were in some way different to those who remained in the study. 3.5 Comment on the generalizability of the study results. The generalization of the study results is that the “catheter removal in hospital should take place at twelve midnight (12:00 MN), if the patient’s condition allows, as evidence shows this encourages an increased chance of voiding” (Kelleher 2002). 4.0 Internal validity The internal validity of this study showed that the causal inferences made in this study are based on experiments as experimental validity. 4.1 Is there evidence of the reliability of the outcome measures? If YES, cite evidence of their reliability. If NO, please state which measures were not reliable and why? Yes, there is evidence of the reliability of the outcome measures. The evidence is the measure used. 4.2 Is there evidence of the validity of all of the measures? If YES, cite evidence of their validity. If NO, please state which measures were not valid and why? There is evidence of the validity of all of the measures. All the measures used were valid. 4.3 Was their blinding of outcome measures in the study? If YES state for what or whom blinding occurred? If NOT, state the impact of the lack of blinding on the study results. Blinding or randomization of outcome measures was not clear in the study. The impact of the lack of blinding on the study results is great. The presence of blinding is essential depending on how objective the outcome measure is. 5.0 Data Analysis The data and information gathered reflected that catheter removal in hospital should take place at twelve midnight (12:00 MN), if the patient’s condition allows. “As the data revealed that this contributed to increased chance of voiding” (Kelleher 2002). To better analyze the data, enough samples are necessary. Hence, the contribution of the data analysis tool is a big factor in the success of the research project. 5.1 What methods of data analysis are used? Are they appropriate? Why/why not? The data analysis used in this study is the sub-analysis which was based on combined data of one hundred twenty male patients and forty female patients with urinary removal. 5.2 Using all the information from your analysis so far, decide on whether or not you recommend the results of this study to be used for clinical practice? There is no definitive right or wrong answer here. If you think the report has a serious flaw that could lead to misinterpretation of the study findings, it should not be used as a base for practice. If you believe that the research is without serious flaws, then it may form a basis for practice, but you may have other reasons for rejecting it. Whatever you decide, you need to justify your decision. You may draw on your answers to the previous questions to help with your decisions. Please include in text referencing to every paragraph or statements were the essay came from. Using all the available, data, information and findings from my analysis so far, I am recommending the results of this study to be used for clinical practice. This paper will contribute to the advancement of this topic. A lot of information provided here are discussed clearly and to the point. The research draws sufficient conclusions for the study to stand-out. According to Webster, et al. (2006), based on their findings removing urinary catheter at any time does not affect the length of stay. However, removing catheters as soon as practical may reduce the incidence of post discharge urinary problems. Urinary catheters may be removed anytime, wherein it is convenient to the patient without affecting time between catheter removal as well as hospital discharge. The report has some very minor flaws. However, they could not lead to misinterpretation of the study findings. Despite those, it should still be used as a base for practice. Through the years, there was no negative feedback on the worth of this research paper. Reference: Experimental Designs. 2008. CLC Pages. Illinois. http://clcpages.clcillinois.edu/home/soc455/psycweb/research/experiments.htm. Griffiths, R., & Fernandez, R. “Strategies for the Removal of Short-term Indwelling Urethral Catheters in Adults.” Cochrane Database of Systematic Reviews 2007. Issue 2. Hill AB. The clinical trial. N Engl J Med1952; 247:113 –119. Inelmen, Emine Meral, Enzi, Giuliano and Sergi, Giuseppe. When are indwelling urinary catheters appropriate in elderly patients?. Geriatrics, October 15, 2007. Kelleher, M.M. (2002). “Removal of urinary catheters: midnight vs. 0600 hours.” British Journal of Nursing, 11 (2), 84-90. Munasinghe RL. Urinary catheters: a one-point restraint? Ann Intern Med. 2003; 38:238. Schulz, Kenneth F., Chalmers, Iain, Grimes, David A. and Altman, Douglas G. (1994). Assessing the Quality of Randomization From Reports of Controlled Trials. Obstetrics and Gynecology Journals, vol. 272, pp.125-128. Variables in Your Science Fair Project. Science Buddies. 2008. Kenneth Lafferty Hess Family Charitable Foundation. http://www.sciencebuddies.org/mentoring/project_variables.shtml. Webster, J., Osborne, S., Woollett, K. Shearer, J., Courty, M., & Anderson, D. (2006). “Does Evening Removal of Urinary Catheters Shorten Hospital Stay Among General Hospital Patients?: A Randomized Controlled Trial. J Wound, Ostomy and Continence Nurses Society. 33(2):156-163. March/April 2006. Read More