The Problem Statement and the Statement of Purpose of the Article
The problem statement was well-authored in the present study. Specifically, the researchers discussed the currently existing knowledge gap and contradictory findings of past studies on the topic of physical restraint that necessitated the need to conduct the research. Specifically, the researchers noted that even though previous empirical studies have shown that educational interventions are associated with positive outcomes such as improved knowledge and attitudes regarding the use of physical restraints, there also exist conflicting findings on the same issue (Eskandari, Abdullah, Zainal, & Wong, 2018). For instance, some of the past studies have reported no change in knowledge, attitudes, practices, and frequency of use of physical restraint following an educational intervention.
These contradictory findings and absence of empirical studies that have examined the influence of educational programs on physical restraint Malaysian health care settings were the primary reasons (problem statement) why the study was undertaken. Consequently, the purpose of Eskandari et al.'s (2018) study was to explore the impact an educational intervention for nurses on the nurses' incidence rate of physical restraint uses as well as their practice, intention, attitude, and knowledge of physical strain used.
Comments on Article's Literature Review
A good literature review should be based on empirical studies that are current. That is, the articles used in the literature review should not be older than five years compared to the present research. Because Eskandari et al.'s (2018) study were published in 2013, it is expected that all articles used in the literature review should have been published between 2013 and 2018. However, a look at the studies cited in the literature review that formed the researchers' arguments and basis for the current study shows that most of the articles reviewed were not current. That is, the majority of the reviewed studies were published more than five years of publication of Eskandari et al.'s (2018) study.
The Participants Studied, Inclusion and Exclusion Criteria
The participants included all nurses who were working in 12 inpatient wards of a large teaching hospital in Malaysia, Kuala Lumpur. The only inclusion criteria used to select the research subjects into the current study included a willingness to partake in the study. On the other hand, all nurses who worked in operation, pediatric, and neonatal units were not involved in the study because of the complexity of defining and applying physical restraint among them. Additionally, head nurses of the following hospital units were excluded from the study: psychiatric wards, geriatric and rehabilitation, neurology-neurosurgery, medical-surgical wards, and intensive and critical care units. Overall, 245 nurses participated in the educational intervention on the physical strain used.
The Sampling Issues
The sampling technique used to choose the participants for this study was not explicitly explained in this study. However, from the discussion of sample and methods, it can be inferred that the researchers employed a purposive sampling method in choosing the research subjects. This is because the researchers selected only nurses from units where it was easy to define and apply physical restraint. According to Gerrish and Lacey (2010), purposive sampling is a sampling approach where individuals from a pre-specified group are purposely chosen and sampled for a particular study. This sampling approach is an example of a non-probability sampling method. Using purposive sampling, 245 nurses were selected to participate in the educational intervention on the physical strain used.
The use of non-probability sampling technique in this study has some implications on the sample and generalizability of the results of the study. In this type of sampling method, the potential research subjects are not provided with an equal chance of being selected into the final sample. Consequently, this sampling technique leads to sampling bias. Lavrakas (2008) noted that sampling bias is present when a sample statistic does not accurately match the actual value of the parameter in the population where the sample is derived from. In such cases, the participants are chosen into a study in a such a manner that some individuals of the target population have a lower likelihood of being included than others. Sampling bias is the major limitation of the non-probability sampling method and, consequently, the current study. Because of the use of purposive sampling method, the findings of the current study lack generalizability. That is, the results of the study do not apply to other settings, times, populations, and regions other than the current sample. This is another limitation of using non-random sample.
The Study Setting
The data collection took place in 12 inpatient wards of a large teaching hospital in Kuala Lumpur.
Discuss Informed Consent
The study was conducted in full adherence to ethical consideration of research studies involving human subjects. For instance, the researcher obtained consent from the participants. Specifically, the researchers invited all nurses for voluntary participation in the study and written consent was obtained from those who were willing to be part of the study. As part of the informed consent process, the nurses and managers of the hospital were informed of the aim of the researcher and were assured that their participation in the study would not result in any harm.
Other ethical considerations of this study included assurance of confidentiality and anonymity. Anonymity was ensured through coding of all restraint forms and b ensuring that there was limited access to patients' information. Also, a coding system was utilized in the questionnaire as the research subjects were not identified in the reports. The access to the information was only by the doctor and nurse tasked with taking care of the patient or treating the patient. Also, the de-identification of the participants in the questionnaire ensured anonymity. It is also worth noting that permission was sought from an author of data collection questionnaire, Janelli, who had the copyright to the questionnaire used for collecting data related to practice, attitude, and knowledge of physical constraints. Additionally, the researchers obtained permission from the Medical Centre's Research Ethics Committee before embarking on the research.
Identify the Hypothesis or Research Question
The authors did not explicitly state the hypotheses or research questions that guided the current study.
The Research Design
The researchers utilized a quasi-experimental pretest-posttest one group design.
Identification of Research Variables
The independent variable was educational intervention. The educational intervention comprised of 20 educational sessions, which were implemented to the nurses. Each of the nurses was invited to a 1-day educational session consisting of 8 hours. Each educational session comprised if 15 to 20 sessions. In each of these sessions, the research subjects were categorized into three groups. The educational intervention consisted of facts and myths related to the use of physical restraint use and alternatives and appropriate use of physical restraint as a last resort in the hospital. The teaching approach comprised of demonstration on some of the currently used variants of physical restraint as well as lecture, video demonstrations, and group discussion, and three video demonstrations on the use of physical restraints.
The independent variable of the present study was nurses' physical restraints, knowledge, attitude, intention, and practice. The independent variable was assessed using valid and reliable instruments. One of these instruments, knowledge, attitude, intention and practice of nurses (KAIP), was developed by Janelli and was used to assess nurses' knowledge, attitude, intention, and practice regarding physical restraint use.
Description of Data Analysis
Data analysis was conducted using descriptive and inferential statistical methods. For instance, the descriptive statistical approaches that were used to report participants' demographic and professional characteristics included mean, standard deviation, percentages. These descriptive statistics were appropriate for reporting participants demographic characteristics (age, marital status, and work experience).
On the other hand, paired sample t-test, a type of inferential statistics, was used to determine the impact of educational intervention on participants' knowledge, attitude, intention and practice. The paired sample t-test was the most relevant type of inferential analysis for testing whether there were changes in participants' knowledge, attitude, intention and practice following an educational intervention. The paired samples t-test is used for comparing two means obtained from the same individuals or related units (Zikmund & Babin, 2012; Zikmund, Babin, Carr, & Griffin, 2013; Esteitie, 2013). In paired sample t-test, two means are used to denote two different times such as in a quasi-experimental pretest-posttest one group design which is comprised of a pre-test and post-test and intervention between the two time points. Consequently, the paired sample t-test was the most appropriate type of inferential statistical analysis of this study because the researchers utilized a quasi-experimental pretest-posttest one group design.
Another type of inferential statistical analysis employed in this study is chi-square test, which was used to assess the demographic (gender, age, and ethnicity) and clinical characteristics (month of hospitalization and diagnosis) of restrained patients pre and post-intervention. Lastly, two-proportion Z-test was used to determine whether there was a difference in the incidence rate of utilization of physical restraint in each ward.
The Results of the Study and Appropriateness of the Methods used
The results of paired sample t-test analysis used to determine the impact of educational intervention on participants' knowledge, attitude, intention and practice showed that educational intervention leads to enhanced nurses' knowledge, attitude, intention and practice on the use of physical restraints. The paired sample t-test was the most appropriate type of inferential statistical analysis of this study because the researchers utilized a quasi-experimental pretest-posttest one group design. Additionally, the researchers found a significant reduction in the incidence rate of physical restraint use in all hospital wards following an educational intervention. The only exception was geriatric-rehabilitation wards, where no decrease in the incidence rate of physical restraint use was found. The limitations of this research include the possibility of social desirability among the participants, inability to identify the actual behaviors of the nurses due to the use of questionnaires, and the limited external validity of the findings.
Level of Evidence Used, Nursing Theory Addressed, And Implications for Nursing Practice or Research
There are various levels of nursing evidence. In the current study, the study used a Level III level of evidence. According to Winona State University Library (2019), Level III level of evidence includes quasi-experimental design, such as the one utilized in the current study. Concerning the theory addressed in this study, the researchers explicitly outlined that the study addresses the theory of planned behavior. One of the weaknesses of the study is the failure of the researchers to discuss implications of the findings for nursing practice and further research.
Research Findings Can Be Applied to the Clinical Area
Findings of this study is a solid basis...
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