Note: Sample below may appear distorted but all corresponding word document files contain proper formattingExcerpt from Essay:
Individual Critique of a Quantitative Analysis Report
"A Randomized Control Trial of Continuous Support in Labor by a Lay Doula:" a Critique of a Quantitative Analysis Report
The process of giving birth places exceptional strain on a mother and is associated with significant risks and complications. According to a recent report published by the Centers for Disease Control and Prevention, 32.3% of all births in 2009 were delivered via cesarean section, a record rate (Martin et al., 2011). There are substantial risks involved with such a procedure for the mother as well as the child. Prolonged labor can increase the likelihood of having to perform a cesarean section (Lopez-Zeno, Peaceman, Adashek & Socol, 1992), while labor analgesia is also associated with a number of serious complications (Norris et al., 1994). The benefits of supportive care for women during labor are well established in the literature but nonetheless present a substantial financial burden that most underinsured women are not able to carry. The authors of the study, A Randomized Control Trial of Continuous Support in Labor by a Lay Doula, conducted a doula training program for a female friend or family member of the mother and examined the effect of their presence on the labor outcomes in women. This could potentially improve the health of the mother and child without placing additional strain on the nursing staff. This paper presents a critique of the various elements of the quantitative research report.
The purpose of the study was to determine the effect of supportive care of women in labor by comparing labor outcomes in women attended by a trusted support person trained in doula care with outcomes in women who did not have additional doula support. The research question that the authors were trying to answer in the study was whether supportive care during labor, specifically by a female friend or family member trained in doula care, would have a clinical impact during the delivery. Does it reduce the anxiety and stress-associated complications such as length of labor, rate of Cesarean section and Apgar scores of the baby? The hypothesis of the authors is not explicitly stated but based on previous studies and current knowledge about the beneficial effects of supportive care, the likely hypothesis of the study was that an additional support person would lower the complications of the labor process in comparison to the control group. The only independent variable of this study was the presence or absence of an additional support person during labor. Dependent variables were length of labor from onset of contractions to delivery of neonate, type of delivery as either spontaneous vaginal, forceps, vacuum-assisted, or cesarean, type and timing of analgesia and Apgar scores of the baby at one and five minutes.
The conceptual framework of this study is based on the physiological effect of the catecholamine hormones that guide the labor process. According to past studies, an elevated level of these hormones during labor reduces blood flow to the uterus and placenta and reduces the contractility of the smooth muscles. This is associated with slower dilation rates, longer labors and therefore higher complication rates. The emotional stress and anxiety of the labor process induces the release of epinephrine, one of the catecholamines, and thereby exacerbates the effect on the uterus and placenta. The conceptual model guiding this study relies on the idea that emotional support during this stressful time by a familiar person who is trained in techniques to comfort the mother, can reduce the levels of catecholamines and thereby increase the contractility of the smooth muscles responsible for delivering the baby. Moreover, the support provided by the doula may also help release the hormone oxytocin, which further strengthens contractions. These assumptions by the authors are well documented in the literature and provide a valid theoretical framework for the study.
The extensive literature review conducted by the authors found several studies that report a significant benefit of supportive care during labor. According to one study, the support of an untrained close female relative resulted in less cesarean sections, less intrapartum analgesia, and less use of oxytocin (Campbell, Lake, Falk & Backstrand, 2006). The authors provide a comprehensive review of the literature to support their assumptions and their study design. They used previous studies to validate the impact that hormones have during labor and to emphasize their assumption that supportive techniques may affect the hormone levels. Further, the authors provide gaps in knowledge to justify the purpose of their study. Specifically, they reference a study that showed little impact of the continuous support during labor of a professional nurse and cite possible explanations for this. This gives credence to their hypothesis that a personal friend instead of a professional could potentially be more effective in helping a mother during labor.
The design of the study was appropriate to obtain the most statistically reliable results. The authors strictly controlled the study population by limiting eligibility to nulliparous, singleton-, low-risk pregnancies with women able to identify a female friend of family member. Only after obtaining consent, did the researchers reveal what group the subject had randomly been assigned to. The pregnant woman and her female friend attended two, 2-hour instructional sessions during which the women were taught coping strategies during labor and the doulas were taught how to provide guidance and comfort measures. The training content was consistent for every training session despite a variety of settings. Each subject received printed material for future reference. On the day of delivery, the personal doulas attended labor along with any other family members or friends of the mother. There were no restrictions placed on who attended the labor and professional medical personnel were not blinded to the group assignation of the subject. This may be seen as a weakness as discussed below.
The study population consisted of 600 women with 300 equally distributed between the two groups. The likelihood of a randomization producing two groups of exactly the same size is relatively unlikely and engenders some doubt about the distribution method. A power analysis was calculated prior to the study to determine the appropriate number of subjects needed to obtain statistically significant results. A total of 586 women completed the study for a 76% power value. The representativeness of the samples was weak as an overwhelming majority of women were white, non-Hispanics in their early twenties. However, the demographic distribution was consistent between the two study groups, which adds strength to the design and helps to control one of the extraneous variables associated with the study. The study was conducted at a women's ambulatory care center located at a tertiary perinatal care hospital in New Jersey. The setting is appropriate in providing ready access to eligible subjects; however, a less advanced or lower resourced facility might have produced even more significant results in favor of the authors' hypothesis.
There are a number of extraneous variables inherent in the study, which the researchers appropriately controlled for. The most significant potential contaminant is the nature of the women's pregnancy. The complications of labor increase with age and number of pregnancies and despite randomization, a heterogeneous pool of pregnancy types would have influenced the labor outcomes. By strictly controlling for the type of pregnant woman eligible for enrollment, the authors reduced the likelihood of confounding their results with an additional variable. Another possible extraneous variable, though less impactful than the type of pregnancy, is the site of the doula training provided by the research assistant. The training was provided in all types of settings. The authors attempted to control for this variable by using the same research assistant, and providing precisely the same content and reference material.
Outcome data were collected from the intrapartum period by a retrospective hospital record review. The validity and reliability of this method is very high because the hospital records are based on objective data that is routinely collected as part of hospital policy. The authors do not explicitly discuss the reliability of the study instruments. This should not be considered an omission because the authors are not involved in the data collection process, which makes it more reliable by removing bias. Specific measures taken to protect the rights of the subjects were not mentioned. One potential but unlikely influence on the data is the subjective evaluation of the neonates by the delivering physician in form of the Apgar score. Knowing what group the subject belonged to may have influenced the physician in his evaluation.
The data were analyzed using standard statistical comparison tests. Two data analyses were performed: one on the entire population and another on only those subjects that met the eligibility criteria throughout the labor process. In this way, the authors removed any subjects that may negatively influence the data and be inappropriate for answering the research question. The data analysis procedures were statistically valid and thorough and the authors showed sensitivity towards removing subjects that in the process of the study disqualified themselves in some way from the original eligibility criteria. Two major strength…[continue]
"Individual Critique Of A Quantitative Analysis Report" (2012, February 19) Retrieved December 3, 2016, from http://www.paperdue.com/essay/individual-critique-of-a-quantitative-analysis-78110
"Individual Critique Of A Quantitative Analysis Report" 19 February 2012. Web.3 December. 2016. <http://www.paperdue.com/essay/individual-critique-of-a-quantitative-analysis-78110>
"Individual Critique Of A Quantitative Analysis Report", 19 February 2012, Accessed.3 December. 2016, http://www.paperdue.com/essay/individual-critique-of-a-quantitative-analysis-78110
Buprenorphine Induction in Primary Care Abstract of the study provides a clear overview of the study. It introduces the uses of the buprenorphine in the primary care settings and the study grouped in the case. It provides the methodology used to study and analyze the topic. For example, it uses different methods of collecting data such as assessment, follow-ups, urine toxicology testing, and measurement of the primary outcomes associated with
(2001) research has considerable questionable areas that require questions to the overall application of the specified survey research. The provided statistical analysis does not assist with validation of their research findings with the provided information having uniformity or little description in the application. For instance, there is an analysis of varying questions through the application of varying confidence levels with t-distributions only provided to support specified statistics. Another concern
Performance Evaluation Critique Several years ago Arrow Electronics instituted an Employee Performance Review (EPR) system. However, the process was not providing the CEO. Steve Kaufman, the results that he had hoped for when it was instituted. The original goal of the EPR system was to help identify those individuals within the company whose performance was outstanding and whose career should be accelerated. It was also designed to pinpoint those who would
Sampling Data Analyses the single-study critique paper 2 individual assignment. Develop individual response Single-Study Paper 2 IOM topic area. Use article Single Study Critiques 1-2. It a requirement a quantitative study paper. Quantitative article analysis The Nursing Research article "Effectiveness of an Aspiration Risk-Reduction Protocol" addresses a proposed method to reduce the risk of aspiration in critically ill patients through a three-pronged intervention strategy. The intervention strategy components include "maintaining head-of-bed elevation
Experimentation Critique Resource Imagine analyzing an article in depth on its experimentation. What will one find? Will the variables impact the study? Will the researchers provide the necessary details for a person to or a group of people to replicate it? One will provide an analysis on a specific business article that deals with employment laws. One needs to note the variables involved that are with the article. Since this is a
The data gathered is subjected to statistical analysis using statistical methods of linear regression and chi square testing. The main purpose of the study was to confirm the hypothesis that consultation with CNS or RN in a drug-monitoring clinic has a significant positive impact on the well being of patients with rheumatoid arthritis. The study involved a single blinded randomized controlled trial over a period of three years. Subjects were
Notwithstanding the challenges involved, the stakes are high and there is little room for false starts or experimentation; therefore, identifying a general set of best practices that Gambian organizations can follow in developing their own set of sustainable productivity practices represents a valuable and timely undertaking, which relates to the purpose of the study which is discussed further below. Purpose of Study The overall purpose of this study was to study