Vallerand, A., Riley-Doucet, C. Hasenau,

Vallerand, a., Riley-Doucet, C. Hasenau, S. And Templin, T. (2004). Improving cancer pain management by homecare nurses. Oncology Nursing Forum. 31(4):809-816.

Fairly critiquing an investigator's research endeavor is a task that must be taken seriously. Although it is quite easy to have an opinion of another's research it is something quite different to be able to evaluate the research activity in terms of topic specificity and soundness, intent or purpose, data analysis, and informational importance. When embarking upon a critical analysis of another's work the reviewer must, at all times, adhere to the basic principle of prudent evaluation; namely, evaluating the structure of the research upon which scientific conclusion are drawn. More specifically, the function of a research report (article) is to inform readers about the problem being investigated, the methods used to solve the problem, the results of the investigation, and the conclusions being inferred from the results. The printed manuscript is to inform the reader, as expeditiously as possible, what was done, the outcome of the doing, and the investigator's conclusion. In line with the research protocol tenets the article authored by Vallerand, Riley-Doucet, Hasenau, and Templin (2004) will be constructively evaluated on the basis of its substantive worth and design quality.

Design Quality. Whether research investigations are designed on the basis of an experimental, descriptive, historical, or case study and/or clinical trial formatted there must exist a clearly defined research question that informs the reader as to the specific intent of the research undertaken. When the research design is experimental (treatment) or descriptive there must follow a well-formulated testable null hypothesis. Should these two research tenets not be in place then the research is said to be ad hoc and of little useful propose with respect to the validity and reliability of professional content knowledge. The present article reviewed and authored by Vallerand and colleagues, (2004) can be best described as ad hoc research as it did not follow the best-fit practice for effective research. At any time, when a research investigator advises the reading audience that a study was conducted to determine the effects of an applied program (i.e., two-tier education program - independent variable), he or she must also inform the reader as to that which is identified as the measured outcome (i.e., dependent variable). For the present investigation all the authors managed to accomplish was to lump both independent and dependent variables into a single category under the title "research variables" (i.e., two-tiered education program and nursing knowledge and attitude toward pain management, pain perception, and barriers to pain management). All that was reported by the authors were the results of the two-tiered program on knowledge about pain management, barriers to pain management, and perception of pain control. The more prudent research tactic to have taken would have been to determine the effects of the two-tier program with respect to pain knowledge, management, and perception on some identified dependent variable such as lowered errors in medication delivery, attitude change toward palliative care, nursing stress levels, or even nursing retention. Any one of these factors might well have been affected by the treatment variable (i.e., educational program) delivered to the sample nursing research audience. In essence what the authors structured was simply a content knowledge-based study minus all forms of application.

In addition to omitting a research question and testable null hypothesis the authors failed in other research areas as well, namely, sampling, instrumentation or measurement, and statistical tool selection. The errors here are of such magnitude that they can only be presented on a very general basis. Notwithstanding the fact that the authors failed to properly identify the type or research, research question, and testable null hypothesis their selection of research design (statistical tool and sample) is completely without merit. When selecting a design the author is obligated to inform the reader as to the rational. The authors for this particular study identified their design as a 'cluster randomized, experimental design." This is simply a 'fruit salad' when speaking about prudent research. Cluster randomized designs are basically regarded as lacking statistical precision and, at best, require a pretreatment covariant to hopefully increase experimental precision. Whomever recommended that the authors employ such a tactic simply needs to return to a 'two-tier" education program wherein the primary objective is to increase one's content knowledge of statistics. Although the authors also make mention of using an ANOVA to garner statistical value nowhere in the report as these values reported other than on a cursory basis. Again, when statistical values are produced they must, at all time be aligned with the null hypotheses previously stated if the conclusions presented are to be accepted.

Substantive Worth. There are those who would argue that any word placed on paper is of value, now or in the future. However, when it comes to healthcare and for those responsible for its delivery, that which is most important is to provide all healthcare practitioners the ways and means to deliver unto the medical consumer that which is effective, that which is holistic, and that which is self-directed. Health care delivery in the twenty first century is facing demands that are not only financially restrictive but also by variables such as increased life span of the American citizenry, a keen awareness of advanced treatment programming, and better quality of life. Unfortunately, however, with better health care there exists a void in the availability of trained professionals who are qualified to provide the necessary medical service. The article authored by Vallerand, Riley-Doucet, Hasenau, and Templin (2004), by virtue of subject area alone, is commendable. Although greatly lacking in research design accuracy and specificity the intent of the investigation is noteworthy. Palliative care, whether hospital, hospice, or home-based has as its foremost tenet, those factors contributing to the Quality Adjusted Life Year (QALY) index - especially in the filed of oncology. The authors of the present research article were able to bring to the forefront an area often overlooked by healthcare practitioners, namely the role the home-based nurse in a medical consumer care. Whether one follows conceptual nursing models that are classified as grand models (Leininger, Neuman, Parse, Orem) or those categorized as mid-range theories (Watson, Peplau, Orlando), all nursing has one very central directive and goal - adherence to a conceptual model of best fit practice for optimal patient care. To this end the authors have brought to light the need for further education with respect to a nurse's need for additional educational training and knowledge in pain management, barriers to pain management, and pain control perception. The authors, although likely unintentionally, have made a case for patient wellness. Principles of wellness that do not include creating a supportive environment, addressing the decisive factors of health, or considering the ethnical, legal, and cultural diversity issues of the individual will do little to reorient health services. For this fact alone home healthcare nurses must be prepared, knowledgeable, and sensitive to the needs of the home patient for whom they are responsible. More importantly the American Nursing Association must adopt the Code of Ethics for End of Life Care such as have the professional organizations of the American Medical Association, American Board of Hospice and Palliative Care, and the American College of Chest Physicians.