Critiquing Nursing Research: Hip Replacement and COA Studies

Introduction to Research Critique

This paper critically evaluates two published nursing research studies. The first, by Ridge and Goodson (2000), examines functional outcomes following total hip replacement. The second, by Gance-Cleveland (2004), investigates school-based support groups for adolescents with addicted parents. Each study is assessed for its significance, validity, limitations, and implications for clinical practice.

Ridge and Goodson (2000): Total Hip Replacement Outcomes

Ridge and Goodson (2000), through the use of functional status measures collected before and after hip replacement surgery, sought to lay the groundwork for the development of comprehensive outcome measures for patients who undergo total hip replacement. This study utilized the Sickness Impact Profile (SIP) and the hip outcome tool.

The statistically significant findings include improvement in functional status between preoperative and postoperative measures on the SIP, including ambulation, mobility, and body care. This was not the case with the hip outcome tool, which did not show significant improvements in mobility or body care. Psychosocial findings were significant for alertness, emotional behavior, and social interaction. Additional indicators — sleep, home management, and recreation — all showed improvement.

The findings carry clinical significance in that they caution against using pain levels alone to make discharge decisions or to determine progress while a patient is hospitalized, given the variability in pain perception among participants (Ridge & Goodson, 2000).

The findings suggest that the hip outcome tool may be effective in assessing the functional status of patients who have had a total hip replacement and could be implemented in clinical settings in conjunction with other measures (Ridge & Goodson, 2000). The SIP, while a useful tool, was found to be too time-consuming for routine clinical implementation. Findings may also be applied to the education of patients and family members regarding outcome expectations. Patient education should focus on what patients and families can expect at three months post-surgery with respect to factors such as pain and mobility (Ridge & Goodson, 2000).

The study also shows that sharing information about psychosocial improvements can help patients make the decision to undergo the procedure (Ridge & Goodson, 2000). Furthermore, the study found that patients continued to have difficulties with lower-extremity dressing at three months post-surgery, which can inform the determination of aftercare services. Nursing education should be geared toward these outcome measures and the psychosocial aspects of recovery, in addition to the physical factors that will need to be addressed during the rehabilitation process.

Validity and Limitations of the Ridge and Goodson Study

Selection threat poses a risk to the internal validity of this study because participants self-selected and approximately 50 percent of those recruited chose not to participate (Ridge & Goodson, 2000). However, validity is supported by the consistency in age, length of hospital stay, and gender between participants and non-participants. The lack of attrition among study participants also increases the significance of the findings.

The limitations of this study restrict its transferability. The self-selection process, small sample size, and the difference in age between this sample and those used in previous studies narrow the extent to which findings can be generalized (Ridge & Goodson, 2000). The sample was also disproportionately male — comprising 13 males and only 8 females — and therefore the findings may be more readily generalized to a male population.

Gance-Cleveland (2004): School-Based Support Groups for Children of Alcoholics

This study sought to explore the characteristics, clinical elements, methods, and benefits of school-based support groups for children of alcoholics (COA). Identifying this information may aid in the intervention process for adolescents who are coping with a loved one's addiction and could improve long-term outcomes for those adolescents.

The author found that the support groups educated participants on the dangers of drug and alcohol use, improved coping strategies, enhanced resiliency factors, improved relationships, and increased school achievement. Of equal importance were the observed positive changes in behavior and an increased awareness of the effect of addiction on participants' lives (Gance-Cleveland, 2004). The findings of this study were consistent with previous literature, including the capacity of the group process to empower youth and create a sense of awareness that may be correlated with improved decision-making and long-term outcomes.

The study provides a model by which school-based support groups for adolescents may be evaluated. Because the individual interviews with participants did not include male participants, students who chose not to participate in the group, or persons who did not complete the group, results can only be generalized to a small population (Gance-Cleveland, 2004). Nonetheless, the potential for positive outcomes and the gains that have been cited make transferability a desirable goal. This model should be replicated in other high schools where adolescents are struggling with a family member's addiction. Given the high prevalence of this phenomenon, identifying an appropriate setting should not present a significant challenge.

References

Gance-Cleveland, B. (2004). Qualitative evaluation of a school-based support group for adolescents with an addicted parent. Nursing Research, 53(6), 379–386.

Ridge, R. R., & Goodson, A. S. (2000). The relationship between multidisciplinary discharge outcomes and functional status after total hip replacement. Orthopaedic Nursing, 19(1), 71–83.