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Quantitative Research Article Critique

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Quantitative Research Article Critique

  1. 1. Running head: RESEARCH CRITIQUE Critique of the Effect of Complementary Music Therapy On the Patient’s Postoperative State Anxiety, Pain Control, and Environmental Noise Satisfaction Chelsea Zabala Southwestern Adventist University NURS 421 Nursing Research Lenora D. Follett, PhD, RN 7/21/2014
  2. 2. 2 Information about the Author Tressa Comeaux, APRN, FNP-C, CEN, is a CICU staff nurse at the Our Lady of the Lake Regional Medical Center in Patient Care Services in Baton Rouge, LA. Susan Steele-Moses, DNS, APRN-CNS, AOCN is a research director at the Our Lady of the Lake Regional Medical Center in Academic Affairs in Baton Rouge, LA. Brief Summary of the Article This is a study of the effect of complementary music therapy on patients’ postoperative state anxiety, pain control, and environmental noise satisfaction. Researchers conducted the study at the Our Lady of the Lake Regional Medical Center (OLOLRMC) in Baton Rouge, Louisiana. The sample participants consisted of postoperative patients. The participants were asked to use non-lyrical music for 30 minutes after prescribed analgesia. Then patients’ filled out questionnaires to measure their anxiety state, pain control, and environmental noise satisfaction. Data collection was done twice (a third time if participant was not discharged— though Time 3 was not used in the findings because of certain limitations). The researchers then analyzed the data and presented the results of the study in the article. They found that anxiety state was not significantly affected—increase or decrease—by the complementary music therapy, but pain control and environmental noise satisfaction was increased with use of the therapy. Though limitations were found in the study, researchers concluded that complementary music therapy “is recommended for use in improving postoperative outcomes in other facilities” (Comeaux & Steele-Moses, 2013, p. 318) and gave suggestions for future research.
  3. 3. 3 Critique of the Effect of Complementary Music Therapy on the Patient’s Postoperative State Anxiety, Pain Control, and Environmental Noise Satisfaction Although I did not necessarily choose to critique this research article, I found it very interesting and applicable to my experience as a nursing student and informative to be able to use in my future clinical practices. I also have an interest in music, so I thought this article particular would be interesting to read and critique. Pain is a common feeling in human beings and anyway to lessen the experience I believe is worthy of investigative research. Research Problem The problem statement is clear and persuasive supported by findings on the subject stating that “unrelieved postoperative pain remains a common problem despite advances in pain management” (Comeaux & Steele-Moses, 2013, p. 313). It was easy to locate—first sentence of the research article—and suggests reasonable evidence to further research the effects of complementary music therapy in “increasing patient satisfaction with the postoperative experience” (Comeaux & Steele-Moses, 2013, p. 313). A positivist paradigm is implied for use in this quantitative article, further evidenced by the use of deductive reasoning to tests the hypothesis and the researchers’ intent to seek generalizability in nursing practice. The purpose of the study is to “determine the effect of music therapy on state anxiety, postoperative pain, and environmental noise perception” (Comeaux & Steele-Moses, 2013, p. 315). The purpose statement and research hypothesis clearly identified the variables and specified population for the research study. Both purpose and hypothesis were properly stated suggesting the nature of inquiry of the research. Several earlier studies were found to support
  4. 4. 4 the suggested research hypothesis. This is not a null hypothesis, though the null hypothesis is implied though not stated. Theoretical or ConceptualFramework and Definitions and Design This is a quantitative study that explicitly stated the use of the Relationship-Based Care (RBC) delivery model to support the study. The article explained the “three crucial relationships in RBC include care of self, care of colleagues, and care of patients and families” (Comeaux & Steele-Moses, 2013, p. 313) thereby explaining the model to the readers briefly. The model appears to be appropriate for the research problem as complementary music therapy falls in the category of care of patients and families in the RBC model. The hypothesis and RBC model are not closely related. The concepts used in the study are consistent with the category of care of patients and families only. In this quantitative article, operational definitions were consistent with the conceptual definition of caring. The researchers did not refer back to the RBC model later in the study, though the findings imply interpretation in regards to care of the patients. The RBC model seems to only be a means to support the research and does not seemto guide the research process. Review of the Literature For this research article, the literature review mentioned the databases used in search for other relevant articles (e.g. CINAHL, The Cochrane Library) and gave a period from 2007-2012 article search criteria (Comeaux & Steele-Moses, 2013, p. 313), therefore literature reviewed for this topic is considered up-to-date. Some of the sources used in the study included some primary sources, but mostly referenced what seemed like secondary sources and opinion articles and included some referenced testing tools used for the testing procedures used in the
  5. 5. 5 article. The study was not an introduction to a newfound study, but the literature review did not support the need for this particular study—instead demonstrating that no gap existed in the literature. Design In the body of the article, the research design was not stated, but upon further review the research design was found in the abstract of the article stating that they used “a quasi- experimental non-equivalent control group design” (Comeaux & Steele-Moses, 2013, p. 314). The research question was therapy question, but the highest, most rigorous design was not used—which are randomized controlled trials. The researchers had one control group and one intervention group. Though it was not randomized, the comparison strategy was effective in highlighting key relationships between complementary music therapy (intervention) and patients’ outcomes in the pilot study. The intervention was stated clearly and accurately in the article. Use of blinding was not explicitly stated, but it was implied that the data collectors were blinded because “daily, clinical support staff rounded…and collected completed packets” (Comeaux & Steele-Moses, 2013, p. 316). Intervention fidelity appeared to be kept as the research procedure was explained to the patient the first postoperative day by “a member of the clinical support team, which consisted of a clinical nurse, specialist, clinical educator, program director for nursing research, and direct-care nurse” (Comeaux & Steele-Moses, 2013, pp. 315-316) and as stated earlier, a clinical support staff rounded daily to collect the questionnaires. The research was done as a longitudinal study. The number and timing of the data collection was appropriate—Time 1 is day of enrollment (1st postoperative day); Time 2 is next
  6. 6. 6 postoperative day; Time 3 is the next day after with no inclusion of Time 3 if patient was transferred or discharged—as it was found “pain in the postoperative patient is often unrelieved” (Comeaux & Steele-Moses, 2013, p. 313). In terms of enhancing the statistical conclusion validity, the researchers used a small sample of 41 participants as a pilot study. Two statistical tests were used to grade the dependent variables including the State-Trait Anxiety Inventory (STAI) for anxiety and the Likert scale (scale of 1-4) to measure the patients’ pain and noise level satisfaction. Overall, these steps were adequate enough to protect the statistical conclusion validity of the study. The research design was not able to control when the patient was going to be transferred or discharge, therefore a rival explanation—such as the cause preceding the effect—may contribute towards the patients’ outcomes. But given the length of time of the study per participant (about 2-3 days) internal validity problems could arise in relation to concurrent events (history effect) and early discharge or partial completion of the questionnaires on discharge day (mortality/attrition). Also the fact that the study was not randomized, can pose a problem. What type of pain medications the patient received and other pain distractions used by patients were external factors not considered that could interfere with the study’s external validity. The design was able to draw causal inferences about the relationship between the independent and dependent variables, despite little attention to the external factors to the study. The article stated the study limitations which included “patients were not assigned randomly to the intervention”, “personal distraction may have confounded findings”, “patients in control group also reported listening to music”, “no manipulation to usual care” may have
  7. 7. 7 caused a crossover effect, “data collected at Time Three were limited due to the unit’s average length of stay or participants’ failure to complete the questionnaire” related to the “tedious, somewhat repetitive, and upsetting for some” STAI Questionnaire (Comeaux & Steele-Moses, 2013, pp. 317-318). These limitations are liable to affect the patients’ outcomes and affect the external validity of the study, though the study does acknowledge the limitations, but claims the support of an earlier larger study (Comeaux & Steele-Moses, 2013, p. 318). Sampling Plan and Data Collection The participants in the study were postoperative patients admitted to the inpatient surgical unit at the Our Lady of the Lake Regional Medical Center (OLOLRMC). Eligibility criteria was clearly stated and included: “anticipated 3-day hospital length of stay, alert and oriented, age 18 or older, able to read and write English, and hematology-oncology diagnosis (Comeaux & Steele-Moses, 2013, p. 315)”. The study stated that the participants “were not assigned randomly to the intervention but rather placed into groups based on the hallway assignment” (Comeaux & Steele-Moses, 2013, p. 315). The article did not explicitly state what type of sampling design was used, but it suggests a consecutive sampling. It is a better choice of sampling than convenience when randomization is not possible. The sample was collected from a “larger study, which is still ongoing” reasoning the need to “test the efficacy and feasibility of the study methods” (Comeaux & Steele-Moses, 2013, p. 315). The smaller sample size taken from the larger study may not be large enough to support the statistical conclusion validity. The suggestion was made in the article that “the study should be replicated with a larger sample size and with different patient populations to validate these findings” (Comeaux & Steele-Moses, 2013, p. 318).
  8. 8. 8 The article did include limitations that could result in sample bias and weaknesses. Data collected on Time Three limited the representative sample “due to the unit’s average length of stay or participants’ failure to compete the questionnaire on the day of discharge”; also the “STAI Questionnaire was tedious, somewhat repetitive, and upsetting for some” (Comeaux & Steele-Moses, 2013, p. 318). Gender and race were key characteristics identified in the study, along with the dependent variables—pain management satisfaction, environmental noise satisfaction, and anxiety states. The sample supports inferences for postoperative patients, but are limited only to those who fulfilled the inclusion criteria, therefore, generalizability would be supported if the study was replicated with a different population and larger sample size. The study used self-reports to collect data in the form of State-Trait Anxiety Inventory Questionnaires which used a 4-point Likert scale and was split into two forms. The 4-point Likert scale was also used in two other standardized tests to measure the patient’s pain management satisfaction and environmental noise satisfaction level. This was the best method to measure the dependent variables given observation could affect the participant’s behavior and biophysiologic measures are not possible in this study. The researchers’ self-report methods were adequate providing appropriate scales and approved forms to collect relevant data from the participants. Two forms of the STAI Questionnaires—STAI Form Y-1 and STAI Form Y-2—were used to ensure no patient biases were taken into account. STAI Form Y-1 was used to measure state anxiety, while STAI Form Y-2 was used to measure “participants’ usual emotional feelings” (Comeaux & Steele-Moses, 2013, p. 315). Also a member of the clinical support team explained the purpose of the study and procedures before obtaining verbal consent and enrolling the
  9. 9. 9 patient into the study. No mention was made that the staff of the clinical support team was trained and specifically chosen. Data was collected three times during the study—Time One being first postoperative day, following 24 hours later consecutively for Time Two and Three. The staff would then round and collect the questionnaires that were placed in manila envelopes daily from the participants’ room. Participants were able to fill out the questionnaires’ in their rooms, but only at the allotted times. Measurement and Data Quality Participants completed State Anxiety Inventory questionnaires and two other standardized tests using the Likert scale to measure pain satisfaction and environmental noise. Evidence of the reliability of the measurement tools used in this study came from other studies and were used because they were “developed and used extensively by a national vendor” (Comeaux & Steele-Moses, The effect of complementary music therapy on the patient's postoperative state anxiety, pain control, and environmental noise satisfaction, 2013, p. 315). The reliability scores for the Likert scales used for the participant’s satisfaction with pain management and environmental noise were both adequate, rating above a 0.7 mark. Reliability of the STAI questionnaires used for the participant’s anxiety states were cited from another article. Internal consistency was only adequate on the STAI Form Y-2 questionnaire, but STAI Form Y-1 questionnaire was under the adequate 0.7 mark for adequate internal consistency. No methods or measures were stated to have been taken for the various tests on validity in the article. Hypothesis may not be supported because of failure to support data quality with low reliability, internal consistency, and no measures of validity to support the measurement tools.
  10. 10. 10 Many tests for the measurement tools for this study were either not stated in the article or not used at all. Data Analysis and Results The sample demographic characteristics were summarized by use of descriptive statistics. The descriptive statistics included number and percentage of males and females (gender) and the race—which consisted of Caucasians and African-Americans with one not disclosed. A paired t-test was used to test the mean differences within the groups, while an independent t-test was completed for the analysis between groups (Comeaux & Steele-Moses, 2013, p. 316). The major key variables were described and the statistics were appropriate for use in this study. The t-test was used as an inferential statistic for the study. The article provided information about hypothesis testing, but a confidence interval was not stated which supports the use of no parameter estimation. Effect sizes or risk indexes were not included in the article either. The articles missing statistical information does not support the hypotheses—instead yielding support to the null hypothesis. Overall, the report yielded minimal information to the readers about the evidence reported in the study. The danger of a Type II error is plausible in this study in light of the minimal use of statistical information to validate statistical information. No multivariate statistical analysis tests were stated to be used for the study. The use of ANCOVA, for example, would have strengthened the study’s internal validity since randomization was not used, therefore use of multivariate statistical tools would have been preferred. The given statistical tests used in the study were appropriate, but statistical significance was not obtained for all of the key variables. Therefore, the study results only
  11. 11. 11 “partially supported the hypothesis that music therapy is effective as a non-pharmacological adjunct to analgesia in increasing pain management and environmental noise satisfaction; however state anxiety remained unchanged” (Comeaux & Steele-Moses, 2013, p. 317). Findings were organized to an extent though not fully explained for the reader to understand the statistical significance. Tables had appropriate headings and summarized large amounts of statistical data, but a legend was not provided to enable the reader to understand the statistical symbols significance to the study results. The tables were hard to interpret, unless one knows the symbols significance. The article partially explained the statistical significance, but did provide enough information to support their conclusion for the partial support of the research hypothesis. Discussion As a result, findings from the study seem to support their hypothesis partially as evidenced by “During the Time One measurement, all participants reported being only somewhat satisfied with pain management over the previous 24 hours….suggesting participants were not satisfied with the standard of care alone.”; also “At Time One, environmental noise satisfaction was slightly higher in the control group than with the music group”; and the “difference between groups at Time Two revealed no significant change in state anxiety” (Comeaux & Steele-Moses, 2013, p. 317). Complementary music therapy only had an effect on the participant’s pain and environmental noise satisfaction, while state anxiety remained unchanged. The study included nursing implications, limitations of the study, and recommendations for future research. Implications included practical and effective ways to implement their study findings. Limitations covered bias and other factors that may have
  12. 12. 12 affected the results of the study. Recommendations for future research included suggestions for researchers who want to undertake a similar experiment. Conclusion of the Student This study stimulated my thinking about the value of music therapy as a complementary treatment for postoperative patients in general. The study was clear and explained their work to the reader well. The relevance of this study was not clearly established by the researchers, since no gap in the research was presented, though the importance of this experiment was supported by the findings of the research. The strengths of the study included that it is was an easy-read while presenting important information that may have clinical implications in future healthcare. Some of the weaknesses of the study included not having a proper literature review, not establishing a gap for the relevance of the study, a wrong choice in the model— hypothesis was supported by the model, instead of the other way around, and there was evidence of attrition in the study. The strengths of the study were that the research was presented clearly and concisely, it is understandable to the readers, and the findings did support the hypothesis—albeit partially. Overall, the study was a good-read and useful for use in my future clinical practice, but planning of the study needed to be more solid, in order, for other healthcare providers to be able to trust the validity and relevance of the study.
  13. 13. 13 References Comeaux, T., & Steele-Moses, S. (2013). The effect of complementary music therapy on the patient's postoperative state anxiety, pain control, and environmental noise satisfaction. MEDSURG Nursing, 22(5), 313-318. Retrieved from http://proxy.swau.edu:2055/login.aspx?direct=true&db=c8h&AN=2012361512&site=eh ost-live

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