Trustworthiness and Integrity in Qualitative Research: Critical Thinking Activity 2

Name

Winona State University

NURS 375: Research and Evidence-Based Nursing Practice

Instructor

November 24, 2024

Question for Article 1: Time-efficient physical activity interventions to reduce blood pressure in older adults: a randomised controlled trial.

1. What is this study about? What are the independent and dependent variables? Other than the article stating it is an RCT, what terms, design processes and other elements tell you that this is indeed a randomized controlled trial and quantitative study?

The study is about investigating the impact of three time-efficient physical activity interventions on resting blood pressure in older adults. The interventions are high-intensity interval training (HIIT) on a cycle ergometer; isometric handgrip training (IHG); and unilateral, upper limb remote ischemic preconditioning (RIPC). In the study, the independent variables are the specific interventions (HIIT, IHG, and RIPC as the non-intervention control); while the dependent variable is the resting systolic blood pressure (SBP). One can tell it is an RCT, due to its randomization process, control group, use of power calculations, and statistical analysis. Quantitative indicators include numerical data, statistical testing (ANOVA), and defined outcome measure (Herrod et al., 2020; Polit & Beck, 2022).

2. The authors of the study conducted a power calculation. What do you understand by this term? What is power important when considering sample size? Comment on the adequacy of the study sample.

Sample size is an important concern in quantitative research. I understand that power calculation is a strategy researchers use to estimate how large sample sizes should be for testing hypotheses. Power is important when considering sample size because it helps ensure that the study has a large enough sample size to detect a statistically significant effect (Polit & Beck, 2022). The study sample is adequate, with 48 participants randomized and no loss to follow-up. The calculation determined that 48 participants were needed for 90% power to detect a 10 mmHg reduction in SBP (Herrod et al., 2020).

3. Was approval by an ethics board obtained and do the benefits of the interpretation outweigh the harms. What safety measures were in place to protect the participants?

Yes. The study received ethical approval to recruit healthy adults s specified by the American Society of Anesthesiologists grade 1 or 2. All participants gave a written informed consent before participation. The approval and consent ensured participant safety and stratification for antihypertensive medication users. The benefits of the interpretation outweigh the harms as the study successfully achieved its objectives with no adverse events reported. Other than having participants sign an informed consent, the researchers implemented monitoring to ensure adherence to safety protocols (Herrod et al., 2020).

4. Which interventions could be deemed statistically significant? Indicate the statistic used to represent the significance.

Both HIIT and IHG resulted in a statistically significant reduction in resting SBP of 9 mmHg. The statistical test used was a two-way ANOVA with Sidak’s multiple comparisons post-hoc testing, showing significant p-values for both groups (p < 0.001 for HIIT, p = 0.002 for IHG) (Herrod et al., 2020).

5. Which interventions could be deemed clinically significant (relevant)? How do you know? How would this be applied in practice?

Both HIIT and IHG could be deemed clinically significantly. The interventions produced a 9 mmHg reduction in SBP, which is clinically significant, potentially reducing the risk of myocardial infarction and stroke by up to 21% and 41% respectively. The interventions could be implemented in clinical settings as general lifestyle interventions, prescribed by primary care physicians to reduce general cardiovascular risk status and treat blood pressure (Herrod et al., 2020).

Questions for article 2: Transition to comfort-based care: Moral agency for acute care nurses

1. On which qualitative research tradition/approach was this study based? Provide a summary of this tradition.

The study as based on a constructivist grounded theory approach. The approach is considered an interpretation, where the data collected and analyzed are acknowledged to be constructed from shared experiences and relationships between the researcher and the participants. In other words, focus is on understanding social processes, as data and analyzes are views as social constructions (Meeker & White, 2020; Polit & Beck, 2022).

2. Did the report indicate the specific approach to data analysis? What do you understand about this approach? Did the report adequately describe the process by which the actual analysis was performed?

Yes. The report indicates that data was analyzed using constant comparative methods, consistent with grounded theory. I understand that the approach involves comparison of elements present in one data source, such as in an interview, with those in another. The process continues iteratively until the content of all sources has been compared so that commonalities are identified. It also adequately described the process by which analysis was performed. The approach involved coding transcripts, creating categories, and identifying relationships between them. The description included a table of categories, sub-categories, and codes; a diagram showing caring during transition to end of life. It explains that the data was managed using Atlas.ti 7.5 software (Meeker & White, 2020; Polit & Beck, 2022)..

3. Review the conceptual map/diagram on page. 534. Are the important processes effectively displayed based on the findings. Was this clear to you? Why or why not? (Provide a clear rationale for your response).

Yes. The important processes are effectively displayed base don the findings. The conceptual map displays processes and relationships identified in the findings. It clearly shows key themes, such as relationship-based caring, opening the discussion, coaching, and facilitating consensus to realize comfort-based care or continued life-prolonging care. The diagram is clear to me as the different themes and connections between them are presented in different colors, showing the relationship. The clarify of the diagram helps in understanding the nurses’ role and the transition process (Meeker & White, 2020).

4. In what way did the researchers ensure trustworthiness (rigor)? Is there any indication that triangulation was used?

The researchers ensured trustworthiness through prolonged immersion of data, member checks, and reflexivity. The researchers documented their thought processes using memos, around emerging categories and relationships, analytic reflections, and methodological decisions. Research meetings were held continuously until a consensus was arrived at in the analysis. Credibility and reflexivity were enhanced by occasional discussions between the members of the research team drawn from diverse fields (Meeker & White, 2020). Triangulation was not explicitly mentioned as used, but peer debriefing and the use of multiple perspectives (multidisciplinary EOL research team with members from social work, nursing, and communication science) ensured a robust qualitative analysis (Meeker & White, 2020; Polit & Beck, 2022).

5. What were the key findings that emerged from the data analysis? How could these key findings be applied to practice?

The key findings from the data analysis highlighted the multifaceted process of helping patients and families transition to the end of life stage. The ethical commitment of nurses makes a significant difference in the care process. Nurses are moral agents who create trust, respect autonomy, and support families during end-of-life transitions to comfort-focused care. The findings can be applied to nursing practice by informing nursing education, emphasizing communication skills and ethical decision-making. Nurses can adopt strategies such as mediating family discussions, contextualizing information, and providing emotional support to improve end-of-life care transitions (Meeker & White, 2020).

References

Herrod, P. J., Lund, J. N., & Phillips, B. E. (2020). Time-efficient physical activity interventions to reduce blood pressure in older adults: A randomised controlled trial. Age and Ageing, 50(3), 980-984. https://doi.org/10.1093/ageing/afaa211

Meeker, M. A., & White, D. (2020). Transition to comfort-focused care: Moral agency of acute care nurses. Nursing Ethics, 28(4), 529-542. https://doi.org/10.1177/0969733020952128

Polit, D. F., & Beck, C. T. (2022). Essentials of nursing research: Appraising evidence for nursing practice (10th ed.). Wolters Kluwer.