Appraisal of the Article “The Effect of a Quiet Environment on the Comfort of Post-Operative Infants and Young Children”

This is the second part of the appraisal of the article “The Effect of a Quiet Environment on the Comfort of Post-Operative Infants and Young Children,” to identify the quality based on aspects that were not addressed in the first section. This section would also figure out the strengths and weaknesses of the paper as well as its applicability in today’s world. We are not forgetting that this quantitative paper was authored by Peggy et al. (2019). This essay presents a critique on the nature of the population, sampling methods used, and the setting of the sample population. Also, in this critique, we would review the legal principles and ethical principles used in the research. This review also incorporates a description of the instruments used to measure the study variables as well as their reliability and validity, their scale of precision and accuracy. More so, in this essay, we would present the procedures used in the collection of data for the study and statistical procedures used in the description of the statistical data. Additionally, in this part two, we will also review the results and how they relate with the hypothesis or the question of the study so that we can highlight at least a strength or a weakness identified in the research.

Population, Sample, and Setting

In quantitative research, a population and sample are terminologies used to explain the participants used in research. In nursing research papers the participants are primarily the number of patients that are incorporated or that take part during the process of data collection. Peggy and colleagues in the bid to address the effect of a quiet environment on the comfort of post-operative infants and young children give us a hint on the type of population that the research targets (MacKay, 2019). We are sure that the study should entirely address the issues interrelated to infants and young children. However, in research, the use of the whole population is not possible as use of the whole population is very expensive and time-consuming, therefore in most research, a representation of the population is selected which is referred to as a sample.

In this study, a sample of 33 subjects was used, for inclusion in the sample a subject was supposed to meet the following three criteria. The first criteria were age between births to six years, secondly, to be admitted to hospital for surgical procedure between 2012 November to 2014 November, and lastly, with either Spanish- or English-speaking parents. In order to access the families that met the criteria, members of their care team approached them to request them to participate in the study (Moser, & Korstjens, 2018). We are not told on any measure of the adequacy of the sample size used, similarly, the criterion was biased on patients whose parents could speak Spanish and English leaving other language dimensions outside. Nevertheless, the study might have been successful as participants were grouped into two, those with odd numbers assigned to a quiet room and those with even numbers as the control group. Unfortunately, there is no information stating how the sample size was determined, neither the acceptance nor refusal rates. However, the paper being on nursing practice we can state that hospital setting is appropriate for the study.

Legal & Ethical Issues

In research, ethical and legal considerations are always at the forefront. This is primarily aimed at approving the study as well as the human rights and dignity related to sharing of personal information are adhered to. In this research paper, the researchers used a vulnerable group of participants who are admitted for surgical practice in the hospital and parents who were either Spanish or English speakers. We, therefore, expect that the study was approved before publishing, by a nurse related body that governs research exercise (Harriss, MacSween, & Atkinson, 2017). However, it is unfortunate that the authors did not present any information on a body that took charge of approving the credibility of this research paper. In the sample section, we get some information on participation that shows some value and respect to human dignity, it is indicated that after the families had met the criteria of inclusion they were asked to participate in the study. After they agreed they were consented by each member of each research team and assigned a study group. Additionally, they were also informed on the behaviors that were expected in each room and activities that were not to be practiced so that before participation each participant would be aware of any potential harm that might result from participation. In this research we are told that post-operative patients were chosen due to their anticipated pain and pain relief needs, this group can be categorized as a vulnerable group even though the authors did not present any additional terms or practices that can be useful in safeguarding their safety. Researchers have a mandate to ensure that all the human virtues and morals that safeguard humanity are kept to standards before and during engagement in research this one of the critical aspects that determines the quality of a paper.

Measurement

Robust quantitative research needs to portray adequate usage of instruments in the measure of variables presented in the research. It is also essential to identify the levels of measurements achieved by each variable. The use of these scales is essential in determining the reliability and validity of the study. In this paper, various variables have been represented which belong to various scales of measurements. In the previous discussion, we had discussed various variables and instruments used to measure the same variables. Some of these variables that we had presented included noise, light, and demographic variables which include age, gender, race, and ethnicity. The latter demographic variables can either be measured using, interval, nominal, interval, and ratio levels of measurements (Kim, Mallory, & Valerio, 2020). Alternatively, the extraneous variables that are light and noise can be measured using lux and sound meter respectively. Despite having the following basic information, in the entire paper, there is no effort discovered to delineate these variables in their subsequent scales of measurements. More so, we do not have any evidence of the list of questions whether on the methodology section or on the appendix showing the questions that were used in the collection of data, therefore, it is not possible to evaluate the reliability and the validity of the questions and the accuracy of the measurements used. Generally, in this research, it would be much difficult to examine the accuracy and validity of past researches using the current one as there is no evidence in the literature review of scales presented to base a strong discussion on the variables.

Data Collection

These are methods or techniques used in research to gather data or information related to the topic of study. Data collection methods can either be from primary or secondary sources, however, for quantitative research, it would be much reliable if the data collection process is done using the primary methods (Mkandawire, 2019). In this study, the process of data collection used primary methods where data was collected for 24 hours and recorded on tables. To become more specific the young children in the Post-Anesthesia Care Unit were used, in this method a FLACC assessment was performed and data obtained was recorded by the nurse. The table on the FLACC Behaviour scale recorded three noise levels in the room (Crellin, et al., 2018). Another table was presented where the nurses assessed the FLACC score, sound level, and LTL L average, slow maximum, narcotic allergies, non-narcotic allergies, and non-pharm strategies. All the latter listed assessments were carried out at an interval of 4 hours, from the period of arrival to a period of 24 hours. The FLACC scale is used to measure pain in non-verbal children, internationally. Based on this instrument used we are sure that the data collected was valid and reliable as internal consistency was maintained, in this research, we are told that the nurses were the data collectors we, therefore, expect that the data they generated was accurate and can be relied on.

Data Analysis

Data analysis procedures in statistical analysis are a procedure that is used to assess the data collected to get a meaning from it and establish its applicability. The process of data analysis is guided by the type of research questions, the purpose, and the hypothesis to be answered. The primary purpose of carrying out this research was to investigate the effect of a quiet environment on children's pain levels. Peggy and colleagues expected that once they create a quiet environment for patients the result would be an increase in the comfort levels and decrease in pain, which would show a low FLACC score when compared to other typical rooms. In order to determine the minimum sample size, a multiple regression was performed in the analysis. Some other procedures were also performed in the analysis, in this research a study sample of 100 was the target as it would help ensure a 95% confidence interval (p < 0.05), the alpha level. For this case, the most desirable effect size was 0.2, with 12 predictors and a statistical level of 0.8. In the bid to establish the relationships between the outcome variables an investigation was carried out using the Pearson Chi-square, ANOVA, and the corresponding p-value. Additionally, to analyze the effect of a quiet room on pain scores a mixed model logistic regression was used.

Based on the hypothesis, purpose, and study hypothesis, we can evaluate the success or appropriateness of the data analysis procedures used. The authors aimed at examining the impact of quiet rooms on hospitalized patients, they stated a hypothesis that there is no significant difference in comfort levels noted between the experimental and control groups. The study focused on data from both the experimental and control groups using various statistical procedures such as regression, Pearson Chi-square, ANOVA, and the corresponding p-value, and a mixed model logistic regression (Mertens, Pugliese, & Recker, 2017). These procedures were used to develop descriptive statistics, which provides statistical data on the results from the study variables, which can be used to determine the levels of significance and thus the capability to either reject or accept the null hypothesis. It is from this data that readers can confidently justify where the quiet environment affects the comfort of children in terms of reducing pain.

Additionally, the researchers use clear tables that concisely present the data analysis results. However, they were reluctant to address the strategies that would be used in the management of missing data. In the analysis the authors opted for a sample of 100 participants who would make it possible in ensuring a 95% confidence interval and thus a significant level, alpha p < 0.05 (Dai, et al., 2020). The descriptive statistics for the demographic variables, means, standard deviations, and t-tests, as well as evaluation of Non-Narcotic used between the intervention groups, were presented in tables making visualization of the results easy. The data in the table is presented as numerical percentages for the demographic data, while the measures of central tendencies are presented as continuous numbers with their relative position from the p-value. Also, the Non-Narcotic difference between the two study groups is illustrated as whole numbers and percentages from which the p-value can be established. From the data presented in the tables above the main objective is to come up with a p-value from where we can base our significance test.

 

 

Researcher Interpretation of Findings

From the study conducted by the authors of this article of study various results were obtained. Despite the expectation that a sample size of 100, only 33 patients who met the criteria were recruited for the study. Based on the study purpose, questions and hypothesis, the study should focus on the two study groups and the effects of the conditions presented on the comfort of patients. It was recorded that an average sound level for both groups was 57.98 (+/- 12.95) dB, with the maximum noise at 97.9 dB, as recorded in the control room. Although the two environments did not vary in average sound levels, the observed LTL-L average in the quiet room was lower than the control group (p=0.0015). The findings from the FLACC scores revealed that there is no significant difference in the reported pain and comfort levels between the experimental and control groups (MacKay, 2019). Moreover, it was found that overall, there is no significant correlation between dB readings and FLACC scale at the time of assessment (p = 0.0789, p = 0.2791).  In the quiet room, there was a weak significance showing a weak correlation between actual dB level and the FLACC scale at the time of assessment (p = 0.2526, p = 0.0121). Additionally, the use of narcotics did not differ significantly between the experimental and the control group (p = 0.1207), neither did the non-narcotics between the same groups (p = 0.4641).

From the findings, it is clear that there is no significant correlation in comfort level between the comfort levels between the two groups. However, it was expected that creating a quiet environment would promote high levels of comfort for the patients which was not the case. The authors thought that creating an environment with few stimuli would create a more comfortable environment that would create more comfort for patients and thus get quick relief of pain. These findings are just are a prover to the past researches carried that reveals the expected outcomes when the hospital environments are modified, most of the background highlighted that a quiet environment would improve patients outcomes. However, the research was successful in answering the research questions and hypothesis we can state that the research was only limited to young children and post-operative pains. The research would have been more successful if it addressed a broader population and a wide variety of other acute infections that are associated with young children such as malaria and polio. Besides, the authors did not highlight any potential threats or present any generalizations about the population of the study.

Overall Evaluation of the Study

This study was successful in examining the problem of the study, as well as answering the research questions. In order to answer the latter questions, researchers used background articles that were mainly focused on the study topic, using variables and terms that revolved around the quiet environment, patient’s comfort, noise, infants, children, and post-operative pain (MacKay, 2019). These articles provided information on past results that were conducted to answer the question of comfort in the hospital environment. The methods used in data collection and analysis, sampling, analysis, and findings are comprehensive and systematic and successful in addressing quantitative research. More importantly, the findings clearly, present the research findings and answer to the research question and statistical information that can be used to justify the hypothesis and whether to accept or reject it (MacKay, 2019). However, the shortcomings of this research are that the authors did not present the software and tools that were used in generating the descriptive statistics, which is important to readers to identify the validity and reliability of the software. Now that the sample size is small, below 100, we cannot put much trust in the result therefore, future researchers should focus on carrying out researches from a much more representative sample. The results obtained, therefore, are not suitable for use in practice, thus of little relevance for use in future researches.

 

References

Crellin, D. J., Harrison, D., Santamaria, N., Huque, H., & Babl, F. E. (2018). The psychometric properties of the FLACC scale used to assess procedural pain. The Journal of Pain, 19(8), 862-872.

Dai, B., Nachum, O., Chow, Y., Li, L., Szepesvari, C., & Schuurmans, D. (2020). Coindice: Off-policy confidence interval estimation. Advances in neural information processing systems, 33.

Harriss, D., MacSween, A., & Atkinson, G. (2017). Standards for ethics in sport and exercise science research: 2018 update. International journal of sports medicine.

Kim, M., Mallory, C., & Valerio, T. (2020). Statistics for evidence-based practice in nursing. Jones & Bartlett Publishers.

MacKay, P. (2019). The Effect of a Quiet Environment on the Comfort of Post-Operative Infants and Young Children. Pediatric Nursing, 45(5).

Mertens, W., Pugliese, A., & Recker, J. (2017). Quantitative data analysis. A companion.

Mkandawire, S. B. (2019). Selected Common Methods and Tools for Data Collection in Research. Selected Readings in Education, 2, 143-153.

Moser, A., & Korstjens, I. (2018). Series: Practical guidance to qualitative research. Part 3: Sampling, data collection and analysis. European Journal of General Practice, 24(1), 9-18.