Introduction
The writers do not indicate the criteria used to select the hospital and where the study was conducted. This is a cross-sectional descriptive study and there is a need to clearly outline the methodology, but the article failed to do so. Even though one hospital was selected, there should be a reason to justify its selection. No sampling technique was used but instead, the study used the entire population in the emergency ward at the time of the study. The good thing about such an approach is that it is due to a lack of sampling bias but on the other hand, it is more tiring and time-consuming compared to when small sample size is used.
Including a large study population that is not clearly defined is cumbersome. In any research study, the age element is usually clearly defined to avoid misconstruction but in this study, their age groups are mixed up. The writers have given a distinct inclusion criterion as a basis for the target group “patients presenting to the ED and were subsequently admitted to a medical-surgical unit or the ICU” (Denby & Rowlands 2010, 36). This has been substantiated by the exclusion criteria. The study, therefore, has clearly stated the subjects that it intends to target. The characteristics of the study population ought to be indicated in the methodology section but this was not the case. It is only after reading the results section that one gets to understand the characteristics of the study population.
Methodology
The methodology presented in the abstract is not a clear representation of the methodology in the text. To begin with, unlike in the abstract, the methodology does not seek to establish an association between variables. Secondly, the length of stay in the Emergency Department was used to define hospital-acquired pressure ulcers during data collection. Therefore it does not qualify to be a variable under study as stated in the abstract, “to examine the relationship between ED length of stay and hospital-acquired pressure ulcers for patients directly admitted from the ED” (Denby & Rowlands 2010, 35).
The writers have tangled up their variables and looking at the research question, there is a need for clarity on what is to be investigated in the body of the article. The methodology fails to give the timeline of the study. While comparing the methodology and the results section of this article, it is as if they are communicating different messages. Under the methodology section, the writers have operationalized their definition of hospital-acquired pressure ulcers, but the results section shows that hospital-acquired pressure ulcers have been defined based on CDC findings as given in the introduction. The writers have failed to give a choice of the methodology used.
In the abstract, the study is descriptive, later in the text, it is cross-sectional exploratory. As earlier mentioned, an exploratory study design usually takes up a qualitative approach aimed at establishing the existence of a problem by obtaining people’s views or reviewing secondary literature. This study is not at all exploratory because the problem of pressure ulcers is already established. Since this study aims at getting the percentage of patients acquiring pressure ulcers based on their length of stay, it qualifies to be a cross-sectional descriptive study (Powers & Knapp 2011).
Therefore, the writers should have maintained one position as far as defining the research design is concerned since the study fits the description of a cross-sectional descriptive. The writers have observed ethical considerations by maintaining the anonymity of the hospital. However, this is relative since other studies will reveal the identity of the hospital under study. The reason for leaving out the name of the hospital, therefore, is dependent on the writer’s discretion.
The study uses secondary sources of information. This is acceptable since a descriptive study aims at understanding a problem in terms of magnitude, person, and place. Data was collected and recorded in a patient form. The researcher relied solely on nursing documentation. Other methods of data collection like observation to validate the documented information are lacking. However, the writers do not say how data was analyzed, whether SPSS or some other software were used. As a result, one can question the authenticity of the results.
The findings are not valid because of all the drawbacks indicated above. The findings presented are hard to comprehend because it is difficult to tell the difference between those who were admitted and did not get the pressure ulcers. However, the results have answered the research question and therefore, “a pressure ulcer prevention protocol should be implemented in the Emergency Department” (Denby & Rowlands 2010). The results are not reliable since they cannot be generalized to other study areas. It is because of this that there is a possibility of obtaining different sets of results in different areas of study. There is no indication that ethical principles such as privacy, and informed consent were used (McMillan & Schumacher 2009).
Results
The results section is more detailed. The writers have made good use of tables in presenting the findings. Tables are recommended during the presentation of data because they are easy and quick to understand (Parahoo 2006). The results have focused on showing the magnitude of pressure ulcers following the CDC criteria of ED length of stay greater than 2 hours. The results answer the question of whether pressure ulcer prevention should be implemented in ED by presenting the number of patients with pressure ulcers. However, these results are only valid to this study area and not any other. The reliability of this study holds if only the same approach is used in the same study area. However, when another approach is adopted such as a change in the data collection method, the reliability of these results may not hold.
The writers have insufficiently compared their results with those of other people. There is a need to at least use various study findings, or summarize findings of various studies published within the latest five years, to supplement or show differences in result findings and to account for the differences (Aveyard 2010).
Limitations
The writers have stated the limitations of their study and this is a very important point that should be considered by future researchers, that the study cannot be generalized. This means that a similar study can be conducted in areas other than the study area, or the same area as part of a study sample. This is because; to begin with, the sample size used is small. The study has also been limited to a specific study area that was not randomly selected. In addition, the writers captured their data through nursing documentation hence lacked inter-rater reliability or other means of data validation.
Conclusion
The findings have established the sure fact that a prevention protocol is needed in the Emergency Department, but the style of establishing this is questionable. Despite the several limitations of the study, it has shown that a significant portion of patients in the ED are at risk of developing PUs, therefore there is a need to implement a pressure ulcer prevention protocol (Denby & Rowlands 2010, 37). The details of the area to be studied are very important but are lacking in this study. The introduction was well written and established the gap for the study but did not adequately introduce the research study topic.
The methodology used was not clear and would make the reader assume that exploratory and descriptive study designs are the same, which is not the case. Even though the study data of all patients for the year 2006, there is a need to give baseline characteristics of the study population based on the medical records for example number of males, adults, children, and so on.
This way, the findings will be better understood and it will be easier to tell which group is mainly affected by the pressure ulcers. The writers have not compared their results with those of other researchers as far as the presented variables are concerned. They have compared their findings based on length of stay, age, and comorbidities using insufficient evidence. The issues of gender and race about pressure ulcers have not been touched. Use of length of stay at the discussion section is about the operational definition and not based on >2 hours. Generally, the authors have mixed up ideas thus future researchers should be more attentive to their research question and way of answering it.
Recommendations
The research study is a viable field as far as the provision of cost-effective healthcare is concerned. There is a need to carry out a similar study in another hospital or representative sample, where the current study area would be part, for comparison of results. This is because the results of the current study cannot be generalized to another geographical study area. The sample size used is small about the prevalence of pressure ulcers. In addition, other studies ought to develop cross relations between various variables related to pressure ulcers to understand the factors that lead to their development. In subsequent research, it would be recommendable to study a clearly defined group of individuals due to age differences. In addition, secondary sources should be supported by primary facts such as observation, interviews, and discussions.