The whole healthcare industry suffers from hospital-acquired pressure ulcers (HAPUs), which highlights the need to discover how one can improve the given situation. This state of affairs leads to the case that various scholarly and peer-reviewed articles investigate the issue and offer possible solutions. Multiple studies utilize different approaches to assess HAPUs, which is beneficial since it allows analyzing the topic from different perspectives. That is why the given paper will comment on one quantitative, one qualitative, and one mixed-method articles that consider how 2-hourly turning can reduce the HAPU incidence.
External and Internal Validity Issues
In the beginning, it is necessary to explain the difference between external and internal validity. On the one hand, internal validity refers to how trustworthy a cause-and-effect relationship is between variables. In other words, this fact shows that the intervention tested is responsible for causing the identified results (Spieth, 2016). On the other hand, external validity demonstrates whether the obtained findings can be applied to different settings. It relates to the generalizability of the data to the general population (Spieth, 2016). These phenomena are interconnected, meaning that increased internal validity typically leads to a decreased external one, and vice versa.
Thus, it is reasonable to comment on the internal and external validity of a quantitative article. It refers to a single-site, open-label, two-arm, randomized controlled trial of 1,812 individuals by Pickham et al. (2016). The presence of randomization and a sufficient number of participants denote that the study has high internal validity (Spieth, 2016). It is so because these phenomena ensure that scientists do their best to minimize the effect of external factors on the study’s variables. However, it is impossible to mention that the quantitative article has high external validity. It is so because the research piece only focuses on intensive care units’ patients. It denotes that it is challenging to generalize the study’s findings for the whole population.
When it comes to qualitative research, it addresses the issues of external and internal validity differently. The given methodology is represented by a scoping review by Jocelyn Chew et al. (2017). Firstly, it is possible to mention that the study has decent external validity. It refers to the fact that the researchers present a detailed inclusion and exclusion process of selecting the articles. For example, it becomes evident that the study by Jocelyn Chew et al. (2017) only focuses on studies that dealt with the effect of turning on HAPU incidence among hospitalized patients. This fact denotes that the findings can be generalized to the entire population since the works do not focus on a specific setting. The desire to achieve high external validity has resulted in issues for an internal one. It relates to the fact that the work by Jocelyn Chew et al. (2017) relies on a small selection of articles; the scoping review analyzes ten studies. This fact denotes that it is impossible to mention that the given research piece can impress with decent internal validity.
Specific attention should also be drawn to mixed-method studies while discussing internal and external validity. As for the present paper, a work by Martin et al. (2017), offering a repeat observational study, pre- and post-test analysis, and qualitative interviews, represents the given methodology. A mixed methodology denotes that the authors analyze both numerical and textual data to identify whether turning is useful and what medical professionals think about it. According to Rutberg and Bouikidis (2018), multiple types of data lead to increased internal validity because the research questions are answered from different points of view. Simultaneously, some external validity issues relate to the numerical calculations. It is so because the pre-test and post-test surveys were conducted in a single regional health authority (Martin et al., 2017). This fact demonstrates that it is impossible to generalize the findings of this article for the whole population.
Using a Different Methodology and Design
The given section is going to comment on how using a different methodology or design might have been beneficial for each study. As for the randomized controlled trial by Pickham (2016), such an approach is often criticized by many scholars. It is so because it typically implies high cost and prolonged duration (Pham et al., 2016). However, it does not mean that scientists should avoid using the given design. For example, Pham et al. (2016) indicate that randomized controlled trials remain the leading way to investigate a relationship between an intervention and its impact on people’s health. It denotes that an internal validity overweighs all the possible disadvantages. This information means that it is not reasonable to offer other designs for the given study.
As for the other two articles under analysis, some recommendations can be offered. As for the scoping review by Jocelyn Chew et al. (2017), a systematic review approach might have been used instead of it. The difference between the two refers to the fact that a scoping review determines the coverage of a literature body on a particular topic, while a systematic one synthesizes research according to specific rules (Munn et al., 2018). It means that the choice of a systematic review can result in the fact that a study has a higher internal validity.
When offering alternatives, it is also necessary to consider the disadvantages of a particular design. As for the study by Martin et al. (2017), a weakness is that the researchers should deal with two types of data, which can be challenging. That is why a suitable option is to utilize a quantitative methodology and focus on numerical information because it is more meaningful regarding the issue of HAPU incidence and prevention.
Conclusion
The paper has demonstrated that qualitative, quantitative, and mixed-method articles address the issue of hospital-acquired pressure ulcers. Various methodologies result in the fact that the studies represent different designs. The work has explained the difference between external and internal validity, and it has been shown that each method has various levels of these validity types. It was also commented on what a connection exists between these validity types. Finally, the paper has suggested which alternative designs and methodologies, if any, might have been used regarding the selected articles to improve their scientific quality.
References
Jocelyn Chew, H.-S., Thiara, E., Lopez, V., & Shorey, S. (2017). Turning frequency in adult bedridden patients to prevent hospital-acquired pressure ulcer: A scoping review. International Wound Journal, 15(2), 225-236. Web.
Martin, D., Albensi, L., Haute, S. V., Froese, M., Montgomery, M., Lam, M., Gierys, K., Lajeunesse, R., Guse, L., & Basova, N. (2017). Healthy skin wins: A glowing pressure ulcer prevention program that can guide evidence-based practice. Worldview on Evidence-Based Nursing, 14(6), 473-483. Web.
Munn, Z., Peters, M. D. J., Stern, C., Tufanaru, C., McArthur, A., & Aromataris, E. (2018). Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Medical Research Methodology, 18(143). Web.
Pham, Q., Wiljer, D., & Cafazzo, J. A. (2016). Beyond the randomized controlled trial: A review of alternatives in mHealth clinical trial methods. JMIR mHealth and uHealth, 4(3), e107. Web.
Pickham, D., Ballew, B., Ebong, K., Shinn, J., Lough, M. E., & Mayer, B. (2016). Evaluating optimal patient-turning procedures for reducing hospital-acquired pressure ulcers (LS-HAPU): Study protocol for a randomized controlled trial. Trials, 17(190), 1-8. Web.
Rutberg, S., & Bouikidis, C. D. (2018). Focusing on the fundamentals: A simplistic differentiation between qualitative and quantitative research. Nephrology Nursing Journal, 45(2), 209-212.
Spieth, P. M., Kubasch, A. S., Penzlin, A. I., Illigens, B. M.-W., Barlinn, K., & Siepmann, T. (2016). Randomized controlled trials – A matter of design. Neuropsychiatric Disease and Treatment, 12, 1341-1349.