Unstable Adult Patient Management in the Emergency Department Essay (Article Review)

Evidence-based practice plays an important role in the advancement of medical research because it provides additional knowledge to improve clinical practice. This is why global health agencies and institutions consider it the “gold standard” of care management (World Health Organization, 2018). A critical part of evidence-based practice is the need to identify the most effective interventions that guide treatment decisions (Saenger and Minis, 2017). Particularly, this view is important in identifying appropriate therapies for selected groups of patients because their unique characteristics are relevant in making the right diagnosis and choosing correct treatment options. Therefore, nurses need to make sure that their care plans are based on empirical research (Yonkaitis, 2018). The first step to realise this goal is to appraise evidence-based studies as the main sources of clinical evidence.

This paper is a critical appraisal of a study, which focused on understanding trends of patient deterioration in the emergency department (Hudson et al., 2015). The study was selected for critique because it focuses on pattern recognition, which is an effective preventive strategy in public health management (World Health Organization, 2018). Indeed, early detection and management of deteriorating patients in the emergency department can help healthcare service providers to identify the most appropriate care for a patient. Caldwell, Henshaw and Taylor’s (2005) critique tool will be the overriding framework for this assessment. Its purpose is to ensure a valid and objective assessment of the appraisal. Relevant aspects of the critiquing tool that will be used in this paper include a methodological review and a strength vs. weakness analysis of the selected research article.

The title of the selected paper “Early Identification and Management of the Unstable Adult Patient in the Emergency Department” was detailed enough to provide a clear understanding of the journal’s main contents. The abstract also provided important details relating to the article, including the approach used (quantitative), the target population (deteriorating patients) and the broader aim of the study, which was to standardise an emergency observation chart to allow healthcare service providers to better understand patterns associated with a deteriorating patient in the emergency department. The paper’s title and study focus are consistent with the guidelines of Caldwell, Henshaw and Taylor (2005) on health research, which suggest that the title of an academic paper should concisely and identify the characteristics of a population, interventions used to undertake the research and desired outcomes. The selected study follows this format. The authors also have a lot of experience in the healthcare field, particularly in the areas of critical care, emergency and nursing management (Hudson et al., 2015). Their qualifications and experiences add credibility to the research.

The abstract of the article provides a detailed explanation of the key parts of the paper, including the research aim, background, methods, results and relevance to clinical practice. The use of a structured abstract made it easier to understand its main parts and interpret the findings without having to examine all the contents of the study. To further improve the article’s credibility, the authors explained the justification for using a quantitative approach, processes and techniques to design and conduct the investigation (Hudson et al., 2015). The main findings of the study and their implications on mental health management are also clearly highlighted in the abstract.

The authors also explained the rationale for conducting the study by comparing its findings with existing evidence in the healthcare field. They talked about the vital signs to look out for among deteriorating patients and the possible use of adult emergency flow charts to extract critical health information (Hudson et al., 2015). Their methodology was designed to explain how documentation could be used to identify patterns among deteriorating patients through early warning systems. They used this basis of investigation to explain the usefulness of chart designs in reviewing health data (Hudson et al., 2015). For example, the pieces of information recorded on emergency room charts were essential in understanding the difference between abnormal and normal vital signs for deteriorating patients. In line with this goal, in the literature review section of the study, the authors used relevant theoretical concepts and models to justify their investigations, while using that the aim of the study will guide the overall research process (Hudson et al., 2015). The authors also presented the aim of the paper as a lived experience for healthcare workers caring for unstable patients (Hudson et al., 2015). Their analysis emphasises the need to use quantitative approaches in assessing healthcare problems because statistics helped to identify known patterns of behaviours that represented vital signs in deteriorating patients.

Although conducting a study with non-human subjects attracts fewer ethical implications compared to those that do not use people (Wasilewski et al., 2019; Bunnik, Timmers and Bolt, 2020), the selected study had an ethical analysis despite not using human subjects. The ethical review contained in the article was consistent with standard guidelines used in recruiting human subjects in medical research (Samuel and Buchanan, 2020; Taylor and Pagliari, 2018; Mckenzie et al., 2017). Coupled with additional ethical approval sought from the ethical committee, the selected study sufficiently covered the ethical requirements for conducting a health research.

The quantitative methodological approach used in the study aligned with the research aim, which was to review adult emergency flow charts and identify trends of patient deterioration. Quantitative studies rely on the effective use of statistics to draw inferences about research variables (Nzabonimpa, 2018; Robbins et al., 2018). However, some statistical gaps emerged in the study, such as the lack of abnormal vital signs in some of the patients who visited the emergency department (Hudson et al., 2015). This finding was presented as a limitation of the study. However, it is common for such information to be omitted from secondary research investigations.

Although the omission of selected data was a limitation of the study, pieces of information relating to its design were discussed and their use justifiably explained. Furthermore, general concepts supporting the study were discussed in independent sections of the report (Hudson et al., 2015). The research design was based on an assessment of patient data recorded in the emergency room setting and a justification for its use provided. The medical flow chart information obtained from the emergency department also allowed for the provision of a detailed narrative of patient vital signs that would be assessed to recognise noticeable patterns of behaviour that are critical in understanding trends signifying patient deterioration.

Participants were not directly included in the study but the health outcomes of patients who visited the emergency room were studied instead. Data was obtained through secondary research and it involved the collection of published research information (Hudson et al., 2015). The quantitative research approach was used to collect research data. Its statistical features explains its use in the study because data collection was based on a review of standard operating chart data relating to emergency room visits. The authors ensured the research process was objective by using proven statistical data collection tools, such as the adult emergency department flow chart, with relative success (Hudson et al., 2015). The information recorded on the chart relates to people’s health information, which is ordinarily treated as private data. This analytical tool provides an upgraded technique of collecting medical data because healthcare service professionals used adult admission and discharge forms that were ineffective due to their inability to cover most details relating to a patient’s health.

Data analysis was done using IBM’s Statistical Packages for the Social Sciences (SPSS) because of the reliance on numerical data for analysis. The use of this software in medical research has been explored and found to be effective in the analysis of quantitative data (Fetters and Molina-Azorin, 2017; Topping and Timmins, 2019). Its generalizability explains its use in the selected research. It also provided a basis for developing structured findings due to the use of relevant statistical tools, such as the chi-square method (Molina-Azorin and Fetters, 2019). Its efficacy in this regard is consistent with the nature of quantitative studies.

Understanding the role of a researcher is important in reviewing the merits of medical research. Caldwell, Henshaw and Taylor (2005) mention its importance in both qualitative and quantitative investigations. Its significance has been further mentioned in mixed methods research (Fenge et al., 2019; Datta, 2018). Regardless of the relevance of researchers in interpreting new findings, the authors failed to articulate their role in interpreting their findings (Hudson et al., 2015). This omission was a limitation of their study, but it was not identified as such. Nonetheless, their merits in co-authoring the research project were pegged on their extensive experience in different areas of medical research. Relative to this assertion, it may be assumed that the authors believed that their role in the research could be undermined by their exclusive use of secondary research data to develop the findings because it denied them a direct role in the collection of research data. In this regard, there is a need to make further commentary on the journal to understand the authors’ reflections broadly.

The results of the investigation were presented systematically and with detailed information relating to the participants’ demographic information, the number of abnormal vital signs recorded and time taken from triage to pattern identification. Key sections of the article provided a summary of data gathered from 181 medical records relating to patients’ vital signs that were recorded during the post-implementation audit phase of the research (Hudson et al., 2015). This approach to data collection is justifiable because it is commonly used in reviewing quantitative research data (Hurst, McCallum and Tilles, 2019; Saldaña, 2018; Abbott and Scott, 2019). Particularly, the adult emergency flow chart helped to provide essential information to identify deteriorating patients based on their vital sign performance. This piece of information helped to link statistical data with the research aim, which was to use the adult emergency flow chart to identify trends in deteriorating patients. Tabulating the results helped to know a patient’s vital signs and identify those requiring additional care.

The discussion section of the article provided an overview of the main thematic areas identified in the research process. The researchers helped to contextualise the findings within the wider body of existing literature investigating the treatment of deteriorating patients. The discussion section also contained sufficient references from several contemporary pieces of literature, which have also discussed the research topic. This research approach is consistent with the criteria for analysing health research articles because they should be adequately referenced to understand how present findings compare with those of past researchers (Caldwell, Henshaw and Taylor, 2005). This link was established by identifying the relationship between the findings of the study with the research aim.

The authors provided a synopsis of the main strengths and weaknesses of their investigation as an introspective assessment of their contribution to the research process. This process is a critical part of self-appraising literature (Caldwell, Henshaw and Taylor’s, 2005). For example, the authors commented on the external validity of their findings by explaining that the findings could be limited in geographic use because they sourced data from two metropolitan hospitals (Hudson et al., 2015). Additionally, they recognised the use of a small sample as another limitation of their study (Hudson et al., 2015). This acknowledgement provided a basis for its recommendations, such as the use of a larger sample data to investigate the research topic.

Lastly, the conclusion section of the selected study offered valuable insights regarding the relevance of its findings to clinical practice. Particularly, the authors emphasised the usefulness of the study in the early identification of vital signs for deteriorating patients in the emergency department (Hudson et al., 2015). Consequently, they suggested that the research study would be helpful in identifying and monitoring unstable patients in the emergency department (Hudson et al., 2015). This information may be used to enhance practical measures or guidelines for identifying and treating deteriorating patients. In this regard, the findings are reasonable and realistic, as is expected of evidence-based research articles.

Broadly, the findings of the study adhere to the generally accepted standards of developing a succinct quantitative research paper. Its strengths are in the data collection and analysis process where the use of statistical software was important in reviewing data and linking them to the research aim, which was to use adult emergency department flow chart information to recognise trends among deteriorating patients. However, the limited volume of information collected from the two health facilities sampled made it difficult to extrapolate the findings beyond a small geographical location. This is why it is proposed that future research should use larger samples of data for in-depth analysis. The implications of these findings to medical practice are predicated on the need to urgently address these limitations and extrapolate the findings to a greater scope of research. Therefore, future studies should focus on filling some of the knowledge gaps identified in the selected article.

Reference List

Abbott, L. and Scott, T. (2019) ‘Reflections on researcher departure: closure of prison relationships in ethnographic research’, Nursing Ethics, 26(5), pp. 1424-1441.

Bunnik, E. M., Timmers, M. and Bolt, I. L. (2020) ‘Ethical issues in research and development of epigenome-wide technologies’, Epigenetics Insights, 13(3), pp. 1-10.

Caldwell, K., Henshaw, L. and Taylor, G. (2005) ‘Developing a framework for critiquing health research’, Journal of Health, Social and Environmental Issues, 6(1), pp. 45-54.

Datta, R. (2018) ‘Decolonizing both researcher and research and its effectiveness in Indigenous research’, Research Ethics, 14(2), pp. 1-24.

Fenge, L. A. et al. (2019) ‘The impact of sensitive research on the researcher: preparedness and positionality’, International Journal of Qualitative Methods, 18(3), pp. 1-10.

Fetters, M. D. and Molina-Azorin, J. F. (2017) ‘The journal of mixed methods research starts a new decade: the mixed methods research integration trilogy and its dimensions’, Journal of Mixed Methods Research, 11(3), pp. 291-307.

Hudson, P. et al. (2015) ‘Early identification and management of the unstable adult patient in the emergency department’, Journal of Clinical Nursing, 24(21), pp. 3138-3146.

Hurst, H., McCallum, K. and Tilles, S. (2019) ‘Dialoguing with the silent researcher: rethinking the role of the transcriptionist in qualitative research’, Methodological Innovations, 12(2), pp. 1-10.

Mckenzie, S. K. et al. (2017) ‘Ethical considerations in sensitive suicide research reliant on non-clinical researchers’, Research Ethics, 13(3), pp. 173-183.

Molina-Azorin, J. F. and Fetters, M. D. (2019) ‘Building a better world through mixed methods research’, Journal of Mixed Methods Research, 13(3), pp. 275-281.

Nzabonimpa, J. P. (2018) ‘Quantitizing and qualitizing (im)possibilities in mixed methods research’, Methodological Innovations, 11(2), pp. 1-10.

Robbins, T. et al. (2018) ‘Diabetes and the direct secondary use of electronic health records: using routinely collected and stored data to drive research and understanding’, Digital Health, 4(8), pp. 1-10.

Saenger, S. and Minis, M. A. (2017) ‘Using evidence-based practice and research in political arenas’, British Journal of Occupational Therapy, 80(8), pp. 457-458.

Saldaña, J. (2018) ‘Researcher, analyze thyself’, International Journal of Qualitative Methods, 17(1), pp. 1-10.

Samuel, G. and Buchanan, E. (2020) ‘Guest editorial: ethical issues in social media research’, Journal of Empirical Research on Human Research Ethics, 15(1), pp. 3-11.

Taylor, J. and Pagliari, C. (2018) ‘Mining social media data: how are research sponsors and researchers addressing the ethical challenges?’, Research Ethics, 14(2), pp. 1-39.

Topping, A. and Timmins, F. (2019) ‘Special collection editorial: mixed-methods research’, Journal of Research in Nursing, 24(5), pp. 283-290.

Wasilewski, M. B. et al. (2019) ‘Using Twitter to recruit participants for health research: an example from a caregiving study’, Health Informatics Journal, 25(4), pp. 1485-1497.

World Health Organization. (2018) Mental health atlas 2017. London: World Health Organization.

Yonkaitis, C. F. (2018) ‘Evidence-based practice and school nurse practice: a review of literature’, The Journal of School Nursing, 34(1), pp. 60-67.