Table of Contents
The article is good, as it clearly states that its study population is patients with stages 4 or 5 CKD, with randomized trial being the main method of selecting the sample.
The article does not have a succinct abstract but has a summary of the research that includes all the contents of the article, including the study design, participants’ results and conclusion among others.
Statement of the problem
The article does not clearly state the problem, though it is easy to identify. The authors argue that to date, there has been no published randomized study of interventions to improve late-stage CKD care and outcomes, thus building a platform for the current study. The problem has significance for nursing, as it out rightly states that the implications will improve the care interventions related to the outcomes of later stage CKD. The quantitative method is the appropriate for this scope of study, as the authors have highlighted that no randomized studies of this nature have been conducted before, thus the lack of literature to build theoretical assumptions.
The article does not explicitly state the hypothesis or research questions. Neither does it justify the reasons for their absence. However, the study tested the rate of hospitalizations among the patients at the late stages of CKD. The purpose of the research, which forms the basis of the hypothesis, is consistent with the conceptual framework, which goes “there is poor education and preparation for end-stage kidney disease, as well as a high rate of hospitalization in this group of patients.”
The literature used by the authors is recent, as they are selected between the years 2009 and 2016. Most of these sources are reports, which are primary research methods. The authors develop a relationship between the literature and the existence of the problem identified by the study. They begin by using literature to prove the suboptimal nature of the outcomes for patients with late-stage chronic kidney disease (CKD) in the United States before applying literature to identify the gaps in knowledge on how to manage patients with late stage CKD.
The main concepts of this research are defined adequately, including the effects and manifestations of later-stage chronic kidney disease, the randomized controlled trial and the risk of hospitalization among the patients with later-stage CKD. Though not clearly stated, the research is based on a theoretical framework that is stated in the background of the article.
Protection of human rights
The study, which was conducted in line with the Good Clinical Practice guidelines, required nurses to seek the consent of all study participants prior to their inclusion in the study. The approach to seek consent safeguarded the rights of the study participants in line with the ethical requirements of clinical practice. The study excluded patients with cognitive impairments and incorporated full information provision to the participants as measures geared towards minimizing the risk to the participants.
The randomized controlled trail was the most appropriate research design for this study primarily because the study had a distinct control group, a factor that limited the expected difference to the outcome variable under study between the experimental and control groups. To promote the interpretability of the findings, comparisons were made between the normal nephrology care and the advanced care provided at the end of the 18 month period. The study had three points of data collection, which were appropriate for purposes of monitoring. The research design minimized the threats to the validity of the study, as it applied the intention to treat as the main approach of determining the outcome of the exposure information.
Population and sample
The article clearly outlines the eligibility of the study population based on their age and their location. The sample size was 130 patients, with the authors presenting the exact demographic characteristics of the patients including their race, ethnicity, weight and gender. The best sampling design used was appropriate, as it only excluded patients with cognitive impairments from the research. The sample size, however, was inadequate, as it consisted only of 130 patients.
Data Collection and measurement
The study clear indicates the meanings of the concepts and explains the exact ways of measuring these concepts in the study. The study has continuous and categorical variables. The former were operationalized using the t-test, while the latter through Fisher exact test. The study explains explicitly why the negative binomial model is used to evaluate the differences in hospitalizations, thus justifying the reason as addressing the exposure times between variables. However, the study does not reveal the results of its validity and reliability tests, thus questioning the presence of these elements in the data.
The study develops an intervention which involved “nurse care manager coordination aided by the use of a disease-based informatics system for monitoring patients’ clinical status, enhancing CKD education, and facilitating preparation for end-stage kidney disease.” Of the 65 allocated to the intervention group, 61 received the intervention. The proof of fidelity is provided in the number of hospitalizations against the number of patients who received the intervention.
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The analysis strived to explain how advanced care practices promote the health outcomes of later-stage CKD patients, which contributes to the high hospitalization rates among these patients. The study employed appropriate statistical methods. The most powerful analytical method was used in analyzing the difference in continuous variables. The research employed the t-test. The intention-to-treat analysis was performed, as four patients withdrew consent within 24 hours as they could not contribute to the analysis either through time of exposure or hospitalization. The missing values were addressed through the negative binomial model.
The study presents information about the statistical significance, with the mean of the days of observation for both the control and intervention groups. The incident ratio was 0.66, with a confidence interval of 95%. The study utilizes charts, tables and figures to summarize its findings. The report format of these findings is consistent with facilitating meta-analysis, further providing adequate information for EBP.
Interpretation of findings
The main finding in this study is that hospitalization rate was significantly lower in the intervention group versus control group. This is consistent with the conceptual framework of the study, which posited that poor education and preparation for end-stage kidney disease is a leading cause of hospitalization among patients in this group. These interpretations take into consideration the limitations of the study. Besides, the authors state exclusively that “We believe that the generalizability of our findings (i.e., the ability of nephrology practices to introduce care management services) is fairly strong.”
The research identified two composite outcomes that can be used by nursing practitioners as indicators of end-stage kidney disease preparation. The study further found that informatics-guided care management resulted in improved outcomes when applied to patients with late-stage CKD. These implications include recommendations for further studies, which are reasonable and complete.
The report features a well-written analysis, with appropriate use of headings and sub-headings that make it easier to conduct a critical analysis. Figure 1 in the research represents the CONSORT flow chart that refines the participant’s flow in the study. The findings of this report are accessible to practicing nurses, as it features discrete application of references that make it easier to identify and navigate.
The researchers have attachments to different departments and divisions of kidney diseases and kidney-related conditions at universities, hospitals and special care units. The clinical qualifications of the authors, coupled with their experience in the field of nephrology, further compound the confidence in their findings. In addition, the research includes in its acknowledgement section that it has been evaluated by two external peer-reviewers. This aspect adds more confidence to the interpretation of the study findings.
The main limitations in this study are the moderate sample size and the limited geographical scope. In spite of these limitations, the findings of the study appear to be valid, as they are supported by statistical analyses that are simplified to suit any audience. Therefore, I have confidence in the truth value of the results. The study contributes significant evidence to nursing discipline, as it reduces the clinical negligence linked with laxity towards offering care to later-stage CKD patients.
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- Fishbane, S., Agoritsas, S., Bellucci, A., Halinski, C., Shah, H., Sakhiya, V., & Balsam, L. (2017). Augmented Nurse Care Management in CKD Stages 4 to 5: A Randomized Trial. American Journal of Kidney Diseases, 70(4), 498-505.