Critique and Ethical Considerations Sample Example

Write a critical appraisal that demonstrates comprehension of two qualitative research studies. Use the \”Research Critique Guidelines – Part 1\” document to organize your essay. Successful completion of this assignment requires that you provide rationale, include examples, and reference content from the studies in your responses.

Use the practice problem and two qualitative, peer-reviewed research article you identified in the Topic 1 assignment to complete this assignment. Critique and Ethical Considerations Sample Example

In a 1,000–1,250 word essay, summarize two qualitative studies, explain the ways in which the findings might be used in nursing practice, and address ethical considerations associated with the conduct of the study.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

 

Literature Evaluation Table

Student Name:

Summary of Clinical Issue (200-250 words):

When used improperly, pain medicines can cause problems in the body, including the kidneys. According to the National Kidney Foundation, as many as 3 percent to 5 percent of new cases of chronic kidney failure each year may be caused by the overuse of these painkillers. Once kidney disease occurs, continued use of the problem drug makes it worse.

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Acetaminophen It is often effective for mild to moderate pain. Its safety depends on how it is used. People who take too much or take it too often risk side effects or worse. Acetaminophen is also found in combination with other ingredients in many cold, sinus, and cough medications. Critique and Ethical Considerations Essay Example. If you take these drugs together, the dose can add up. Ibuprofen and other NSAIDs block prostaglandins, natural body chemicals that normally dilate blood vessels leading to the kidneys. Blocking prostaglandins may lead to decreased blood flow to the kidneys, which means a lack of oxygen to keep the kidneys alive. That can cause acute kidney injury. A simple blood test may show a rise in creatinine if your kidneys are being affected, usually seen within the first three to seven days of NSAID therapy. In people with high blood pressure, taking NSAIDs long-term may worsen underlying high blood pressure. Also, people with existing kidney problems more often get in trouble with NSAIDs Critique and Ethical Considerations Sample Example.

 PICOT Question: In patients with normal renal function who have had recent surgery are nonsteroidal anti-inflammatory drugs (NSAIDs) associated with adverse renal effects?

 

Criteria	Article 1	Article 2	Article 3
APA-Formatted Article Citation with Permalink	Bloom, L., Boyle, K. E., Myers, A. E., Blacketer, C., & Weinstein, R. (2019). Frequency of nonaspirin NSAID-relevant coexisting medical conditions in the primary-care setting: A retrospective database review. Therapeutics and Clinical Risk Management,Volume 15, 579-588. doi:10.2147/tcrm.s189833	Lai, K. M., Chen, T., Chang, C., Chen, H., & Lee, Y. (2019). Association between NSAID use and mortality risk in patients with end-stage renal disease: A population-based cohort study. Clinical Epidemiology,Volume 11, 429-441. doi:10.2147/clep.s204322 Critique and Ethical Considerations Essay Example	Gawande, A., Gupta, G. K., Gupta, A., Wanjari, S. J., Goel, V., Rathore, V., . . . Nijhawan, S. (2019). Acute-on-Chronic Liver Failure: Etiology of Chronic and Acute Precipitating Factors and Their Effect on Mortality. Journal of Clinical and Experimental Hepatology. doi:10.1016/j.jceh.2019.04.050
How Does the Article Relate to the PICOT Question?	It researches on use of NSAID with coexisting conditions.	It researches the use of NSAID and mortality rates with CKD patients	Prevalence of acute on chronic liver failure, underlying etiology and precipitating factors.
Quantitative, Qualitative (How do you know?)	Qualitative	Qualitative	Quantitative
Purpose Statement	To find the effects of NSAID with coexisting conditions.	investigate the association between the use of NSAIDs and the risk of mortality in patients with end-stage renal disease.
Research Question	Frequency of non-aspirin NSAID-relevant coexisting medical conditions in the primary-care setting	Association between NSAID use and mortality risk in patients with end-stage renal disease: a population-based cohort study	Estimating the prevalence of acute on chronic liver failure in our institute, etiology of underlying chronic liver disease, precipitating acute event and mortality rate.
Outcome	the prevalence of renal disease was low in all three databases	In the study cohort, 2,623 (78%) patients used NSAIDs during the follow-up period. The median follow-up period was 4.0 years, during which 1,515 patients died. The results of multivariable analysis demonstrated that compared with NSAID nonuse, the use of any NSAIDs, nonselective NSAIDs, and selective cyclooxygenase-2 inhibitors was associated with a significantly increased risk of all-cause mortality	Out of 386 patients, 150 patients were admitted with acute on chronic liver failure with a prevalence of 39%. In 41% of patients, infection was the precipitating factor for ACLF either in the form of Sepsis, spontaneous bacterial peritonitis, Lower respiratory tract infection or skin, and soft tissue infections. Alcohol was the second most precipitating factor (32%), followed by upper gastrointestinal hemorrhage (12%) and drugs (2%).
Where did the study take place?	USA	Taiwan	Rajiv Gandhi Government General Hospital
Sample	Patients aged ≥18 years in 2013 with a visit to a PCP in the same year were included in the study. Only patients with ≥1 year of enrollment prior to their first PCP visit in 2013 were included, so that medical history was available to review.	A total of 3,383 patients with newly diagnosed end-stage renal disease requiring long-term dialysis between 1998 and 2012 were included in the current study, and the study outcome was evaluated until December 31, 2013.	386 patients in Rajiv Gandhi Government General Hospital
Method	A retrospective database review was performed.	Time-dependent Cox regression models were applied to examine the association between NSAID use and mortality risk.	Database review
Key Findings of the Study	Overall, the prevalence of renal disease was low in all three databases relative to cardiovascular and gastrointestinal bleeding risk factors. Similar percentages of women and men were diagnosed with renal disease within each database. In each database, a higher percentage of individuals with a musculoskeletal diagnosis had a CMCOI compared to the total study population	The results suggest that NSAID use was associated with an increased risk of mortality in the patients with end-stage renal disease. Future randomized controlled trials are needed to validate these observational findings.	Out of 386 patients, 150 patients were admitted with acute on chronic liver failure with a prevalence of 39%. In 41% of patients, infection was the precipitating factor for ACLF either in the form of Sepsis, spontaneous bacterial peritonitis, Lower respiratory tract infection or skin, and soft tissue infections. Alcohol was the second most precipitating factor (32%), followed by upper gastrointestinal hemorrhage (12%) and drugs (2%)
Recommendations of the Researcher	The analyses reinforce the critical role HCPs can play in identifying patients with nonaspirin NSAID-relevant coexisting conditions, providing those patients with ongoing guidance on appropriate choice and use of OTC analgesics, and educating patients about the impact that aging, health status, concomitant conditions, and medicines has on selection of all medicines, including analgesics.	Future randomized controlled trials are needed to validate these observational findings.	A multi-centre study involving a larger number of patients are needed to know the clinical characteristics, other precipitating factors and to form a standard treatment protocol for this dynamic syndrome.

 

Criteria	Article 4	Article 5	Article 6
APA-Formatted Article Citation with Permalink	Lee, A., Cooper, M., Craig, J., Knight, J., & Keneally, J. (2004). Effects of nonsteroidal anti-inflammatory drugs on postoperative renal function in adults with normal renal function. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.cd002765.pub2	Plantinga, L., Grubbs, V., Sarkar, U., Hsu, C., Hedgeman, E., Robinson, B., . . . Powe, N. (2011). Nonsteroidal Anti-Inflammatory Drug Use Among Persons With Chronic Kidney Disease in the United States. The Annals of Family Medicine,9(5), 423-430. doi:10.1370/afm.1302	Brown, E. A., & Davison, S. N. (2014). Pain Management in Chronic Kidney Disease. Management of Chronic Kidney Disease,297-304. doi:10.1007/978-3-642-54637-2_22
How Does the Article Relate to the PICOT Question?	It measures NSAID relation to CKD in post op patients	It relates to the topic due to describing the use of NSAIDS in individuals with CKD	Discusses how to properly manage pain in people with CKD.
Quantitative, Qualitative (How do you know?)	Qualitative	Qualitative	Qualitative
Purpose Statement	The primary objective of this review was to determine the effects of NSAIDs on postoperative renal function in adults with normal preoperative renal function.	Due to avoidance of nonsteroidal anti-inflammatory drugs (NSAIDs) is recommended for most individuals with chronic kidney disease (CKD), we sought to characterize patterns of NSAID use among persons with CKD in the United States.	This article will focus on identifying the challenges of pain management for CKD patient undergoing surgical intervention and explores avenues to overcome these difficulties through simplifying some of the published guidelines in this field to provide optimum pain control for this patient population.
Research Question	Effects of nonsteroidal anti-inflammatory drugs on postoperative renal function in adults with normal renal function. Critique and Ethical Considerations Sample Example	Nonsteroidal Anti-Inflammatory Drug Use Among Persons With Chronic Kidney Disease in the United States	Postoperative pain management in patients with chronic kidney disease
Outcome	Twenty-three trials (1459 patients) fulfilled the selection criteria for this review. NSAIDs reduced creatinine clearance by 16 mL/min (95%CI 5 to 28) and potassium output by 38 mmol/day (95%CI 19 to 56) on the first day after surgery compared to placebo. There was no significant difference in serum creatinine on the first day (0 umol/L, 95%CI -3 to 4) compared to placebo. No significant reduction in urine volume during the early postoperative period was found. There was no significant difference in serum creatinine in the early postoperative period between patients receiving diclofenac, ketorolac, indomethacin, ketoprofen or etodolac.	Reported current use of NSAIDs was not uncommon in the US population (3.7% overall). Persons with moderate to severe CKD were slightly more likely than those with no or mild CKD to report current use of NSAIDs (Figure 3A). The great majority of currently used NSAIDs were available over-the-counter (Figure 3A). Among those with CKD, current NSAID use was similar among those were aware and those who were unaware of their CKD status.	Acetaminophen is considered the safest analgesic agent in ESRD and should be used routinely as an analgesic foundation. With chronic use, however, acetaminophen itself may cause nephrotoxicity. Although some authors suggest there is no need to adjust the acetaminophen maximum daily dose in patients undergoing intermittent hemodialysis, the 4 g/day recommended maximum dose may not be applicable for the majority of patients due to the presence of other factors that increase the risk of toxicity.
Setting (Where did the study take place?)	N/A
Sample	NSAIDs with either each other or placebo for treatment of postoperative pain, with relevant postoperative renal outcome measures, in adult surgical patients with normal renal function.	A total of 12,065 adult (aged 20 years or older)
Method	The inclusion criteria were randomised or quasi-randomised comparisons.	Participants in the cross-sectional National Health and Nutrition Examination Survey (1999–2004) responded to a questionnaire regarding their use of over-the-counter and prescription NSAID	Critique and Ethical Considerations Essay Example
Key Findings of the Study	NSAIDs caused a clinically unimportant transient reduction in renal function in the early postoperative period in patients with normal preoperative renal function.	Among those with moderate to severe CKD who were currently using NSAIDs, 10.2% had a current NSAID prescription and 66.1% had used NSAIDs for 1 year or longer. Among those with CKD, disease awareness was not associated with reduced current NSAID use:	Pharmacotherapy pain management strategies for patients with CKD change as kidney function becomes progressively impaired. When devising a strategy, physicians must strive to protect the kidney from further damage as well as avoid developing serious side effects due to accumulations of analgesic agents or their metabolites.
Recommendations of the Researcher	NSAIDs should not be withheld from adults with normal preoperative renal function because of concerns about postoperative renal impairment.	Physicians and other health care clinicians should be aware of use of NSAIDs among those with CKD in the United States and evaluate NSAID use in their CKD patients.	Further clinical studies are required to address the optimal medication regimen that can be used for postoperative pain management in the different stages of CKD, including hemodialysis.

 

Critique and ethical considerations

Article 1.

“Bloom, L., Boyle, K. E., Myers, A. E., Blacketer, C., & Weinstein, R. (2019). Frequency of nonaspirin NSAID-relevant coexisting medical conditions in the primary-care setting: A retrospective database review. Therapeutics and Clinical Risk Management, 15, 579-588. doi: 10.2147/tcrm.s189833” Critique and Ethical Considerations Essay Example

Summary

Bloom et al. (2019) present the results of a retrospective database review to determine how coexisting medical conditions and non-steroidal anti-inflammatory drugs (NSAIDs) influence treatment modalities as noted in primary care practices. The retrospective approach collected data from the claim databases of three medical facilities with a focus on patients either 18 years of age or older. The data was collected for the period covering 2013. The focus was on non-aspirin NSAID-relevant coexisting medical conditions of interest (CMCOI), asthma, cardiovascular risk factors, gastrointestinal bleeding risk factors, and renal insufficiency. Statistical analysis of the collected data determined that patients with musculoskeletal diagnosis reported a significantly higher risk of treatment challenges when compared to their counterparts without musculoskeletal diagnosis. Similarly, age was noted to influence treatment challenges, with an increase in age being matched by an increase in the occurrence of treatment challenges. The reported results indicate that non-aspirin NSAID-relevant CMCOI and age are useful statistical for use among primary care professionals with regards to predicting the occurrence of treatment challenges. In fact, the results show that even as patients advance in age, their medical conditions change and their reactions to different medications also change Critique and Ethical Considerations Essay Example. Using the information, primary care professionals can identify patients at high risk and offer them guidance on how their age, health status, concomitant conditions, and medication influence treatment modalities (Bloom et al., 2019).

Using findings in nursing practice

The findings from Bloom et al. (2019) are useful to nursing personnel who act as primary care professionals. That is because NSAIDs are a common medication that are typically prescribed or recommended for almost all medical conditions. Although commonly used, NSAIDs are associated with substantial side effects and complications for a particular demographic of patients. Despite the labels for NSAIDs listing these side effects and complications, patients and medical personnel would often overlook them thereby presenting opportunities for them to occur with potentially fatal effects. Through identifying this demographic of patients, nurses are able to anticipate the care complications and offer appropriate advice on how to either address or prevent the complications. Besides that, they can use their position as primary care professionals to reinforce the importance of the advice contains in the labels as instructions and not simply suggestions. Overall, the findings allow nursing practice to contribute towards the safe use of NSAIDs as well as improving care outcomes through anticipating and addressing treatment challenges Critique and Ethical Considerations Sample Example

Ethical considerations for the study

Bloom et al. (2019) does not mention how ethical concerns were addressed in the study. However, there is a need to address the ethical aspects of retrospective database review studies, especially with regards to the primary concern of issues pertaining to confidentiality and informed consent. Besides that, the study received approval from The New England Institutional Review Board (NEIRB, 12–284), specifying that the study did not meet the definition of human-subject research thus not requiring its approval. Critique and Ethical Considerations Essay Example.

The study is based on information that is already available as medical records with the researcher only required to retrieve the information. This is an indication that the ethical concern about confidentiality and informed concern is an inherent concern since the researchers do not have direct contact with patients. The concern is further highlighted by the fact that medical records are not collected with the explicit intention of informing research studies. As such, there is no a-priori informed consent for the records to be used in research studies. In essence, using the records is ethically questionable since confidential information is accessed and could be misused thereby jeopardizing the relationship between patients and doctors. This is particularly true when sensitive data is accessed by persons not bound by patient-doctor confidentiality, leading to unwanted disclosure that would distress and cause difficulties for the patient. Critique and Ethical Considerations Essay Example. Given the nature of medical records and the difficulty in getting informed consent from patients, retrospective studies using these records can address the ethical concerns about informed consent and confidentiality through four approaches. Firstly, minimal information should be collected and only if necessary. The collected information should only include routine clinical information that does not require informed consent. Secondly, any information that could identify the patients should be eliminated or coded to conceal the patients’ identities. Thirdly, safeguards should be implemented to ensure the ethical use of the collected information, such as having protocols for the information storage and authorized access. Finally, ethical clearance should be sought from an Institutional Review Board (IRB) that provides the required oversight (Sarkar & Seshadri, 2014). Critique and Ethical Considerations Essay Example.

Article 2.

“Lai, K. M., Chen, T., Chang, C., Chen, H., & Lee, Y. (2019). Association between NSAID use and mortality risk in patients with end-stage renal disease: A population-based cohort study. Clinical Epidemiology, 11, 429-441. doi: 10.2147/clep.s204322” Critique and Ethical Considerations Essay Example.

Summary

Lai et al. (2019) presents the results of a study that investigated the association between NSAIDs use and risk of mortality for persons diagnosed with end-stage renal disease. It acknowledges that pain is a concern among persons diagnosed with end-stage renal disease and it is not uncommon for NSAIDs to be administered. However, it notes that although the pain associated with the disease is a concern and NSAIDs can partially address this concern, of greater concern is the risks associated with the use of NSAIDs. The study seeks to document the risks, providing evidence to show that the adverse effects are tangible thus informing patients and clinicians. Towards this end, the study applies a retrospective approach that collects data from the Taiwan National Health Insurance Research Database. The selected population sample is for 1 million patients records selected from among 27 million patients records covering the period between 1997 and 2013. The study determined that 78% (2,623) of persons diagnosed with end-stage renal disease and requiring long-term dialysis used NSAIDs. During the study period that covered four years, 1,515 patients in the study population died. The study determined that the use of NSAIDs significantly increased the risk of all-cause mortality for persons diagnosed with end-stage renal disease (Lai et al., 2019). Critique and Ethical Considerations Essay Example.

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Using findings in nursing practice

The study results are useful for improving care outcomes for persons diagnosed with end-stage renal disease. Using the study results, nursing practice can recommend alternatives to NSAIDs that reduce the risk of mortality. In addition, the results can be used to justify stringent monitoring of patients using NSAIDs so as to reduce the risk of mortality (Lai et al., 2019) Critique and Ethical Considerations Essay Example.

Ethical considerations for the study

Lai et al. (2019) mentions that the study was approved by the Joint Institutional Review Board of Taipei Medical University, and the requirement of patient-informed consent was waived (TMU-JIRB No. N201506025). The approval is an indication that the study did not pose any avoidable risk to the participants. Still, the study makes use of medical records thus raising ethical concerns with regards to confidentiality and informed consent since it would be difficult to obtain consent from all participants before the information was used. Although there is no mention of how these concerns were addressed, there is an indication that they were addressed through four approaches. Firstly, minimal information was collected with focus on what was necessary to inform the study and does not require informed consent. Secondly, information was coded to conceal the patients’ identities. Finally, ethical clearance was sought from an IRB that provided the required oversight (Sarkar & Seshadri, 2014). Critique and Ethical Considerations Essay Example.

References

Bloom, L., Boyle, K. E., Myers, A. E., Blacketer, C., & Weinstein, R. (2019). Frequency of nonaspirin NSAID-relevant coexisting medical conditions in the primary-care setting: A retrospective database review. Therapeutics and Clinical Risk Management, 15, 579-588. doi: 10.2147/tcrm.s189833 Critique and Ethical Considerations Essay Example

Lai, K. M., Chen, T., Chang, C., Chen, H., & Lee, Y. (2019). Association between NSAID use and mortality risk in patients with end-stage renal disease: A population-based cohort study. Clinical Epidemiology, 11, 429-441. doi: 10.2147/clep.s204322 Critique and Ethical Considerations Sample Example