Part 3A: Critical Appraisal of Research

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Part 3A: Critical Appraisal of Research

NURS – 6052N – RUE-WK 71.9.21

Part 3A: Critical Appraisal of Research

Conduct a critical appraisal of the four peer-reviewed articles you selected by completing the Evaluation Table within the Critical Appraisal Tool Worksheet Template (see attached blank form that you will use to complete this assignment).

Choose a total of four peer- reviewed articles that you selected related to your clinical topic of interest in Module 3 (See attached document that shows the previously completed version). Part 3A: Critical Appraisal of Research

Part 3B: Critical Appraisal of Research

Based on your appraisal, in a 1-2-page critical appraisal, suggest a best practice that emerges from the research you reviewed. Briefly explain the best practice, justifying your proposal with APA citations of the research.

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Evaluation Table

 Use this document to complete the evaluation table requirement of the Module 4 Assessment, Evidence-Based Project, Part 3A: Critical Appraisal of Research

 

 

Full APA formatted citation of selected article. Article #1 Article #2 Article #3 Article #4
 

Williams DR, Lawrence JA, Davis BA. Racism and Health: Evidence and Needed Research. Annu Rev Public Health. 2019;40:105-125.doi:10.1146/annurev-publhealth-040218-043750.

 

 

 Stanley, J., Harris, R., Cormack, D., Waa, A., & Edwards, R. (2019). The impact of racism on the future health of adults: protocol for a prospective cohort study. BMC public health, 19(1), 346. Ben, J., Cormack, D., Harris, R., & Paradies, Y. (2017). Racism and health service utilisation: A systematic review and meta-analysis. PloS one, 12(12), e0189900. Benjamins, M. R., & Middleton, M. (2019). Perceived discrimination in medical settings and perceived quality of care: A population-based study in Chicago. PloS one, 14(4), e0215976.
Evidence Level *

(I, II, or III)

 

 Level 1 Level 1 Level 2 Level 3
Conceptual Framework

 

Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here).**

 

 This research has reinforced perceptions of the different ways in which mental and physical health can be affected by inequality, race, tension, class, social, and religious engagement. In this peer-reviewed article, the researchers suggest that substantial advancement has been made in clinical studies investigating the different dimensions wherein racism can have a negative impact on health.

 

 

 

 The study is based on analyzing ways in which social determinants cause health inequalities. It expands on the negative impacts of racial discrimination on physical and mental health outcomes. The study is based on the difference and inequality of healthcare access. Some patient experience also shows that ethnic or racial inequities would be happened to different levels of satisfaction. The research is based on how Perceived discrimination in medical settings remains prevalent within the U.S. health care system
Design/Method

 

Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria).

 Qualitative research design was used whereby the relationship between cultural, structural and individual level racism was analyzed. A prospective cohort study design was used. A questionnaire was developed to cover the mental and physical health measures and the utilization of recent health service. It involves the comparison of analysis outcomes between exposed and unexposed to racial discrimination. The paper describes and prove systematic review and “meta-analysis of quantitative empirical literature Logistic regression was used estimate relationships between perceived discrimination in the medical setting
Sample/Setting

 

The number and characteristics of

patients, attrition rate, etc.

  

Black Americans, Hispanics and Native Americans.

 

 

 

 Participants include adults of more than 15 years sampled from New Zealand survey of 2016/17 based on their exposure to racism. 59 papers reporting 52 studies, which were analyzed using random effects models and mean weighted effect sizes Data from the Sinai Community Health Survey
Major Variables Studied

 

List and define dependent and independent variables

  

The dependent variables are structural racism, institutional racism, and individual-level discrimination while the independent variables are mental and physical health outcomes

 The dependent variables are the racial health inequalities while the independent variables are the social determinants. The RCTs met all criteria for random allocation, allocation concealment, blinding and use of intention-to-treat analysis. Two additional trials reported random allocation but not allocation concealment, blinding or intention-to-treat analysis. One trial did not report meeting any criteria. The dependent variable is Health Care utilization while the independent variable is discrimination  medical settings
Measurement

 

Identify primary statistics used to answer clinical questions (You need to list the actual tests done).

 The study was randomized The study was controlled The study was controlled The study was randomized
Data Analysis Statistical or

Qualitative findings

 

(You need to enter the actual numbers determined by the statistical tests or qualitative data).

 The whites have the highest degree of racial stereotypes compared to non-whites. Negative health effects of racism are overally evident by the perception of unfair treatment and bias. Social determinants of health leads to health inequalities brought about by racism The exact data and details of patients’ reported racism and related healthcare measures to prove the appearance of racism how to happen and appear in the health service. These data make reader believe the writer more about what they say; furthermore, it makes the essay be more credible. The study in Chicago  assessed multiple measures of perceived racial/ethnic and economic discrimination in medical settings and investigated the locations based on a population sample of 1,543 Black, White, Mexican, Puerto Rican, and Other adults
Findings and Recommendations

 

General findings and recommendations of the research

 This study explores proof for interventions of racism reduction approaches and outlines research needed to advance expertise in this area. Research have shown that racism tend to lower one’s self-esteem, bring in anxiety, suicide ideation, depression, contribute to the rise of behavioral problems, and so much more. Furthermore, any form of racial-based discriminatory act can trigger an inflammatory response The result indicates that racism affects the health service and it might be a “particularly detrimental experience” for those people who most in need of the health service or healthcare system. So, I think we need more efforts to reduce racism in the healthcare system, and make sure all people can obtain same equality that improve “cultural competency” of health services or healthcare systems. Racial and ethnic disparities in regards to access and quality of healthcare continue to contribute to health outcomes in communities of color. Discrimination is not limited to just hospitals or ambulatory clinics. Patients who use community clinics rather than doctor’s offices as their source of primary care reported higher rates of discrimination
Appraisal and Study Quality

 

 

Describe the general worth of this research to practice.

 

What are the strengths and limitations of study?

 

What are the risks associated with implementation of the suggested practices or processes detailed in the research?

 

What is the feasibility of use in your practice?

 The purpose of this research was to clarify the impact of racism on health outcome. The study showed that people are more tolerant to interventions that promote collaboration between patients and families than of strategies that invoked conflict. Encouraging empowerment and constructive involvement of patients in healthy health care practices as co-producers of healthcare professionals in IPC action.

Limitation of the study:

Ø  The research is limited to only a few ethnic groups.

 

Ø  The analysis focused largely on future interventions only.

 

Ø  The largest number of participants had more than one history of involvement in practice.

 Criteria have been explicitly established. Several related outlets have been searched. Search dates have not been recorded but studies have been conducted in 2010. Limitation of papers in English implied that some of the trials may have been skipped. There was no proof of bias in publication by systematic analysis, but this analysis is erroneous in a limited number of studies. The analysis contained effective ways to avoid the error and prejudice of the author. The findings of the quality assessment have been published. The investigators have opted to provide a secondary review of the experiments which were initially omitted on the basis of consistency parameters which have not substantially altered the findings. The time limitation is among the limitations of the research. There were some benefits and weaknesses due to all the various individuals performing different areas of the research as well as the harmful effects involved with the existing activities.
 

 

Key findings

 

 

 

 The study of current racism and its influence on health is intricate, as indicators of structural, cultural, and interpersonal racism adjust to changes in cultural norms, technology, and political events Racial discriminative acts among ethnic-racial minorities tend to lower their self-esteem, bring in anxiety, suicide ideation, depression, behavioral problems, and so much more Racism affects the health service and it might be a “particularly detrimental experience” for those people who most in need of the health service or healthcare system. Discrimination may cause disparities in healthcare and health outcomes. This can also reduce the value care added incentives that are now coming from the government for healthcare providers and facilities. More studies need to be done on discrimination in healthcare and in medical settings, however the studies that have been done seem to be limited by measurement issues and single question assessments.
 

 

Outcomes

 

 

 

 Places with low reported racism cases experienced excellent mental and physical outcome Racial experiences tend to have a negative impact on the health statuses of the people. Data and details of patients’ reported racism and related healthcare measures to prove the appearance of racism how to happen and appear in the health service In this study it was found that 40% of all subjects reported some type of discrimination in a medical setting.
General Notes/Comments  

 

The researchers propose that there has been tremendous progress in scientific studies examining the various ways in which racism can harmfully affect health.

 

 

  The researchers found that any racial-based discriminatory act can trigger an inflammatory response subsequently with the rise of chronic illness and other risk-related health issues such as heart attacks, metastatic cancer, neurodegenerative diseases, and so forth The article to talk about how different people access health services and the quality of services that they get following their skin color The majority of studies in this area focus on African American populations, with limited investigation into discrimination among other groups of color and between racial/ethnic populations typically combined into one group

 

*These levels are from the Johns Hopkins Nursing Evidence-Based Practice: Evidence Level and Quality Guide

 Level I

Experimental, randomized controlled trial (RCT), systematic review RTCs with or without meta-analysis

  • Level II

Quasi-experimental studies, systematic review of a combination of RCTs and quasi-experimental studies, or quasi-experimental studies only, with or without meta-analysis Part 3A: Critical Appraisal of Research

  • Level III

Nonexperimental, systematic review of RCTs, quasi-experimental with/without meta-analysis, qualitative, qualitative systematic review with/without meta-synthesis

  • Level IV

Respected authorities’ opinions, nationally recognized expert committee/consensus panel reports based on scientific evidence

  • Level V

Literature reviews, quality improvement, program evaluation, financial evaluation, case reports, nationally recognized expert(s) opinion based on experiential evidence

**Note on Conceptual Framework

  • The following information is from Walden academic guides which helps explain conceptual frameworks and the reasons they are used in research. Here is the link https://academicguides.waldenu.edu/library/conceptualframework
  • Researchers create theoretical and conceptual frameworks that include a philosophical and methodological model to help design their work. A formal theory provides context for the outcome of the events conducted in the research. The data collection and analysis are also based on the theoretical and conceptual framework.
  • As stated by Grant and Osanloo (2014), “Without a theoretical framework, the structure and vision for a study is unclear, much like a house that cannot be constructed without a blueprint. By contrast, a research plan that contains a theoretical framework allows the dissertation study to be strong and structured with an organized flow from one chapter to the next.”Part 3A: Critical Appraisal of Research
  • Theoretical and conceptual frameworks provide evidence of academic standards and procedure. They also offer an explanation of why the study is pertinent and how the researcher expects to fill the gap in the literature.
  • Literature does not always clearly delineate between a theoretical or conceptual framework. With that being said, there are slight differences between the two.

References

The Johns Hopkins Hospital/Johns Hopkins University (n.d.). Johns Hopkins nursing dvidence-based practice: appendix C: evidence level and quality guide. Retrieved October 23, 2019 from https://www.hopkinsmedicine.org/evidence-based-practice/_docs/appendix_c_evidence_level_quality_guide.pdf

Grant, C., & Osanloo, A. (2014). Understanding, Selecting, and Integrating a Theoretical Framework in Dissertation Research: Creating the Blueprint for Your” House”. Administrative Issues Journal: Education, Practice, and Research, 4(2), 12-26.

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Walden University Academic Guides (n.d.). Conceptual & theoretical frameworks overview. Retrieved October 23, 2019 from https://academicguides.waldenu.edu/library/conceptualframework

Part 3B: Critical Appraisal of Research

At the forefront of the study was the need to consider the best practice correlated with the elimination of racism in healthcare. After a critical study of the chosen research materials, the best practices that arise from the research examined deal with racism and its detrimental health consequences. Racial inequality among ethnic minority groups continues to decrease their self-esteem, give rise to anxiety, suicidal ideation, depression, mental disorders, and more. It indicates that the best practice targeted at regulating these actions would understand what can be achieved by the end of healthcare professionals (Williams et al., 2019). Nurses perform a vital role in protecting patient safety and are also responsible for guaranteeing that patients are safe from the likelihood of racial prejudice. Nevertheless, this cannot be done if the hospital is biased and also needs a high degree of quality care provided to patients.Part 3A: Critical Appraisal of Research

It is important to make sure that the hospital is properly staffed with human resources to address the demands of patients and providing quality treatment to deter racial discrimination. Benjamins & Middleton (2019) claimed that prejudice could lead to inequalities in employment and clinical outcomes. It will also reduce the value-added benefits for healthcare services and hospitals that are already coming from the government (Stanley et al., 2019). More analysis need to be carried out on inequality in healthcare and in medical settings, but the research that have been carried out appear to be constrained by measurement problems and single-question tests. The results of this report are consistent with the recommendations of Ben et al. (2017), highlighting the need for stronger measures to eliminate racism in the healthcare sector, and ensuring that all people will receive the same equity that increases the cultural competence of health facilities or healthcare programs.

Reference

Ben, J., Cormack, D., Harris, R., & Paradies, Y. (2017). Racism and health service utilisation: A systematic review and meta-analysis. PloS one, 12(12), e0189900.

Benjamins, M. R., & Middleton, M. (2019). Perceived discrimination in medical settings and perceived quality of care: A population-based study in Chicago. PloS one, 14(4), e0215976.

Stanley, J., Harris, R., Cormack, D., Waa, A., & Edwards, R. (2019). The impact of racism on

the future health of adults: protocol for a prospective cohort study. BMC public

health, 19(1), 346.

Williams DR, Lawrence JA, Davis BA. Racism and Health: Evidence and Needed Research. Annu Rev Public Health. 2019;40:105-125. doi:10.1146/annurev-publhealth-040218-043750. Part 3A: Critical Appraisal of Research