This assignment is based on the importance of research and how it enables nurses to provide the best quality care within the clinical setting with the use of evidence based practice. The literature retrieval process will be discussed with three articles being summarised and critiqued, along with the rationale for the choice of paper. The research articles will be referred to as papers 1, 2 and 3, (Appendix 1) they will critically analyse the methodology, strengths and limitations of each paper. The findings will also be discussed in the conclusion to decide if the articles are suitable for clinical practice.
Research is an essential part of nursing with its importance being reflected on the current use of evidence based practice within the clinical setting (Polit and Hungler, 1997). Evidence-based practice means that evidence is used to either support current practice or guide changes in practice with the use of current research (Youngblut et al, 2001) This first came about so that practices would be based on research evidence rather than tradition to provide best practices within the clinical setting (Ingersoll, 2000). Using research evidence as a basis for practice is important for improving patient outcomes and for keeping pace with new technologies and knowledge developments.
Its can change practice for the better and nurses are encouraged to use an evidence based approach, supported by the NMC (2000) this would also be within keeping of achieving clinical governance within the NHS (DOH, 2000). However although research findings are often considered to be appropriate sources of evidence, there is sometimes disagreement about the necessary number of studies and types of research designs considered. In many areas, there are research studies that support a particular practice and others that refute that same practice. Because of this it is sometimes dangerous to base practice on only one study (Zingberg, 1997). Therefore it is vital for nurses to interpret and analyse research papers effectively. McKenna (2000)
Before searching for my papers it was important to provide a rationale for the types of papers I would search for (Flemming, 1998), as nursing is a profession that deals with anxious patients everyday I felt it appropriate to first establish what anxiety was and then what intervention could be used to alleviate some anxiety. Anxiety is a biological driving force and a natural response to threatening or stressful situations (NHS Direct, 2004). Evans (2001) suggests that trying to relax by thinking about things that make you feel calm such as listening to music can often reduce such anxiety. Therefore I felt it important to research the effects of music on anxiety.
The title of a study is an important factor, Parahoo (1997) suggests that a title should draw the reader’s attention to the precise area of study and make reference to the population from whom the data is collected. For this reason the question arose: Does a music therapy intervention reduce anxiety in patients either before or after invasive procedures taking place?
Three papers were found by the use of a comprehensive literature search, Ovid online database was used, within Ovid database Cinahl was accessed which covers a wide range of nursing, midwifery and medical journals. With the use of the keyword box, relevant words such as “anxiety” and music “therapy” were searched for. When combined together with the use of the “combine” and “and” button it narrowed the search to specific journals of interest. Again these were narrowed down by the use of research articles only. The abstract of the journals were read to see if the papers would be suitable and three were kept for the purpose of the assignment.
The title of the first paper is “Effects of a Single Music Therapy Intervention on Anxiety, Discomfort, Satisfaction and Compliance with Screening Guidelines in Outpatients Undergoing Flexible Sigmoidoscopy (FS). It aims to test the effectiveness of Music therapy on Anxiety during Flexible Sigmoidoscopy (FS), discomfort during FS satisfaction with the FS procedure itself and perceived compliance with colon cancer screening guidelines based on the current FS experience. The sample consisted of 64 participants from the mid west of America average age of 54.6, 44 female 20 male.
The research used a two group pre test, post test design with repeated measures however most of the conclusions are drawn between groups rather than from repeated procedures. The results were analysed using the ANOVA test of multi variance. The study found a significant reduction in state anxiety after trait anxiety had been controlled for. It found a significant reduction in reported discomfort during the procedure between the two groups. However there was no significant difference in satisfaction with the process or perceived compliance with colon cancer guidelines. 83% of the music /Experimental group stated the music was helpful.
The title of paper 2 is “A Music Intervention to Reduce Anxiety Prior to Gastrointestinal Procedures”. It is a quantitative analysis of how a single 15 minutes of self selected music intervention affects anxiety. It is a randomised controlled trial of 198 participants and uses the State Trait Anxiety Inventory to measure the participant’s anxiety. The aim of the study was to evaluate whether a music intervention reduced patients anxiety prior to GI procedures.
The research questions were Will listening to music for 15 mins prior to a GI procedure reduce patient’s anxiety? Will listening to music for 15 mins prior to GI procedure decrease patient’s blood pressure and pulse rates? The sample was made up of 193 men and 5 women with the average age of 61. They all attended the West coast (USA) Veterans Affairs Medical Centre. The results showed that patients who listened to music reduced there anxiety score from 36.7 to 32.3 while those patients who did not listen to music reduced their anxiety score from 36.1 to 34.6 these differences were significant at p= .007.
The title of paper 3 is “The effect of music interventions on anxiety in the patient after coronary artery bypass grafting”. The aim of the study was to examine the influence of music intervention during the early postoperative period on mood and anxiety of patients undergoing heart surgery. It used a prospective, repeated measures design i.e. the same group of participants were compared on separate occasions. It was a quasi experimental method using random assignment of participants. The independent variable was type of intervention Music, Music/ video or scheduled rest. The dependent variable was anxiety as measured by the STAI Mod measured by NRS and physiologic variables i.e. Heart rate and BP. The results were analysed using Chi-square and the ANOVA test of multi variance. The major finding of this study was that the use of music, music video or rest periods did not significantly reduce anxiety of patients after CABG.
The chosen papers use a Quantitative method, this is a term used for studies which are experiments using a large sample size and statistical analysis (Beyea, 1997). Quantitative researchers tend to produce and test hypothesis rather than look at problems and questions. They describe their work statistically in the representation of numbers; the researchers would argue that their technique is more scientific, reliable and open to checking by other researchers (Cormack, 2001).
Randomised control trials were used in all papers; theses are experiments to measure and compare the outcomes of two or more clinical interventions (Parahoo, 1997). A Quasi experiment was also used in paper 3; this type of experiment resembles some of the characteristics of an experiment but not with the quality of a “true” experiment. Draw backs with this experiment are that there can be know direct manipulation, so the experimenter does not have complete control, also random allocation isn’t possible (Cormack, 2000).
Validity is a vital key to effective research, as research that is invalid is worthless (Cohen, 2000). One important aspect of validity is that if research is valid then it is also considered reliable. There are several types of validity that contribute to the overall validity of a study. The two main dimensions are Internal and External validity, Internal Validity is concerned with the degree of certainty that observed effects in an experiment are actually the result of the experimental treatment or condition (the cause), rather than intervening, extraneous or confounding variables. Internal validity is enhanced by increasing the control of these other variables (Abbot & Sapsford, 1997).
External Validity Is concerned with the degree to which research findings can be applied to the real world, beyond the controlled setting of the research. This is the issue of generalisability. Attempts to increase internal validity are likely to reduce external validity as the study is conducted in a manner that is increasingly unlike the real world (Abbot & Sapsford, 1997).
The internal validity of each of the papers can be questioned on a number of counts. The researchers of each paper have been caught between the high desire to make there research quantitative and scientific. Paper 1 used an independent measures design as the experimental group and control group were made up of different people. This leaves the study open to the criticism that it was individual differences and not the independent variable that led to differing outcomes for the Dependent Variable. Variables are measurable entity or characteristic; in experiments variables are manipulated to establish cause and effect (Polit, 1995).
The design states in paper two the research used repeated measures design but proceeded to compare two distinct groups one experimental and one control it also states that individuals were randomly allocated, this was not a counter balance but an allocation of participant to groups, an experimental or control group, each participant only experienced the procedure once suggesting an independent measures design. This casts some doubt on the validity and reliability of the procedures reported. If the research used repeated measures design then order effects must be controlled for (Powers & Knapp, 1995).
However it appears from the procedure that they used independent design and are open to the same critic as paper one i.e. that it is individual differences and not the Music which is responsible for any differences in the Dependent Variable. Paper three does use repeated measures design measuring the difference between pre and post anxiety, however this leaves the research with out a real control group to compare any effects against therefore the validity of any findings will be affected. It is not possible to really establish cause and effect without an adequate control group (Cormack, 2001).