University of Colorado Hospital -
Quantitative Research Critique Facilitator of Journal Club
Name: Raelyn Nicholson Date: 2/23/2014
Article Reviewed: (Author names, Title of article, Journal, Year, Volume, Page numbers)
Buchko, B.L., Robinson, L.E., & Bell, T.D. (2013). Translating an evidence-based algorithm to decrease early post-operative urinary retention after urogynecologic surgery. Urologic Nursing, 33(1), 24-32. doi: 10.7257/1053-816X2013.33.1.24
Research Purpose:
· What is the purpose of the study? The purpose was to determine whether an evidence-based algorithm to manage post-operative urinary retention in women who have undergone urogynecologic surgery would prevent urinary retention and improve voiding efficiency.
· Is the research question clearly identified? Yes. Will the implementation of an evidence-based algorithm and comprehensive nurse education reduce the incidence of POUR in women undergoing urogynecologic surgery?
Review of Literature/Background:
· Do the authors specify a theoretical/conceptual framework guiding the study (do they provide a “word picture” or visual image of the framework)? Specify the framework/conceptual model used: Yes. The John Hopkins Nursing Evidence-Based Practice (JHNEBP). The JHNEBP model facilitates bedside nurses’ translation of evidence into nursing practice.
· Literature reviewed relevant to the study purpose? Yes.
· Review logically and clearly organized? Yes.
· Does the review primarily use current literature? (published within the last 5 years, unless a “classic” ) No. Many were outdated. 16 sources dated 2000-2012. 5 sources within 5 years of publication submission.
· Were primary sources used? (A primary source is written by the person who originated the ideas published)
Buchko and Robinson referenced two of their previous studies, including:
Research Design and Methods:
· Institutional review board (IRB) approval? Not mentioned
· What type of design(s) was (were) used? Circle all that apply: Experimental; Quasi-experimental; Correlational; Exploratory; Descriptive; Survey; Other: Comparative
· Was sample described? Women who had undergone urogynecologic surgery between Aug 2005 and Dec 2006, performed by gynecologist, and cared for in the postpartum-gynecologic unit.
· What is sample size? N=56 met inclusion criteria (15 pre-implementation, 41 post-implementation)
· Is the sample size, selection, and representativeness adequate and appropriate? Size limited, but only a pilot study. Insufficient pre-implementation numbers, which affects statistical significance.
· What sampling method was used? Randomized; Convenience; Other:
· List the inclusion and exclusion criteria:
· What is the setting for the study? 572-bed Magnet-designated teaching hospital (postpartum-gynecologic unit)
· Can you identify the variable in the study? Using an evidence-based algorithm to manage POUR and nursing education on urinary retention.
· List key variables:
Data collection, measurement, and analysis:
· Describe the method of data collection: Retrospective charting (chart audits). Patients were divided into two groups according to whether they were cared for pre- or post-implemenation of the voiding trials algorithm. Data collected included date and time of indwelling urethral catheter insertion; date and time of indwelling catheter removal; date, time, and amount of each measured void; date, time, and amount of bladder ultrasound assessment for bladder volume either if patient unable to void or PVR; and date, time, and amount of intermittent catheterization when required by algorithm.
Use of algorithm was evaluated by: a) time to first void, b) measurement of PVR, c) urinary retention >300 ml, d) use of intermittent catheterization, e) measurement of voiding efficiency, f) urinary retention > 500 ml
· Did they make sense to you? Yes. Very descriptive and multi-faceted.
· Are instruments/tools used reliable and valid? The tool used was designed from the evidence in the literature and so was testing. The tool had not been used before. Margin for error because information was based on RN’s charting.
· Describe the method of data analysis: Chi-square test or Fisher’s exact test were used to test for significance for categorical variables. The Mann-Whitney U was used to assess the difference between groups for continuous variables (especially since pre- and post-intervention groups were unequal. Statistical significance was identified as p < 0.05.
Findings/Results and Conclusions
· Results organized logically and presented clearly? Yes. See tables.
· Briefly describe results and the conclusions drawn from them. Are the conclusions consistent with the results? Do the answers make sense? 6 pre-implementation (40%) and 6 post-implementation (14.6%) required reinsertion of an indwelling catheter (p<0.092). There were also fewer intermittent catheterizations performed in the post-implementation group. The pilot study noted an increase in length of stay, but probably associated with more complex urogynecologic surgeries (pelvic reconstructive surgery).
· Are the conclusions discussed in relation to the theoretical/conceptual framework? Yes. Buchko et al. (2013) references the JHNEBP model when standardizing practice based on results with a plan to implement recommendations more broadly (i.e. application to all surgical patients). Buchko et al. (2013) also discusses other studies which demonstrated conflicting and similar results.
· Does the researcher place the report in the context of what is already known about the research question? (e.g., other studies, philosophies) Yes. Buchko et al. (2013) references:
- Lewthwaite and Girouard (2006) – reduction in catheterization after implementing a guideline, did not use bladder ultrasound, decrease lengths of stay
- Fedorkow et al. (2005) – results not accurate with bladder ultrasound
- Teng et al. (2005) – fewer catheterizations improves efficiency of nursing time
- Frederickson et al. (2000) – fewer catheterizations decreases cost
· Are the limitations/biases concerning enough to cause you to question the validity of the results? Limitations: Insufficient sample size (especially pre-implementation group – only 15). Due to limited size, the algorithm needs an ongoing analysis. Only 56% of RNs attended the educational program. Increased nurse participation is required. There was also inconsistent documentation of PVR and bladder assessment. During the study, nurses reported that PVRs were not always measured due related to the unavailability of the bladder scanner.
· Are suggestions for future research included? If so, what are they? A larger comparison group would give more meaning to results. Researchers recommend ongoing analysis of the algorithm.
Professional context:
· Are the implications for practice clearly stated (i.e., how do the conclusions of the study affect my practice)? List the implications: An evidence-based algorithm can improve voiding efficiency, reduce urinary retention, and decrease the incidence of bladder distension among urogynecologic patients.
Summarize one element/finding in this article that you will/will not use in your practice as a result of reading this article. Should the current algorithm we use be applied to inpatients? Should we encourage every patient to void with 3-4 hours of last void? Should we consider voiding efficiency and assess PVR after high risk patients void?
Retrospectively auditing documentation provides a review of the nurse’s knowledge of POUR and use of the algorithm.
What is the level of evidence for this study? Level 6
6 - Single descriptive or qualitative study
Article Reviewed: (Author names, Title of article, Journal, Year, Volume, Page numbers)
Buchko, B.L., Robinson, L.E., & Bell, T.D. (2013). Translating an evidence-based algorithm to decrease early post-operative urinary retention after urogynecologic surgery. Urologic Nursing, 33(1), 24-32. doi: 10.7257/1053-816X2013.33.1.24
Research Purpose:
· What is the purpose of the study? The purpose was to determine whether an evidence-based algorithm to manage post-operative urinary retention in women who have undergone urogynecologic surgery would prevent urinary retention and improve voiding efficiency.
· Is the research question clearly identified? Yes. Will the implementation of an evidence-based algorithm and comprehensive nurse education reduce the incidence of POUR in women undergoing urogynecologic surgery?
Review of Literature/Background:
· Do the authors specify a theoretical/conceptual framework guiding the study (do they provide a “word picture” or visual image of the framework)? Specify the framework/conceptual model used: Yes. The John Hopkins Nursing Evidence-Based Practice (JHNEBP). The JHNEBP model facilitates bedside nurses’ translation of evidence into nursing practice.
· Literature reviewed relevant to the study purpose? Yes.
· Review logically and clearly organized? Yes.
· Does the review primarily use current literature? (published within the last 5 years, unless a “classic” ) No. Many were outdated. 16 sources dated 2000-2012. 5 sources within 5 years of publication submission.
· Were primary sources used? (A primary source is written by the person who originated the ideas published)
Buchko and Robinson referenced two of their previous studies, including:
- An evidence-based approach to decrease early post-operative urinary retention following urogynecologic surgery (2012)
- Exemplars: Prevention of post-operative urinary retention after uro-gynecologic surgery (2007)
Research Design and Methods:
· Institutional review board (IRB) approval? Not mentioned
· What type of design(s) was (were) used? Circle all that apply: Experimental; Quasi-experimental; Correlational; Exploratory; Descriptive; Survey; Other: Comparative
· Was sample described? Women who had undergone urogynecologic surgery between Aug 2005 and Dec 2006, performed by gynecologist, and cared for in the postpartum-gynecologic unit.
· What is sample size? N=56 met inclusion criteria (15 pre-implementation, 41 post-implementation)
· Is the sample size, selection, and representativeness adequate and appropriate? Size limited, but only a pilot study. Insufficient pre-implementation numbers, which affects statistical significance.
· What sampling method was used? Randomized; Convenience; Other:
· List the inclusion and exclusion criteria:
- Inclusion: urogynecologic surgery between Aug 2005 and Dec 2006 (suburethral sling, Marshall-Marchetti-Krantz or Burch procedure, vaginal hysterectomy, and anterior/posterior colporrhaphy), surgery performed by gynecologist, women cared for on the postpartum-gynecologic unit after transferring from PACU
- Exclusion: women whose surgery was performed by surgeons other than gynecologists and who were cared for on a unit other than the postpartum-gynecologic unit.
· What is the setting for the study? 572-bed Magnet-designated teaching hospital (postpartum-gynecologic unit)
· Can you identify the variable in the study? Using an evidence-based algorithm to manage POUR and nursing education on urinary retention.
· List key variables:
- Independent (intervention): Using an evidence-based algorithm to manage POUR and nursing education on urinary retention.
- Dependent (outcome): time to first void, length of hospital stay, frequency of bladder assessment, use of intermittent catheterization, length of time for indwelling catheter,
differences in urogynecologic surgery, frequency of PVR measurement, use of the bladder scanner, indications for intermittent/foley catheterization, charting variances
- Demographics: Female, average age 58, undergoing urogynecologic surgery, cared for on the postpartum-gynecologic unit after transferring from PACU.
Data collection, measurement, and analysis:
· Describe the method of data collection: Retrospective charting (chart audits). Patients were divided into two groups according to whether they were cared for pre- or post-implemenation of the voiding trials algorithm. Data collected included date and time of indwelling urethral catheter insertion; date and time of indwelling catheter removal; date, time, and amount of each measured void; date, time, and amount of bladder ultrasound assessment for bladder volume either if patient unable to void or PVR; and date, time, and amount of intermittent catheterization when required by algorithm.
Use of algorithm was evaluated by: a) time to first void, b) measurement of PVR, c) urinary retention >300 ml, d) use of intermittent catheterization, e) measurement of voiding efficiency, f) urinary retention > 500 ml
· Did they make sense to you? Yes. Very descriptive and multi-faceted.
· Are instruments/tools used reliable and valid? The tool used was designed from the evidence in the literature and so was testing. The tool had not been used before. Margin for error because information was based on RN’s charting.
· Describe the method of data analysis: Chi-square test or Fisher’s exact test were used to test for significance for categorical variables. The Mann-Whitney U was used to assess the difference between groups for continuous variables (especially since pre- and post-intervention groups were unequal. Statistical significance was identified as p < 0.05.
Findings/Results and Conclusions
· Results organized logically and presented clearly? Yes. See tables.
· Briefly describe results and the conclusions drawn from them. Are the conclusions consistent with the results? Do the answers make sense? 6 pre-implementation (40%) and 6 post-implementation (14.6%) required reinsertion of an indwelling catheter (p<0.092). There were also fewer intermittent catheterizations performed in the post-implementation group. The pilot study noted an increase in length of stay, but probably associated with more complex urogynecologic surgeries (pelvic reconstructive surgery).
· Are the conclusions discussed in relation to the theoretical/conceptual framework? Yes. Buchko et al. (2013) references the JHNEBP model when standardizing practice based on results with a plan to implement recommendations more broadly (i.e. application to all surgical patients). Buchko et al. (2013) also discusses other studies which demonstrated conflicting and similar results.
· Does the researcher place the report in the context of what is already known about the research question? (e.g., other studies, philosophies) Yes. Buchko et al. (2013) references:
- Lewthwaite and Girouard (2006) – reduction in catheterization after implementing a guideline, did not use bladder ultrasound, decrease lengths of stay
- Fedorkow et al. (2005) – results not accurate with bladder ultrasound
- Teng et al. (2005) – fewer catheterizations improves efficiency of nursing time
- Frederickson et al. (2000) – fewer catheterizations decreases cost
· Are the limitations/biases concerning enough to cause you to question the validity of the results? Limitations: Insufficient sample size (especially pre-implementation group – only 15). Due to limited size, the algorithm needs an ongoing analysis. Only 56% of RNs attended the educational program. Increased nurse participation is required. There was also inconsistent documentation of PVR and bladder assessment. During the study, nurses reported that PVRs were not always measured due related to the unavailability of the bladder scanner.
· Are suggestions for future research included? If so, what are they? A larger comparison group would give more meaning to results. Researchers recommend ongoing analysis of the algorithm.
Professional context:
· Are the implications for practice clearly stated (i.e., how do the conclusions of the study affect my practice)? List the implications: An evidence-based algorithm can improve voiding efficiency, reduce urinary retention, and decrease the incidence of bladder distension among urogynecologic patients.
Summarize one element/finding in this article that you will/will not use in your practice as a result of reading this article. Should the current algorithm we use be applied to inpatients? Should we encourage every patient to void with 3-4 hours of last void? Should we consider voiding efficiency and assess PVR after high risk patients void?
Retrospectively auditing documentation provides a review of the nurse’s knowledge of POUR and use of the algorithm.
What is the level of evidence for this study? Level 6
6 - Single descriptive or qualitative study
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