This assignment will be submitted to Turnitin®.Instructions
Synopsis/Appraisal Final Paper Overview and Instructions
Purpose: This activity is a culmination of all activities and concepts covered in this class. You will summarize and appraise a quantitative study to determine its potential usefulness to inform nursing practice. As part of this analysis, you will determine the rigor of the investigation and appraise credibility. You can do this by answering some key questions about the integrity with which they collected and analyzed data and employed techniques to reduce bias.
Assessment: The final paper is worth 157 points and represents 25% of the final course grade. Graded according to the rubric at the bottom, right hand section of this Brightspace page.
Instructions:
1. Research the importance of the topic and write an introduction that includes these main points:
1.
a. Obtain relevant background information from a credible source other than the article
b. Explain why the topic is important for researchers to explore
2. Write a study synopsis that includes these main points:
a. what known and not known about the topic and what gap in knowledge this study intends to fill
b. research design and setting
c. sample
a. sampling method
b. number of subjects
c. inclusion/exclusion criteria
d. attrition, loss to follow up, or response rate (if any)
e. important characteristics of the sample
d. how the study was conducted
a. explain how the data was collected
b. include measurement instruments and what they measured
c. if the study involves an intervention, how the intervention was carried out
3. Appraise the article in narrative format by answering the following questions.
a. What are the strengths and weaknesses of the sampling method, as applied to this study? Give a rationale for your claims.
a. Be sure to consider the inclusion/exclusion criteria, if any, and extraneous variables that the criteria control for.
b. Were the measurement instruments reliable and valid? Why or why not?
c. If the study was experimental, was the intervention performed consistently? Why or why not?
d. Were the conclusions of the study supported by the results? Why or why not?
a. Include key statistical results and p-values as part of your rationale.
b. Consider study limitations when appraising conclusions with respect to results.
4. State your analysis of the nursing implications based on the findings of the study.
o Take statistical significance into account.
o DO NOT use implications to nursing from the article; provide your own analysis.
5. Complete the APA Checklist and TutorMe session. See the Writing Support content tab for documents and instructions.
6. Submit your article in pdf format and your appraisal and synopsis in Word format with the following filenames.
7.
o Lastname article
o Lastname paper
o Lastname checklist
o Lastname tutorme chat
1
Synopsis and Appraisal of a Study Exploring Music and Hypnotic Suggestion to Manage
Chronic Pain
Studentfirstname Studentlastname
College of Nursing, Resurrection University
NUR4440: Research in Nursing
Professor Carina Piccinini
April 13, 2020
2
Synopsis and Appraisal of a Study Exploring Music and Hypnotic Suggestion to Manage
Chronic Pain
The purpose of this paper is to summarize and appraise a research study that investigated
the effects of music and hypnotic suggestion on patients enduring chronic pain. The Center for
Disease Control and Prevention (CDC, 2016) highlighted that over 60% of drug overdose deaths
involve opioids initially prescribed for pain relief. Therefore, the CDC recommends a shift
toward non-opioid treatment that include many multimodal and multidisciplinary therapy
options. Besides reducing the cost of drug treatment and possible addiction or death, mental
stability and overall quality of life for patients in chronic pain chronic pain would be improved
for patients in chronic pain if it was managed with safer options. Although further research is
being conducted to fully understand the long-term effect of music and hypnosis on chronic pain,
currently they are both considered a method in multidisciplinary therapy.
Summary of the Study
There is a movement in medicine to look at more non-pharmacological treatments for
chronic pain due to possible dependency and the serious side effects risk. With so much interest
in the practice of mind-body interventions, there has already been evidence that shows hypnosis
and music are effective separately for patients in pain, but there is no research on combining the
two interventions for a better outcome. This study addresses that gap by testing the interventions
together.
Johnson et al. (2017) conducted a quasi-experimental study to explore the possible
combined effect of hypnotic suggestion and music to improve components of chronic pain, pain
bothersomeness, anxiety, depression, and distress. Interventions and data collection took place
in the homes of the participants.
Commented [CP1]: This answers “Why is this important
to study?” It’s not just testing out a new intervention…it
goes beyond that to fatalities through the pharmacological
methods that have led to an opioid crisis and finding
solutions for chronic pain management.
The CDC and other healthcare related organizations are
great sources of information on the importance of topics.
Commented [CP2]: What is known (we need new nonpharm methods, music and hypnosis work separately), not
known (do music and hypnosis work better in combo?), and
gap in knowledge (to test the combo).
This information is found in the introduction to every
research article. DO NOT use the discussion/conclusions
section of an article for this information! It will be WRONG
Commented [CP3]: Study being summarized/appraised is
correctly cited.
Specific research design stated.
Setting of study stated.
3
The researchers acquired their samples through a nonrandom snowball sample, where
participants were first referred by physicians from an integrative cancer center in Texas. Later,
patients self-enrolled—a volunteer/convenience sampling method—due to difficulties with
enlisting participants through referral. Twelve participants originally enrolled under the inclusion
criteria of anyone over the age of 18 who was English or Spanish speaking, diagnosed with
cancer or other serious illness, and rated their pain > 4 on an 11-point numerical rating scale.
Two participants were lost to follow up, with a final sample size of 10. The average age of the
participants was 58.3 years, with most of the participants being white (75%), women (67%),
married (58%) and an associate’s degree or higher (55%).
At the beginning of the study for baseline data, each participant completed a
demographic form, the Hospital Anxiety and Depression Scale (HADS), and numeric rating
scales (NRS) to assess pain, pain bothersomeness, and distress. The HADS has a score range of 0
to 42, with higher scores indicating more depression and anxiety. The NRS for the three
variables required participants to rate on a scale of 0 to 10, with 0 representing “none” and 10
representing “worst possible.” Participants were then asked to rate and document their pain daily
upon waking up, as well as before and after the intervention, for two weeks.
The three-part recorded audio intervention was provided to patients for selfadministration. First, participants listened to a 5-minute hypnotic suggestion. Then, they listened
to 15 minutes of string orchestra music (Fantasia on a Theme of Thomas Tallis by Ralph Vaughn
Williams). Finally, they listened to a post-hypnotic suggestion to continue the pain relief attempt.
Researchers called participants once per week for two weeks to discuss progress and remind
participants to record their pain and do the intervention consistently. Data on the same three
numeric ratings scales and HADS were submitted after the second week of the intervention. The
Commented [CP4]: Sampling method stated and
explained.
Inclusion criteria listed.
Exclusion criteria listed.
Loss to follow up explained.
Selected demographics reported with stats.
Commented [CP5]: Measurement instruments defined
with context to values.
When measurements were taken (in this case by the
participants with timing noted).
4
participants were also asked to complete an NRS for Treatment Satisfaction with a range of 0 to
11, with 0 representing “not satisfied at all” and 11 representing “totally satisfied.” The
researcher concluded the study with Study Completion/Dropout interviews, which was
qualitative data to verify treatment fidelity.
Appraisal
The combined snowball and volunteer/convenience sampling method may have attracted
participants that were predisposed to the effects of complementary and alternative medicine
(CAM) methods, creating a potential placebo effect on the intervention. There was no exclusion
criteria; however, a scale to measure the participants’ attitudes toward CAM and including it in
the statistical analysis would have reduced bias considerably. The participants in the sample had
multiple conditions, including musculoskeletal conditions (5), cancer (4), fibromyalgia (2), mood
disorders (3) and inflammatory conditions (3). With the wide range of illnesses, it would be
difficult to draw conclusions about the effect of the intervention on a particular illness or
disorder. For these reasons, the sampling method was not appropriate for an experimental study,
and the lack of exclusion criteria was problematic.
An NRS has been validated for pain in two previous studies, but the authors did not
mention if it has been tested for pain bothersomeness or distress. It is unknown if the scale is
reliable and valid for at least two major variables in this study, bringing into question
measurement error for them. The Treatment Satisfaction NRS has been tested for reliability and
validity in one previous study, and the HADS demonstrated internal consistency reliability with
Cronbach’s alpha scores of 0.83 and 0.84 in previous studies.
Researchers called participants once per week to remind them to adhere to the protocol,
but timing of the calls was not reported. The authors failed to report complete compliance data
Commented [CP6]: The intervention is described, with
additional post-intervention measurement tools stated and
described.
Commented [CP7]: Analysis of sampling method and
inclusion/exclusion criteria. Rationales are fully developed.
Commented [CP8]: Validity/reliability of measurement
tools stated and analyzed.
5
for collection and the intervention, but they did report that 9 of the 11 participants listened to the
audio recording multiple times a day. Due to this, treatment fidelity was compromised by
introducing a “dosing” variable that was not controlled for in the analysis.
The researchers concluded that their findings supported their hypothesis that the
combination of hypnotic suggestion and music help in the reduction of chronic pain in
participants. Each participant reported a reduction in their pain from 6.6 to 5.4, pain
bothersomeness from 7.5 to 5.4, distress from 5.9 to 4.9, anxiety from 7.2 to 6.5, and depression
from 6.1 to 4.1. The conclusion in a reduction in pain is technically correct, but no statistical
significance was calculated or reported in this study, so eliminating chance differences is
impossible. The limitations acknowledged by the authors (small sample size and not controlling
for usual care with pain medication), plus the fact that a majority of participants used the
intervention multiple times a day, means that the conclusions are not fully supported.
Conclusion
The conclusions of this study were not fully supported, but other studies cited in the
article indicate that an effect is evident. Acceptability of the combined intervention was high in
this study, and the limited medical-related cost and lack of complications imply that the
intervention is possible to recreate and practice in many hospitals, clinics, and home settings.
The practice of including hypnotic suggestion and music (possibly of the patient’s choosing and
not the prescribed classical music that some participants in this study complained about) could be
beneficial to a wide range of pain sufferers with no side effects. The study, if nothing else,
implied that patients who are invested in the idea of non-pharmacological pain reduction would
experience the benefit from the intervention. Nurses can use this study and others like it to
further explore the option of hypnosis/music recordings that they can offer to chronic pain
Commented [CP9]: Treatment fidelity explained and
analyzed.
Commented [CP10]: Conclusions analyzed with regard to
results and lack of p values, with consideration of limitations
noted by the authors.
6
sufferers, in hopes of lessening the chronic effects on their acute problems. Patients can selfadminister, reducing the burden of nursing-driven interventions on busy bedside caregivers.
Commented [CP11]: Careful balancing between lack of
conclusive evidence and relative safety and low-cost of
intervention. Specific ideas for nursing implications end the
paper.
7
References
Center for Disease Control and Prevention. (n.d.). Module 2: Treating chronic pain without
opioids. Retrieved from
https://www.cdc.gov/drugoverdose/training/nonopioid/508c/index.html
Johnson, A. J., Kekecs, Z., Roberts, R. L., Gavin, R., Brown, K., & Elkins, G. R. (2017).
Feasibility of music and hypnotic suggestion to manage chronic pain. International
Journal of Clinical & Experimental Hypnosis, 65(4), 452–465.
https://doi.org/10.1080/00207144.2017.1348858
1
Quantitative Synopsis and Appraisal
Studentfirstname Studentlastname
College of Nursing, Resurrection University
NUR4440: Research in Nursing
Professor Carina Piccinini
February 14, 2020
2
Quantitative Appraisal and Synopsis
The purpose of this paper is to summarize and appraise a research study testing the use of
disinfectant caps on intravenous (IV lines) to reduce the rate of hospital associated bloodstream
infections (BSI). The Centers for Disease Control and Prevention (CDC, 2019) reports that
central line associated bloodstream infections (CLABSI) remain a major concern in hospital
settings causing fatalities, increased length of stay, and increased costs. The CDC (2019)
recommends proper maintenance of intravenous lines to reduce the risk of infection. Current
research is still looking to define what proper maintenance should be, including whether
disinfectant caps influence rates of infection for intravenous (IV) lines.
Summary of the Study
The CDC recommends that healthcare workers disinfect all needleless connectors for
peripheral and central IVs prior to connection to reduce the risk of CLABSIs without further
recommendation on the type or length of disinfections. The authors of this study note other
studies have tested disinfecting caps and sought to confirm those results.
Merrill et al. (2014) conducted a quasi-experimental study to identify if disinfectant caps
reduce CLABSI incidence and the relationship between nursing compliance with the caps and
CLABSI rates. This study was held in a single Trauma 1 hospital with 430 beds in the United
States.
The researchers obtained their sample through nonrandom convenience sampling by
including all patients meeting inclusion criteria at the hospital starting January 2012. Participants
were included if they had a central or peripheral intravenous line, of any age, and were admitted
to 13 specific hospital floors. Subjects were excluded if they were on the following floors:
emergency department; labor, delivery or post-partum; ambulatory care, surgical services; and
Commented [CP1]: This answers “Why is this important
to study?” It’s not just ensuring our patients do not get
CLABSIs…it goes beyond that to fatalities, length of stay in
hospitals, and healthcare costs.
The CDC and other healthcare related organizations are great
sources of information on the importance of topics.
Commented [CP2]: What is known (recommendation to
disinfect ports), not known (what specifically should be
used), and gap in knowledge (confirmation of other study
results).
This information is found in the introduction to every
research article. DO NOT use the discussion/conclusions
section of an article for this information! It will be
WRONG.
Commented [CP3]: Study being summarized/appraised is
correctly cited.
Specific research design stated.
Setting of study stated.
3
well-baby nursery. The study did not report any demographic information about participants, the
number of participants, or attrition or loss to follow up.
The intervention involved applying a Curos brand disinfectant cap to all ports on
peripheral lines, central lines, and IV tubing when not in use on patients. The nurses on the
involved units were trained on the use of the disinfectant caps with a 1:1 follow up by the
researchers. Nurses were then responsible for placing caps. The researchers intermittently
observing nurses for compliance to the intervention and reporting compliance to nursing
departments twice a week.
CLABSIs were defined as a positive blood culture drawn within 48 hours symptom onset,
and CLABSI information was retrieved from medical record audits presumably, although the
authors never explicitly state how they collected the data. CLABSI information was collected for
12 months prior to the intervention and during the 12 months following the intervention for
comparison.
Appraisal
The sampling method for this study included all patients with peripheral or central lines,
with data collection for CLABSIs both pre- and post-intervention. Given that a control versus
experimental group design and sampling may have made it difficult to control for extraneous
variables due to variations in patient conditions and the number of connector access attempts, the
sampling method was appropriate. Inclusion and exclusion criteria were included in the report.
The exclusion criteria eliminated areas with rapid turnover in patients who would not have IV
lines placed at all or for very long. This adequately ensured that the CLABSI rate would not be
skewed positively by short-term IV access. If these care areas had been included, the dwell time
of the line, not the presence or absence of the Curos caps would logically be the primary cause of
Commented [CP4]: Sampling method stated and
explained.
Inclusion criteria listed.
Exclusion criteria listed.
Selected demographics/characteristics, sample size, and loss
of sample size was not included in the article, but that is
clearly stated in the paper.
Commented [CP5]: Description of the intervention for this
experimental study.
Commented [CP6]: The variable for the study (CLABSI
rate) defined and how it was measured is stated. The
timeframe in which the variable was measured is also stated.
Commented [CP7]: Appraisal of the sampling method
with rationale for its appropriateness.
4
a low CLABSI rate.
Intervention fidelity was met through training the nurses and 1:1 follow-up. However,
the mere fact that compliance rate was audited indicates that intervention fidelity, i.e. compliance
with the intervention, was questionable. In addition, the authors did not include the actual
compliance rate of the intervention in the article, which affects the credibility of the overall
findings.
Although the measurement of CLABSIs using medical records has inherent bias, it was
the only feasible way to obtain the data. Missing data in the medical record was not reported by
the researchers, which affects the validity of the data. The researchers did not explain fully how
they observed if the disinfectant caps were on all patients or how compliance was counted,
leading to a reliability issue. In fact, the authors state that nurses complained that ports high on
IV tubing were being counted against them as noncompliance when there is no research
indicating whether caps should be placed on those ports. Therefore, measurement bias for cap
application and compliance could be quite high for this study.
According to the results, the mean rate of CLABSIs was 1.5 for 12 months before
implementation and 0.88 for 12 months after implementation, and the authors concluded that the
use of disinfectant caps decreased the rate of CLABSIs. Of note, the difference in mean rates
before and after the intervention was not tested for statistical significance. Using a different
statistical method, the authors found that the incident rate ratio after implementation was
statistically significant, causing a 40% drop in BSIs. The authors acknowledged that ongoing
education about reducing BSIs and using central line bundles was given to nurses independent of
the study protocol. This extraneous variable was not measured nor included in the results or
conclusions of the study, leading to a large chance of bias in attributing the CLABSI decrease to
Commented [CP8]: Explanation of what the exclusion
criteria was controlling for and appropriateness.
Commented [CP9]: How the intervention was kept
consistent with analysis of its effectiveness.
Commented [CP10]: Analysis of validity and reliability of
the measurement tools (medical records and observations).
Commented [CP11]: Analysis of the conclusions
compared to the statistical results. Lack of statistical
significance being calculated for the change in the CLABSI
rates before and after the intervention is explained.
5
the disinfectant cap intervention alone.
Conclusion
This study indicates that disinfectant caps could reduce rates of bloodstream infections.
However, given the fact that certain aspects of the study as explained in the appraisal may have
influenced results in favor of disinfectant caps, more research with fewer extraneous variables
interfering with results needs to be conducted.
Although the difference in CLABSIs before and after the intervention was not tested for
significance, there is evidence of a reduction in BSIs in this study, and the CDC (2019) does
recommend disinfection to BSIs in hospitals. Therefore, the implications of this and other
research exploring the same issue is that nurses should be compliant with existing facility
protocols for intravenous line maintenance, regardless of the method used. Nurses should also
advocate for all patients by providing reminders and education to peers that do not adhere to
protocols or best practices, as they are now defined. Nurses could also advocate and participate
in hospital-based studies to test nursing interventions intended to decrease BSIs. Commented [CP12]: Nursing implications of the study,
taking into account the validity of the conclusions/results,
limitations, statistical significance, and other research noted
in the report.
6
References
Centers for Disease Control and Prevention. (2019). Bloodstream infection event [PDF file].
Retrieved from https://www.cdc.gov/nhsn/pdfs/pscmanual/4psc_clabscurrent.pdf
Merrill, K. C., Sumner, S., Linford, L., Taylor, C., & Macintosh, C. (2014). Impact of
universal disinfectant cap implementation on central line–associated bloodstream
infections. American Journal of Infection Control, 42(12), 1274–1277.
https://doi.org/10.1016/j.ajic.2014.09.00
