RESEARCH CRITIQUES AND PICOT STATEMENT FINAL

RUNNING HEADER: QUALITATIVE RESEARCH CRITIQUE AND ETHICAL CONSIDERATIONS 1

QUALITATIVE RESEARCH CRITIQUE AND ETHICAL CONSIDERATIONS 7

Qualitative Research Critique and Ethical Considerations

Angelique Christoffel

Grand Canyon University

Nurs 433V

June Helbig

August 23, 2020

Qualitative Research Critique and Ethical Considerations

The following critical appraisal of two studies is based on the PICOT question; In mental health patients with substance use disorders, does treatment, compared to non-treatment, reduce readmissions within 90 days? The articles chosen for the appraisal are "Qualitative study of perspectives concerning recent rehospitalizations among a high-risk cohort of veteran patients in Connecticut, USA" by Antony, Grau, and Brienza, and "Contribution of Psychiatric Illness and Substance Use to 30-Day Readmission Risk" by Burke, Donzé, and Schnipper.

Background of Study

In the article by Antony et al., the authors note that hospital readmissions have been a rising problem that has now become a national issue. It is said that readmissions are related to increased cost, and the relationship between quality of care and readmissions has been vague. Besides, the costs that readmissions incur, readmissions cause more complications for patients such as chronic comorbidities and increase impaired functional status, which makes increases their risk of death (Antony et al., 2018). Moreover, there have been system-level factors that have been associated with increased negative patient outcomes of death and rehospitalization. The study focuses on veteran affairs. These patients are at a higher risk of rehospitalization due to their older age, poor or lack of social support, low socioeconomic status, and pre-existing comorbidities (Antony et al., 2018). The study's objective was to explore patients' perceptions about the factors that contribute to rehospitalization and recommendations that minimize this risk.

In the article by Burke et al., the authors also note that readmissions are costly, especially among psychiatric patients. The study seeks to investigate the influence of psychiatric illness to readmission risk. According to the study, a psychiatric sickness may contribute to readmissions within the first 30 days, which is related to increased resource utilization (Burke et al., 2013). In New York hospitals, for example, mental illness patients discharged from the hospitals were more likely to be readmitted than their counterparts without mental illnesses. This resulted in an increased length of stay by approximately a day on average (Burke et al., 2013). The study's objective was to evaluate the independent contribution of psychiatric illness and substance abuse to the potentially avoidable 30-day readmissions in medical patients. The study's purpose is to determine the function of psychiatric illness and substance use in the risk for medical readmission.

How do these two articles support the nurse practice issue you chose?

According to the objectives of the two studies, it is clear that both studies are set to find the relationship between readmissions and psychiatric illness and substance use, and other factors that affect readmissions and how to reduce the risk. Antony et al. (2018) found that the participants cited structural barriers such as the inability to access primary care providers and restricted involvement of care providers in medical choices as the main factors, although some thought that readmission could not be prevented (Antony et al., 2018). The study found that the most effective intervention was to increase primary care providers during medical decision-making about readmission alongside effective communication between patients and their families (Antony et al., 2018).

Burke et al. (2013) found that patients treated for mental illnesses were at a higher risk of avoidable readmissions, while outpatient clients prescribed with psychiatric medication were at a higher risk for all-cause readmissions. The study suggests that inpatient medical providers' compulsory community treatment and follow-up would be helpful interventions to reduce readmission risk (Burke et al., 2013). These interventions relate to the PICOT question since they are non-treatment options that would help reduce readmissions in mental illness patients.

Method of Study

In the article by Antony et al., the study was qualitative and purposive sampling. It was applied to employ potential veteran affairs (VA) patients who were above 18 years, readmitted within the last 30 days after discharge, and were mentally competent to give consent and were medically stable. The participants were determined through a retrospective chart review, and a talk was held with the ward nurse for admissibility (Antony et al., 2018). After that, interviews of between 20-30 minutes were held, and audiotapes and all participants gave their written consent. An advantage of using the interviews was that it identified essential contextual factors that would not be otherwise found in a qualitative study (Antony et al., 2018). However, the study involved a small sample size through a non-probability method that limited the probability of generalization. Moreover, the study mostly involved Caucasian male patients; therefore, it would not accurately present the theme across all VA patients and females.

The study by Burke et al. (2013) was a reflective group study of repeated adult patients cleared from the Brigham and Women's Hospital. The study used a mixture of inpatient and outpatient administrative and clinical data to recognize study participants. Patients were excluded if they left against medical advice or were discharged to another facility. The exclusion was also made in the case of death within the facility. The study approach allowed for quick identification of a large cohort unaffected by selection bias (Burke et al., 2013). The disadvantage of the study method was that it was single-centered and limited generalization while limiting its ability to diagnose psychiatric disease conclusively. The two study methods differed in sampling methods since one used probability sampling, while the other used non-probability sampling.

Results of Study

In the article by Antony et al., the mean age of the participants was 71.6 years, with all participants having previous medical situations or accounts of mental disorders. Of the 18 participants, 17 were male and one female (Antony et al., 2018). The participants noted that inaccessible care providers and limited care provider involvement in their readmissions contributed to their readmissions. However, there were some that thought that readmission was inevitable.

In the article by Burke et al., there were 1260 readmissions out of 6987 discharged patients (18%), where 5.6% (388) readmissions were potentially avoidable. The multivariate analysis found that two or more prescribed outpatient psychiatric drugs were related to increased all-cause readmissions. In contrast, the discharge diagnosis of substance abuse or anxiety was related to fewer all-cause admissions (Burke et al., 2013). According to Antony et al., (2018), strategies such as proactive post-discharge outreach for high-risk patients, increased access for patient care, and patient education was essential in light of the results. The study by Burke et al. suggests that their findings be used to stratify patients in hospital facilities in terms of risk.

Ethical Considerations

Ethical considerations in research involve processes such as protecting the rights of the subjects, and publication of research information. Some of the issues include informed consent and respect for anonymity and confidentiality. Informed consent means that the participants are fully aware of their participation in the research, and knowingly agree to participate by giving a clear and manifest consent. In the article by Antony et al., the participants gave a written consent form, which they submitted before the study commenced (Antony et al., 2018). Respect for confidentiality and anonymity is expressed when a person's identity is not connected to their responses, and the participant's identity is protected. Moreover, both studies ensured confidentiality and anonymity by protecting personal information and only publishing medical information relevant to the studies. The study participants' identities were not revealed in the studies.

References

Antony, S. M., Grau, L. E., & Brienza, R. S. (2018). A qualitative study of perspectives concerning recent rehospitalizations among a high-risk cohort of veteran patients in Connecticut, USA. BMJ Open, 8(6), e018200.  https://doi.org/10.1136/bmjopen-2017-018200

Burke, R. E., Donzé, J., & Schnipper, J. L. (2013). Contribution of psychiatric illness and substance abuse to 30-day readmission risk. Journal of Hospital Medicine, 8(8), 450-455.  https://doi.org/10.1002/jhm.2044