According to Craig and Smyth (2002) cited in Boswell and Cannon (2010:Chapter) “Evidence-based practice has emerged from the desire of the majority of healthcare providers (both institutions and individual) to do what is right for the patient and what will result in more good than harm.” The Nursing Council of Hong Kong has devised a Code of Ethics for an accurate representation ofNurses’ ethical responsibilities since 1999. Code of Professional Conduct and Code of Ethics for Nurses in Hong Kong (2002:7) states that: “The nurse is responsible for ensuring that the standard of nursing practice is congruent with the agreed standards of the profession and participates in identifying, implementing and also evaluating evidence-based practice"
Paper 1 Wang L & Chien W (2011) Randomised Controlled Trial of a family led mutual support programme for people with dementia. Journal of Clinical Nursing, (20) 2362-2366 1 Did the trial address a clearly focused issue?
No, there is no research question and there is no hypothesis stated. The PICOT format is a helpful approach for summarizing research questions that explore the effect of therapy (Guyatt et al 2008). This study could be constructed in PICOT format in this way, the health outcome (Outcome) of caregivers and their family member with dementia resided in the community after a family-led mutual support group programme (Intervention) is delivered to the caregiver (Population) compared to whom the intervention not delivered (Control) over a 6-month follow-up period The population studied was well indicated, however physical condition of caregivers was not take into account, also the hours of caregiving for patient per day was important to identify the equality of the population studied. The comparator and the outcome were well described. The intervention were not well described in the research, whether it was in group discussion, workshop, role play, individual sharing or talk. the whole process and details was not clearly described.
2 Was the assignment of patients to treatments randomized?
Yes, the study was a randomized control trial study, as it was comparing the health outcome of clients with dementia and their caregivers who participate in family-led mutual support group programme to those without. The randomization was done by computer generated numbers. However, the randomized control trial is a study in which people are allocated at random to receive one of several clinical intervention (Jadad 1998), but no interventions was target to dementia patients directly .
3 Were all of the patients who entered the trial properly accounted for at its conclusion 97.5% of patients in both groups were accounted for this study. 95.0% of the families completed the family-led mutual support group programme (intervention group), 100% of the families in the control as receiving routine care were recruited as the control group. Intention-to-treat analysis was used as in the study one patient was died in both control and treatment group, and no family in both groups dropped out from the study. (Li & Wai 2011) Intention-to-treat analysis is usually described as Hennekens et al (1987: 207) “once randomized, always analyzed”, which includes every subject who is randomized according to randomized treatment assignment. It ignores anything that happens after randomization, such as withdrawal, protocol deviations and noncompliance. This avoids overoptimistic estimates of the efficacy of an intervention and distort the results. (Sandeep 2011)
4 Were patients, health workers and study personnel ‘blind’ to treatment? According to Schulz and Grimes (2002: 696) “The term blinding refers to keeping trial participants, investigators (usually health-care providers), or assessors (those collecting outcome data) unaware of the assigned intervention, so that they will not be influenced by that knowledge”. In the study, the participants were not unaware of...
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