HLSC122 Evidence for Practice

Introduction

Critical appraisal based on a specific paper or research findings generally considered as one of the beneficial and effective ways to enhancing the quality of the evidences in nursing or clinical field. In this paper the article, “Impact of hand dominance on effectiveness of chest compressions in a simulated setting: a randomized, crossover trial”, which was conducted by Cross et al, (2019) will be critically apprised with the help of a significant tool called CASP or Critical Appraisal Skills Program checklist. Besides that, this paper will also cover, application of clinical findings and its significance.
Identifying a clinical problem

Nowadays, cardiac issues and complications are one of the most common incidents in health care sector. Nurses have deal with several types of cardiac disorders. Among them the rate of patients with sudden cardiac arrest is also increasing day by day. The significant of external cardiac compression on increasing patient survival outcomes has been known to all (Bastami et al., 2019).  The hand dominance of recourse often impacts the chest compression process. According to some of papers and researches it has been found that the effect of hand dominance plays a significant role in this process (Jiang et al., 2016). However, there are lack of evidences regarding the effect of hand dominance on the ECC. Hence, it is one of the clinical issues that should evaluate through more researches (Nestaas et al., 2016). In this context, for getting proper information regarding the use and effect of hand dominance on ECC the study of Cross et al, (2019) was conducted.

Research question and justification

“Does hand dominance have a significant effect on chest compression in a simulated setting?”

The research question has been clearly identified in the paper. after going through the paper, it can be stated that the research question is justified as the aim of the paper is to evaluate the effectiveness of hand dominance on chest compression. And this should be considered as one of the important aspects of research as this process have several significant benefits such as in preventing sudden cardiac arrest absence of tools and instrument (Kim & Oh, 2019). In addition, proper knowledge and education regarding the technique of chest compression by using hand dominances among rescuers should present.

Critical Appraisal

In this critical appraisal CASP tool will be use, this is one of the significant tools for critical appraisal. In order to apprise various types of evidences critically this tool have a huge role. This tool consists different questions on different aspects of a research paper as per the hierarchy of evidences, randomized controlled trial considered as second most important evidences (Naidoo et al., 2020).

Study design

Proper study design able to provide better outcomes of research (vanDijk et al., 2016). After going through the title and basic of the paper it can be stated that, yes, the study has been able to address a clearly focused research question. The research question is focused on population studied, as the author select participants from university student. Comparison was done between dominance and non-dominance effect on ECC.

Ethical approval

Ethical approval was taken from the Western Sydney University Human Research Ethics Committee (approval number HREC 11036).

Sample size

In order to conduct this research, the sample size selected by the researcher were the participants of the Western Sydney University, in simulated setting. They set some inclusion criterion such as those people will able to participant in this study who have a valid first aid certificate on physiotherapy, occupational therapy and podiatry. At first total 75 students of this university enrolled for this study, however at the end of the study 66 students were followed up and completed this study.

Data collection

The selection of participants was done by following randomized process. The paper is single blinded, and participants were blinded to the research question. Participants were asked to take part in a study that looked at general CPR results, but they were kept blind about the main research issue at all times to avoid performance bias. As natural reactions of the students are important to evaluate more accurately the effect of hand dominance on ECC.

Data analysis

Data analysis is one of the significant parts in every research process (Ali et al., 2016). After going through the data collection and computer-based randomization process, it can be said that proper protocols of randomized control trails were adhere in this study. Analysis of this study was done as per the data and responses of the students with the help of Stata© version 13. Descriptive statistics was done that provides data about variables on primary and secondary outcomes (Kaliyadan & Kulkarni, 2019). The result of the study revealed that, Differences in chest release depending on hand dominance did not result in clinically relevant improvements in external cardiac compressions total efficacy.

Strengths and weakness

The strength of this study is that, the study is single blinded. Hence, it reduces the chance of biases in the study. Lack of experience among student is one of the important weakness of this study.

Limitations

The participants of this study are undergraduate students, who have no clinical experiences from real life. Another limitation is there was no investigation of the relationship between hand dominance and "side of approach". Besides that, limitations regarding applicability of these results to real-world resuscitation on real patients during real-world resuscitation.

Application of evidence in the clinical area

As there are lack of evidences regarding the impact of hand dominance on ECC, in this context, this study has a significant role in evaluating this issue and its applications for better result or outcomes among cardiac patients. The findings of the analysis were derived using a manikin technique and are linked to the efficacy of hand dominance on external chest compressions. This study involved undergraduate students by using randomized single blinded process to get bias free natural responses from them and it’s impact on ECC.  According to the paper the students were selected in this study were from a local university and total experiment was done by local people. Thus, the findings would benefit the local population since the research focuses on the effect of using the dominant hand on the chest during the ECC method. The study's population was made up of local people, resulting in findings that were relevant to the community. However, there are some research gap and limitations are also present such as the participants in this research are university students who do not have a comprehensive understanding of the issue, do not hold a primary paramedic's degree, and have no clinical experience. This can be seen as a possible constraint that could slightly alter the outcomes (Choi et al., 2018). In addition, the study was conducted in a simulated setting, and as per the several researches it is revealed that in most of the cases differences occur between simulated and real-life cases. And another important aspect of the issue that have not been studied in this paper is investigation of side approaches, there still remain some confusion regarding this part. There are several experiments that emphasizes the side approach in order to perform ECC (Jiang et al., 2016).  After going through this paper, it can be stated that, the application of the findings of this study may help in further clinical fields, however, more researches and evaluation is needed in this topic by maintain all research protocols in order to utilize the findings in real life clinical issues.

Conclusion

Cardiac issues and complications are one of the most common incidents in health care sector. Nurses have deal with several types of cardiac disorders. Cardiac arrest is one of them, the topic of the selected paper has a significant aim to evaluate the impact of hand dominance on external cardiac compression. Critical appraisal of that paper is done in this paper. This paper covers all the fundamental elements that needed for performing critical appraisal of a research paper including study design, sample size, data collection, data analysis, strengths, weakness and limitation by using CASP tool.

References

Ali, S. M., Giordano, R., Lakhani, S., & Walker, D. M. (2016). A review of randomized controlled trials of medical record powered clinical decision support system to improve quality of diabetes care. International journal of medical informatics, 87, 91-100.https://www.sciencedirect.com/science/article/abs/pii/S138650561530085X

Bastami, M., Soliemanifard, P., Hemmati, R., Ameri, G. F., Rasouli, M., & Shohani, M. (2019). A comparison of the effect of two methods of positioning the hands during basic and advanced cardiovascular life support on the chest compression depth in adults. Journal of cardiovascular and thoracic research, 11(4), 314. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6891040/

Choi, H., Lee, C. C., Kim, H. J., & Singer, A. J. (2016). Identifying the optimal hand placement site for chest compression by measuring hand width and sternal length in young adults. The American journal of emergency medicine, 34(3), 407-411.https://www.sciencedirect.com/science/article/abs/pii/S0735675715009596

Cross, J., Lam, T., Arndell, J., Quach, J., Reed, B., Thyer, L., & Simpson, P. M. (2019). Impact of hand dominance on effectiveness of chest compressions in a simulated setting: a randomised, crossover trial. Australasian Journal of Paramedicine, 16.https://doi.org/10.33151/ajp.16.672

Jiang, S., Jiang, C., Zhao, Y., & Bing, X. U. (2016). Effects of dominant hand in contact with sternum on the quality of external chest compression on high-fidelity manikin. Chinese Journal of Emergency Medicine, 25(1), 33-37.http://wprim.whocc.org.cn/admin/article/articleDetail?WPRIMID=490433&articleId=490433

Kaliyadan, F., & Kulkarni, V. (2019). Types of variables, descriptive statistics, and sample size. Indian dermatology online journal, 10(1), 82. https://dx.doi.org/10.4103%2Fidoj.IDOJ_468_18 

Kim, C. W., & Oh, J. H. (2019). Effect of metronome guidance on infant cardiopulmonary resuscitation. European journal of pediatrics, 178(6), 795-801.https://link.springer.com/article/10.1007/s00431-019-03357-0

Naidoo, N., Ravaud, P., Young, B., Amiel, P., Schanté, D., Clarke, M., & Boutron, I. (2020). The research burden of randomized controlled trial participation: a systematic thematic synthesis of qualitative evidence. BMC medicine, 18(1), 1-11.https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-019-1476-5

Nestaas, S., Stensæth, K. H., Rosseland, V., & Kramer-Johansen, J. (2016). Radiological assessment of chest compression point and achievable compression depth in cardiac patients. Scandinavian journal of trauma, resuscitation and emergency medicine, 24(1), 1-8.https://sjtrem.biomedcentral.com/articles/10.1186/s13049-016-0245-0

van Dijk, M. R., Oostingh, E. C., Koster, M. P., Willemsen, S. P., Laven, J. S., & Steegers-Theunissen, R. P. (2017). The use of the mHealth program Smarter Pregnancy in preconception care: rationale, study design and data collection of a randomized controlled trial. BMC pregnancy and childbirth, 17(1), 1-7.https://link.springer.com/article/10.1186/s12884-017-1228-5

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