[Most papers would have an introductory paragraph prior to the first level heading. This is being omitted in this assignment template]
Title
The title for the article critiqued is, “Perceived benefit of a telemedicine consultative service in a highly staffed intensive care unit,” (Romig, et al., 2012). This title is clearly stated, precise and very telling about the research that was conducted.
Research Problem
The research problem is not clearly stated in the abstract of the article. However, in the introduction the first two paragraphs give background information pertinent to the research problem and the third paragraph explains the problem. The problem the article identified is studies that failed to show a benefit after the implementation of tele-ICU may be a result of staff perception (Romig et al., 2012). The article further explained that tele-ICU may be perceived as a threat to unit processes and culture (Romig et al., 2012).
Research Purpose
The research purpose is clearly stated in the abstract of the article. The purpose defined,
“the aim of this study was to evaluate whether a nocturnal telemedicine service improves culture, staff satisfaction, and perceptions of quality of care in a highly staffed university critical care system,” (Romig et al., 2012). The purpose is only clearly stated in the abstract; however, the introduction does thoroughly explain the purpose. Also, the study does effectively evaluate the purpose through method of data collection.
Research Hypotheses
[This heading was moved to the next page because it did not fit with the first sentence of the associated paragraph on the previous page] Commented [LR1]: This is called widow/orphan control. The research hypotheses is well written and clearly stated in the third paragraph of the introduction. Directly stated, “We hypothesized that an effective tele-ICU could improve communication with and satisfaction of the bedside nurse providers,” (Romig et al., 2012). The authors’ clearly identified the hypothesis in this study which is rare. Many times the hypothesis is inferred from the article.
Literature Review
The literature review for this study defines telemedicine, how it works, and the benefits
of telemedicine implementation. However, this article explains there has only been one other study to evaluate the staff perceptions of telemedicine consultive services (Romig et al., 2012). This literature review thoroughly explains the background information needed and supports the need to further investigate the research hypotheses. All of the studies and articles cited are current within 12 years from the publish date of this study.
Variables
Grove and Gray (2019) describe variables as being dependent or independent. For this
study the independent and dependent variables can be identified in the purpose statement. The independent variable is the implementation of telemedicine. The dependent variable is the effect of the independent variable on the nursing staff satisfaction and perception of quality of care. In addition the hypotheses identified a third dependent variable of improved communication with the bedside nurses (Romig et al., 2012). The variables of this study are easily identified and evaluated through the methods used.
Human Subjects [Widow/orphan control]
This study has two sets of human subjects the patients and nurses. The population evaluated for patient information included all patients admitted to the two ICU’s during the intervention and all patients admitted pre-intervention for the same dates one year prior (Romig et al., 2012). It was determined by the internal review board for this hospital that informed consent was not needed to extract the information needed from the patient’s charts because no specific patient identifiers would be used in this study. This study also collected data through surveys sent to the nurses who worked in these two ICU’s. It was not discussed how informed consent was obtained from these participants. It would have been more through if the authors would have explained this.
Design
This study used a reversed-treatment nonequivalent comparison group with pretest and posttest quasi-experimental design. This study has a treatment of using the tele-ICU with one ICU at a highly staffed university hospital while another ICU in the same hospital does not get that intervention/treatment (Romig et. al., 2012). The experimental and control group were compared to evaluate the intervention of the tele-ICU (Romig et. al., 2012).
Sample
This study utilized stratified random sampling. The criteria identified for the nurse participants were nurses who worked in the two ICUs before, during and after the implementation of tele-ICU. The criteria for the patient population would be any patient admitted to these units 1 year prior to the study on the same dates and during the study. The authors of this study thoroughly discussed the sample population and how the population was chosen.
Measurements and Data Collection
This study measured the nursing staff satisfaction, perception of quality of care and communication after the implementation of the telemedicine intervention (Romig et al., 2012). The data collection was obtained through pre and post-intervention surveys. The survey tool used was adapted from a previously published and validated study to assess the perceptions of the implementation of a 24-hour staffing model (Romig et al., 2012). The survey tool used organized the data into five domains: perceived effectiveness, communication and relations within the unit, psychological working conditions and burnout, and job satisfaction and intention to quit (Romig et al., 2012). The final survey contained 26 questions and respondents were assigned a numeric identifier to match pre and post surveys (Romig et al., 2012).
Data Analysis
The responses from the surveys were collected into, “an Access 2007 database…and
Prism v5.03…software,” used for analysis of the data (Romig et al., 2012). The questions were compared for each individual ICU and the mean calculated for the pre/post-intervention responses (Romig et al., 2012). Responses were compared using the Student t test or Wilcoxon signed rank test (Romig et al., 2012). The results used 95% confidence intervals and P values of less than 0.05 were statistically significant (Romig et al., 2012).
Statistics
Five of the questions of the post-intervention survey reached statistical significance. These five questions have a P value of less than 0.05. The questions were in two subgroups that demonstrated improvement in the study ICU: relations and communications and job satisfaction
(Romig et al., 2012). The survey results for the study ICU were 17 questions trended favorably, four questions were unchanged and five trended unfavorably (Romig et al., 2012). However, the only questions that reached statistical significance trended favorably.
Discussion/Interpretation
This study makes the claim that it is the only study to date that has evaluated the perception of the tele-ICU from the staff while using a control and experimental unit (Romig et al., 2012). Over all this study found that in a highly staffed intensive care unit the implementation of the tele-ICU can benefit the perception of care, communication, and staff satisfaction (Romig et al., 2012). The authors also note that no other quality or cultural improvements were implemented during the study in either of the ICUs utilized (Romig et al., 2012). This study did a thorough job of isolating the intervention of the tele-ICU to truly evaluate the effect on the culture and staff of a highly staffed ICU. Doing this almost eliminates the possibility the results are invalid due to extraneous variables that are not accounted for.
Summary of Strengths and Weaknesses
The authors of this study recognized several weakness: insufficient power to evaluate patient outcomes, cannot confirm the results would be the same over a longer period of time, and survey evaluation tool was not formerly validated (Romig et al., 2012). The weakness of insufficient power to evaluate patient outcomes is explained as beyond the scope of this study (Romig et al., 2012). This study was conducted over a relatively short period of time so it cannot be known if the results or improvement would continue or if other factors would influence the outcome (Romig et. al., 2012). The survey tool used was previously validated in a different study. However, for this experiment changes to the instrument were made. After these changes were made the researchers did not validate the tool in the use of this study. The authors note the changes made are not likely to bias the outcomes (Romig et al., 2012). Other influences noted about this study are the nurses in both ICUs were aware of the implementation of the tele-ICU. This was noted as a possibility of influence the results of the control ICU. Also it was noted that this institution has the expectation that employees will participate in project improvements so the results may not be generalized (Romig et al., 2012).
Nursing Practice
This study was able to correlate the implementation of tele-ICU with improved communication, improved perception of care, and improved staff satisfaction (Romig et al., 2012). The implications for nursing practice are to embrace the use of telemedicine consultive services in the ICU as a tool to better care for the patients. Through working together with the telemedicine service the care of the patient can be improved. Also the communication among the critical care team can become clearer. Embracing the potential care improvements is important to properly utilize the tele-ICU service. It is important to know that tele-ICU is a tool for quality care improvement not a replacement for the bedside team.
Conclusion [Most papers include a conclusion. It is not needed for this assignment.]
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References
Grove, S.K., & Gray, J.R. (2019). Understanding nursing research: Building an evidence-based practice (7th ed.). Elsevier
Romig, M. C., Latif, A., Gill, R. S., Pronovost, P. J., & Sapirstein, A. (2012). Perceived benefit of a telemedicine consultative service in a highly staffed intensive care unit. Journal of Critical Care, 27(4), 426.e9-426.e16. https
