HLSC122: Nursing - Evaluating usefulness of Evidence - Assessment Answer

Nursing Assignment

Case Scenario/ Task

The intention of a researcher when undertaking a study is to provide evidence which is useful, either practically, or in furthering research. Any research which is undertaken is based on this research. The evidence which is provided by studies can be used to various scenarios. In this case, the evidence provided by Von Haaren et al., (2015) and Kim, Yang and Schroeppel (2013) are studies which have investigated emotional stress and how to deal with stress using two different techniques aerobic exercises and using Kouk Sun Do. The articles are evaluated based on a scenario which involves Mariana who is a first year student in a university with concerns on interacting with their students as a result of her difference in priority to her 18 month old daughter. In addition, she had a difficult birth with her daughter suffering from severe asthma and Mariana suffering from diabetes as well as a rare blood disorder. The following is a discussion of the quality of each paper by analysing the level, type, and location of evidence, in the hierarchy and its strengths and weaknesses. The discussion of the paper further involves identification of the article which provides the strongest evidence which is related to Mariana’s scenario.

Critical Review of First Article

The first article is by von Haaren et al., (2015) titled, ‘Reduced emotional stress reactivity to a real life academic examination stressor in students participating in a 20 week aerobic exercise training: A randomised controlled trial using Ambulatory Assessment’. The study was aimed at examining whether 20-week aerobic exercise interventions (AET) results to decreased emotional stresses. The study utilised a randomised controlled trial whereby 61 students were assigned into a control group while others in the AET. The studies utilised electronic diaries to capture data whereby the participants reported their moods as well as experienced stress over 2 days before and after the intervention occurred. The pre-test begins at the start of the semester while the post intervention occurred during a stressful time during the academic examination sessions. The study concluded that emotional stress reactivity was observed n both group in the periods. However, AET participants illustrated lower stress levels compared to those in the control group. As such, according to this study, AET have beneficial impacts on stress levels when the participants had stress during the exam time.

In addressing the quality of evidence provided by an article and its usefulness, there are a number of elements which needs to be considered. These include type of evidence, location of evidence on evidence hierarchy, level of evidence as well as its strengths and weaknesses. Jekauk et al, (2013) argues that when evidence is protected against various forms of biases, it results to more confident in decision making. It is important for individuals to apply evidence in the care of the individual patient a in the case scenario.

According to NHMRC, there is an evidence hierarchy with categorisations of evidence into different levels (NHMRC, 2000). The levels include level I, II, III-1, III-2,III-3, and IV; level I involves a review of level III studies; level II involves a randomised controlled trial studies; level III-1 involves a pseudo-randomised controlled trials; level III-2 involves comparative analysis of either case control study, cohort study and non-randomised experimental (Whiting et al., 2003); level III-3 is a comparative study having no con-current controls with the historical control studies which have no guarantee control group; and finally level IV involves having both post and pre-tests outcomes (NHMRC, 2001).

According to the analysis above, the NHMRC (2000), level II involves a randomised controlled trial. Von Haaren et al., (2015) are level 11 in NHMRC’s evidence hierarchy. This is due to using the randomised controlled trial whereby it is accurately tested using an independent as well as blinded comparison with a valid reference standard. As illustrated by Whiting et al., (2003), this involves determining the situational elements at hand with the criteria determining validity of reference standard required to be stated beforehand. Level one is considered to provide the highest forms of clinical evidence.

There are different types of evidences as described below. Statistical is a type of evidence which is utilised and relies on statistics and numbers while testimonial evidence involves qualitative data and analysis to prove a point. On the other hand anecdotal evidence involves using individuals’ observations on a specific issue while analogical evidence involves using one element to provide evidence for another similar issue. Von Haaren et al., (2015) utilises statistical evidence whereby it uses statistical evidence to provide evidence. This is where the study carried out multilevel models in comparing within and between subject associations. The location of evidence is discussed in the results part of the article whereby the study findings are discussed with the existing knowledge at the time the study was conducted.

The study’s strengths is found in the fact that it was a randomized controlled trial. Further, the study utilised a period of reduced stress and another one of high stress in examining whether AET was successful in reducing stress levels for the participants. The study was also strong in that it utilised two periods of time before and after the intervention. This also allowed for increased representatives which provide a better basis for increased level of generalisations. However, the study did not take into consideration the other factors which could have influenced the stress reduction. For instance as stated in von Haaren et al., (2015) fitness levels can impact the manner through which accurate as well as regular exercise in interacting with emotional reactivity. As such, the study should have made consideration on the different issues which can mediate the reduction of stress levels through the use of a regular exercise. As proposed by Hamer (2012), regular exercise has an impact on the physiological and emotional stress reactivity. As such, the study should have incorporated the manner through which various factors influence the stress reactivity in the participants.

Critical Review of Second Article

The second article is by Kim, Yang and Schroeppel (2013) titled, ‘A pilot study examining the effects of Kouk Sun Do on university students with anxiety symptoms’. The study investigated a pilot study through an examination of impacts that Kouk Sun Do (KSD) have on the students in an university who experienced symptoms of anxiety. The study focuses on a KSD, which is a mind body exercise which is utilised by a mental health. The study was conducted on university students whereby a sample of 30 students who made self-reports on experiencing anxiety whereby they were randomly grouped into the treatment and control group. Seven of the students were in the treatment category while eleven were in the waiting list control groups. Both of these groups completed a pre-tests as well as a post tests with 12 participants not completing the study. The treatment group involved a ten-70 minutes KSD session undertaken over a 4 week period. Various elements such as trait anxiety, self-efficient in dealing with stressful situations as well as depressive symptoms were measured in both the pre-test category and the post-test category. The authors utilised a group and time repeated measure of variance analysis in analysing the data. The results of the study illustrated that anxiety and depressions levels reduced while efficacy increased. This is as compared to the control group over time. The study supported the self induced relaxation impacts of KSD and how it results to reduced anxiety.

According to the NHMRC (2000), level II involves a randomised controlled trial. Kim et al., (2013) utilised a randomised controlled test whereby they conducted a study randomly assigning the participants to a treatment and the others in a controlled group. As illustrated by Merlin et al., (2009), the test for accuracy involves an independent blinded comparison having valid reference standards with the study’s prognosis a prospective cohort study. It can be concluded that the Kim et al., (2013) is level 11 in NHMRC’s evidence hierarchy with the study concluded that the impacts of auto induced relation though the use of KSD can result to a reduction in anxiety as well as depressive symptoms.

In regards to the type of evidence utilised, the study followed statistical evidence whereby the authors derived their findings and relied on statistical or mathematical analysis to derive the results. The authors utilised a group and time repeated measure of variance analysis in analysing the data gathered with anxiety as well as depressive symptoms on a lower level while being self-efficient increased with this results compared to the control group over time. The location of evidence is discussed in the results part of the article whereby the study findings are discussed with the existing knowledge at the time the study was conducted. The strength of the study by Kim, Yang and Schroeppel (2013) was that it undertook a randomised controlled trial using two periods of time before and after the intervention to inform the study. University students participated before and after an exam allowing the authors to gather information before the stress time and after the stress time. Further, the study also evaluated the impact of using the KSD before and after the using the intervention thus providing the authors with adequate authorities standing to conduct comparisons of the using the method. The study’s weakness on the other hand is based on only qualitative data which could result to biases unlike the use of quantitative approaches or mixed methods.

Appropriate Article

The case scenario involves a student in her first year that has an 18 month old daughter. The sources of stress for the student, Mariana stems from the fact that she has a daughter who have severe asthma while she deals with diabetes and a rare blood disorder in addition to dealing with how to interact with other students as her priorities are different. From the analysis of the two articles above, the most appropriate article to apply the scenario is Kim et al., (2013). This is because this study conducts a general study on university students who are experiencing anxiety symptoms. This is similar to Mariana’s case as she is a university student with anxiety on dealing with her personal issues and whether her status as a mother will enable her to interact with her colleagues at the university. The study by Kim et al., (2013) provides the best approach through the use of KSD a mind body exercise which Mariana can use to reduce her stress symptoms. In addition, the relaxation effects are self induced thus Mariana can utilise KSD in a self inducing relaxation approach.