Unexpected Cardiac Arrest in Acute Care Hospital Paper

Running Head: QUANTITATIVE RESEARCH CRITIQUE AND ETHICAL CONSIDERATION Cardiac arrest is one of the most common causes of death for patients. Due to its severity and what is often a quick onset, it is critical that immediate care is provided to patients for treatment. Two quantitative studies conducted research on cardiac arrest and what strategies hospitals are implementing in order to decrease the mortality rate of the disease and what the overall effects of the strategies are. The study Reducing in-hospital cardiac arrests and hospital mortality by introducing a medical emergency team by David Konrad focuses on the implementation of a medical emergency team. Another study conducted Hospital Strategies for Reducing Risk-Standardized Mortality Rates in Acute Myocardial Infarction by Elizabeth Bradley searches strategies used by hospitals in the U.S. Konrad’s study is conducted in order to evaluate the effects of having an in-hospital medical emergency team. Patients who suffer cardiac arrest have gradual physical deterioration which may go unnoticed. The idea of a medical emergency team is that there will be early recognition of these symptoms and timely treatment which will reduce the risk of cardiac arrest. There are hospitals in other countries which have shown a decrease in cardiac arrest statistics. The gap in research is whether or not a medical emergency team would be beneficial for this hospital. The significance of the study is that if the results show a significative reduction in cardiac arrest then there would be an overall decrease in mortality rate, length of stay and increased survival in patients. This makes the study important for improving healthcare and survival of patients. The study asks if an MET would decrease the number of cardiac arrests and reduce hospital mortality. The background of the study conducted by Bradley is similar to the previous study. The importance of myocardial infarction in the U.S. is critical as it is one of the Running Head: QUANTITATIVE RESEARCH CRITIQUE AND ETHICAL CONSIDERATION most common causes of death. The gap in knowledge which prompted the study is the lack of knowledge on “modifiable factors that are associated with hospital risk-standardized mortality rates” (Bradley, 2012). The study aimed to study these factors and identify hospital strategies which are associated with the risk-standardized mortality rates (RSMR’s) for patients with acute myocardial infarction. The benefits and risks of the studies were similar for both studies. For Konrad’s study, the benefit would be a reduction in the risk of cardiac arrest and hospital stay and well as improving survival. These would be direct benefits for the patient caused by having an inhospital medical emergency team. For Bradley’s study, there were no direct benefits at the moment of the study as the information collected was from data and not an actual trial. Unexpected Cardiac Arrest in Acute Care Hospital Paper

Yet the benefit of the study would be to identify the key strategies so that they may be implemented in other hospitals and over time gain positive benefits such as patient survival. Neither study presented informed consent from the participants as for the first study the medical attention was given as a part of the hospital stay and the second study was simply a recollection of data. Both of the studies were reviewed and approved by their review boards. Konrad’s study does not list or define specifically what the major variables of the study are. The data collected in Konrad’s study was done by the hospital and the rationale was that the study was conducted in the same hospital. The time period for the intervention study was from January 1st, 2005 to December 31st, 2006. For Bradley’s study, the data was collected by a survey conducted to several hospitals. The information was based in hospital discharges between January 1st, 2008 and December 31st, 2009. The analysis of the data was very thorough utilizing mean, variance and comparisons. A Running Head: QUANTITATIVE RESEARCH CRITIQUE AND ETHICAL CONSIDERATION linear regression model with RSMR as the dependent variable, weighted by the inverse variance of the RSMR (Bradley, 2012). Then independent associations of specific strategies were analyzed using multivariate least squares regressions. Konrad interests his findings by breaking them down to results during MET, hospital mortality, and the MET patient. During the MET it was found that hospital admissions decreased in total and patients were younger, this showed a significant decrease in heart failure. The hospital mortality for the study showed a decrease after the implementation of the MET program. After adjustments, the relative risk for overall hospital mortality decreased by 10%. The MET was activated a total of 689 times and the most common interventions were supplemental oxygen and intravenous boluses. These findings are valid and is accurate as it is expected that the MET team would decrease the overall findings in the hospital. The limitations of the study were that the comparison for MET survival were made using historical data. The study mentions that further research can be done in order to understand which patients will best benefit from the medical emergency team program ( Konrad, 2009)”. The findings in this study have several implications for the nursing practice. For example, if these programs are implemented in hospitals then nurses who are the healthcare provider who usually monitors patients will be the ones looking for key symptoms in patients which will require the medical emergency team to respond. The results of the study conducted by Bradley found significant data regarding the strategies used by several hospitals. For example, those hospitals who had a meeting that Running Head: QUANTITATIVE RESEARCH CRITIQUE AND ETHICAL CONSIDERATION reviewed acute myocardial infarction care between clinicians and staff had lower RDMR rates. Another strategy which showed lower RSMS were hospitals who had cardiologists always on site. Another important point found was that hospitals with only nurse champions had higher RSMRs. The limitation listed in the study is that the results show statistical associations but cannot establish causal relationships. This study has an impact on the nursing practice because like the previous study it identifies factors which can be changed in hospitals which directly affect nurses. For example, the results showing that RSMR rates were higher in hospitals with nurse champions alone can bring up important points of interest. This can imply that nurse champions are in need of further training in order to deal with these types of patients and situations. Both studies were approved by institutional review boards. The study conducted by Konrad was approved by the Regional Ethics Committee of Northern Stockholm. The board also waived the need for consent from patients. The study does protect patient privacy as the data was simply collected and kept by the hospital there was no need to identify any specific or personal data from patients. This study did not present any ethical considerations regarding treatment as the medical emergency team was simply an addition to the treatment already offered by the hospital and it was available to all patients admitted without exclusions. The study conducted by Bradley was accepted by the review board at the Yale School of Medicine. This study did not require consent forms because the data gathered does not specify patient information. Unexpected Cardiac Arrest in Acute Care Hospital Paper

The study did not present any ethical considerations either. The study was based on data previously collected by hospitals so there was no lack of treatment for any of the patients. Running Head: QUANTITATIVE RESEARCH CRITIQUE AND ETHICAL CONSIDERATION Cardiac arrest is very common in hospitals and survival after it is a serious issue. Both studies analyze different aspects of the principal problem yet are both looking to identify potential strategies which will overall benefit the patient and their survival. The nursing practice can benefit from these studies by increasing awareness of the issue as well as providing more training in cardiac arrest. Nurses are the provider which usually becomes aware of cardiac arrest because they are constantly monitoring patients being aware of the symptoms or of what available strategies are available in a hospital can greatly increase survival rates. Running Head: QUANTITATIVE RESEARCH CRITIQUE AND ETHICAL CONSIDERATION References Bradley, E. H., Curry, L. A., Spatz, E. S., Herrin, J., Cherlin, E. J., Curtis, J. P., Thompson, J.W., Ting, H.H., Wang, Y., & Krumholz, H. M. (2012). Hospital strategies for reducing riskstandardized mortality rates in acute myocardial infarction. Annals of internal medicine, 156(9), 618-626. Retrieved from https://www.ncbi.nlm.nih.gov/ pubmed/22547471. Konrad, D., Jäderling, G., Bell, M., Granath, F., Ekbom, A., & Martling, C. (2010). Reducing inhospital cardiac arrests and hospital mortality by introducing a medical emergency team. Intensive Care Medicine,36(1), 100-106. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/22547471. Running Head: QUALITATIVE RESEARCH CRITIQUE AND ETHICAL CONSIDERATION Background of Study The primary research gap, in this case, revolves around the lack of sufficient data to support the effectiveness of the application of medical emergency teams on the reduction of inpatient mortality rates. The authors, in this case, focused on the implications of the lack of the application of medical emergency teams (MET) relating to the mortality rates of patients. This study focuses on the evaluation of the efficacy of the implementation of MET. The primary purpose of the study according to the objectives revolves around the determination of the changes witnessed in the cardiac arrest patients and cases after the implementation of MET. The probable research question in the study is as follows. What effects arise from the implementation of MET in reducing the incidents of cardiac arrests? The purpose and the formulated research question relates to the problem in that they all seek to document the implications of the application of MET in reducing cardiac arrests (DeVita et al., 2004). Method of Study Qualitative approaches, in this case, are appropriate in responding to the question based on the nature of the data in the context. The author claims that the study was developed from the clinical perspective citing the effectiveness of MET. The authors cite both qualitative and quantitative studies as references thus making the research effective and reliable. The study based on the date of publication used reliable, qualitative, quantitative and sources older than 5 years. The authors indicate that the existing studies do not show the explicit effects of the application of MET on the inpatient outcomes but only highlight that MET is efficient in improving care. The literature review in the study offers both a qualitative and quantitative approach that forms a foundation for the creation of a logical argument to support the objectives. Running Head: QUALITATIVE RESEARCH CRITIQUE AND ETHICAL CONSIDERATION The study through the results forms a framework used to expound on the outcomes on the discussion and conclusion. The thesis statement in this study formed the foundation for the completion of the research. For instance, the study formed its conclusions on the concepts presented by the problem statement and hence the thesis. The article in this case offers a good platform for understanding the implications of MET on patient outcomes. The study allows the nurses to consider applying the most effective approaches in assisting the patients who would create a useful framework for guaranteeing successful cardiac treatments. The results of the study rhyme with the underlying thesis and problem statement are thus relevant. The results of the study form a framework for the nurses to use when it comes to approaching the day to day activities that they carry out. The study, in this case, provides information that the increased application of MET leads to an improvement in the patient outcomes. The increased use of MET helps to reduce the cases associated with cardiac arrests and hence inpatient mortality rates (DeVita et al., 2004). The study exploited the retrospective analysis approach on the clinical results based on the comparison of the mortality rates arising from cardiac arrests and the level of use of MET (DeVita et al., 2004). Results of the study The study found out that the mortality rates associated with cardiac arrests declined with an increase in the use of MET. It follows that the study, therefore, would help to improve the effectiveness of the nursing practice by focusing on the use of MET (DeVita et al., 2004). The findings focus on the shaping of the nursing practices to focus on the effectiveness of MET on patient outcomes while promoting education and administration which in the end would lead to an improvement in the patient outcomes. Running Head: Unexpected Cardiac Arrest in Acute Care Hospital Paper

QUALITATIVE RESEARCH CRITIQUE AND ETHICAL CONSIDERATION Ethical considerations The study was evaluated by an Institutional Review Board which approved it on the basis of the satisfaction of the various standards such as patient privacy and ethical consideration. The approach used did not exhibit ethical issues of concern as it involved the evaluation of the increased implementation of MET on the patient outcomes. The study did not violate the ethical aspects of research since it based its arguments on qualitative literature and not experimental. Conclusion The thesis statement rhymes with the conclusions, findings and problem statement. The relevance of the study increased the validity of the outcomes gained in the end. Such results act as evidence to the nursing practice which in the end may inform the best practices to follow to achieve the desired outcomes. The findings in this study form the foundation for understanding the implications of the use of MET on the patient outcomes. The study offers knowledge such as the importance of the increased use of MET on the patient outcomes based on the data given above. Running Head: QUALITATIVE RESEARCH CRITIQUE AND ETHICAL CONSIDERATION Background of study This study outlines a problem existing not in the implementation of the MET and cardiac arrest teams in hospitals but on the level of education that the associated nurses may exhibit to judge when to activate such professionals. The gap that the study seeks to fill revolves around the determination of the potential implications of supporting the nurses and MET among other associated teams with the necessary education to improve their effectiveness in responding to cardiac arrest patients. The study claims that cardiac arrest patients usually die as a result of the failure of the respective teams top respond in time based on the lack of sufficient knowledge. The purpose of the study revolves around the desire to outline the potential impacts that offering supplemental education to nurses may bring to the cases of cardiac arrests in hospitals. The following stands out as the primary research question formulated from the study (Buist, Harrison, Abaloz & Van Dyke, 2007). What impacts does multidisciplinary and multifaceted education system bring to the efficacy of MET in responding to cardiac arrest cases? The research question and the purpose rhyme to the problem statement presented. Method of Study The primary method of study selected by the research, in this case, includes prospective audit using data for five years on cardiac arrest and MET application. Using a qualitative approach is efficient in gathering and documenting the findings. The study according to the author develops the study from the educational perspective of the nurses. According to the time of the presentation of the research, the author relied on recent and a combination of qualitative and quantitative references in supporting the literature. Through the study, the author highlights weaknesses in the past literature claiming that they did not focus on Running Head: QUALITATIVE RESEARCH CRITIQUE AND ETHICAL CONSIDERATION the effects that lack of supplemental education may bring to the mortality rates of cardiac arrest patients (Buist, Harrison, Abaloz & Van Dyke, 2007). The study uses a variety of past studies to create a logical argument which in the end helps to form the ultimate framework to arrive at the final conclusions. Results of the study The study found out that most of the cardiac arrest deaths came as a result of the failure to call the medical emergency teams on time. The findings, in this case, show that the lack of sufficient nursing education may cost a lot of lives (Buist, Harrison, Abaloz & Van Dyke, 2007). The findings and conclusions, in this case, form the foundation for showing that nurse education offers a good platform for fostering the attainment of the required results. The results and conclusions obtained may help to shape the ultimate approach taken by nurses when it comes to handling cardiac arrest patients and cases. Ethical considerations An Institutional Review Board approved the completion of the study focused on its ability to meet the set ethical and compliance standards. The study protected the privacy of the patients by refraining from publishing their personal information. Conclusion The thesis statement of the study, forms the ultimate path for the completion of the research. The findings revolve around the thesis statement and play a crucial part in responding to the previously presented research question. Based on the analysis performed on the study, it follows that the authors, in this case, manage to evaluate the additional factors that may affect the efficacy and efficiency of MET among other teams in minimizing cardiac arrest cases. The findings presented in the study show that the nursing practice may benefit from the offered Running Head: QUALITATIVE RESEARCH CRITIQUE AND ETHICAL CONSIDERATION conclusions especially in the provision of additional multifaceted and multidisciplinary education. The study provides relevant evidence, findings, and conclusions based on reliable methods. The valid results obtained in this case form the foundation for the improvement of the approaches used by nurses when dealing with cardiac arrest patients. The findings show that the management should seek to offer additional education to nurses in the aim of increasing their efficaciousness. The primary lesson learned from the study focuses on the explanation that the provision of additional knowledge and skills to MET may help to reduce cardiac arrest cases. Further, the study also shows that most of the cardiac arrest cases came from the lack of sufficient knowledge to understand the right time to call the assistance of MET and cardiac arrest teams. Running Head: QUALITATIVE RESEARCH CRITIQUE AND ETHICAL CONSIDERATION References Study 1: DeVita, M. A., Braithwaite, R. S., Mahidhara, R., Stuart, S., Foraida, M., & Simmons, R. L. (2004). Use of medical emergency team responses to reduce hospital cardiopulmonary arrests. BMJ Quality & Safety, 13(4), 251-254. Buist, M., Harrison, J., Abaloz, E., & Van Dyke, S. (2007). Six-year audit of cardiac arrests and medical emergency team calls in an Australian outer metropolitan teaching hospital. BMJ, 335(7631), 1210-1212. Running Head: PICOT QUESTIONS AND LITERATURE SEARCH Literature Evaluation Table Summary of Clinical Issue (200-250 words): Clinical Problem: Unexpected cardiac arrest in Acute Care Hospital. Unexpected cardiac arrest is a condition in which the heart abruptly stop beating. This prevents the heart from pumping blood to the lungs, brain and other vital organs of the body. Unexpected cardiac attack causes death within minutes if it is not treated immediately. However, with rapid intervention, survival is possible. Giving comp …