Begginers guide to critical care download pdf

Many, many papers in health and social care are written in this way. While you might find them useful for information, you should be aware that they do not necessarily give you a comprehensive range of information on the topic because they do not tell you the criteria by which they included information.

If you find an information or discussion article which has included various references and wonder if it is a literature review, have a look to see if there is a clearly written methods section telling you how the information included was identified.

What if you cannot find a literature review or systematic review? If no reviews are available, the next best thing is to access individual pieces of research on a topic. If you have done a thorough and focused search, you will see the range of research papers that are available on your topic, rather than just identifying one paper as you might if you just flick through a journal that you come across.

Therefore if you cannot find a review, then look at as many research articles as you can on the topic you are interested in. In the absence of a review, these will be your best available evidence. As with a literature review, a research paper will have a research question, stated aims and a methods section which tells you how the research was undertaken.

There follows a results or findings section and a discussion with recommendations. What type of individual research papers should you look for? It is very useful to consider what type of research will address what you are hoping to find out this does not matter as much in a literature review as reviews can contain both qualitative and quantitative papers.

When there is no literature review, you need to think about the type of research that is most useful to you. The type of research you find is often determined by the type of question you are asking. So you need to think critically about this before you start your search. First of all it is useful to consider the main differences between qualitative and quantitative research.

The main differences between qualitative and quantitative research Qualitative research generally uses interviews to explore the experience or meaning of an issue in depth. The results are presented as words.

Quantitative research generally explores if something is effective or not, or measures the amount of something. Results are generally presented using numbers or statistics. Some topics are best explored using qualitative research and others will be best explored using quantitative research.

Therefore it is not possible to say which type of research is better in any general sense. There is broad agreement that literature reviews are at the top of the hierarchy of evidence for all situations you can think of. After that, it depends on what you are looking for. This hierarchy applies to situations only when you need to measure the effectiveness of something; for example, does something work or not?

If only things were so simple! There is a danger of oversimplification here. Unfortunately there is not one hierarchy that works for all situations. While it is probably true that a systematic review will be most useful to you, after that what is most useful depends on what you are hoping to find out. Different situations require different types of evidence. You can see from the discussion of qualitative and quantitative research above that the two approaches are different and give different types of evidence.

The hierarchy suggests that quantitative studies, and in particular RCTs, are stronger than qualitative studies. However, this is not always the case; it depends what you are trying to find out — you cannot find everything out using an RCT or even quantitative research.

For example, if you want to know whether a particular intervention is successful — such as providing day care for children at risk, or using a new type of leg ulcer dressing — you need a study that directly compares one intervention with another. In other words, comparing two types of day care, or comparing day care with staying at home, or comparing different types of leg ulcer dressings.

This would probably be an RCT. A direct comparison of the effectiveness of either day care or dressings will not tell you about what the care or treatment was like for the patient or client. In order to find out about this you will usually need qualitative research. A rough hierarchy of evidence when looking at patient or client experiences is as follows.

Systematic reviews of research Qualitative research Anecdotal reports So, there is no such thing as one hierarchy of evidence that works for all situations. Beware of any literature that describes one hierarchy of evidence as if there is only one. This is because qualitative research explores topics through discussion with people involved in the situation, often using interviews or group interviews. Qualitative research is used to explore topics which cannot be measured numerically.

Qualitative research studies tend to use smaller numbers of participants than quantitative studies. The aim of all qualitative approaches is to explore the meaning of and develop in-depth understanding of the research topic as experienced by the participants of the research.

Qualitative research is useful when you are looking for in-depth answers to questions that cannot be answered numerically. The aim of most qualitative data analysis is to study the interview scripts or other data obtained for the study and develop an understanding of this data.

The data is coded and themes are then generated from the data set. For this reason, large numbers of participants are rarely used and are not necessarily appropriate in qualitative research. Instead, they code the data according to ideas arising from within it. This process is often referred to as inductive. A small sample is required because in-depth understanding rather than statistical analysis is sought from informationrich participants who take part.

This is sometimes called transferability. Quantitative research If you are looking to find out about a treatment or intervention that can be directly measured, or you need to find out if something works well or not, then you need to look for quantitative research. This is because quantitative research sometimes called positivist research uses numerical measurement to explore research questions. Qualitative research studies tend to involve larger numbers of participants.

This is called generalizability. Some examples of qualitative and quantitative research It is important to have a clear idea in your mind about the differences between qualitative and quantitative research. To get you used to thinking about the differences, we have given some examples of topics you may want to find out about. Read each example carefully and decide whether you would be looking for qualitative or quantitative research to address each question.

The answers are given below. Looking at the questions below, decide which approach is best — qualitative or quantitative? Or maybe a mixture of both multiple methods? What types of illegal drugs are used by people aged between 18 and 21?

Do antibiotics shorten the length of an episode of tonsillitis? Which universities have the highest attrition rates? Answers What is it like to be a single mum in an inner city? You would be looking for qualitative research because this information is likely to be obtained through in-depth interviews which explore the experiences of single mums in detail. What type of illegal drugs are used by people aged between 18 and 21?

You would be looking for quantitative research because this information can be measured numerically, that is, the types of drugs and who they are taken by can be measured — whether it is possible to get an accurate answer to these questions is another question! Again, this would be explored using quantitative research as this information can be measured numerically. In this case you can measure the length of an illness and then find out whether the person had taken antibiotics or not.

This is not a question that can be easily considered using exact numerical measurement. This is because the information is not easily quantifiable. The information is likely to be collected using in-depth interviews and therefore using a qualitative approach. This is a question which is easily answered using quantitative methods — attrition rates are straightforward to measure and can be counted.

This contrasts with the question above which necessitates a qualitative approach. As a critical thinker, rather than ignore or avoid complex and challenging methods of research as you progress through your learning, look up words and methods that are new to you in a research textbook or dictionary.

Many topics can be explored using both qualitative and quantitative approaches; it depends which aspect of the topic you are considering. Consider these three topics and look at how each topic could be explored using either a qualitative or quantitative approach. We give some suggestions below. What is it like to be a young carer?

Why has the incidence of binge drinking escalated in recent years? Quantitative research questions Which drug is most effective in managing diabetes? How many young carers are there in the UK? At what age do people who binge drink start drinking?

Examples of research approaches using quantitative and qualitative research If you are finding these concepts easy to understand then you may like to begin thinking more deeply about the specific type of information you would be looking for if you were searching for information on one of the above topics.

This will help you to be more selective about the information you require for your academic writing or your professional practice. For example, if you were looking for information about whether antibiotics shorten the length of an attack of tonsillitis, then you would be looking for quantitative research, but the exact type of quantitative research would be a study which compared the recovery rate of children who had received antibiotics and those who had not.

This type of study is called a randomized controlled trial RCT , mentioned previously and discussed in more detail later on. If, however, you were looking for evidence about the types of drugs used by young people, then you would again need to search for quantitative research but this time you would probably need to find a survey which had addressed drug use by young people.

It is important to note that these concepts can be difficult to understand especially if you are new to thinking about research, and refining these concepts further can be confusing. If this is the case, then re-focus on more simple considerations such as whether the research you require is qualitative or quantitative. However, it is useful to be aware of the different approaches that may be used in qualitative and quantitative research, as outlined below.

Approaches used in qualitative research There are a wide variety of approaches to qualitative research. You are likely to encounter many different approaches to this type of research when you read the literature.

It is useful to be able to recognize these different approaches and to understand why one approach may have been selected for a specific research question. Three popular approaches are outlined below. These studies often use in-depth interviews as their means of data collection as they allow participants the opportunity to explore and describe their experiences within an interview setting.

An ethnographic study focuses on a community i. How can you identify a good qualitative study? This is a qualitative research appraisal tool, and one of many such tools available at www. Remember that well designed qualitative studies produce better data than poorly designed studies. Do not be put off by a small sample size — qualitative studies tend to be small. You would expect to see detail as to how the study was carried out and, if interviews were conducted, how these were transcribed and analysed.

Data analysis in qualitative studies is generally descriptive. The findings or results are often written up as themes which describe the main findings. You do not usually see results presented numerically or as statistics within qualitative studies, and the findings are not directly generalizable to other situations — that is, we cannot make predictions from the results of a small study to apply to the wider population.

Randomized controlled trials RCTs Quantitative experimental methods can be used to measure the effectiveness of an intervention in other words, studies that find out whether a specific intervention really works.

The most rigorous form of study is the RCT. This can be used to test the effectiveness of many care or treatment options where it is permissible and ethical to randomly divide the sample group and monitor the outcome. In an RCT, participants are allocated randomly into two or more groups — this is called randomization. An intervention is then given to only one of the groups and the outcome in the different groups is compared.

You can then look at the differences between the groups at the end of the study and see whether those who received an intervention fared better than those who did not.

This is really the only way to tell whether or not an intervention is effective. Other experimental methods It is important to bear in mind that it is not always possible to undertake an RCT because you cannot always withhold care or treatment from one group.

Other quantitative research methods can also be used for experimental research designs which are not RCTs. Other studies you may come across are cohort studies and case control studies. Cohort studies and case control studies were first used to observe the effects of an exposure e.

These studies tend to be quantitative as it can be difficult to get good descriptive data from a questionnaire. Questionnaires and surveys are useful when you are looking for evidence about the prevalence of a particular activity, or information about a large group of people.

Remember that studies based on questionnaires and surveys have many limitations as outlined below and the results of these should be viewed with caution. There are different tools suitable for quantitative research available using CASP, available at www.

Remember that poorly designed quantitative studies produce weak data. In order to tell if a study has been carried out well, you need to know the method by which the study has been undertaken. In general the study will be more reliable if the sample size is large and the method of study is appropriate to its aims. As with qualitative research, look for a clear description of the method by which the study has been carried out. Data analysis in quantitative research Data analysis in quantitative research is usually presented using numbers or statistics.

Sometimes it is really hard to understand the statistics and tables in quantitative research but there are a few key things you should be able understand. Researchers themselves sometimes employ statisticians to help them analyse and interpret the results. When you next look at a quantitative research study, read the discussion where the results are explained and then go back to the actual numbers to see if you can understand them better.

Statistics There are two types of statistics: descriptive and inferential. Descriptive statistics describe the data or results in a paper. These statistics should describe clearly the main results. A study by Gill et al. This was clearly a quantitative study as mortality rates can be counted.

The researchers undertook a trial in which Zambian birth attendants were randomly allocated to receive intervention training which included resuscitation or to continue with their existing practice. The neonatal mortality rate of the babies delivered by those who practised in the standard way and those who had received training was compared. This should be clearly presented as such and you should be able to see easily what the results of the actual study were.

Inferential statistics are used to make predicitions. Once we have a detailed description of an event the more or the bigger the better; we would not be very confident in the results of a comparison of one trained birth attendant and one untrained attendant we can use the results of the study in statistical tests to make predictions about the outcome of other similar events. We do this all the time in sport. If you follow a particular sport, you will see that commentators make predictions about who is going to win.

These predictions are made on the basis on many observations as to who has won on previous occasions. Now of course we cannot tell if a sportsman will win again but if we have enough prior evidence to go on, we can make a reasonable prediction. This is what statisticians do. They look at what has happened in a particular event such as in a study situation and they then make a prediction as to whether we are likely to see this result outside the research setting.

The better the data they have to work from, the better the predictions they can make. From these statistics we can then make generalizations about whether the results of the study are applicable elsewhere. You can see why this is important; if we think that the results of a study are applicable elsewhere then the study is very useful to us indeed.

When predictions are made about what is likely to happen in a bigger population not the sample used in the study on the basis of the findings of a study, we call this making inference or using inferential statistics. In other words, statisticians try to determine the extent to which the data obtained from a sample is reflective of the wider population as a whole.

They tell us what might be expected to happen in a wider population. In simple terms, the bigger the sample, the surer you can be that the sample prevalence is close to the population prevalence. In other words, if the sample size in the research is large it is more likely it can be applied to the whole population.

For example, if you have a questionnaire survey of 1, people from around the country, of which stated a preference for holidaying abroad, inferential statistics can be used to determine whether this result would be likely to be accurate for the whole population.

But if the sample size was only 50 it would be less likely that the results would represent national views. When you read a quantitative research paper, these ideas are expressed either as confidence intervals or as p values. Gill et al. This is a descriptive statistic, the result found in their study.

They then report a 95 per cent confidence interval of 4. In addition to confidence intervals, you might find probability expressed as a p value or probability value. The p value expresses the probability of the results shown in the paper being due to chance. It is important to determine the likelihood that the findings are down to chance or whether they reflect what happened in the research. The lower the p value, the less likely it is that the occurrence is due to chance.

If a p value is less than 0. In their study of birth attendants, Gill et al. Even if both groups were attended to by a trained birth attendant, you would be likely to see a variety of outcomes in each group due to natural differences between the groups. This could be just a chance variation, as no two groups are ever exactly the same, or it could be due to the intervention.

What we want to find out is whether the difference between those cared for by the trained birth attendants and those cared for in the traditional manner can be attributed to the training of the birth attendant or whether it is just a chance finding. The p value can then be calculated to determine whether the differences in outcomes observed is due to chance or not.

To calculate the P value we use the null hypothesis. This is a phrase that is used when you state in order to test it that there is no relationship between the different elements or variables under study. This can be calculated using a statistical test, such as the Chi squared test. A p value of 0.

This would mean that there is a chance that the differences were due to chance alone. Here we have provided a brief overview of the commonly held beliefs about and ways of presenting inferential statistics. If this applies to you, then do re-read the section above. You might also find it useful to read other textbooks which describe the use of statistics. For those who find the concepts easy to follow, consider developing your understanding through further reading of books on statistics which are specifically designed for health and social care professionals.

Will you always find up-to-date research and information for your practice? While there has been a huge increase in the amount of available information, it is still the case that some areas of health and social and social care are underresearched.

Research is still a developing area in some fields, and not all areas of health and social care are underpinned by a sound body of knowledge. If you can find a literature review on your topic then you have probably identified the best available evidence. Failing that, the next best thing is to collate the available research evidence on your topic. If there is no research then guidelines or policy may help and if these are not available then professional and expert opinion should be drawn on. Although finding evidence is very important, sometimes there is no specific evidence for what we need and we have to rely on experience and common sense.

The following abstract from Smith and Pell , taken from a Christmas edition of the British Medical Journal, and written somewhat in jest we think! Abstract Objectives: To determine whether parachutes are effective in preventing major trauma related to gravitational challenge. Design: Systematic review of randomised controlled trials. Data sources: Medline, Web of Science, Embase, and the Cochrane Library databases; appropriate internet sites and citation lists.

Study selection: Studies showing the effects of using a parachute during free fall. Results: We were unable to identify any randomised controlled trials of parachute intervention.

Conclusions: As with many interventions intended to prevent ill health, the effectiveness of parachutes has not been subjected to rigorous evaluation by using randomised controlled trials. Advocates of evidence based medicine have criticised the adoption of interventions evaluated by using only observational data. We think that everyone might benefit if the most radical protagonists of evidence based medicine organised and participated in a double blind, randomised, placebo controlled, crossover trial of the parachute.

Smith and Pell We acknowledge that this research paper is presented in jest, although it is evidence that the researchers did carry out a real-life systematic review to study this topic. Their point is that you will not always find evidence and this should not stop you carrying out care that is based on common sense or observations that if you jump from an aeroplane without a parachute you are likely to suffer serious injury!

In summary To adopt a critical approach to accessing the best available evidence you need to think about how you can find high quality, relevant evidence rather than relying only on readily available evidence. To do this you need to search effectively and this is a skill that takes time to learn. You need to be clear about what you need to find out. You also need to develop skill in understanding the different types of research.

We suggest you look for literature reviews and systematic reviews in the first instance as these will summarize the available evidence. If there are no reviews, then look for available research that has been done on your topic and collate all that is available. You need to think carefully about the type of research that is most useful to you and consider whether you are looking for qualitative or quantitative approaches.

We suggest that you get used to thinking critically about the type of research that is most useful to you. Try to follow what is going on in the research, rather than just relying on a summary or abstract. If there is no research then draw on professional and expert opinion and other sources. Why is it important to incorporate critical thinking into your writing and verbal presentations? In health and social care, it is important to demonstrate that you can convey your ideas in a thoughtful fashion.

Showing that you have a critical approach to what you read, see and hear will greatly enhance the quality of your work, whether written or a verbal presentation. Reflect on why it is important for you to be able to demonstrate your critical thinking and appraisal skills in your writing and verbal presentations. When you engage in presenting your ideas verbally and in critical writing you are developing your ability to express your own informed opinions and arguments clearly related to your subject.

In both your writing and verbal presentations, you need to show that you question and analyse what you read, see or hear, rather than accepting it at face value.

You can achieve this by demonstrating that you understand the information you use, rather than just reporting it and saying no more about it. This will give your work greater authority. In your academic work and your professional role you will need to express your ideas and arguments both in writing and verbally, demonstrating that you are well informed, able to identify relevant information and to appraise the sources of information that you come across.

A much higher level of skill is therefore needed for critical writing and presenting compared to that needed for purely descriptive writing and presenting. This is often reflected in grading criteria, particularly once you move into the later stages of a diploma or degree programme, or onto a masters-level course — you will be awarded higher grades if you clearly demonstrate your skills of critical thinking.

In this chapter we will explain how to do that most effectively. Demonstrating skills of critical thinking through your writing or your presentations is a skill that can be learned. Have you ever spotted a speaker or writer who was able to demonstrate their skills of critical thinking clearly?

What did you notice about the way they presented their ideas? In addition, Wellington et al. Later in this chapter, we will provide some tips and strategies for how you can demonstrate these features in your own work. When will you need to incorporate critical thinking into your writing and presentations? There are a variety of reasons for which you may need to write information or present it verbally, whether as a student or as a qualified practitioner.

Case studies. Academic essays or assignments. Research reports, for example on a particular aspect of care, intervention or treatment. Drawing up and justifying recommendations regarding appropriate interventions for the care of a client. A dissertation, thesis or research project. Policies or guidelines.

Care plans or care pathways. Quality documentation and audits. Reflective diaries or journals. The importance of skilfully crafted, knowledgeable critical writing should not be underestimated — the ability to argue a case in writing can be the key to creative practice and to positive changes in health and social care.

Giving a presentation for an academic assignment. Presenting a viva for a dissertation or thesis. Giving a verbal presentation for the education of others such as in a teaching session.

Getting your ideas across in a presentation is just as important as if they are written down. The importance of planning your work Planning is essential for producing work that clearly demonstrates your skills of critical thinking. Think about the last time you had to write a professional or academic document or an assignment, whether a written piece of work or a verbal presentation. Use the questions below to help you reflect on how you planned your work.

How did you carry out research into your topic? Did you consult anybody for advice or ideas? Did you access any new information? How confident were you in putting together your work? Were you able to express your ideas clearly and logically? If you adopt an unplanned and haphazard approach to preparing your writing or presentations, you are less likely to think critically about what you write and you may not demonstrate your critical thinking skills effectively within your work. Investing some time in thinking before you write or present your ideas will pay dividends.

You will be more able to adopt a critical approach if you plan your work effectively before you start to write. Underline any key words that help you identify what approach you should take e.

If you are unsure what to do, seek advice. This may be particularly important in relation to an ethical or controversial subject. You could draw a spider diagram to map out your ideas, or write out your thoughts, to set out your starting point on the topic — this will help you to explore your existing knowledge, experience and views in relation to it.

How to demonstrate your critical thinking skills effectively in your writing and presentations Once you have located the information you need, and thought critically about it, you are ready to start writing or preparing your presentation. There are a variety of strategies that you can use to enhance your work. Use simple language Sometimes the best writing and presentations use very simple language.

The author or speaker does not try to impress by using complicated words or expressions. This is a good aim to have in mind. You can achieve this by expressing your ideas simply, clearly and logically. You should also explain any complex ideas or professional jargon and state what any abbreviations mean.

In your writing, you can do this by making sure you have full and complete paragraphs that present a point. Each paragraph should focus on one point, and should lead logically on to the next paragraph.

Sometimes it helps to put a heading or title for each paragraph. You might remove these before you present your finished writing, but it might help to keep you focused. In your presentations, you need to ensure that you use simple and clear language, and structure your presentation in a logical way, so that your audience can follow your line of reasoning.

Demonstrate your use of the best available sources Select relevant and high quality research, theory and policy to use in your presentation or writing, and incorporate appraisal of these sources. Remember to search thoroughly as outlined in Chapter 3.

Make sure the sources you refer to are relevant to your focus and to the argument you are making. You will start this process when you search for information, but it is always worth reconsidering whether the information you use is the most appropriate for your case, as you continue to write. Demonstrate your skills of critical appraisal and critical analysis Give your reader or audience information about the types and quality of evidence you are using.

This helps to show them that you understand and have thought carefully about the sources you are using, rather than just using the information that is most readily available. It also demonstrates that you are using the best available evidence to support your academic work. You should avoid just citing a name and a date in your academic work with no further reference to the type of evidence you are referring to; otherwise your reader or listener cannot tell if you are using the best available references.

As a result of a large scale, high quality systematic review, Jones et al. In a multi-centred, international randomized controlled trial Jacques et al. In this brief newspaper report from the UK in , Davies speculated that. For example:. We recommend to our followers to purchase the book from the original publishers. Post a Comment please do not enter any spam link in the comment box.

All Surgical Instruments pdf book With more than hundreds of detailed, full-colour photographs of almost surgical instruments, The Surgical Sunday, July 11, The idea of your first day working in intensive care can be a daunting prospect.

In reality, with the benefit of time, you will realise that the ICU continues the basic tenets of treatment carried out in the rest of the hospital, except with closer monitoring and some additional interventions, which require a high staff-to-patient ratio. Often, basic medical treatment is continued but with the addition of organ support, to maintain physiology in as normal a state as possible, allowing time for the actual treatment of the underlying condition to work.

Using sepsis as an example, the treatment is antimicrobial medication. However, the profound vasodilation and resulting hypotension could result in death before the antibiotics can work. No comments:. Newer Post Older Post Home. Subscribe to: Post Comments Atom. Milton Keynes: Open University Press. A useful text on understanding critical thinking and writing Maidenhead: Open University Press.

Bahn, D. A beginner's guide to critical thinking and writing in health and social care 2nd ed. Doing a literature review in health and social care : a practical guide.

A beginner's guide to critical thinking and writing in health and social care. Oxford: Blackwell Publishing. London: Open University Press.