In a substantive manner, using scholarly tone and correct grammar, address each

In a substantive manner, using scholarly tone and correct grammar, address each of the components of the critique. Your responses should demonstrate thought and critical appraisal. Although some of the questions could be answered with a Yes/No response, you are expected to offer your thoughts in full and complete sentences. You will incorporate feedback on this assignment in the EBP Paper. Answer each block with 2–3 full sentences. If you are unsure if an article meets the requirements for this assignment, contact Dr. Morales. Post the full text article link in the APA reference.

Jessica Harper

Trinity Byrom

Joao Eaton

Melissa Agyemang


Critical Appraisal Questions to Guide Evaluation

Background and Significance see Chapters 2 and 3;

2–3 full sentences):

Does the background and significance section make it clear why the proposed study was conducted?

Research Question and Hypothesis (see Chapter 2;

2–3 full sentences):

1. What research question(s) or hypothesis (or hypotheses) are stated, and are they appropriate to express a relationship (or difference) between an independent and a dependent variable?

2. Has the research question(s) or hypothesis (or hypotheses) been placed in the context of an appropriate theoretical framework?

3. Has the research question(s) or hypothesis (or hypotheses) been substantiated by adequate experiential and scientific background material?

4. Has the purpose, aim(s), or goal(s) of the study been substantiated?

5. Is each research question or hypothesis specific to one relationship so that each can be either supported or not supported?

6. Given the level of evidence suggested by the research question, hypothesis, and design, what is the potential applicability to practice?

Review of the Literature (see Chapters 3 and 4;

2–3 full sentences):

1. Does the search strategy include an appropriate and adequate number of databases and other resources to identify key published and unpublished research and theoretical resources?

2. Is there an appropriate theoretical/conceptual framework that guides development of the research study?

3. Are both primary source theoretical and research literature used?

4. What gaps or inconsistencies in knowledge or research does the literature uncover so that it builds on earlier studies?

5. Does the review include a summary/critique of the studies that includes the strengths and weakness or limitations of the study?

6. Is the literature review presented in an organized format that flows logically?

7. Is there a synthesis summary that presents the overall strengths and weaknesses and arrives at a logical conclusion that generates hypotheses or research questions?


Internal and External Validity (see Chapter 8;

2–3 full sentences):

1. What are the controls for the threats to internal validity? Are they appropriate?

2. What are the controls for the threats to external validity? Are they appropriate?

3. What are the sources of bias, and are they dealt with appropriately?

4. How do the threats to internal and external validity affect the strength and quality of evidence?

5. Was the fidelity of the intervention maintained, and if so, how?

Research Design (see Chapters 9 and 10;

2–3 full sentences):

1. What type of design is used in the study?

2. Is the rationale for the design appropriate?

3. Does the design used seem to flow from the proposed research question(s) or hypothesis (or hypotheses), theoretical framework, and literature review?

4. What types of controls are provided by the design that increase or decrease bias?

5. What level of evidence is this according to page 13 of your book?

The design of the study used for this experiment is case-control. A case-control study has a dependent variable already affected by the independent variable. The objective is to find the correlation between present and past events (LoBiondo-Wood & Haber, 2018).

This study method is entirely appropriate. We would not want to induce PPH (Post-Partum Hemorrhaging) or manipulate the health of real individuals. This would not be ethical.

The article and experiment are thorough and organized. The researchers are transparent about what is being evaluated and aim to provide evidence for their hypothesis.

They used two groups of women; those that experienced severe PPH and those that did not. They decreased bias because the control group consisted of women who could have experienced prolonged labor but did not succumb to PPH. The researchers also ensured that the control group was more significant than the group that experienced severe PPH to decrease bias further.

For a case-control study, typically retrospective, the level of evidence is III. In some instances where there are appropriate controls, the experiment may fall into level II.

Sampling (see Chapter 12; 2–3 full sentences):

1. What type of sampling strategy is used? Is it appropriate for the design?

2. How was the sample selected? Was the strategy used appropriate for the design?

3. Does the sample reflect the population as identified in the research question or hypothesis?

4. Is the sample size appropriate? How is it substantiated? Was a power analysis necessary?

5. To what population may the findings be generalized?

The sampling strategy was to use an accessible population—not to discount the use of hospital records as a population. There were two targeted (study) populations within one source population. The source population was all women delivering at Oslo University Hospital and Drammen Hospital between January 1st, 2008, and December 31st, 2011. The eligible population is women with intended vaginal delivery, and the excluded population was planned cesarean sections. The study populations were random controls (no severe PPH) and all cases (severe PPH). They also excluded women who received a blood transfusion because of postpartum anemia without evidence of excessive bleeding.

The researchers performed a de facto power analysis and exceeded the minimum number of cases needed to eliminate error. “A de facto power analysis indicated that we needed at least 646 cases and 1292 controls considering two controls per case, type I error of 5%, power of 80%, frequency of prolonged labor in control subjects of 3%, and cases being twice as likely to be exposed to prolonged labor compared to controls (odds ratio (OR) = 2.00).” (Nyfløt et al., 2017). Because the researchers were concise in the inclusion and exclusion factors of the study populations, the findings are generalized.

Legal-Ethical Issues (see Chapter 13; 2–3 full sentences):

1. How have the rights of subjects been protected?

2. What indications are given that institutional review board approval has been obtained?

3. What evidence is given that informed consent of the subjects has been obtained?

The use of the data was approved by the Regional Ethics Committee in the South-East Health Region of Norway. Patients were not notified of the experiment, and individual consent was not obtained. The researchers were granted permission to use the data from the desired years and births. Although there was no identifying or personal information, I would still like to have seen letters of intent issued to the following individual’s medical records used in this study, or I would have liked to see that consent was retrieved. Although this type of study focuses on data, I understand why obtaining individual consent from all patients wasn’t necessary.

Data Collection Methods and Procedures (see Chapter 14; 2–3 full sentences):

1. Physiological measurement:

a. Is a rationale given for why a particular instrument or method was selected? If so, what is it?

b. What provision is made for maintaining accuracy of the instrument and its use, if any?

The researchers used existing data for this study and stated what the measurement of error could potentially be based on analysis. The study attempted to outline how they defined all pertinent focuses in this study. Such as what defines severe blood loss or PPH. The measurement of all three stages of labor. The study stated, “The potential for selection bias is minimal because cases and random controls were derived from the same source population during the same time period, and the eligibility criteria applied equally to both groups. There is a probability that some cases were misclassified.” (Nyfløt et al., 2017). The researchers also performed a power analysis to maintain accuracy.

2. Observation:

a. Who did the observing?

b. How were the observers trained and supervised to minimize bias?

c. Was there an observation guide?

d. Was interrater reliability calculated?

e. Is there any reason to believe that the presence of observers affected the behavior of the subjects?

There was no observation involved in the study. Therefore, the researchers had to rely on medical documentation to examine further the interventions and state of the individuals being used in the study.

3. Interviews:

a. Who were the interviewers? How were they trained and supervised to minimize bias?

b. Is there any evidence of interview bias, and if so, what is it? How does it affect the strength and quality of evidence?

Because this research was conducted with retrospective data to predict outcomes further, no interviews were conducted. They used medical examiners and doctors to interpret and investigate the medical records obtained for the study, but no actual interviewing took place. Organizations and individuals were used for formal analysis, conceptualizations, data curation, investigation, and methodology.

4. Instruments:

a. What is the type and/or format of the instruments (e.g., Likert scale)?

b. Are the operational definitions provided by the instruments consistent with the conceptual definition(s)?

c. Is the format appropriate for use with this population?

d. What type of bias is possible with self-report instruments?

there are more

5. Available data and records:

a. Are the records or data sets used appropriate for the research question(s) or hypothesis (or hypotheses)?

b. What sources of bias are possible with use of records or existing data sets?

6. Overall, how was intervention fidelity maintained?

Reliability and Validity (see Chapter 15;

2–3 full sentences):

1. Was an appropriate method used to test the reliability of the instrument(s)?

2. Was the reliability and validity of the instrument(s) adequate?

3. Was the appropriate method(s) used to test the validity of the instrument(s)?

4. Have the strengths and weaknesses related to reliability and validity of the instruments been presented?

5. What kinds of threats to internal and external validity are presented as weaknesses in reliability and/or validity?

6. How do the reliability and/or validity affect the strength and quality of evidence provided by the study findings?

Data Analysis (see Chapter 16;

2–3 full sentences):

1. What were the statistically significant findings?

2.  Were the descriptive or inferential statistics appropriate to the level of measurement for each variable?

3. Are the inferential statistics appropriate for the type of design, research question(s), or hypothesis (or hypotheses)?

4. If tables or figures are used, do they meet the following standards?

a. They supplement and economize the text.

b. They have precise titles and headings.

c. They do not repeat the text.

5. Did testing of the research question(s) or hypothesis (or hypotheses) clearly support or not support each research question or hypothesis?

Conclusions, Implications, and Recommendations (see Chapter 17;

2–3 full sentences):

1. Are the results of each research question or hypothesis presented objectively?

2. Is the information regarding the results concisely and sequentially presented?

3. If the data are supportive of the hypothesis or research question, does the investigator provide a discussion of how the theoretical framework was supported?

4. How does the investigator attempt to identify the study’s weaknesses and limitations (e.g., threats to internal and external validity) and strengths and suggest possible research solutions in future studies?

5. Does the researcher discuss the study’s relevance to clinical practice?

6. Are the results generalizable? Are any generalizations made, and if so, are they made within the scope of the findings?

7. Are any recommendations for future research stated or implied?


Applicability to Nursing Practice (see Chapter 17;

2–3 full sentences):

1. What are the risks/benefits involved for patients if the findings are applied in practice?

2. What are the costs/benefits of applying the findings of the study?

3. Do the strengths of the study outweigh the weaknesses?

4. What are the strength, quality, and consistency of evidence provided by the study findings?

5. Are the study findings applicable in terms of feasibility?

6. Are the study findings generalizable?

7. Would it be possible to replicate this study in another clinical setting?


Include a proper reference citation for the research article and any other sources you might have cited in this assignment. Please note: You need to upload the pdf file of your article or a workable link. Failure to do so will result in a 5 point deduction from your grade.

Citation for Textbook: (LoBiondo-Wood & Haber, 2018)

Citation: (Nyfløt et al., 2017)

Direct Quote Citation: (Nyfløt et al., 2017, p. PAGE #)

LoBiondo-Wood, G., & Haber, J. (2018). Nursing research: Methods and critical appraisal for evidence-based practice (9th ed.). St. Louis, MO: Elsevier. ISBN: 9780323431316

Nyfløt, L. T., Stray-Pedersen, B., Forsén, L., & Vangen, S. (2017). Duration of labor and the risk of severe postpartum hemorrhage: A case-control study. PLOS ONE, 12(4), e0175306.

LoBiondo-Wood, G., & Haber, J. (2018). Nursing research: Methods and critical appraisal for evidence-based practice (9th ed.).

St. Louis, MO: Elsevier. ISBN: 9780323431316

Nyfløt, L. T., Stray-Pedersen, B., Forsén, L., & Vangen, S. (2017). Duration of labor and the risk of severe postpartum hemorrhage: A case-control study. PLOS ONE, 12(4), e0175306.