Method (Research Design)
The research on the effect of hydrocortisone cream on reducing pain by Manfre et al. (2015) is an excellent study design. It utilizes a randomized controlled trial study design, with adequate randomization and appropriate procedures. The research goal is well stated, which is, " To determine if the use of hydrocortisone cream decreases perineal pain in the immediate postpartum period” (Manfre et al., 2015). The authors applied appropriate comparisons that are crucial in the interpretation of the study findings. The authors based their research from earlier studies and a broadened conceptual model. Relevant interventions were used in this research, where each patient acted as their own control. Besides, the analysis uses appropriate variables, with the change in perineal pain level being the primary dependent variable.
The rationale for data collection points was suitable for the study. The intervention versus control study designs was likely to offer both statistically significant results and credible findings. For instance, the data collection method is set in a way that is likely to occur minimal or no problems with regards to statistical power. Also, data collection and analysis procedures are unlikely to cause biasness. This is because the study design includes the use of blinding, and measures are taken to minimize attrition. The authors concluded that hydrocortisone cream significantly reduces pain. However, the study is limited to one type of hydrocortisone cream as well as placebo cream (Manfre et al., 2015). Perhaps the study should have been designed in a manner that incorporates other types of topical cream for a better empirical comparison.
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Population and Sample
The authors identified and offered a clear description of the population used in the study. Besides, the sample was excellently described in detail. For instance, 26 patients were each given three treatments, totaling 78 treatments. This was a reliable sample for use in the study, as it was sufficient in enhancing the sample's representativeness. Since the authors found it difficult to clinically justify the parameters of measure, such as time, inconvenience connected to topical medication, and expense, they set the pain difference of 20% (Manfre et al., 2015). This was a good rationale that aimed at eliminating the sample biasness. The sample size was also adequate in coming up with meaningful mean estimates using the standard deviation. For effective size calculation, the authors based their calculations on prior studies where they obtained a justifiable value of 0.36. Finally, the validity of the survey was bolstered by the use of power analysis in the estimation of sample size needs.
Data Collection and Measurement
The authors used a credible method of data collection and measurement. Since it is hard to measure patients' level of pain through observation, the authors used an instrument called the visual analog scale (VAS). This instrument may be considered the best for this study because it was used by previous researchers, such as Gelinas et al. (2008), Williamson and Hoggart (2005), and Hjermstad et al. (2011). The VAS instrument was also suitable for use in this study because it has no psychological implications on the patients. This means that the research was ethically acceptable.
Besides, the study deployed proper preparations for data collection and measurements. For instance, it is indicated that the participants received prior training on the proper handling and usage of the VAS, further increasing the accuracy of data measurement and collection. However, there is some doubt regarding the credibility of the study consent. There is the likelihood that some patients may be psychologically affected when they learn that a study is being conducted on them. Thus, the patients may release some hormones, such as adrenalin, and may change the results.
Procedures
There is substantial evidence that this research used an excellent and reliable method. The study offered adequate interventions, which are adequately described. For instance, the participants were given consent on the research and adequately trained on the use of the VAS instrument. The intervention was appropriate because it served to minimize errors during data collection and measurement. There is evidence that the study procedure offered accurate results, as the clinicians involved in the study were exempted from other miscellaneous duties. Besides, the investigators selected for the study were at no time the participants' primary nurses. This implies that the data collected had a minimum of free from biasness.
The procedure was also designed in a manner that significantly minimizes avoidable errors. The authors indicate that all the nurses involved as the investigative group were adequately trained and tested for credibility. Although the application of the hydrocortisone is limited for use (four times a day), the authors indicate that the procedure was repeated every six hours in a day, which is an adequate time of the study. However, the study procedure applied in this study is ethically questionable. It is unethical to subject a patient to pain at the expense of research. Therefore, it was inhuman for the authors to test the workability of the hydrocortisone on patients which are in deep shock when there are alternative drugs of reducing pain.
Results (Data Analysis)
The study used a recommendable method of data analysis, that is, intent to treat analysis. Also, the descriptive statistical tools used in this research were suitable in coming up with reliable conclusions. The authors offer an excellent formula for use in the data calculation. The accuracy of data analysis was enhanced by the use of multiple comparison tests for the various groups implicated in the study design. This implies that the authors used powerful analytical methods of data analysis, which yielded a significant result of 0.05.
Although it is usually challenging to eliminate both type 1 and type 2 errors simultaneous, this study design was structured in a manner that balances the two. For instance, the authors set a standard null hypothesis of p>0.5. From this value, various tests were conducted, and many results recorded in a well-constructed table. The application of both forward and backward itinerary calculations contributed significantly to minimizing both type1 and type 2 errors. However, it is not clear whether the procedure was designed in a way to reduce or eliminate the biasness of the study. The authors evaluate the efficacy of the topical cream in pain reduction only for the first day and fail to consider the fact that prolonged usage of the topical creams may give varying results in the subsequent days.
Findings and Interpretation
In terms of outcomes, the authors present statistically significant information that is well articulated as per the results of the research. The results of the study are stated adequately with an apparent explanation. The reader finds no difficulty in understanding the concepts presented in this research. For instance, each finding is stated as a point and closely followed by a detailed explanation, where the reader is continuously referred to the table where data was recorded. In the case where numerals calculations are used, the formula used is properly defined.
The information presented offers the effect size and precision of estimates. The data is presented in the form of confidence intervals, where each variable is first discussed separately, and finally, all various combined to come up with acceptable conclusions. To build their credibility in their findings, the authors appreciate that a few areas might have occurred in the process of data collection. Thus, they give both a range of estimation and the anticipated actual values of their findings.
The authors also offer a detailed discussion regarding the clinical significance of the findings. This is what any reader of the article would expect to find. One of the clinical implications of the research is that the study offered an alternative form of reducing pain among new mothers. The drug is also cost-effective as compared to the other painkillers. Through the findings, the reader is also made to understand that hydrocortisone cream has anti-inflammatory properties (Manfre et al., 2015). With this regard, the authors argue that unlike the earlier findings, hydrocortisone cream may be used to treat perineal edema effectively. These findings are, therefore, attractive to the reader. However, the results seem exaggerative. For instance, the authors major on giving only the positive implications of their findings, while neglecting the negative implications. There is the likelihood of the drug causing side effects to the patients, an issue that was not discussed in the study.
Summary Assessment
Overall, the study is engaging to the reader. The study presents one of the research designs that any reader would like to follow to the end. First, the reader is attracted to the abstract, which offers a summary of what the reader would expect to find in the article. Besides, each part of the study has a sub-heading, which makes work easier for the reader. The sub-headings also indicate that the survey was properly planned and that no relevant information was left unaddressed. The use of the tables of findings and analysis also makes the interpretation of the study findings more comfortable to understand.
Although the study has some areas of limitations, its clinical implications cannot be overemphasized. Unlike the previous studies, this research evaluates in detail the application of hydrocortisone cream in the treatment of perineal pains. Thus, through education, healthcare professionals learn that hydrocortisone cream is not only an effective drug in the treatment of perineal pain but also cost-effective to the healthcare facilities. Therefore, it is recommended that healthcare providers across the globe should read this article to gain vital knowledge regarding the effect of hydrocortisone cream on reducing pain. This is because the study offers substantial, meaningful evidence applicable in the nursing practices that are critical for application in the nursing discipline.
References
Manfre, M., Adams, D., Gould, P., Callahan, G., Lang, S., McCubbins, H., Mintz, A., Williams, S., Pharm, M.B., Dempsey, A., & Chulay, M. (2015). Hydrocortisone Cream to Reduce Perineal Pain after Vaginal Birth: A Randomized Controlled Trial. 40 (5): 306-312. Accessed October 29, 2019; from file:///C:/Users/User/Downloads/Quantitative%20Critique%20Article_Hydrocortisone%20Cream%20TO%20REDUCE%20pain%20(1).pdf
