SAMPLE PAPERRunning head RESEARCH CRITIQUE ON P.docx

SAMPLE PAPER
Running head: RESEARCH CRITIQUE ON PREOPERATIVE
EDUCATION AND PATIENT OUTCOMES 1
RESEARCH CRITIQUE ON PREOPERATIVE EDUCATION
AND PATIENT OUTCOMES 2
Research Critique on Preoperative Education and Patient
Outcomes
Preoperative patient education for surgery can be done at
different times and by different methods. The purpose of this
paper is to critique four research articles that show how
different preoperative education methods affect patient
outcomes. The first two research articles to be discussed are
quantitative research papers Postoperative Instructions
Preoperatively-Evaluating Effectiveness of a Teaching Model
on Patient Satisfaction Regarding Instructions for Home Care
and Preoperative Education Reduces Preoperative Anxiety in
Cancer Patients Undergoing Surgery: Usefulness of the Self-
Reported Beck Anxiety Inventory. Additionally, two qualitative
research studies will be discussed, A Multidisciplinary
Preoperative Teaching Session for Women Awaiting Breast
Cancer Surgery: A Quality Improvement Initiative.
Rehabilitation Process and Outcome and A Qualitative Study of
Patient Education Needs for Hip and Knee Replacement. This
paper will discuss how these four studies relate to the PICOT
question, nursing practice and their ethical considerations. The
author will critique the four articles and answer the PICOT

statement about preoperative patient education and its effects on
patient outcomes.
Nursing Practice Problem and PICOT Statement
Many surgery patients experience fear and anxiety associated
with their surgery that results in low patient satisfaction scores
and poor postoperative outcomes. Prior research has shown that
preoperative teaching that includes postoperative care is
effective in reducing fear and anxiety in surgery patients.
Surgery can be a difficult experience for many patients with
fear of the unknown.
The PICOT statement asks a question related to preoperative
patient education. In a 66-year old woman scheduled for hip-
replacement surgery, will preoperative patient education as
compared to no preoperative patient education improve patient
outcomes over a 1-month time frame? The patient in the
scenario shares many similarities to a typical surgery patient
including a high anxiety level and fear of the unknown due to
scant preoperative education. She is unsure of what to expect
during the surgery and the postoperative requirements.
Analyzing both quantitative and qualitative research articles
will help answer the PICOT question.
Background of Study
The first quantitative research article by Hovsepian,
McGah & O’Brien (2017) aimed to increase patient satisfaction
scores for discharge teaching and improve retention of home
care instructions. They were not meeting their goals for patient
satisfaction for discharge teaching at their outpatient surgery
facility where they serve a diverse patient population in
Massachusetts. The researchers felt moving the timing of Post
Anesthesia Care Unit (PACU) teaching to the preoperative area
and delivering the information via multiple methods would lead
to improving these outcomes (Hovsepian, McGah & O’Brien,
2017). The second quantitative study looked at the efficacy of
preoperative education in reducing the anxiety of cancer
patients undergoing surgical treatment under general anesthesia
for endometrial cancer. Researchers conducted the short-term

observational study that was conducted at the National Cancer
Institute in Brazil (Lemos et al., 2019).
The first qualitative research article also addressed the fear
and anxiety for their patients who were scheduled for breast
cancer surgery at their facility in Montreal, Canada (Ibrahim et
al., 2018). The goal of their study was to assess the introduction
of a multidisciplinary approach to preoperative education. The
second qualitative research article was performed in a large
Canadian orthopedic center which specialized in joint
replacement surgeries. The researcher’s purpose was to provide
their patients with quality health information that would
increase patient engagement and increase self-management
while enhancing the healthcare experience by involving the
patient’s family. The study aimed to assess their informational
needs and delivery preferences (Kennedy et al., 2017).
Method of Study
The first quantitative article aimed to improve
postoperative care for surgery patients by creating a
multimodality process targeting several approaches to improve
how patients get the information needed for discharge such as
videos, medication sheets, and creating a designated teaching
room (Hovsepian, McGah & O'Brien, 2017). Researchers
collected quantitative data for analysis to assess the efficacy of
the multimodal postoperative teaching in the preoperative phase
program by analyzing the patient satisfaction questionnaire
scores. The researchers compared 6 months of results from their
patients who responded to the specific patient satisfaction
questionnaires. The study included 175 patients who were
taught postoperative instructions in the preoperative phase and
257 patients who were taught in the postoperative phase
(Hovsepian, McGah & O'Brien, 2017). The research approach
was appropriate to this study as it aimed to raise those specific
scores. The second quantitative study by Lemos et al. (2019)
who conducted a short-term quantitative study to evaluate the
effects the preoperative education based on the Beck Anxiety
Index (BAI) as well as on hemodynamic values such as heart

rate and blood pressure. The study sample included 72 female
patients with endometrial cancer who were scheduled to
undergo surgical treatment under general anesthesia. The
quantitative approach was appropriate as it was intended to
evaluate the effects of the preoperative education on the
quantitative measures.
The first qualitative study by Ibrahim et al. (2018)
assessed the efficacy of the multidisciplinary preoperative
teaching program. The preoperative breast cancer education
sessions were delivered in group settings. The data was
collected through a researcher-developed two item questionnaire
administered at two points: before and after teaching sessions to
compare the participants anxiety and knowledge levels (Ibrahim
et al., 2018). This approach was appropriate to the study as they
intended to gain the patient’s perspective typical of
phenomenological research. The second qualitative study was
conducted to elicit patient experiences for development of
effective strategies for education along the care continuum for
hip and knee replacement. The study sample was divided into
six focus groups and telephone interviews were conducted with
32 participants (Kennedy et al., 2017). The qualitative approach
was appropriate as it was intended to view the education from
an individual perspective indicative of phenomenological
research.
Results of Study
The quantitative research studies were both great examples of
evidence-based research that contribute to the knowledge base
for improving patient education prior to surgery. The study
done in Massachusetts indicated that providing home care
instructions before surgery is the optimal time for patient
teaching (Hovsepian, McGah & O'Brien, 2017). The researchers
concluded that when postoperative teaching is done in the
preoperative period before receiving any medication, the
patients had higher satisfaction and felt more prepared for
discharge home (Hovsepian, McGah & O'Brien, 2017). The key
findings of the study done in Brazil were the BAI scores of

preoperative cancer patients that were significantly reduced
with the preoperative education. Blood pressure and heart rate
were also significantly improved when patients received
preoperative education (Lemos et al., 2019).
The results of both the qualitative research articles also
showed the need for better preoperative education. The
researchers in Montreal, Canada collected qualitative data to
assess the efficacy of their multidisciplinary preoperative
teaching program. The preoperative breast cancer education
sessions were delivered in group settings. The facility
implemented a preoperative education team from many health
care disciplines including nursing, occupational therapy, and
physiotherapy (Ibrahim et al., 2018). The Canadian orthopedic
research study conducted a qualitative study with a study
sample divided into six focus groups and telephone interviews
were performed with 32 participants. The study data was coded
and organized into four main themes: 1.) Education gaps
relating to pain management; 2.) Participant’s validation of
existing organizational education materials; 3.) Informal
sources of information; and 4.) Interest in new delivery modes
for education, such as mobile health applications (Kennedy et
al., 2017).
Ethical Considerations
All four of the research articles followed standard and local
ethics protocols for research studies. Ethical considerations for
the study conducted in Massachusetts were not mentioned but
the article did state the facilities Internal Review Boards formal
policy does not require review of this type of quality
improvement initiative (Hovsepian, McGah & O'Brien, 2017).
Lemos et al. (2019) obtained approval from the local
Institutional Review Board of the National Cancer Institute in
Brazil where the study took place and patients signed an
informed consent. Ethical considerations for the study
conducted in Montreal were in accordance with the facilities
quality improvement activities under the Quality Program. As
such, all participants were informed that they were

participating; all data collected was kept anonymously to
protect patient privacy and all procedures performed in the
study involving human subjects in accordance with established
ethical standards (Ibrahim et al., 2018). The researchers at the
large Canadian orthopedic surgery center did obtain approval
from the local research ethics board and all study participants
consented to their participation.
Link between Research, Practice Problem, and PICOT
The link between the research, the problem of inadequate
preoperative patient education and the PICOT question has been
identified. All four studies mentioned the significant benefits of
preoperative patient education that includes postoperative
teaching has on surgery patients fear, anxiety, patient
experience and postoperative outcomes. The research supports a
need to make a change in practice where both patients and
healthcare organizations will benefit.
The patient in the PICOT scenario would benefit from a
more thorough preoperative patient education experience. One
that would include PACU teaching as well as the information to
be delivered by a multidisciplinary team and with multiple
methods tailored to her learning preferences. In this scenario,
the preoperative teaching could have been done in the patients
preferred method prior to the surgery date in order to minimize
anxiety, reduce fear and have better prepared her for discharge
home.
Proposed Change of Practice
Successfully preparing patients for a stressful event such as
surgery can be done in a more effective manner. It should be
proposed to standardize the preoperative patient education
process to include PACU teaching prior to surgery. The
preoperative education should be offered to the patient at the
time of scheduling and in multiple delivery methods such as
written, verbal, video and face to face interaction based upon
the patient’s preferred learning style. Surgery patients need to
know about pain management, physical therapy, diet and
physical restrictions as well as have the chance to have their

questions answered. This form of preoperative patient education
will decrease fear, anxiety and increase patient satisfaction.
Conclusion
In conclusion, a change in practice such as this has many
barriers. The evidence presented in the four articles discussed,
were great examples of medically ethical and evidence-based
research that contributes to the knowledge base for improving
patient education prior to surgery. The goal of all healthcare
providers should be to serve and care for the patient in the best
way possible. Preoperative education is a major component for
surgery patients. Preoperative patient education that includes
PACU teaching and that is delivered in the patient’s preferred
method for learning is paramount for ensuring the best patient
experience and improved patient outcomes.
References
Hovsepian, J., Mcgah, C., & Obrien, C. (2017). Postoperative
Instructions Preoperatively—Evaluating the Effectiveness of a
Teaching Model on Patient Satisfaction Regarding Instructions
for Home Care. Journal of PeriAnesthesia Nursing,32(3), 231-
237. doi: 10.1016/j.jopan.2015.12.014

Ibrahim, M., Lau, G. J., Smirnow, N., Buono, A. T., Cooke, A.,
Gartshore, K., . . . Johnson, K. (2018). A Multidisciplinary
Preoperative Teaching Session for Women Awaiting Breast
Cancer Surgery: A Quality Improvement Initiative.
Rehabilitation Process and Outcome, 7, 117957271879093.
doi:10.1177/1179572718790937
Kennedy, D., Wainwright, A., Pereira, L., Robarts, S., Dickson,
P., Christian, J., & Webster, F. (2017). A qualitative study of
patient education needs for hip and knee replacement. BMC
Musculoskeletal Disorders, 18, 1–7.
Lemos, M. F., Lemos-Neto, S. V., Barrucand, L., Verçosa, N.,
& Tibirica, E. (2019). Preoperative education reduces
preoperative anxiety in cancer patients undergoing surgery:
Usefulness of the self-reported Beck anxiety inventory.
Brazilian Journal of Anesthesiology (English Edition), 69(1), 1-
6. doi: 10.1016/j.bjane.2018.07.004
Exercise 2 - Making a Difference
Grading Rubric
Criteria Level 4 Level 3 Level 2 Level 1
Criterion 1 - Describe both
organizations
(Full credit: 40 pts)

40 points
Described both
organizations clearly,
including mission
statement, type of
organization, founding date,
focal environmental issue,
and two current initiatives
of each organization.
40-36 points
35 points
Described both
organizations moderately,
but left out one of the
following: mission
statement, type of

and two current initiatives of
each organization.
35-28 points
27 points
Described one
organizations clearly, but
omitted or weakly
described the second
organization's mission
statement, type, founding
date, focal environmental
issue, and two current
initiatives.
27-24 points
20 points
Weakly described both

organizations and omitted 2-
3 of the following: mission
statement, type of
and two current initiatives.
23-0 points
Criterion 2 - Describe differences
between the organizations
40 points
Clearly described at least
three differences between
the two organizations using
both external references and
personal insight.
40-36 points
35 points

Clearly described at least
two differences between the
two organizations using both
external references and
personal insight.
35-28 points
27 points
Weakly described at least
1-2 differences between
the two organizations
using only personal
insight.
27-24 points
20 points
Weakly described at least a
difference between the two

organizations using only
personal insight.
23-0 points
Criterion 3 - Comprehensive
Summary
40 points
Concluded with a
comprehensive summary
that compared/contrasted
each organization with the
35 points
Concluded with a moderate
summary that
compared/contrasted each
organization with the your
27 points

Concluded with a weak
summary that
compared/contrasted each
organization with the
20 points
Did not conclude with a
comparison of each
organization and your own
worldview. Failed to state
your own
worldview. Clearly stated
which organization you'd
rather take part in and
why. Closed with
thoughtful, relevant
remarks.

40-36 points
own worldview. Clearly
stated which organization
you'd rather take part in and
why. Closed with
thoughtful, relevant remarks.
35-28 points
your own
worldview. Stated which
organization you'd rather
take part in and why. Did
not close with thoughtful,
relevant remarks.
27-24 points
which organization you'd
rather take part in or did not
describe why. And/or did
not close with thoughtful,

relevant remarks.
23-0 points
Criterion 4 - References
10 points
All references listed at the
end
In-text references are
included
Correct APA format
10-9 points
8 points
Missing one reference,
and/or
Minor problems with APA
format, and/or
Missing in-text references

8-7 points
6 points
Missing several
references, and/or
Major problems with
APA format, and/or
No in-text references
6-1 points
0 points
No references cited
0 points
Criterion 5 -
Format/Length/Grammar/Spelling
10 points
1-4 minor
spelling/grammatical errors,

paper is 3-4 pages in length
(excluding any optional
figures), paper is double-
spaced
10-8 points
7 points
5-8 spelling/grammatical
errors, paper is not 3-4 pages
in length (excluding any
optional figures), paper is
not double-spaced
7-5 points
4 points
9 -
14 spelling/grammatical
errors, paper is not 3-4
pages in length

(excluding any optional
figures), paper is not
double-spaced
4-1 points
0 points
15 + spelling/ grammatical
errors, paper is not 3-4
pages in length (excluding
figures), paper is not double-
spaced
0 points
Overall Score
Level 4
126 or more
Level 3
112 or more
Level 2
98 or more

Level 1
0 or more
Running head: MAINTAINING SMOKING FREE
ENVIRONMENT IN THE CLINICAL SETTING 1
MAINTAINING SMOKING FREE ENVIRONMENT IN THE
CLINICAL SETTING 2
Research Critique
Background
Sanitation remains a major concern in healthcare as hospitals
and clinics are expected to maintain high levels of hygiene. The
cleaning staff within healthcare facilities should ensure that
high levels of cleanliness are maintained (Caselli et al., 2018).
Failure to observe hygiene can expose patients and nursing
community to various hospital acquired infections. Smoking in
health facilities is one of the major sanitary problem facing
healthcare facilities such as hospitals and clinics.
Several studies have been conducted to find out various ways
through which the issue of tobacco and nicotine smoking can be
prevented. The researches have deeply explored the element of
managing the problem of smoking in healthcare setting –
including various ways through which smoking can be stopped.
Notably, the issue of smoking in healthcare facilities is evident

especially among the 18-30-year-old adult population. This
study seeks to explore various ways through which tobacco and
nicotine smoking among patients in healthcare facilities can be
stopped. Moreover, the study seeks to establish the alternatives
for smoking whose effects are less severe.
Problem Statement
Smoking in healthcare facilities is among critical problems
which seem to compromise the type of sanitation available in
hospitals and clinics. This is indeed an issue that require quick
attention and management since it puts the lives of patients and
nursing community at risk. A gap exists in the researches which
have been carried out to educate the public and nursing
professionals on the effects tobacco and nicotine smoking as
well as how to manage and stop those unhealthy behaviors.
Significance
The significance of the study is to help management in
healthcare facilities understand and gain knowledge on the
effects of tobacco and nicotine smoking within their premises –
including the common diseases associated with the behavior.
Moreover, the study will be significant in helping the nursing
community to improve the efficiency in preventing smoking as
well as alternatives to this practice.
Purpose
The purpose of the study is to improve the level of hygiene
within the healthcare facilities in order to eradicate the hospital
acquired infections associated with tobacco and nicotine
smoking.
Objective
The objective of this study is help nursing professionals to
enhance the quality of healthcare delivery by helping tobacco
and nicotine smokers to stop the unhealthy smoking behavior.
Research Question
How does cessation of tobacco and nicotine smoking among
adult patients help to improve sanitation and reduce hospital
acquired infections?
Article Analysis

There two articles –one by Metrick et al. and another one by
Buller et al. – forms the basis of this study. The two articles
have been used to answer my PICOT question. First, in terms of
problem/patient/population, the problem of smoking that is
common among the population of adults aged 18-30 years has
been addressed. Moreover, intervention or indicator highlighted
in the articles is replacement therapy treatment; comparison is
lack of undertaking replacement therapy treatment; while the
outcome of interest is smoking cessation.
The interventions and comparison groups highlighted in the two
articles are equally similar to those identified in my PICOT
question in a number of ways. First, the population of study
used in both cases include young adults aged between 18-30
years –group that is mostly addicted to smoking. The
interventions are meant to stop smoking behaviors or even seek
an alternative way whose effects are less severe. The focus of
these interventions is to ensure that there is reduction in
nicotine and tobacco smoking in healthcare facilities. Finally,
the main aim of the interventions is to ensure that both patients
and nursing professionals are not exposed to the risk of
contracting hospital acquired infections resulting from smoking
behaviors.
Method of Study
The two articles use different methods of study. The first article
by Buller et al. (2014) uses qualitative research methods
involving grey literature, database, and articles review. On the
other hand, the article by Metrik et al. (2014) uses observation
and direct experimentation. However, the first article uses deep
analysis of previous researches while the second one explores
comparative element seeking to compare various samples from
the population of study. The method used by Buller et al. is
more appropriate since it involves thorough analysis of
materials relevant to the study in order to help researchers in
establishing the gaps available. This allows the study to address
those gaps. However, the research by Metrik et al. lacks
academic rigor due to the fact that the findings were based on

generalization hence affecting their validity.
Observation
Benefit
· It is one of the easiest and time saving method since it does
not require any technical knowledge to use it in collecting data.
Limitation
· It lacks reliability since it is subject to “personal bias of
observer” (Jamshed, 2014).
Article reviews
Benefit
· It provides deep information regarding a particular topic
within the shortest time possible hence enabling the researcher
to understand any gap available (Rowe, 2014).
Limitation
· Lacks clarity since it is prone to biasness in terms of the
materials selected by the researcher
Direct Experimentation
Benefit
· The researcher has a high control over the study variables
Limitation
· Direct experimentation can produce unreliable and artificial
findings (Barker & Milivojevich, 2016).
Study Results
The results of the study by Buller et al. indicates that smoking
is prevalent among young adults in United States. The findings
also propose preferential treatment aimed at reverting the
behavior of nicotine smoking among the target population.
Moreover, the study findings indicate that replacement therapy
including nicotine patch is effective in helping to stop the
smoking habit among the target population.
Additionally, the article by Matrik et al. sought to establish
ways through marijuana can be used to help the target
population to cease smoking tobacco and alcohol drinking. It
was found that marijuana can be used as an alternative way of
stopping tobacco smoking since the effects of bhang are less
severe compared to those of tobacco that can cause cancer

among other effects.
Implications of the Study
Notably, the two studies chosen to guide my research can have a
positive implication in nursing practice. First, they can enable
nurses to improve healthcare delivery but helping the target
population to stop smoking nicotine and tobacco which have
negative effects on the users. Secondly, it can help nursing
professionals in enhancing the sanitation of healthcare facilities
reducing the possibilities hospital acquired diseases that
exposes patients and nurses to serious risks.
Comparing Outcomes
The first anticipated outcome for my PICOT question is
reduction of tobacco and nicotine smoking in hospitals.
Secondly, the anticipated outcome is improved sanitation and
reduction of risks that patients and nurses are exposed to as a
result of poor hygiene. Thirdly, there is need to improve the
quality of healthcare service delivery and reduction in risks of
contracting dieses associated with smoking.
The anticipated outcomes of my study have particular
similarities to those of the two chosen articles since all of them
seeks to ensure that the target populations stop smoking
nicotine or tobacco. Moreover, the outcomes of the both studies
are aimed at helping the target population to switch to
alternative smoking that is less severe, for instance, smoking
marijuana.

References
Barker, T. B., & Milivojevich, A. (2016). Quality by
experimental design. Chapman and Hall/CRC.
Buller, D. B. et al. (2014). Effect of nicotine replacement
therapy on quitting by young adults in a trial comparing
cessation services. Journal of Public Health Management and
Practice: JPHMP, 20(2), e7–e15.
DOI:10.1097/PHH.0b013e3182a0b8c7. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3966563/.
Caselli, E., Brusaferro, S., Coccagna, M., Arnoldo, L., Berloco,
F., Antonioli, P., ... & Conte, A. (2018). Reducing healthcare-
associated infections incidence by a probiotic-based sanitation
system: A multicentre, prospective, intervention study. PloS
one, 13(7), e0199616.
Jamshed, S. (2014). Qualitative research method-interviewing
and observation. Journal of basic and clinical pharmacy, 5(4),
87.
Metrik, J., Spillane, N. S., Leventhal, A. M., & Kahler, C. W.
(2011). Marijuana use and tobacco smoking cessation among
heavy alcohol drinkers. Drug and alcohol dependence, 119(3),
194–200. DOI:10.1016/j.drugalcdep.2011.06.004. Retrieved
from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3199036/.
Rowe, F. (2014). What literature review is not: diversity,
boundaries and recommendations.
Running head: CRITICAL APPRAISAL: SANITATION AND
HOSPITAL ACQUIRED INFECTION

1
CRITICAL APPRAISAL: SANITATION AND HOSPITAL
ACQUIRED INFECTION 2
Critical Appraisal: Sanitation and Hospital Acquired Infection
Critical Appraisal: Sanitation and Hospital Acquired Infection
Introduction
The clinical issue at hand is the consideration of the general
population as an issue in the effective management of
prevention measures. In that way raising the question of the
management of the patient population and the risk of exposure
to affects both the nursing community and the patients. This is
especially important in understanding the inconvenience created
by a specific demographic of patients such as tobacco and
nicotine users. The main issue at hand is focused on is the
cleaning staff whose actions affect patients. In intention to
understand this aspect, the question is the personal motivation
in curing and the need for information dissemination. This is
necessary for the general population to understand the
symptoms and gain more knowledge of common diseases. This
paper will look at two peers reviewed qualitative research
articles to understand the findings and its contribution to this
research question in the context of nursing practice.
Additionally, there will be a discussion on the ethical

considerations at institutional and individual participation
levels to the article’s contribution in the improvement of care
delivery and improved outcomes by establishing a purpose.
Qualitative Study Background of Study
Developing technology means there are developing issue in
other parts including the type of sanitation that can be available
in the hospital and the clinic. Therefore, the likelihood of the
increased need for efficiency in prevention is considered
through the identification of alternative to smoking in
healthcare facilities.
Article 1: Replacement Therapy in Smoking Cessation
According to the article, Buller et al. (2014), there is a need to
understand that smoking as a vice affect the 18-30-year-old
adult population and therefore, in trying to prevent the issue at
hand in a healthcare setting, the consideration of using a patch
is necessary. Regarding this, the paper addresses the issue of
the effectiveness of nicotine patch in smoking cessation and
thus provision of an opportunity to help in smoking cessation.
Given this, the article supports the preferential treatment to
smoking as replacement therapy especially in young adults who
are the prevalent population in the U.S. Therefore the question
is raised are:
· Identification of an alternative method of smoke cessation
· The effectiveness of replacement therapy in helping cessation
of smoking in the identified population.
In consideration of this, the purpose and the research question
were related to the same problem by taking into account the
intervention, the population affected, eth existing systems, and
the available solutions.
Article 2:
On the other hand, according to Metrik, Spillane, Leventhal, &
Kahler (2011), there is a question of the gap in understanding
whether marijuana affects the outcomes of cessation of
smoking. As a comparative element, the article points out that
alcohol use is known to impede cessation of smoking.
Therefore, there is an existing gap to understand the effects of

marijuana to the user population hence the authors establish the
significance of the study by pointing out that there is little
known, frequency of smoking marijuana is high on the users and
in effect a need for predictability in relapses. Therefore the
questions raised are:
· Does marijuana smoking affect cessation of nicotine smoking?
· Can marijuana smoking be used is the substitution of alcohol
use and tobacco smoking?
The question as is related to the research purpose and question
as they explicitly question the availability of more information
and address the gap in research while taking into account, the
effect on the user population.
Method of Study
In the research by Buller et al. (2014), the main method of study
was qualitative research through article and database review in
addition to grey literature. A representative sample has been
used form a pool carefully chosen in line with intervention
measures. This methodology was appropriate for the study as it
took into account the existing research that has been extensively
done hence used in recognition of available gaps. Several
articles have been cited in support of developing an issue and
tackling the argument with careful consideration of the gaps in
study hence logic in the arguments. This gaps and challenges
have been addressed using even more studies and further
elaboration of the developing changes with time. This can be
seen in the carefully developed framework of study findings
that point out that available statistics and its interpretation.
In the research by Metrik, Spillane, Leventhal, & Kahler (2011),
The methodology used is direct experimentation and
observation in replacement of tobacco and alcohol use with
marijuana. There is, therefore, a comparative element of alcohol
using marijuana nonsmoker and smoker with nonalcoholic users
from the sample pool. Older article and recently done have been
used to show the generational development of information and
the existing information. However, there is a lack of evaluation
of the strengths of the article used and eth challenges hence a

lack of addressing of the validity of claim generally. However,
this does not stop the authors from having a logical explanation
to the information and in that way buildup of a well thought out
argument such as the definition of desirable goal for the user
and smoker in cessation trial to the difficult that create relapses.
Results of Study
Buller et al. (2014), concludes that many of the young adult
population have tried to cease smoking and the replacement
therapy with nicotine patch has been successful in community-
based services. Therefore, it shows that nursing practice should
be considered outside the healthcare facility to effectively reach
to a wider population especially when it comes to preventive
measures. In this way, information dissemination is key in the
improvement of population health.
Metrik, Spillane, Leventhal, & Kahler (2011) conclude that
marijuana smokers would need intervention in smoking
cessation and the lack of information is one of the challenges in
this area. There is an indication of heavy alcohol use with
marijuana smoking and difficult level of cessation is similar
across in both nicotine and marijuana smokers. The article,
therefore, contributes to nursing by pointing out that there is no
differentiation between these patients and therefore the type of
smoking should affect the diagnosis and methodology of
treatment. However, more study is needed at the institutional
and administrative level to provide education on the same.
Ethical Considerations
Both articles show that consent was asked from the participants
with no conflict of interest declared and where there is the
condition have been clearly stated and author names given.
Participation for the counseling session in Southeastern New
England for one of the article shows a consent in research from
the individual. This shows the institutional review and approval
for both articles by the health board and the HHS. Where the
article is published after review. Subsequently, there is
confidentiality that gives privacy to the participants by only
using their age and smoking history. Declaration of

communication channel and availability also shows openness to
the public for complaints to be raised f they arise with legal
disclaimers declared.
Conclusion
The article gave insight into the logical development of research
question in line to nursing roles and practice and thus
generalization of the understanding of issues to address.
Therefore there is a critical analysis of information from
historical and present study to account for the developing of
nursing care implementation and applicable intervention by
pointing out the interest, existing gaps, and purpose.
References
Buller, D. B. et al. (2014). Effect of nicotine replacement
therapy on quitting by young adults in a trial comparing
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Practice: JPHMP, 20(2), e7–e15.
DOI:10.1097/PHH.0b013e3182a0b8c7. Retrieved from
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Metrik, J., Spillane, N. S., Leventhal, A. M., & Kahler, C. W.
(2011). Marijuana use and tobacco smoking cessation among
heavy alcohol drinkers. Drug and alcohol dependence, 119(3),
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