Running head: RESEARCH ARTICLE CRITIQUE 1

A Research Article Critique on Khalaila’s “Patients’ Family Satisfaction with Needs met at the

Medical Intensive Care Unit”

Kennedy E. Burton

University of Saint Mary

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Research Article Critique

Introduction

Title

The title of the research article, “Patients’ Family Satisfaction with Needs met at the

Medical Intensive care unit”, identifies the general idea of the study. The theme of the article,

family satisfaction with needs met in the intensive care unit, is easily recognizable but readers

are left with the responsibility of delving further into the research to establish a more

knowledgeable grasp of the study. Upon initial glance, the title does not grab the readers’

attention, however, it is short, sweet, and to the point. Furthermore, the title does not explicitly

state the qualifications of the author but her credentials are noted further down the page. The

author, Rabia Khalaila, is dually qualified, as not only a doctorate holder and a registered nurse,

but also resides as Director of the Nursing Department at Zefat Academic College in Israel.

Additionally, the writer's credentials align with the study of the research article because the

subject focuses on the needs and satisfaction of the family and according to the research,

“planning nursing interventions help meet these needs is an important part of critical care

nursing” (p 1173).

Abstract

The abstract allows readers to discover more information on the study. The abstract is

succinct, outlining the aim, background information, design of the study, methods used, overall

findings, and conclusive data that will be uncovered in the subsequent article. Compared to the

title, the abstract grabs the readers’ interest by shining light on a topic that has yet to be

researched all that well—the importance of incorporating nursing interventions that focus on

family-centered care in a predominately patient-centered care professional field. The abstract is

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well within the normal 250-word limit making it easily readable and straight-forward about the

concept of the research being conducted.

Problem and Purpose

The problem statement is found in the “Introduction” section of this article, just prior to

background information (p. 1173). The problem the author is addressing pertains to the lack of

studies conducted about the gap between perceived importance and perceived met needs of

family members of intensive care unit patients. The author, then, relates those to family

satisfaction with those identified needs met, which prior studies have not researched.

Additionally, studies of this nature have been previously conducted within pediatric intensive

care units, however, evaluating needs met and family satisfaction of adult intensive care units

prove to be just as significant as parental needs met of pediatric patients. The scope of the

problem is narrow enough to be researchable, however, due to the specificity of needs discussed

not being identified prior to this study, it does make for a more complicated and perplexing

research subject. The problem would be more clear had the researcher identified the importance

of the family members’ needs prior to the research of this article. This would have created a

more well-defined research topic rather than packing too many variables into the current

research. The research problem stated by Khalaila is certainly testable to pinpoint the exact needs

of family members of patients in an adult intensive care unit.

The purpose of the study, also known as the aim, is exact and distinguishable—ranking

the importance of family member’s needs and whether or not they are being met, together with,

assessing family satisfaction with needs met. The purpose statement outlines three potential

outcomes of needs met: total satisfaction, satisfaction with care, and satisfaction with

information and decision-making. The purpose is not significant to the clinical skill of nursing
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but remains significant to the idea of holistic nursing—healing the whole person. The research is

feasible because of the qualifications of the author, the availability of resources, and the minimal

funding that was required to conduct this investigation.

Literature Review

The literature review consists of background information on the study and relevant

findings from past conducted research, which is presented in a concise and organized manner.

The study consisted of 35 sources with publication dates ranging from 1970 to 2011. Fifteen of

the 35 referenced articles were published within a range of five years of the 2013 publication

date of this study. The review of literature referenced 26 articles with dates ranging from 1979-

2011. Twelve of the referenced articles in the review of literature were published within five

years of the study’s publication date. This information indicates that about half of the overall

reference list, throughout the entire article and within the review of literature is current to the

study.

This article references and cites relevant sources that discuss the importance of family

presence, needs of relatives in intensive care units, family satisfaction, experiences of family

members in adult and pediatric intensive care units and family member contributions to patient

care. Furthermore, 33 of the referenced articles are primary sources and two secondary sources.

An overwhelming majority of the articles being primary sources signifies that the references in

this research are reliable and dependent on original research findings.

Theoretical Framework

A theoretical framework was not overtly stated within the article although more than one

could have been used to better support its purpose. One theoretical framework that would have

been useful is the Crisis Theory by Julie Kneedler, RN, EdD. The Crisis Theory “relates to an
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individual's emotional reaction to a situation and to the nursing process as a systematic approach

for delivery of quality care” (Kneedler, 1984). This theory works as a theoretical framework for

Khalaila’s study because it relates directly to the nursing process having an effect on the quality

of care received by both patients and family members.

Additionally, Jean Watson’s Theory of Caring could also be utilized. This model

discusses the importance of not only focusing on the patient’s condition but looking at

everything that involves the patient including culture, environment, and family (Watson, 2008).

This theory is consistent with Khalaila’s study on family needs met and satisfaction because it

places importance on patient care through external variables including the family.

Evaluation of the Research Methods

Research Design Elements

The design of the research is found in the abstract and “The study” section (p. 1174). The

design is simply stated as a non-experimental correlational-descriptive study. The design is

adequately described and congruent with the methods used to conduct the research. Because the

research did not implement interventions, the design of the study does fit the needs of the

purpose of this article. However, it would be interesting to see a quasi-experimental follow-up

study conducted using a control group and experimental group to test distinguished nursing

interventions that relate directly to meeting family needs.

The hypothesis is not clearly implied and the formation of a hypothesis was left to the

reader’s discretion. A hypothesis that correlates with this study is, “if the established importance

of needs of patients’ family members are met, then it will lead to better outcomes for the patient

and family and will, ultimately, increase family satisfaction with overall care.” Therefore, a

positive correlation between needs met and overall family satisfaction of care is distinguishable.
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The hypothesis that was created identifies as complex, directional, causal and research. There are

no independent or dependent variables because interventions were not implemented. The

research variables identified in this study include family needs importance, family needs met,

and family satisfaction.

Data Collection and Instruments

The data for this study was collected in a nine-bed medical intensive care unit in

Jerusalem, Israel. The data collection location was appropriate for the study as it measures family

needs met and satisfaction in intensive care units. All data was collected in a 30 minute face-to-

face structured interview (p. 1174). This setting does reflect the real world because the study was

integrated into the typical daily workings of a real intensive care unit. Validity and reliability

were discussed in length in the article which increases the article’s credibility (p. 1176). This

section of the article talks about how the instruments used were translated into Hebrew by two

bilingual translators and how some questions were modified before final approval for use.

The instruments that were used to conduct this study include the Critical Care Family

Needs Inventory to measure family needs importance and family needs met, as well as, the

Family Satisfaction in the Intensive Care Unit to measure family satisfaction. Each instrument

used a 4-point Likert scale and a 5-point Likert scale, respectively. For the purposes of this

research, using the Likert scales were an appropriate form of data collection.

Protection of Human Subjects

Details on the ethical considerations can be found on page 1176 of the article. This study

was approved as ethical by both the institutional ethics committees and the Research Ethics

Committee of Zefat Academic College. Full consent was given by all participants, all of who
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were over the age 18. Participants were explained their rights to withdraw at any time and strict

anonymity was maintained.

Replication

The methods used to conduct this study are stated clearly and a replication study could be

conducted. Information on the design, participants, data collection, measures, and how the

instruments were used are described in detail and would be easily followed if this study were to

be replicated.

Data Analysis

Descriptive

The target population for this study is family members of intensive care unit patients. The

accessible population consists of 70 family members of critically ill patients. Family members

were interviewed in order to establish if they met the criteria of the population. The criteria

included age 18 and older, family members of patients who have been in the intensive care unit

for more than 48 hours and relatives had to have visited the patient for at least three hours each

day. Non-family visitors were strictly excluded from the study and the sampling size was based

off of previous research done. A sample size of 70 subjects was finally decided on and

determined sufficient to yield a power of 0.85 (p. 1174).

The demographic characteristics taken into consideration include age, education, gender,

marital status, family relationship to the patient and employment status. The findings from the

aforementioned characteristics express a true heterogeneity of the sample because of the wide

range of family members that were included in the study.

There was no power analysis conducted which increases the risk of developing a

statistical type-II error. This means that there is a higher risk of retaining a false negative result.
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Study Results

For the results to be considered statistically significant in this study, the test of

significance should be (p< 0.05). According to Grove, Gray, and Burns (2015), establishing

statistical significance in the results indicates that the findings coincide with the predictions set

by researchers and back the logical associations that were developed in the study. In the

“Results” section, a negative correlation yet statistical significance (p< 0.05) was found between

education level and total satisfaction, as well as, education and care satisfaction (p< 0.001).

Additionally, all items in exception to information domain on the needs met subscale were found

to be statistically significant (p< 0.001) and were positively related to care satisfaction. Finally,

information needs met and support needs met were positively related to higher satisfaction in

combination with information and decision-making and were also statistically significant (p<

0.001). All the results are clinically significant because they help show future nursing

interventions geared towards these findings should take place to meet the needs of family

members in order to increase overall family satisfaction.

Understanding

The result statistics are stated in a slightly confusing manner. While it is easy to find the p

values of the variables tested, the description of the study and results that were found are difficult

for readers to understand. The results are presented in three tables and one figure which helps but

the lengthiness of the results section competes with the tables and figure in clarity and

congruency.
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Discussion and Conclusions

Discussion of Findings

The author offered an objectified interpretation of the results. The results were discussed

in association with the findings from prior studies. In the “Discussion” section, the author

reported, “The current study reconfirms findings from earlier studies about needs met as reported

by family members of ICU patients,” (p. 1177). The author proposed explanations of results that

were discussed in the “Results” section of this article and reaffirmed the results of being

clinically significant. Unfortunately, the author does not relate the results back to a theoretical

framework, which would have increased the significance of the findings.

Conclusions

The products of this study align with the hypothesis that was comprised due to the lack of

an overt hypothesis statement. In the “Conclusion” section of the article, the author remarks,

“The results also revealed that unmet needs of family members impact negatively on family

satisfaction with care, information, and decision-making,” (p. 1180). The hypothesis speaks to a

positive relationship between needs met and an increase in family satisfaction and the author

concludes that a negative relationship is found between unmet needs and decreased family

satisfaction.

The author notes that this study is the first to recognize perceived importance of family

needs to find correlation between that and physically meeting those needs. The findings are hard

to generalize because the convenience sample comes from a small, single site and is not

randomized. Moreover, the author advises clinicians to consider the results of this study and

implement the findings into all programs to improve the holistic approach of care to the ICU
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setting. Finally, the author notes that by following these recommendations, nursing interventions

for patient- and family-centered care will increase overall family satisfaction.

Limitations

The limitations of this study are proposed in the “Limitations” section of the article. The

limitations discussed include the type of design, the small size of the convenience sample

making the study challenging to generalize, and the lack of a control group which relates back to

the type of design of the study. The author offers defense for the article, stating that is an initial

insight into the association between the variables at hand. The author reports that additional

studies should be conducted.

In addition to the discussed limitations, the lack of theoretical frameworks and power

analysis hinder the relatability of this study to the real nursing world and increase the risk of

developing type II errors, respectively.

Confidence

Overall, the confidence of this study is dependent on the following factors. Firstly, the

implications for practice are proudly stated and relate to holistic nursing, a staple in every nurses’

education. These implications directed towards nurses gives reasonable advice to move towards

a family-centered fashion of care. After reading this study, it is easy for nurses to recognize the

importance of incorporating family-centered care nursing interventions in their everyday work.

The results were both statistically and clinically significant which shows that there is a

relationship between the variables and can be addressed in the clinical setting. Because there was

a detailed description of the instruments used, accompanied with their validity and reliability, the

results prove to be usable and able to be merged into the clinical setting.
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Moving forward, it would be interesting to see this study conducted as a quasi-

experimental study which focuses on finding correlations between unmet needs of family

members and specific nursing interventions designed to meet those needs. Conducting a study of

this type further reinforces the need for family-centered nursing interventions to be incorporated

into intensive care units. Second, the limitation about the sample size affecting generalization of

the study decreases the confidence of the results. It is testing attempting to state that the findings

of a nine-bed intensive care unit in Jerusalem will have the same results if the study were

conducted in a hypothetical 20-bed intensive care unit in Western society.

As stated previously, the lack of theoretical framework does hinder the studies ability to

relate back to the established nursing theories. Finally, the last fault that deters the confidence of

this study is the lack of a power analysis which increases the risk for retaining a false negative.
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References

Burns, N. Gray, J. & Grove, S. K. (2015). Understanding nursing research: building an

evidence-based practice. Saint Louis, MO: Elsevier Saunders.

Khalaila, R. (2013) Patients’ family satisfaction with needs met at the medical intensive care

unit. Journal of Advanced Nursing 69(5), 1172–1182. doi: 10.1111/ j.1365-

2648.2012.06109.x

Kneedler J. (1984). Crisis Theory: A Framework for Nursing Practice. Journal of Continuing

Education in Nursing. 15(1) 31. doi: 10.3928/0022-0124-19840101-13

Watson, J. (2008). Nursing: The Philosophy and Science of Caring (rev. ed.), Boulder:

University Press of Colorado.