The purpose of this paper is to discuss and explain the processes involved in research and the methods involved. It will also explore the principles underpinning quantitative and qualitative research.

As part of the paper I will critique an article titled ‘Out-of-hospital cardiac arrests in the toilet in Japan: a population-based descriptive study’ (Kiyohara et al., 2018) using the Coughlin, Cronin and Ryan (2007) critique tool.

The Research Process

Phase 1: Identify the research question or topic

Deciding what topic or area in which the research is to be carried out forms the first part of the research process (Wood and Kerr, 2011). Identifying areas where processes or procedures, gaps in knowledge can be improved are common when performing healthcare research (Holloway and Wheeler 2010).

Phase 2: Literature review

Once the topic or area of research has been decided a literature review is performed, searching for what research or exploration of the topic has already been completed by others. Repeating research that has already been conducted and published on the chosen area of research could be construed as unproductive (Gerrish and Lathlean, 2015). This in-depth summary completed prior to the reseach taking place shows issues and approaches which have already been published on the same topic (Kiteley and Stogdon, 2014).

Carrying out the literature review shows how others have potentially carried out their research, clarifying any issues and informs the current researcher how similar topics have been formulated (Polit and Beck, 2016).

Phase 3: Research design

Planning the structure of the research needs to be completed before any data is collected or analysed. For example, the decision on whether a descriptive or experimental study is to be performed plus the target population the researcher intends to aim the research at (Bowling, 2014).

The selection of procedures and research tools are decided during the planning phase, for example data may be collected using a variety of methods including observing subjects, questionnaires and interviews (Parahoo, 2014).

Phase 4: Collection and analysis of data

Collecting the data is a crucial part of the process aiding the success of any research performed. False or meaningless data results in poor acquired data (Offredy and Vickers, 2010). Observing, assessing, measuring, analysing, interpreting and finally reporting data forms the processes involved in this phase of the research process (McIntosh-Scott et al., 2014).

When all the data has been collected, analysis needs to take place. Interpretation and analysis must take place in order to make the data presentable (Parahoo, 2014).

Raw data taken from the research tools is not enough to support or disprove/reject the subject of the research. The data is simplified and made easier to interpret to reader enabling better understanding (Offredy and Vickers, 2014).

Phase 5: Presentation and discussion of results

Presenting the results of the research is the culmination of what could be years of work. On completion of the previous stages and steps, the researcher may present their results to various audiences including examiners, commissioning groups or agencies, peer reviewed journals and professional journals (McIntosh-Scott et al., 2014). Further to these publications, relevant textbooks may publish the research findings as educational material (Glasper and Reeves, 2017; Holloway and Galvin, 2017).

Quantitative and Qualitative Research

Various research methods exist for researchers to choose from. Quantitative, Qualitative and mixed methodology are common in research (LoBiondo-Wood and Haber, 2017).

Rolf (2012) describes how the different methodologies and methods can be applied to research.

Both qualitative and quantitative research aim to answer questions posed, qualitative looks at what, why and how whereas quantitative looks at how much or how many (McCluster and Gunaydin, 2014).

Quantitative research method focuses on the use of numbers and accuracy instead of experiences and perceptions (Polit and Beck, 2016). Quantitative research is defined by Gaskin and Chapman (2014) as a method that collects information in number format to analyse.

Defining quantitative research Yilmaz (2013) describes how data is analysed using mathematical methods before being presented and published. Saunders et al., (2012) describes quantitative research as the backbone of a research study as it allows generalisation of results due to the responses and views of the sample population used for the study.

Advanced statistical analysis packages may be required to calculate the data produced from the research sampling due to the possible high number of results produced by quantitative studies (Curtis and Drennan, 2013). Studies can use a population of millions to a very small survey pool where only minimal technology such as a calculator can be used to produce the results Curtis and Drennan, 2013).

Quantitative research has a long history of use and is a well-respected method (Brannen, 2016). It is stated by Rutberg and Boukidis (2018) that a better structured environment is made by using quantitative research enabling more control over variables. It is further suggested that it is more beneficial as a research method as it allows the researcher to collect and tabulate data in numbers, allowing numerical calculations and interpretation of results (McCusker and Gunaydin, 2014).

In contrast to the stated benefits quantitative research studies can require a large sample size incurring recruitment, authorisation and cost issues (Fagerland, 2012). Where data is being collected regarding customer or patient feedback numerical data is the least reliable instrument in the improvement of services whereas written feedback and opinions (qualitative data) is much more valuable (Macur, 2013).

Maxwell (2013) describes qualitative research as an interactive approach where Hanson, Balmer and Giardino (2013) describe it in more depth and state research data is gathered from words, images and observations. Holloway and Galvin (2016) interpret qualitative research as a social enquiry focused on the way it is interpreted by people.

Qualitative research is an umbrella concept covering group or one-to-one interviews; observing the participants and analysing documentation (Tracy, 2013). It is associated with purposeful searches, processes and investigations, which when evaluated provide information which gains an understanding and knowledge of the focussed study (Carey, 2017).

Research studies benefit from a qualitative approach as the enquiries can be open-ended; they provide the ability to take beliefs, values and assumptions into consideration (Choy, 2014).

Until recently qualitative research wasn’t taken seriously due to having no objectively verifiable results or the inability to verify the interviewer’s skills or knowledge of the subject being researched (Choy, 2014).

Qualitative research when utilised within healthcare develops a patient or relative centred perspective. This enables the researcher to interpret the patient’s experiences of care, communication and interaction (Holloway and Galvin, 2016).

Qualitative research can be a strong tool as it allows researchers to learn about the subject’s society and their personal interpretation of the experience being discussed (Tracy, 2013). Learning from the participants personal experiences enables feedback and improvement of services improving the patient experience (Wang, 2009).

Qualitative research cannot hold the same confidence level as in quantitative research due to its limitations. The wider population used in quantitative research isn’t possible as the data received is not tested to discover whether it is significant statistically or due to change (Wang, 2009).

With limitations to both quantitative and qualitative research methods, a mixed method of research gives better results than one single research tool used on its own (Leppink 2017).

Critical appraisal of article

From the articles available to critique I have chosen ‘Out-of-hospital cardiac arrests in the toilet in Japan: a population based descriptive study’.

My reason for choosing the article is the title suggests close similarity to a job I have encountered whilst in practice. Also the possible contrast between Japanese and British methods could be interesting.

To critique the article I will follow the tool designed by Coughlin, Cronin and Ryan (2007) as it is clear and has a step by step format ensuring all elements are covered.

Research papers are traditionally written in a third person format due to the impression of the writer being impartial and offering a critical approach (Zhou and Hall, 2016). The article being appraised is written in this third person style for the majority of the paper.

It is stated by Coughlin, Cronin and Ryan (2007) that research papers should be well written, grammatically correct and well organised. The layout of the article is in columns due to it being published in a professional healthcare journal. The layout works well on paper as the whole article can be seen and read in a methodical manner; however this style of presentation is less reader-friendly when viewed on a computer screen or tablet due to scrolling up and down when changing columns. It is suggested by Tondreau (2008) that this format makes passages of text easier to read.

Bold font introduces each section and sub-section making each section clear to understand and can aid quicker searching of specific sections.

As the topic being discussed is of medical nature, the writers have limited the amount of technical medical terms used, there are no unnecessary complex terms which would have a reader of none-medical background misunderstanding or not understanding sections of the paper. As highlighted by Rakedzon et al., (2017) researchers not only present their findings to their peers but also public readers.

The authors of the paper should hold positions or qualifications relating to the topic of the paper. This would indicate their potential knowledge in the subject matter or field. This paper has six research contributors each with positions relating to university hospitals or healthcare facilities.

Focusing on one contributor, Takeyuki Kiguchi holds a Doctorate of Medicine and Philosophy (MD-PhD) and has held the position of assistant professor at Kyoto University Hospital, Japan. He has been credited with contributing to multiple papers published with the out-of-hospital cardiac arrest studies in differing locations such as in a motor vehicle and at home. Currently his research is focussed on stem cell therapy for easing Parkinson disease symptoms.

Coughlin, Cronin and Ryan (2007) ask if the report article is clear, accurate and unambiguous. This study doesn’t have a quick, easy to remember title as it stretches over two lines. However the descriptive nature of it clearly describes what the paper is about.

Looking at the abstract section of the paper, this gives the reader an insight into the aim of the study as well as methodology. It gives a clear detailed description of the study and the conclusion without having to read the full article. It is suggested by Pyrczak and Bruce (2017) that an abstract should be between 150 and 250 words. This paper’s abstract is 248 words long, suggesting to me it has been edited down to fit the 250 word specification.

Continuing through the Coughlin, Cronin and Ryan (2007) critiquing guidelines, the purpose of the study should be clearly identified. The title states quite clearly due to its length that this is a population based descriptive study. Published articles can vary depending on the journals target audience (Gerrish and Lathlean, 2015).  As the article can be read by anyone without a medical background, the sub headings give an indication of what each sub section involves without using jargon.

A literature review is suggested by Coughlin, Cronin and Ryan (2007) however reading through the paper by Kiyohara et al., (2018) it is difficult to see if this has been done. No section or sub heading point to this and there is no mention through the text. Completing a literature review is an essential tool for those who have limited knowledge of the subject of the paper (Dunne, 2017).

The use of a theoretical framework within a quantitative research can be absent if the subject is not linked to any exact study (Fothergill and Lipp, 2014). Coughlin, Cronin and Ryan (2007) tool asks if the researchers have used a conceptual theoretical framework for their work, through the text no mention is made of this as suggested by Connelly (2014).

At the start of the abstract the first line starts with the aims of the study. These two lines explain what the study was about but do not pose any research question or objectives.

The sample size should be clearly described within the text, the researchers state their population target is the 2.7 million people living within Osaka City, Japan. Coughlin, Cronin and Ryan (2007) ask whether the sample size, method and participants were suitable for the study. The sample size is stated within the abstract as suggested by Dale et al., (2019). The eligibility of the participants for the study is stated as being 733 meeting the study requirements of cardiac arrests occurring in the toilet.

Ethical considerations are the centre of more healthcare discussions than ever before Confidentiality is a key principle for researchers to consider (Fothergill and Lipp, 2014).

Patient confidentiality is maintained through the study by anonymising any patient information. The Ethics Committees of Kyoto University approved the study as the researchers state confidentiality has been maintained. Personal details were removed from the database prior to the data being used, as a result of this; informed consent from the participants was not required.

Coughlin, Cronin and Ryan (2007) critique tool asks whether the operational definitions are clearly defined. The title of the paper describes the research as a population-based descriptive study; the population in question being Osaka City, Japan. The concept of the study is described within the abstract.

The critiquing tool by Coughlin, Cronin and Ryan (2007) asks if the research design is clearly identified. No mention of this is made in the text. Data gathering instruments are not mentioned in the paper either. It is stated how the researchers collected their data and what criteria was to be met for the study.

Data and statistical analysis is questioned by the Coughlin, Cronin and Ryan (2007) critique tool. The researchers mention that analysis of data was undertaken by the ‘SSPS Statistical Package’ version 24.0J by IBM. No further explanation of choosing this package is made and why it may be appropriate, relevant or specific to this study.

Coughlin, Cronin and Ryan (2007) critique tool asks what number of the sample took part in the actual research and if there are any significant findings.

The research focuses on out of hospital cardiac arrests (OHCA) that occur in toilets over a seven year period. Within the seven year period there were 18,458 occurrences of OHCA recorded. Filtering of these cases revealed that 849 happened within toilets. Further eligibility criteria reduced this number to 733.

Discussing the research paper as directed by Coughlin, Cronin and Ryan (2007) it asks if the findings of the research can be linked back to the literature review. The researchers have not indicated that a literature review was conducted and this makes it difficult to link the findings back. Previously explained in section two of Coughlin, Cronin and Ryan (2007) critique tool, a literature tool is essential to enable comprehensive understanding of the subject matter. Without this an understanding cannot be fully obtained (Wakefield, 2014).

The study’s strengths and limitations are mainly directed towards the limitations. The participant’s medical history and prescribed medication were unobtainable for the study. The research presumes that all OHCA were the result of a cardiac issue unless there is evidence to the contrary. Due to the lack of information in some cases some participants may have been included when their eligibility could be questioned.

The researchers should acknowledge the limitations of their work to enable the reader to understand and make an informed judgement on the topic being researched (El-Masri et al., 2018).

In addressing if the research is generalizable to the wider public there is no mention of this in context throughout the paper.

Coughlin, Cronin and Ryan (2007) critique tool asks if there is any recommendation for further research. Measures to prevent OHCA in toilets are mentioned and early recognition of the event is needed as is the case with all cardiac arrests.

The Vancouver reference system was used in the writing of the research as requested by the publisher of the paper. The researchers used only 13 references out of the allowed 30 for this publication. Looking deeper at the references several were older than 10 years giving the possibility that some reference data could have been dated.

Evaluation of literature

Returning back to my reasons for choosing this research paper to evaluate, the title suggests a somewhat unusual topic however my clinical practice experience does draw some comparisons to the research topic. An article from which I can draw comparisons to my own practice I find interesting and gives opportunity to gain further knowledge. The size of the research paper report was not excessively long enabling fairly easy reading without getting lost or losing focus.

Physically the article format is easy to follow being arranged in a double column format. Each section and sub section has clear titles enabling speed reading or being able to jump to a specific section.

Illustrations are limited to a four step flow chart showing how the eligibility criteria filtered those suitable for the trial. A vertical composite bar chart displays the breakdown of data into months showing the highest occurrences being in January and March. This composite bar chart I personally find difficult to understand as data is stacked on top of other data causing me confusion on how to interpret it.

Reading the paper fully several times I found nowhere that it mentioned if the research was qualitative or quantitative in its methods. This could have been mentioned in the title or the abstract. As the abstract was at the upper limit of its word count some other content would be lost.

Within the text, the researchers suggest that differences in room temperature being a warm living areas and a cold bathroom/toilet increases sympathetic nerve tone further causing an increase in heart rate.

Within my own practice I have attended numerous patients considered elderly who keep a very warm living area compared to a cold bathroom with open windows to aid ventilation of steam and moisture. The patients may have gone to the bathroom according to relatives complaining of not feeling well and subsequently suffered a cardiac arrest. Being in a private room they would only be discovered after a considerable amount of time has passed. This knowledge wouldn’t change how we practice as paramedics as it isn’t feasible for relatives to monitor those who suffer cardiac arrests prior to the event in a domestic setting.

Attending elderly patients for any reason advice can be given regarding keeping bathrooms a temperature consistent with the rest of the house. Cardiac history patients who do not live alone could be advised to inform their relatives at home they will only be a short time in the bathroom giving the best chance for assistance if required or commence cardio pulmonary resuscitation (CPR) if needed. For male patients with a cardiac history advise them to exercise caution when shaving due to carotid sinus massage possibly causing syncope or cardiac arrest.

Using the information and knowledge gained through reading the research paper my clinical practice may not change much however the understanding I have of the condition has increased. Advising patients to the risks associated within the study can be a preventable measure easily considered.

Bigham et al., (2013) state paramedics should have more involvement in research and their input can help clinical performance in practice. The research would be more beneficial if carried out by paramedics due to their role specific view.

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