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Running head: CRITIQUE OF NURSE-DRIVEN MOBILITY PROTOCOL ARTICLE

Critique of Nurse-Driven Mobility Protocol Article
Rita Daniels, Cheryl Howard, and Angie Robl
Ferris State University

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Abstract
The purpose of this paper is an exercise on critiquing a published study. The published study
dissected for the purpose of this paper is “Impact of a Nurse-Driven Mobility Protocol on
Functional Decline in Hospitalized Older Adults,” by Cynthia A. Padula, PhD, RN; Cynthia
Hughes, MSN, RN; and Lisa Baumhover, RN, CNS, BC. The article was divided into eleven
sections: purpose and problem, review of literature, theoretical/conceptual model, hypothesis
and research questions, research design, sample and sampling methods, data collection,
measurement, data analysis, study findings, study conclusions, implications and
recommendations. Each section presents the evidence, support and analysis of information
found in the article. The support of what should be in each section is summarized from two
sources: Burns & Grove‟s 2011 “Understanding Nursing Research” (5th ed.) and Nieswiadomy‟s
2008 “Foundations of Nursing Research” (5th ed.). After each section‟s evidence and support is
outlined, the authors of this critique analyze whether each section is strong or weak. “Research
is a major force in nursing, and evidence generated from research is changing practice,
education, and health policy,” (Burns & Grove, 2011, p. vii).
Keywords: acute hospitalization, functional decline, mobility, older adults, protocol,
critique, nursing research

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Critique of Nurse-Driven Mobility Protocol Article
The purpose of this paper is to critique the article by Padula, Hughes and Baumhover
titled, “Impact of a Nurse-Driven Mobility Protocol on Functional Decline in Hospitalized Older
Adults,” (2009). It is important to critically evaluate the nursing research process to determine
validity and reliability of the research in question. Evidence based nursing practice is developed
through nursing research, (Burns & Grove, 2011). This paper outlines the article‟s strengths and
weaknesses using criteria from Nieswiadomy (2008) and Burns and Grove (2011) texts in order
to determine this article‟s value as evidence for nursing practice.
Purpose and Problem Statement
Evidence
The research article entitled “Impact of a Nurse-Driven Mobility Protocol on Functional
Decline in Hospitalized Older Adults” is a quasi-experimental research study conducted at the
Miriam Hospital in Providence, Rhode Island in 2009. The purpose of this study was clearly
stated, written in a single sentence and was “to determine the impact of a nurse-driven mobility
protocol on functional decline in hospitalized adults,” (Padula, Hughes & Baumhover, 2009, p.
326). Furthermore Padula et al. stated, “We explored whether a mobility protocol would
maintain or improve functional status from admission to discharge and reduce length of stay,”
(2009, p. 326).
The literature supports a finding of a functional decline in older adults after a stay in the
hospital. Padula et al. state that functional status is a significant component in older adults‟
health status and quality of life (2009). Maintaining functional status forms the foundation of
continued independence and health and encompasses behaviors necessary to actively engage in
daily life. Yet, research has demonstrated that low mobility and bed rest are common during

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acute hospitalization. The authors proposed looking at research specific to mobility changes
during hospitalization, (Padula et al., 2009). The study was conducted ethically stating, “training
included human subjects‟ protection and achievement of high-level proficiency with the protocol
and data collection instruments,” (Padula et al., 2009, p. 328).
The feasibility of the article was addressed in the research methods paragraph covering
design, sample, site, interventions, procedures, and instruments. The article stated the research
was conducted on two nursing units, “both equal in size, cared for similar patient populations,
and were characterized by similar nursing staff composition,” (Padula et al., 2009, p. 327). The
significance to nursing is that implementation of the mobility protocol improved or maintained
functional status and had a reduced LOS for older adults who participated.
Support
Burns and Grove report a critical appraisal of the problem and purpose sections of a
qualitative study should identify the clinical problem and research problem that led to the study
(2011). It should identify what was not known about the clinical problem, that if it were known,
nurses could use the information to make a difference. The problem and purpose section should
identify how the authors established the significance of the study and clarify why the readers
should care about this study, (Burns & Grove, 2011). Burns and Grove further report the
requirements to critically appraise the problem statement and purpose and research paragraph of
a research article are: identifying the purpose of the study, listing the research questions the study
was designed to answer, asking if the purpose and research questions were related to the problem
and questioning if qualitative methods were appropriate to answer the research questions (2011).

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Analysis
The problem and purpose statements in the article are clearly stated to the reader. It is
imperative to have a strong problem and purpose statement as a problem statement identifies a
gap in the knowledge needed for practice. The problem and purpose statements guide the
development of the objectives and hypotheses. “A nonequivalent control group design was used;
the independent variable was mobility protocol and dependent variables were functional status
and length of stay” (Padula et al., 2009, p. 326). There are clear objectives and goals in the
written statement, “the goal of this study was to determine the impact of a mobility protocol on
functional decline in hospitalized patients (Padula et al., 2009, p. 326). This is related to the
statement, “The study findings suggests that early and ongoing ambulation in the hallway may be
an important contributor to maintaining functional status during hospitalization and to shortening
length of stay” (Padula et al., 2009, p. 330).
The reader can determine feasibility and significance of the study. The authors identified
a significant gap in knowledge and a feasible purpose for research. The authors‟ expertise is
established with the paragraph author affiliations which states:
Author Affiliations: The Miriam Hospital (Dr Padula and Ms Hughes) and Rhode Island
College (Dr Padula), Providence; and Iowa Health Systems, Des Moines (Ms
Baumhover). The authors sincerely thank the nursing staffs of 4East and 3East for their
participation in this project. Corresponding Author: Cynthia Padula, PhD, RN, The
Miriam Hospital, 164 Summit Ave, Providence, RI 02906 (cpadula@lifespan.org). This
research was funded by the Levy Foundation, Boston, Massachusetts, and supported by
the Nursing Department of The Miriam Hospital. (Padula et al., 2009, p. 325)

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The purpose and problem statement is strong because the required information and statements
are included in the article.
Review of Literature
Evidence
The sources cited in the nurse driven mobility protocol article includes 28 various
sources. The introduction of the article presented the review of literature which represented 19
sources out of the 28 total sources. Of those 19 sources, 18 were journal articles and one was a
gerontological nursing book. The journal sources came from the areas of medical-surgical
nursing, geriatric nursing, gerontology, critical care medicine, hospital medicine, American
Geriatric Society, American Journal of Medicine, and the Archives of Internal Medicine (Padula
et al., 2009).
The introduction used information from the sources that claimed mobility declines related
to hospitalization were linked to older adults‟ poor outcomes, decreased functioning, and
increased need for home health, hospitalization, institutionalization, rehabilitation and health
care spending (Padula et al., 2009). There was evidence found explaining the association of
early ambulation relating to positive functional outcomes, maintenance of cognitive status and
high rate of patient-family satisfaction (Padula et al., 2009).
Support
The purpose of the entire study is based on the review of literature. The purpose of a
literature review is to identify the focus of the article and what is known and not known about the
area of study (Burns & Grove, 2011). All sources in the literature review must be relevant,
concise and current. A current source is considered to be within five years before the
publication acceptance date of the journal article (Burns & Grove, 2011).

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Critiquing a literature review includes making sure the relevant sources are cited
correctly. Research should mainly include primary sources versus secondary sources. Primary
sources are data-based and written by the research conductors (Burns & Grove, 2011). Other
literature critique principles according to Nieswiadomy„s guidelines include presentation of
comprehensive material, paraphrased wording for logical flow, and supporting and opposing
theory and research (Nieswiadomy, 2008).
Analysis
Analysis of the nurse driven mobility protocol article identifies that the focus is clear:
research exists that support a nursing focus on mobility for older adults during hospitalization.
The sources are comprehensive because there are 19 sources from reputable, critically appraised
journals with data to support research. There is a relevant range of disciplines that the sources
are gathered from including nursing, medical-surgical, critical care, hospital medicine and most
importantly geriatrics. The sources are also concise because there is a wide range of closely
related disciplines which is summarized. Paraphrasing is used most often in a logically flowing
manner which is easy to understand. The sources appear to be primary sources for the most
part; this author was able to locate over half of the 19 sources in CINAHL database which were
classified as research, clinical trial, and table/charts.
The nurse driven mobility protocol article was submitted for publication in 2009. In order
for sources to be considered current in this article they need to be no earlier than 2004. Seven of
the sources were published earlier than this acceptable time from ranging from 1993 to 2003.
This does not meet the standard to be considered current research. The authors of this article
state what is known and not known about this topic. They describe over a page of background
information on known research then point out that little research was available, “specific to

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mobility changes during hospitalization,” (Padula et al., 2009, p. 326). However more could
possibly have been shown about what is not known.
All 19 of the citations in the article‟s introduction/review of literature are listed in the
references section and all references are used. No errors were found, the information was
presented in an understandable way, and the authors did build a case for the study‟s purpose
using the review of literature presented. Overall the literature review appears to be strong
support for this study, however there could have been better current research and explanation of
what is not known about this topic.
Theoretical/Conceptual Model
Evidence
The theoretical framework for this research is not stated in the article. The Geriatric
Friendly Environment through Nursing Evaluation and Specific Intervention for Successful
Healing (GENESIS) is briefly discussed as the framework for delivery of nursing care on unit for
the treatment group. The propositional statement is part of the introduction, “The goal of this
study was to determine the impact of a mobility protocol on functional decline in hospitalized
patients,” (Padula et al, 2009).
Support
Burns and Grove describe the framework of a study as, “an abstract, logical structure of
meaning, such as a portion of a theory, which guides the development of the study and enables
the researcher to link the findings to nursing‟s body of knowledge,” (2011, p. 238). According to
Nieswiadomy‟s guidelines, discussion of a study framework should be able to clearly identify
many aspects of the theoretical model. The framework should be clearly identified and based on
a nursing theory or a theory from another discipline. The framework should be appropriate for

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the study and concepts clearly defined. The relationships among the concepts should be clearly
presented. The propositional statement should guide the research question or hypothesis. Lastly,
operational definitions should be provided for the theoretical concepts tested, (Nieswiadomy,
2008).
Analysis
The theoretical framework of this research is weak. There is not a clearly identified
framework. There is a brief description of GENESIS. However, they do not expand on the
background of GENESIS. There is no discussion of propositions or assumptions that could
strengthen the study. According to Burns and Grove, “in a well-thought-out quantitative study,
the researcher explains abstractly in the framework why one variable is expected to cause the
other,” (2011, p. 239). The weakness of the theoretical framework will cause difficulty in
linking this study to previous nursing knowledge.
Hypothesis and Research Questions
Evidence
Padula et al. clearly state two hypotheses, which are “(1) older adults who participate in a
mobility protocol will maintain or improve functional status from admission to discharge and (2)
older adults who participate in a mobility protocol will have a reduced LOS” (2009, p. 327).
Support
The hypothesis is used to outline the anticipated results of a study between two or more
variables. Many of the study‟s components such as study design, sampling method, data
collection, analysis process and interpretation of findings are influenced by the hypothesis,
(Burns & Grove, 2011). Burns and Grove outline four categories of hypotheses,” (1) associative
versus causal, (2) simple versus complex, (3) non-directional versus directional and (4) null

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versus research,” (2011, p. 176). In the first category, an associative hypothesis will state that
the variables are related because when one variable will change when the other also changes.
Casual hypothesis has a cause and effect relationship between the variables, (Burns & Grove,
2011). The second category refers to the number of variables being studied. A simple
hypothesis is related to the interaction between two variables while a complex hypothesis is
related to the interaction between two or more variables, (Burns & Grove, 2011). The third
category describes the type of relationship between the variables. A non-directional hypothesis
does not indicate the type of relationship, but simply states that a relationship exists. A
directional hypothesis indicates whether the variable‟s relationship is positive or negative and
what type of interaction occurred. Lastly, a null hypothesis is used for statistical purposes and
outcomes, (Burns & Grove, 2011).
Analysis
Overall the hypothesis and research section is weak. The variables would be stronger if
an operational definition was provided. Another weakness of this section is the lack of
conceptual framework. The results would be better understood in the context of a conceptual
framework. The hypotheses show the reader to purpose of the study and what results are
expected. The hypotheses in this article are clearly stated simple and directional hypotheses with
clear variables. The independent variable is the “[participation] in a mobility protocol,” (Padula
et al., 2009, p. 327). There are two dependent variables, “maintain or improve functional status,”
and “reduced LOS,” (Padula et al., 2009, p. 327).

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Research (Study) Design
Evidence
Impact of a Nurse-Driven Mobility Protocol on Functional Decline in Hospitalized Older
Adults is a quasi-experimental study conducted in 2009 at two units of Miriam Hospital in
Rhode Island. The study was to determine the impact of a mobility protocol on functional
decline in hospitalized patients. The study was a nonequivalent control group design with an
independent variable of a mobility protocol and dependent variables of functional status and
LOS, (Padula et al., 2009, p. 325). The study concluded that “early and ongoing ambulation in
the hallway may be an important contributor to maintaining functional status during
hospitalization and as a vital component of quality nursing care,” (Padula et al., 2009, p. 330).
Support
According to Burns and Grove, a critical appraisal of a quantitative study should have
clearly stated objectives based on the study purpose (2011). It should also clearly focus on each
objective presented. Further, Nieswiadomy (2008), reports that a critical appraisal of a
quantitative study design should be clearly identified and appropriate to test the hypothesis. If
the study used an experimental design the most appropriate type should used and the means to
control threats to validity should be identified. The researcher should be able to draw a cause
and effect relationship between the variables. If the design was non-experimental, it should be
clearly appropriate and means should be explained for the control of extraneous variables.
Analysis
This research design is a strong section as the research questions in Padula et al. (2009)
are clearly stated in the study purpose paragraph. The problem is addressed in the purpose
statement. The purpose statement read:

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The purpose of this study was to determine the impact of a nurse-driven mobility protocol
on functional decline in hospitalized older adults. We explored whether a mobility
protocol would maintain or improve functional status from admission to discharge and
reduce LOS, (Padula et al., 2009, p. 326).
The study objectives were based on the purpose and the focus of each objective was
clearly presented. The Geriatric Friendly Environment through Nursing Evaluation and Specific
Interventions for Successful Healing (GENESIS) nursing care module included a nurse-driven
mobility protocol that served as the intervention for this research. Research concluded that
patients served with the mobility protocol maintained or improved their functional status from
admission to discharge and that the LOS was reduced.
Means were used to control for threats to internal validity included two nursing units as
study units, both equal in size, cared for similar patient populations, and were characterized by
similar nursing staff composition. An advanced practice nurse was hired to collect data and
participate in screening patients for eligibility and scoring. Controls for extraneous variables,
such as acuity and disease burden, were an acknowledged limitation of the study. “Further study
with quantification of the impact of disease is indicated, especially because participants in this
study experienced, on average, about 7 comorbid conditions,” (Padula et al., 2009, p. 330).
Additionally, the article stated that the presence of a unit-based advanced practice nurse working
with the control group may have affected the outcomes of patient mobility outcomes, (Padula et
al., 2009).

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Sample and Sampling Methods
Evidence
The sample size used in the nurse-driven mobility protocol article is 50 adults who are 60
years of age and older. Subjects were included in the study that only had a medical diagnosis,
(Padula et al., 2009). The inclusion criteria was a non-surgical diagnosis, LOS of three days or
more, ability to understand English, being cognitively intact or having a caregiver that could
participate, and absence of physical impairment that would significantly limit mobilization,
(Padula et al., 2009).
The method used for finding subjects was that 453 patient records were screened for
eligibility. After screening, 84 subjects were enrolled. Then 34 were withdrawn for the study
for various reasons which were listed individually leaving a final sample size of 50. “Study data
was collected with 48 hours for eligible subjects,” (Padula et al., 2009, p. 327). Sample size
statistics were conducted. Statistics for nursing staff characteristics were listed for each unit in
the categories of registered nurse (RN) hours per patient day, unlicensed assistive personnel
(UAP) hours per patient per day, total nursing hours per patient per day, and percent of total
nursing hours by RN and UAP, (Padula et al., 2009).
Support
Critical appraisal of samples requires knowledge of sampling theory, sampling
methodology and sample size, (Burns & Grove, 2011). First the target population needs to be
defined and the accessible population identified. The sample should be of adequate size and
representative of the target population‟s demographics. Sampling inclusion and exclusion
criteria also need to be clearly identified, (Burns & Grove, 2011). The sampling method should

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be named, described and deemed appropriate. The sampling method should also discuss the use
of either probability or non-probability sampling, (Nieswiadomy, 2008).
The sample size should be identified and appropriate as indicated by the power analysis,
(Burns & Grove, 2011). Power analysis determines the adequacy of sample size which includes
factors such as “type of quantitative study, number of variables, sensitivity of measurement tools
and data analysis techniques,” (Burns & Grove, 2011, p. 308). Sampling biases should be
identified and subject dropout discussed, (Nieswiadomy, 2008).
Analysis
The sampling methods in the nurse-driven mobility protocol article were weak overall
although there are a few sections that are strong. The power analysis was not specifically
identified and the sample size was very small at 25 in two groups for a total of 50 study
participants. Sample sizes of less than 218 subjects per group have an increased risk of a type II
error, (Burns & Grove, 2011). Sample size statistics were conducted but not described.
Potential sampling biases are not identified. Small sample size is a considerable weakness
because an adequate sample size is needed to be statistically significant, (Burns & Grove, 2011).
The stronger parts of this article is that the purpose statement identified the target
population as “hospitalized older adults” and the sample population was, in fact, hospitalized
older adults, (Padula et al., 2009, p.325). The accessible population was identified as 483
subjects screened and the sampling method was described but not named. This was a
nonprobability sampling method because only subjects admitted to the medical units were
included. Again the sampling information was included in the sample description but not named.
Nonprobablity sampling is commonly used in nursing studies even though this decreases the
sample‟s representativeness, (Burns & Grove, 2011).

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The sampling method appears to be appropriate for the study because it targets patients
who fit the eligibility criteria. The inclusion and exclusion criteria were described briefly to
address the characteristics of participant characteristics. The subject dropout was discussed
adequately because it named the specific reasons that 34 subjects were withdrawn for the original
84 chosen. Sample methods could have been improved by having a larger sample size, giving
power study statistics, naming the specific sampling method, identifying potential sampling
biases and describing sample size statistics. Despite the presence of many required components,
the sample analysis was weak overall due to small sample size, lack of power analysis and
missing descriptions.
Data Collection Methods
Evidence
In the nurse-driven mobility protocol study, subjects were recruited by convenience
sample on medical nursing unit. The research nurse conducted 483 patient screenings which
resulted in 50 total sample subjects. The data collection nurse was an advanced practice nurse
with expertise in geriatrics, (Padula et al., 2009). The article states that reliability was achieved
and data collection process was periodically evaluated. Demographic sheets were developed
which included age, gender, primary diagnosis, use of assistive devices, fall risk assessment,
presence of mobility restrictions, use of therapy, LOS, times out of bed and type of out of bed
activity. Functional status was measured by using the modified Barthel Index and the Get Up
and Go test. The scoring methods of both of these tests were described in detail. Mini-Mental
State Exam was conducted to evaluate cognition and when any subject scored less than 24, data
was collected from significant others, (Padula et al., 2009).

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Support
The data collection process describes how subjects are acquired and data is collected for
the study. Data should be collected in a consistent way with study controls maintained, (Burns &
Grove, 2011). Data collection methods need to be described thoroughly. They must be
appropriate to test the research hypothesis. The number and types of methods used to collect
data should be explained. The data collection instrument and scoring method should be
described in detail as well as the rationale for using the method presented, (Nieswiadomy, 2008).
Analysis
The data collection methods of the nurse-driven mobility protocol study were relatively
strong. The data collection methods were described adequately but could have been more
detailed in the description. The methods used were very appropriate to test the research
hypotheses and related directly to measuring activity, functioning and mobility during the
subject‟s LOS. Two methods were used to collect data, the Barthel Index (BI) and the Get Up
and Go test which adds to the data collection‟s depth of data collection. The nurse driven
mobility protocol study states that the data collection process was “periodically re-evaluated”
and “reliability was achieved” but does not describe exactly how often or how that was done,
(Padula et al., 2009, p.328). Data was collected consistently by a trained research nurse and
advanced practice nurse. The intervention was consistently implemented. Although there were
some shortcomings, the data collection methods appear to be relatively strong as described by
the authors.

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Measurement
Evidence
The nurse driven mobility protocol article describes a quasi-experimental study
conducted in 2009 at two units of Miriam Hospital in Rhode Island. The study was a
nonequivalent control group design with an independent variable of a mobility protocol and
dependent variables of functional status and LOS, (Padula et al., 2009). The study concluded
that “early and ongoing ambulation in the hallway may be an important contributor to
maintaining functional status during hospitalization and as a vital component of quality nursing
care,” (Padula et al., 2009, p. 330).
Support
How research information is measured affects the validity of the research study. Burns
and Grove offer critical appraisal guidelines for evaluating measurement methods. A strong
study will describe measurement methods for each variable, if the measurement was direct or
indirect, and the level of the measurement, (2011). In addition, the reliability and validity of
each measurement should be thoroughly described in order to judge the extent of measurement
error, (Burns & Grove, 2011).
Analysis
This section is strong as the study recruited a convenience sample of adults 60 years or
older, who were admitted with a medical diagnosis, (Padula et al., 2009). Measurement was
direct, involving a demographic data collection sheet, and included a LOS of three or more days,
ability to understand English, without a physical impairment that would significantly limit ability
to mobilize, and cognitively intact or with a significant other able to participate, (Padula et al.,
2009).

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Reliability was tested in this study using three standardized tools: a modified Barthel
Index (BI), the Get Up and Go test and the Mini Mental Status Examination (MMSE), (Padula et
al., 2009). The modified BI measures individual‟s capacity for activities of daily living
performance by using a five point rating scale for each item. The modification of the rating scale
improves sensitivity to detect changes. The Get Up and Go test measures the performance in
three activities: ability to stand up from a chair, walk three meters, turn around, walk back then
sit back down. The MMSE was used to evaluate cognitive abilities. For patients with a low
MMSE score of less than 24, the significant other rated the patient‟s abilities were assessed
rather than the patient themselves. Padula et al state that these tests have been proven to be
“reliable and valid,” (Padula et al., 2009, p. 328).
The validity of each measurement was adequately described, in that, of 84 eligible
subjects, 34 were withdrawn for a variety of reasons, including discharge, transferred off study
unity, occurrence of disqualifying procedure and personal reasons. The researchers provided an
adequate description of the measurement methods to judge the extent of measurement error.
“Subjects in the treatment group were out of bed to chair less often (5.9 times treatment vs 8.7
times control, P = .05) and ambulated in the room less often (5.54 times treatment vs 7.16 times
control, NS) than the control group,” (Padula et al., 2009, p. 329). The LOS of the treatment
group was much shorter, “4.96 days treatment vs 8.72 days control; P < .001” (2009, p. 329).
Data Analysis (Descriptive and Inferential Statistics)
Evidence
Padula et al. state that the Sigma Stat statistical program was used to calculate results and
calculations were done to before data collection to find adequate sample size, (2009, p. 329).
“Descriptive statistics were completed for study variables and comparisons between the groups

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on baseline characteristics were examined,” (Padula et al., 2009, p. 329). Inferential statistics
were used to compare contrasts in the two groups‟ dependent variables, (Padula et al., 2009).
Support
Burns and Grove note that critical appraisal of statistics in a study must identify if the
generalizations made are justified by examining the study results, (2011). According to
Neiswiadomy‟s guidelines the type of inferential statistic must be identified and appropriately
used. They must be clearly and thoroughly discussed. There must be information provided
about calculated values, levels of significance and degrees of freedom. The discussion results
should be shown in table and text form. Inferential statistics should be presented for each
hypothesis stated in the study, (Nieswiadomy, 2008). The descriptive statistics should identify
which of types of statistics used. The type of statistics used should be appropriate for the
situation. The measures of central tendency and variability should be both presented. The
demographic characteristics of subjects should be clearly presented. The statistics should be
clearly presented in the text and tables, (Nieswiadomy, 2008).
Analysis
The presentation of the data analysis is weak. The section of the paper “Data Analysis”
merely states where descriptive and inferential statistics are used. The descriptive and inferential
statistics are not clearly identified and explained. The statistics are only expressed as part of the
results section which is not concise.
Study Findings
Evidence
Findings of the Nurse-Driven Mobility Protocol article were presented in the discussion
section and conclusion section. The conclusion stated clearly that research supports existing

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literature about early mobility. The findings were concisely explained. Generalizations were
made to connect this research to a clinical setting of hospitalized older adults. Study results were
directly related to hypothesis one and two. Statistical and clinical significance was explained in
detail. Limitations were pointed out clearly that there were several other factors that could have
influenced the findings in this study such as lower functional status, effect of disease impact,
weaknesses in the Up and Go test and differences in control group, (Padula et al., 2009).
Statistical & clinical significance was explained in relation to existing literature that immobility
is related to functional decline and hall ambulation is most effective at maintaining mobility.
The conclusion was concisely stated, “findings suggest that early and ongoing ambulation in the
hallway may be an important contributor to maintaining functional status during hospitalization
and to shortening length of stay,” (Padula et al., 2009, p.330).
Support
Study findings explain the evidence of the researchers‟ critical thinking process about the
study. Explaining the significance of findings is important because it relates the study findings
to the body of knowledge contributions, (Burns & Grove, 2011). Study findings should be
presented clearly, concisely and objectively. Findings should be compared to other studies and
related to the framework. Each hypothesis should be addressed separately. Both statistical and
clinical significance should be discussed then related to implications for nursing practice,
education and research. Limitations and conclusions should be clearly stated, (Nieswiadomy,
2008).
Analysis
The study finding section was rather strong because it outlined all of the pertinent
information with concise details and clearly defined the study‟s limitations, even though there

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were a few requirements lacking in substance. The explanation of findings was clearly
explained. The findings were objective because the authors took time to point out several
limitations on the study in detail. The significance of findings was also explained in detail.
There was no suggestion for future research. The conclusion was concise, but not necessarily
definitive. The authors summarized their findings and suggested that ambulation may be
important to maintaining functioning and decreasing LOS, (Padula et al., 2009).
Study Conclusions, Implications, and Recommendations
Evidence
The nurse driven mobility protocol study concluded that early and ongoing ambulation in
the hallway, conducted by a nurse-driven mobility protocol, is a critical factor to maintaining
functional status during hospitalization and to shortening LOS for older adults (Padula et al.,
2009). The authors recommended that, “ambulation should be viewed as a priority and as a vital
component of quality nursing care,” (Padula et al., 2009, p. 330).
Support
According to Burns and Grove, a critical appraisal of a quantitative study should look at
what conclusions are drawn from the study and whether or not the conclusions were appropriate
based on study results, (2011). Additionally, the population for which study findings should be
described and appropriately generalized. A critical appraisal should include implications for
nursing knowledge, theory and practice as well as implications for nursing practice that were not
considered. The researchers should make recommendations for further studies based on the
study‟s results, findings, limitations and conclusions, (Burns & Grove, 2011).

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Analysis
Padula et al. provides specific conclusions for their study with a paragraph labeled
conclusions, (2009). This is a strong section as the conclusions were consistent with study
results and findings. The authors concluded their research supported existing literature that
identifies functional decline begins in the preadmission period and that ambulation is an
important element in maintaining functional status during hospitalization. Padula et al.
concluded a mobility protocol must be nurse-driven as a vital component of quality nursing care,
(2009). It is imperative that all nurses be aware of the benefits of increased mobility and
lessening of decline in older adults and be active participants in getting hospitalized older adults
to ambulate. Nurses must be the driving motivator behind this nursing intervention. Both
hypotheses, older adults who participate in a mobility protocol will maintain or improve
functional status from admission to discharge, and older adults who participate in a mobility
protocol will have a reduced LOS, were supported by the findings of the study.
The authors clearly presented their implications included a nurse driven mobility protocol
was effective in increasing overall functioning and reducing LOS. These are appropriate based
on the study findings and conclusions. The authors recommended “further study with
quantification of the impact of diseases,” (Padula et al., 2009, p. 330). This is appropriate in that
the authors identified the types of diseases participants had may have affected the findings of the
study. The authors also recommended further study of the Get Up and Go test, as that instrument
did not detect functional differences identified in the Barthel Index instrument. The
recommendations are based on study findings, and stress the need for further research before
expanding on additional implications for nursing practice.

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Conclusion
A critical appraisal is essential toward evidence-based practice and should be a balanced
appraisal of a study‟s strengths and weaknesses. Learning to do a critical appraisal is essential
toward increasing an understanding of the research process and to determine how accumulated
evidence can be used in practice. Comprehension, comparison, analysis and evaluation, phases
of the critical appraisal process, are necessary to the process of expanding understanding and
learning abilities of the nursing professional, (Burns & Grove, 2011).
The critique of the article “Impact of a Nurse-Driven Mobility Protocol on Functional
Decline in Hospitalized Older Adults” reveals both strong and weak sections. Strong sections
include the purpose and problem statement, review of literature, sample and sampling methods,
data collection methods, measurement instruments, findings and conclusions. Weak sections
include the theoretical framework, hypothesis, study design and data analysis. Overall the
critique of this study is weak mainly due to the lack of framework, small sample size, lack of
power analysis, and poorly designed hypothesis. Although critique of this study is weak as a
whole, there are strong sections that indicate the study‟s findings may be useful in order to
support the need for further study in the area of nursing focus on early ambulation for adults
during hospitalization.

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References
Burns, N., & Grove, S. K. (2011). Understanding nursing research (5th ed.). Maryland Heights,
MO: Elsevier Saunders.
Nieswiadomy, R. M. (2008). Foundations of nursing research (5th ed.). Upper Saddle
River, New Jersey : Pearson Education.
Padula, C. A., Hughes, C., & Baumhover, L. (2009). Impact of a nurse-driven mobility protocol
on functional decline in hospitalized older adults. Journal of Nursing Care Quality,
24(4), 325-331. doi:10.1097/NCQ.0b013e3181a4f79b

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Research Critique
Grading Criteria
APA Format: up to 30 points or 30% can be removed after the paper is graded for Title
page, abstract, headers Margins, spacing, and headings, reference page, title page, abstract
Sentence structure, spelling, grammar & punctuation.
Headings

Possible Points Comments
Points
Earned

Abstract andIntroduction: No heading for intro, but there should
be a introduction of the study and what your paper will address,
why you are doing the critique

10

Purpose & Problem Statement (Identify the problem & purpose
and analyze whether they are clear to the reader. Are there clear
objectives & goals? Analyze whether you can determine feasibility
and significance of the study)

10

Review of the Literature and Theoretical Framework (Analyze
relevance of the sources; Identify a theoretical or conceptual
framework & appropriateness for study)

10

Hypothesis(es) or Research Question(s) (Analyze whether
clearly and concisely stated; discuss whether directional, null, or
nondirectional hypothesis[es])

10

Sample & Study Design (Describe sample & sampling method &
appropriateness for study; analyze appropriateness of design;
discuss how ethical issues addressed)

10

Data Collection Methods & Instruments (Describe & analyze
the appropriateness of the what, how, who, where and when;
describe & analyze reliability and validity of instrument)

10

Data Analysis (Describe descriptive & inferential statistics &
analyze whether results are presented accurately & completely)

10

Discussion of Findings (Analyze whether results are presented
objectively & bound to the data, whether there is a comparison to
previous studies and whether new literature is introduced that was
not included in the Literature Review

10

Conclusions, Implications, & Recommendations (Analyze
whether the conclusions are based on the data, whether hypotheses
were supported or not supported, whether implications are a result
of the findings, and recommendations consider limitations

10

Your paper should end with a brief conclusion of your critique

10

PAPER POINTS

100

CRITIQUE OF NURSE-DRIVEN MOBILITY PROTOCOL ARTICLE

Deductions for APA, grammar and Spelling

26

Final GRADE