According to Gray et al, (2017) “critical appraisal is the


According to Gray et al, (2017) “critical appraisal is the process of carefully and systematically assessing the outcome of all aspects of a study, judging the strengths, limitation, trustworthiness, meaning, and its applicability to practice”. The steps involved in critical appraisal include “identifying the study’s elements or processes, determining the strengths and weaknesses, and evaluating the credibility and trustworthiness of the study” (Gray et al., 2017). The journal article chosen is “change in staff perspectives on indwelling urinary catheter use after implementation of an intervention bundle in seven Swiss acute care hospitals: a result of a before/after survey study” by Niederhauser, Zullig, Marschall, Schweiger, John, Kuster, and Schwappach. (2019).

Identifying the study’s elements or processes

A significant issue addressed by the study is the nursing “staffs’ perspective towards indwelling urinary catheter (IUC) and evaluation of changes in their perspectives towards indwelling urinary catheter (IUC) use after implementation of a 1-year quality improvement project” (Niederhauser et al, 2019). the process of the research was conducted in “seven acute care hospitals in Switzerland” (Niederhauser et al, 2019). With a “sample size of 1579 staff members participated in the baseline survey and 1527 participated in the follow-up survey. The survey captures all nursing and medical staff members working at the participating hospitals at the time of survey distribution, using a multimodal intervention bundle, consisting of an evidence-based indication list, daily re-evaluation of ongoing catheter needs, and staff training were implemented over the course of 9 months” (Niederhauser et al, 2019).

Determining the strengths and weaknesses

A great strength of the study is a large sample size of over 1000 and the use of well-constructed and easy-to-read heading for better understanding. Also, the use of figures, graphs, and tables make the article less cumbersome to read. Another strength is the implementation of the ethical principles of research by enabling informed consent and voluntary participation as well as confidentiality and anonymity of information.

On the other hand, the study has several weaknesses such as the use of “the theory of planned behavior to model intentions to reduce catheter use, but it is not possible to know if changes observed in staff perception led to a true change in practice” (Niederhauser et al, 2019). Another weakness of the study is the repeated survey design which allows assessment of changes in staff perspectives after implementation of a quality improvement intervention but the sustainability of the effects over time could not be evaluated.

Evaluating the credibility and trustworthiness of the study

Although the study used a larger sample size of over 1000, the “use of a single-group design and no control group weakens its credibility and trustworthiness because there are no causal inferences about the contribution of the intervention bundle to the observed effects, as it is possible that other secular trends or measures within the hospitals may have affected the outcomes” (Niederhauser et al, 2019). Also, there is bias, as only nurses and physicians were involved as participants. Other healthcare workers such as certified nurse aids at one time or the other have access to and take care of patients with an indwelling urinary catheter therefore should have been included.  Lastly, it is possible that “only high-performing units open to change have been chosen to participate in the intervention project and this may limit the generalizability of the findings to other units and hospitals” (Niederhauser et al, 2019).

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