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Need a 1600 word paper on research critique and picot statement final draft. This assignment is based on two previous assignment papers which are to be combined based on instructor feedback, follows a rubric and guidelines on research critique. APA formal required, assignment will be submitted to lopeswrite for similarity index and for plagiarism. 16 CRITQUE OF QUALITATIVE AND QUANTITIVE ARTICLES Critique of Breastfeeding Education Running head: ASSIGNMENT TITLE HERE 1 Running head: CRITQUE OF QUALITATIVE AND QUANTITIVE ARTICLES Critique of Qualitative and Quantitative studies to support increased breastfeeding education Qualitative research can help explore a person’s lived experiences through thoughts feelings and behaviors which can add meaning to a phenomenon in order to identify what needs to be changed in healthcare practices, enhance patient’s experiences or to help identify different ways of health education and promotion (Setia, 2017). However, quantitative research provides numerical data that is based on manipulation of variables, comparing their relationships, classifying cause and effect relationships to back up the researcher’s hypotheses or disprove it (McNiff, & Petrick, 2018). Thus, both qualitative and quantitative research articles should be appraised to help identify the meaning of the problem, examine the statistically significant in order to support evidence-based practice (EBP) changes that can be generalized to the target population or nursing interventions to increase patient care and outcomes (McNiff, & Petrick, 2018). This paper will be critically appraising two qualitative and two quantitative research articles to support increased breastfeeding education aimed at both parents by identifying the practice problem and PICOT question, reviewing the articles background of study, method of study, results of studies, ethical considerations, and the connection of the research articles to propose an EBP change. Practice problem and PICOT Question Breastfeeding has a variety of health benefits for both the mother and baby, and the global goal of women breastfeeding exclusively for six months isn’t accomplished in many countries (Dellen, Wisse, Mobach, & Dijkstra, 2019). There have been many efforts to encourage breastfeeding promotion by guidelines from the World Health Organization on ways to globally implement breastfeeding promotions and initiation of baby friendly hospitals to help enhance the initiation and duration of breastfeeding (Marks, O’Connor, 2015). Breastfeeding promotion at a universal level “could prevent approximately 823,000 child deaths and 20,000 deaths due to breast cancer worldwide annually” (Dellen et al., 2019, p. 2). Thus, a nursing practice problem is ineffective breastfeeding related to basic breastfeeding knowledge or support from their spouse. Nurses are in a unique position to directly impact this problem through breastfeeding promotion, education, inspiring women to breastfeed and ways to overcome obstacles that can cause early cessation of breastfeeding practices (Dellen et al., 2019). So, two peer-reviewed qualitative and quantitative studies were reviewed to help support and answer how additional education on breastfeeding towards both parents affected breastfeeding outcomes. The PICOT question is: in antenatal and postnatal women how does education from nursing staff on breastfeeding targeted at both parents compare to no additional education affect exclusive breastfeeding their infant after delivery. Also, two qualitative articles (Spencer, Greatrex-White, & Fraser, 2014) and (Marks, O’Connor, 2015) correlates to the PICOT intervention group and comparison group by the first article identifying the women were both educated antenatal and postnatal which all initiated breastfeeding, but the second study reflecting the comparison group of the PICOT question by demonstrating lack of education to both the parents on breastfeeding due to their beliefs that they wouldn’t affect the mother’s decision to breastfeed. The first quantitative study (Dellen et al., 2019) correlates to the PICOT intervention group through additional education aimed at the mother, but the father is still educated in the program, and the control group correlates to the PICOT control group by providing no additional education to both parents. Lastly, the second quantitative study (Bich, Hoa, & Målqvist, 2014) reflects the intervention group of the PICOT through an educational program aimed at the father but the mother is still educated per standard of care, and the control group compares to the PICOT control group by no additional education provided to the father. Background of Qualitative and Quantitative Studies The first qualitative study by (Spencer et al., 2014) was examining the problem of women not sustaining exclusive breastfeeding their infant until at least six months of age which is the current global recommendation for breastfeeding. Thus, the significance to nursing is how to better educate and promote breastfeeding to women antenatal and postnatal in order to inspire them through knowledge to increase the duration and exclusive breastfeeding by exploring their personal experiences. So, the aim of this study was to explore human experiences through interviews with women that breastfed their infant from a phenomenological approach in order to explain and understand their experiences of breastfeeding (Spencer et al., 2014). Also, the objectives were to analysis their experiences of breastfeeding in order to identify themes, so they can be better educated and prepared for breastfeeding their infants after delivery (Spencer et al., 2014). Then, the researcher asked “how do women experience breastfeeding” (Spencer et al., 2014, p. 83). The next qualitative article by (Marks, & O’Connor, 2015) examined the issue of health care professionals’ attitude towards breastfeeding who work directly with women antenatal and postnatal can affect breastfeeding outcomes by how they communicated breastfeeding education and promotion. Thus, the issue is vital for nursing to identify barriers that prevent breastfeeding education and promotion that aren’t effective in order to train staff, acknowledge nurses concerns about breastfeeding promotion, and establish new policies supported by EBP to provide clinical guidelines for breastfeeding promotion. The intent of the study was to explore health professionals’ opinions about breastfeeding, and how their opinions affected breastfeeding promotion (Marks, & O’Connor, 2015). Then, the objectives were to recognize major themes that were identified from focus groups of healthcare participants that worked with women antenatal and postnatal in order to increase breastfeeding promotion and duration (Marks, & O’Connor, 2015). Finally, the researcher asked “to investigate in a qualitative manner health professionals views regarding breastfeeding promotion, to obtain a clearer image of the depth, nature, and complexity of underlying attitudes” (Marks, & O’Connor, 2015, p. 51). The first quantitative article by (Dellen et al., 2019) addressed the problem of women stopping breastfeeding prematurely across the nation, but particularly in the Netherlands that can be addressed through increased breastfeeding education antenatal and postnatal. This is a significant nursing issue that nurses can help address since nurses are the primary educators of women antenatal and postnatal on how to breastfeed, teaching them different positions, latch techniques, benefits and by discovering different ways to educate women will help support breastfeeding exclusivity and duration. The aim of this study was to explore if an evidence-based breastfeeding support program (BSP) would encourage extended periods of exclusivity and duration of breastfeeding from the participants (Dellen et al., 2019). Then, the objectives of the study were to examine EBP by developing a BSP which included; involvement from the father for support, promoting positive attitudes regarding breastfeeding, educational sessions from a lactation consultant, examining the effects of a breastfeeding support line on the mother’s behavior control and the effects it had on exclusivity at four and six months (Dellen et al., 2019). Thus, the researcher asked “do the mothers enrolled in the BSP engage in prolonged breastfeeding in terms of duration and exclusivity compared to mothers in a control group” (Dellen et al., 2019, p. 3). Next, the second quantitative article by (Bich et al., 2014) examined the issue of how to increase exclusive breastfeeding in Viet Nam by a breastfeeding campaign and educational sessions targeting fathers to encourage mothers to breastfeed until or past six months. Thus, nurses should explore how they promote and educate mothers to include the father in educational sessions on breastfeeding to help support the mother to inspire longer periods of breastfeeding exclusivity. The purpose of the study was to examine the results of how the community-based education program in Viet Nam aimed at the paternal influence antenatal and postnatal effected their participation in supporting breastfeeding exclusivity (Bich et al., 2014). Next, the objectives were to explore the effects of breastfeeding promotion and education through media campaign, community events, group education sessions coupled with individual sessions targeting fathers to determine the effects it had on enhancing breastfeeding exclusivity rates in Viet Nam (Bich et al., 2014). Finally, the researcher “hypnosis was that after educational intervention the community under intervention will have a higher proportion of women practicing exclusive breastfeeding at 4 and 6 months than women in the control community” (Bich et al., 2014, p. 1445). Method of Study The first qualitative article by (Spencer et al., 2014) used an interpretive phenomenology approach to explore the experiences of breastfeeding among women by interviewing 22 women that used purposive sampling from an Observatory in the United Kingdom. Next, the Heidegger’s theoretical theory was used to interpret the results which shines light on experiences by focusing on details to understand and analysis the data, interviews were recorded, transcribed word for word to validate their notes, and all authors participated in authenticating the transcriptions of the interviews to guarantee rigor was accomplished (Spencer et al., 2014). Then, the second article by (Marks, & O’Connor, 2015) used a qualitative study design with varying health professionals including nurses that participated in 10 focus groups that were recorded, transcribed after each focus group session, using thematic coding until data saturation was reached, and used a constructive approach to identify the patterns and interpret the meaning of the human experiences from 51 participants that recruited from a Scottish National health services (NHS) by purposive sampling. They are different in the way they collected data by the first article (Spencer et al., 2014) using interviews and interpretation of data by phenomenology, and the second qualitative article (Marks, & O’Connor, 2015) used a qualitative constructive theory approach to interpret four open-ended questions from focus groups. The limitations of the first study (Spencer et al., 2014) are small sample size, and can’t be generalized. Lastly, the second article (Marks, O’Connor, 2015) was limited by focus groups can create increased biases, and can be hard to manage by a facilitator. The first quantitative study (Dellen et al., 2019) was a quasi-experimental study with an intervention group of 77 participants, control group of 66 participants, and the study used a theoretical framework that incorporated the theory of planned behavior into developing their BSP. The dependent variable was duration and exclusivity of breastfeeding and the independent variable was the BSP, recruited by non-probability convenient sampling with the criteria that they had intentions to breastfeed (Dellen et al., 2019). Also, the study took place online by using pretest questionnaire at six months, post-test questionnaire around ten weeks postpartum, data was analysis statistically by survival analysis and cox proportion hazard regression ratio by using SPSS version 23 (Dellen et al., 2019). Lastly, the intervention group received six lactation consultants either by phone or in person through pregnancy until 10 weeks postpartum, and access to breastfeeding support number (Dellen et al., 2019). The next quantitative article (Bich et al., 2014) used a quasi-experimental study that used complete sampling due to limited eligibility of women that fit the criteria, structured questionnaire’ to evaluate the dependent variable at four and six months after the baby was born, and the independent variable being the educational program aimed at the fathers. Next, the study took place in Hai Duong province in northern Viet Nam in two separate districts, control group was 230 in Chi Linh district, intervention group was 239 in the district of Thanh Ha, epidata and SPSS for windows 13 was used to statistically analyze the data, and used a theoretical framework based off the life cycle approach which is the foundation of their program by providing interventions early in pregnancy and at different points across the healthcare continuum (Bich et al., 2014). The intervention group received educational sessions that were intertwined throughout antenatal and postnatal through routine services by local health staff that consisted of media campaign, group counseling sessions, and community events (Bich et al., 2014). However, they are different by the first article (Dellen et al., 2019) using structured questionnaire to evaluate the BSP interventions aimed at the mother, and the second study (Bich et al., 2014) using pretest and post-test questionnaire to collect data and evaluate the outcomes of a community-based educational program targeting the father. Thus, the first study (Dellen et al., 2019) was limited by lack of randomization, limited sample size compared to confounding variables. Lastly, the second study (Bich et al., 2014) was limited by the control group and participant group being in two separate districts, lack of randomization and possible language translation errors in the questionnaire. Results from Studies The key findings from the first qualitative article were breastfeeding experiences weren’t what they expected by expectations that breastfeeding is instinctive for the infant and its easy, they wanted more education on the realities of breastfeeding antenatal and postnatal, the education by health professionals failed to educate them on how to sustain breastfeeding long-term and trouble-shoot common breastfeeding problems which directly affected the results of exclusive breastfeeding (Spencer et al., 2014). However, the second qualitative article (Marks, & O’Connor, 2015) key themes identified were health professionals felt powerless in affecting the breastfeeding outcomes of the mother due to the strong influence of the spouse or family had on the mother’s decision to breastfeed or discontinue breastfeeding, breastfeeding promotion related to pressuring them to breastfeed, they didn’t make breastfeeding a priority, the healthcare facility position on promoting breastfeeding and questioning their role in breastfeeding promotion. The first quantitative study (Dellen et al., 2019) results showed the effects of the BSP by providing additional breastfeeding education antenatal and postnatal decreased the risks of early cessation of breastfeeding and increased the duration. Then, the benefits demonstrated by having additional information from lactation consultant, paternal support, utilization of breastfeeding support line to answer questions contributed to enhancing their knowledge of breastfeeding and trouble-shooting problems (Dellen et al., 2019). Thus, a sub-study was performed on the first-time mother’s only to statistically verify the main studies outcomes, which the results were comparable making the evidence stronger that the BSP was an effective program to extend the duration and exclusivity of breastfeeding at four and six months (Dellen et al., 2019). Lastly, the second quantitative study results (Bich et al., 2014) were the intervention benefited both the mother and father, the mother had increased breastfeeding exclusivity at four and six months, the father had better understandings of breastfeeding nutrition, they had reliable resources of information, community support, and education provided along the care continuum equips the father with knowledge on breastfeeding to provide better emotional support to the mother to enhance exclusivity of breastfeeding. The qualitative study (Spencer et al., 2014) nursing implications were nurses need to change how they educate women antenatal and postnatal to include topics on common breastfeeding problem solutions, feeding cues, long-term maintenance of breastfeeding, and education aimed at the realities of breastfeeding versus unrealistic expectation of breastfeeding. However, the second qualitative study (Marks, & O’Connor, 2015) implies that attitude can affect how midwives and nurses educate and promote breastfeeding by minimizing their role they play in promoting and educating women on breastfeeding, the need for additional staff training to remove the barriers in promoting breastfeeding education, making it a priority, and including the spouse in their educational session. The first quantitative article (Dellen et al., 2019) demonstrated the strong need for nurses to provide additional education on breastfeeding to the mother antenatal and postnatal that includes the father or support person in the education, resources for lactation consultant, support groups, breastfeeding support numbers, and lobbying for nurses to make additional education and breastfeeding promotion a priority in nursing practice to enhance duration and exclusivity of breastfeeding. Whereas, the second quantitative study (Bich et al., 2014) nursing implications were nurses need to incorporate the father into breastfeeding education and promotion by educating them on common breastfeeding problems, explanation of the nutrient differences between formula and breast milk, provide resources to both parents across the healthcare continuum in order to help increase the exclusivity of breastfeeding. Ethical Consideration in Research Studies The first qualitative articles (Spencer et al., 2014) ethical considerations were verbal and written consent were received prior to each interview, information sheet of the study, voluntary participation, and received ethical approval for the study from NHS ethical committee. Then, the second qualitative study (Marks, O’Connor, 2015) received approval for their study from the NHS ethical committee, all participants gave their informed consent, explanation of the study was provided along with an information sheet, participants were informed that the data would be reported anonymously and the study was voluntary. Next, the quantitative study (Dellen et al., 2019) was conducted after informed consent was received, participation was voluntary, explanation of the study, results reported anonymously, informed they can withdrawal from the study at any time, and ethical approval from the ethical committee of psychology of the university of Groningen in the Netherlands. Lastly, the second quantitative study (Bich et al., 2014) received ethical approval for their study from the Institutional Review Board of Hanoi school of public health and from local health departments board of directors. Overall, the four research articles complied with the most important ethical considerations of informed consent, ethical board committee approval and beneficence. Evidence-Based practices changes and conclusion The two qualitative articles reviewed for this paper (Spencer et al., 2014) and (Marks, & O’Connor, 2015) revealed both barriers to breastfeeding that women face who are being educated on breastfeeding, and health professional attitudes towards breastfeeding which can all affect the initiation, exclusivity and duration of breastfeeding. Also, the first article (Spencer et al., 2014) concluded a strong theme that revealed the need for women to be educated antenatal and postnatal more on the realities of breastfeeding versus unrealistic description of breastfeeding. Then, the next qualitative study (Marks, & O’Connor, 2015) results were descriptive of health professionals being positive about breastfeeding, lacking confidence that their health promotion and education of breastfeeding would increase breastfeeding rates without the support from their spouse or family, and conceived that their efforts to promote breastfeeding didn’t change their mind so it wasn’t made a priority. Thus, the results of these studies can be applied to develop educational training for health professionals who work with women antenatal and postnatal on ways to remove those barriers to enhance breastfeeding duration and exclusivity by including the father in educational sessions, betters ways for staff to promote breastfeeding in order for them to make it a priority, the need for more education on how to maintain breastfeeding, breastfeeding resources, and ways to manage the challenges that women face every day with breastfeeding. The quantitative articles utilized for this paper (Dellen et al., 2019) and (Bich et al., 2014) concluded that a BSP was effective when aimed at the mothers and the breastfeeding educational program aimed at the fathers antenatal and postnatal both identified a strong theme that additional education provided to both parents can increase the duration and exclusivity of breastfeeding. Thus, the results of the first article revealed that there was “66% less risk of cessation of any breastfeeding and on average 54% less risk of cessation of exclusive breastfeeding at any point in time compared to those in the control group” (Dellen et al., 2019, p. 1). While the results were significant the limitations of the study demonstrated the unknown ability of generalization due to lack of randomization which a future study on randomization with a larger sample size could provide stronger evidence to support the BSP (Dellen et al., 2019). The second article (Bich et al., 2014) results were significant at six months but weren’t as significant at four months on the exclusivity of breastfeeding between the intervention group and control group. For example, “the mothers in the intervention group were almost six times more likely than mothers in the control group to be practicing exclusive breastfeeding at six months” (Bich et al., 2014, p. 1450). These studies can be used to support additional nursing educational programs that incorporate both the mother and father in educational sessions antenatal and postnatal on breastfeeding to help increase the duration and exclusivity of breastfeeding. Critical appraisal of these four studies helped answer the PICOT question indirectly and directly by providing strong evidence to answer the PICOT question: in antenatal and postnatal women how does education from nursing staff on breastfeeding targeted at both parents compare to no additional education affect exclusive breastfeeding their infant after delivery. Also, these articles helped to come up with a solution to the nursing practice problem of ineffective breastfeeding knowledge related to lack of basic breastfeeding knowledge or support by identifying better ways to promote breastfeeding education to both parents and what topics to include. The two qualitative articles by (Spencer et al., 2014) and (Marks, & O’Connor, 2015) reflects each viewpoint of their experiences with breastfeeding, the first article addressing the experience from the mother’s perspective and the second article from the health professionals’ point of view on breastfeeding promotion in order to identify the meaning, barriers or lack of breastfeeding education provided to them to indirectly answer the PICOT question. Next, the two quantitative articles by (Dellen et al., 2019) and (Bich et al., 2014) directly answered the PICOT question through statistical analysis of how additional breastfeeding education directed at both parents increased the exclusivity and duration of breastfeeding at four and six months. Also, the effects that fathers can have on their ability to support mother’s through breastfeeding knowledge to increase exclusivity compared to no education for the fathers (Bich et al., 2014). Finally, the study (Dellen et al., 2019) demonstrated that additional education from trained health professionals on breastfeeding can increase the duration and exclusivity which directly answers the PICOT question. Overall, these four studies (Spencer et al., 2014), (Marks, & O’Connor, 2015), (Dellen et al., 2019), and (Bich et al., 2014) provided evidence-based research to help make a practice change that promotes breastfeeding promotion and education to be aimed at both parents to help increase the exclusivity rate and duration of breastfeeding, and the need for continued education for nursing staff working with mothers antenatal and postnatal. Thus, critical appraisal of these studies made this writer aware of the significance role nurses have on helping increase breastfeeding exclusivity and duration through education of both parents. This writer identified a key theme from reviewing these articles that provided a strong message that paternal influences are key to helping support the mother in breastfeeding combined with the right kind of education from nursing staff and health professionals will significantly affect the duration and exclusivity of breastfeeding which directly answers the PICOT questions and addresses the nursing practice problem. Overall, nurses have the power to change nursing practices based on evidence-based research, enhance patient care through critical appraisal of quantitative and qualitative research articles which can all improve patient outcomes, patient safety standards and provide nursing interventions based on EBP (McNiff, & Petrick, 2018). References Bich, T., Hoa, D., & Målqvist, M. (2014). Fathers as Supporters for Improved Exclusive Breastfeeding in Viet Nam. Maternal & Child Health Journal, 18(6), 1444–1453. Retrieved from https://doi-org.lopes.idm.oclc.org/10.1007/s10995-013-1384-9 Dellen, S. A. V., Wisse, B., Mobach, M. P., & Dijkstra, A. (2019). The effect of a breastfeeding support program on breastfeeding duration and exclusivity: a quasi-experiment. BMC Public Health, 19(1), 993. Retrieved from https://doi-org.lopes.idm.oclc.org/10.1186/s12889-019-7331-y Marks, D., & O’Connor, R. (2015). Health professionals’ attitudes towards the promotion of breastfeeding. British Journal of Midwifery, 23(1), 50–58. Retrieved from https://search-ebscohost-com.lopes.idm.oclc.org/login.aspx?direct=true&db=ccm&AN=103867014&site=ehost-live&scope=site McNiff, P., & Petrick, M. (2018). Quantitative Research: Ethics, theory, and research. In Grand Canyon University, Nursing research: Understanding methods for best practice. Retrieved from https://lc.gcumedia.com/nrs433v/nursing-research-understanding-methods-for-best-practice/v1.1 Setia, M. S. (2017). Methodology Series Module 10: Qualitative Health Research. Indian Journal of Dermatology, 62(4), 367–370. Retrieved from https://doi-org.lopes.idm.oclc.org/10.4103/ijd.IJD_290_17 Spencer, R., Greatrex-White, S., & Fraser, D. M. (2014). “I was meant to be able to do this”: a phenomenological study of women’s experience of breastfeeding. Evidence Based Midwifery, 12(3), 83-88. Retrieved from https://search-ebscohost-com.lopes.idm.oclc.org/login.aspx?direct=true&db=ccm&AN=103887804&site=ehost-live&scope=site