Puntillo Research Critique

In your words, what was the purpose of the study? List any research questions or hypotheses (if you use direct quote remember to properly cite).   

The objective of the study by Puntillo et al. (2004) was to identify particular pain-related factors and behaviors that can be used in predicting the level of behavioral reactions during the six medical procedures, which included femoral sheath removal, tracheal suctioning, wound care, wound drain removal, and central venous catheter insertion. In order to achieve this objective, Puntillo et al. (2004) used the following research questions: (a) what behaviors are exhibited frequently at the baseline and when undergoing the specified procedures among the patients with and without pain? (b) What is the probability of an increase in behaviors from baseline in the patients with versus patients without pain? (c) Does the level of behavioral reaction exhibited by patients undergoing the specified procedures differ among patients with and those without procedural pain? (d) What is the relationship between the level of the reported pain intensity and the level of behavioral reaction exhibited by patients who are undergoing the specified procedures? (e) What are the factors that determine the degree of the patient’s behavioral reactions in the course of a medical procedure?

What was (were) the independent variable(s)?                                                    

The independent variables in the study of Puntillo et al. (2004) were procedural pain and lack of procedural pain among patients.

What were the dependent variables?         

The dependent variables in this study included the behavioral responses during the selected procedures, such as eyes closed, verbal complaint, moaning, clinched fists, wince, rigid face and grimace.

How were the dependent variables measured (what instrument/tools were used)?

The dependent variables were measured using the behavior observation tool, which contained the operational definitions of each behavioral response. The data collectors were supposed to checkmark each behavior exhibited by the patient during the procedures. Facial responses comprise of grimace, frown, wince, eyes closed, eyes wide open with eye brows raised, looking away in the opposite direction, away from the direction of pain, smile, mouth wide open to expose the tongue and teeth, clenched teeth exposing a slightly open mouth, and none. The verbal responses included moaning, verbal complaints associated with pain, protest words, crying, whimpering, screaming, none, and inability to assess. The body movements included lack of movement, rigid face, guarding, pushing, defensive grabbing, restlessness, touching site, flailing, shaking, clenched fists, none, and inability to assess.              

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Were reliability and validity of the measures described?

Fully described for all / partially described / not described                                  

Puntillo et al. (2004) fully described validity of the measures they used in their study. For instance, validity of the behavior observation tool for usability and completeness was affirmed through review by an expert advisory group, after which it was pre-tested in 7 hospitals before the actual study. In addition, the data collection nurses took part in educational training sessions offered by the site coordinator in order to guarantee the consistency and accuracy of the procedures. 

Describe the sample size and characteristics.                                          

The sample size for the study was 5,957 and was conducted in 169 sites. The male participants accounted 59.4 percent and female participants accounted 41.6 percent. In terms of ethnicity composition, 75.7 percent were white, 7.8 percent were black, and 16.5 percent others.

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What statistical tests were used to analyze study data?                          

Puntillo et al. (2004) deployed a number of statistical tests to analyze the study data. Frequencies were deployed to analyze the prevalence of behavioral responses during the baseline, during the procedure and to make comparisons regarding the behavioral responses exhibited during the two test times. Cramer’s V and Chi-square analyses were deployed to test the relationship between an increase in behavioral response during the baseline test and during the procedure. Other tests, used by Puntillo et al, (2004), included the Mann-Whitney test and the T-test to analyze the difference between behaviors exhibited by patients with and those without procedural pain. In addition, the study used Pearson-product moment and multiple regressions for data analysis.

For each dependent variable, list and interpret the results?                   

Puntillo et al. (2004) reported that patients who lacked either procedural pain or background pain showed significantly less signs if pain-related behaviors compared to the patients who had pain. Thus, patients with pain tend to respond more behaviorally when compared to the patients without pain. Puntillo et al. (2004) also reported specific behaviors exhibited more frequently among patients with and those without procedural pain. The behaviors associated with procedural pain include verbal complaints, eyes closed, wince, rigidity and grimace. In addition, patients with procedural pain exhibited less movements when compared to the postoperative patients. Puntillo et al. (2004) also affirmed that there is a relationship between expression of behavior and experience of procedural pain.

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In one sentence and using your own words, what is the “take home message” from this study?        

The findings by Puntillo et al. (2004) are important in the health care context and the findings can be generalized.                                

Based on your answers above, should these results be applied in practice? (yes or no). Why or why not? And if yes, with whom?           

Yes, the results of the study can be applied in practice. This is because the study has few threats to internal validity and no threats to external validity, which implies that the results of the study can be generalized and applied to other people and situations in a health care setting. The study can be applied in practice by health care professionals, particularly those who are involved in conducting medical procedures, such as surgeons and dentists among others. 

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