RESEARCH CRITIQUE

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Qualifications of author(s).

All the seven authors have high level of qualification. ShaheenMajad, Brendan Luyt, Yin Leng Theng and Tun Ke Chang are associateprofessors at the Nanyang Technological University while Schubert Foois a professor in the same university. Xue Zhang holds a Master ofScience degree and a PhD student in the same university. The otherauthor, Intan A. Mokhtar is an associate professor at the NationalInstitute of Education, Singapore in the department of policy andleadership studies. Therefore, all the authors are experienced andrenowned scholars and researchers who have authored numerous researcharticles.

Does title fit well with the content of the article?

Yes. The title of the article is an accurate description of what iscovered in the article. It mentioned all the concepts addressed inthe article, including perceptions, knowledge and barriers toapplication of evidence based practices in clinical decision makingprocesses.

Discuss the content of the abstract, is it a good overview of thecontent, is it consistent with content, are some elements missing?

According to Andrade (2011), many readers do not read an articlebeyond the abstract. Therefore, the abstract, together with the titleof the paper set the tone for the paper. The abstract can be a freeflowing paragraph of up to 250 words or can be a structured abstractwith defined sections. This is dependent on the requirement of thejournal in which the article is published or the writing style of theauthor. In both cases, the author or authors have the responsibilityof ensuring that the abstract is a fair representation of the paper.In this article, the authors use a structured abstract where it isdivided into four sections, objectives, methods, results, andconclusion. Although it does not strictly follow the structure of thearticle, it is consistent with the contents and all the elements of agood abstract are present. Therefore, the abstract provides a goodoverview of the article.

Problem/Purpose

State the problem.

A statement of the problem is an important part of a researcharticle. The statement can be in form of a few sentences or a shortparagraph. Many authors use more words to define the purpose of thestudy to ensure that the reader clearly understands the problem. Someof the most important aspects of a problem statement includevaluables in the study and their relationships, and how they areagree with empirical studies (Montgomery, 2013). The authors in thearticle clearly state the purpose of the study, “to investigate theperceptions of registered nurses, working in public hospitals inSingapore, towards the adopting of EBP in their practice”.

Do they provide adequate background information to support theproblem?

Yes. Before stating the purpose of the study, the authors gave afairly detailed background of the problem.

Do the authors explain the purpose or aim of the study?

Yes. The authors gave an explanation of the purpose and aims of thestudy in at least one paragraph.

Literature Review

Are the references current? (Number of sources in the last 10years and in the last five years.)

The authors refer to 21 references which includes scholarly articlesand books. Although there are some articles relatively old, majorityof them were published at most ten years before the research wasconducted. Out of 21 sources used in the article, five are more thanten years old, while eleven sources were at most five years old. Thismeans that sixteen sources were not more than ten years old.

Do the authors “critique” the research studies they cite?[i.e., point out some of the limitations, contradictions, weaknesses,etc.

Yes. The author provides a critique of the research studies sited andidentify some of the limitations. The authors use the limitation todevelop the purpose of the study. For example, indicates that theliterature review identifies the barriers in adoption of evidencebased practices in nursing and the role of positive attitudes. Theweakness identified in these literatures is the fact that all thesestudies have focused on the western countries in Europe and NorthAmerica. There are inadequate studies and knowledge on adopting ofevidence based practices in other counties with different social andcultural values that affect nursing practices.

Do the authors summarize their review of the literature to revealwhat is known/not known and the need for further study?

Yes. The authors summarize the literature review in order to informthe audience about what is known and not known in the adoption ofevidence practices. They summarize the findings of other studies inorder to enable the audience understand the strengths and weaknessesof the studies as well as provide a background for the current study.

Framework/Theoretical Perspective

Is the framework [theoretical model or theory] explicitlyexpressed in the introduction or the literature review?

Yes. A theory is formulated to explain or help in the understandingof a particular phenomenon. On the other hand, the theoreticalframework includes structures that are used to support the theory ina study. The theoretical framework provides the assumption andgeneralization in the study as well as the connection between thecurrent studies with existing knowledge (Anfara, 2015). In thearticle, the theory of the study is explicitly expressed in theintroduction and literature review. The theoretical model underreview is the adoption of evidence based practices by nurses inmaking clinical decisions. The theoretical framework enables theaudience of the article to relate the problem to existing literatureand finding of the current study.

Do the authors specifically tie theframework/theory to their study—concepts/variables of interest? Ifso, how is this accomplished?

Yes. Evidence based practices in health care involves the use ofscientific evidence from research studies in improving the deliveryof health care services. This is the theoretical framework of thestudy. However, there are some barriers to effective adopting ofevidence based practices in nursing practice, which includesknowledge and attitudes of the nurse as well as social and culturalfactors. These are the variables that are of interest in the study.The authors provide an effective link between the theory of study andthe variables.

If a specific theory or framework is notidentified, what nursing theory do you think would fit with the focusof this study? Explain your answer.

A specific theory was identified in the article.

List the Research Question(s) or Hypotheses

Research hypothesis or hypotheses.

Hypothesis in a study gives the relationship between the valuables.It is a speculation created by the researchers that the researchstudy seeks to prove. In the article, the hypothesis of the study isnot explicitly stated by the authors.

Research question(s).

Research question refers to the question the study seeks to answer.Usually, there are more than one research question in a researchstudy. The objectives and aims of the research are based on theresearch question or questions (Vogt, et al, 2012). In this article,the authors clearly states and explains the research question. Thequestion that the study seeks to answer is what are the perceptionsof registered nurses towards adopting evidence based practices inclinical decision making processes? The research question is alsoconcerned with “understandings, beliefs, and attitudes of nursestowards EBP barriers preventing them from adopting EBP, theirtraining needs, information sources they prefer and their literaturesearching skills”.

Identify and Define Variables

Independent variables [intervention/treatment] identify and definevariable(s)—what is the treatment or intervention and how is itimplemented?

Independent valuables in the study include beliefs and attitudes,self efficacy skills and level of education.

Dependent variables [outcome of the treatment—“effect”]define the dependent variable and describe how it is measured.

The dependent valuable includes attitudes towards adoption ofevidence based practices. The valuable was measured through selfreporting.

If the study does not have an independent and dependent variable,what are the study variables of interest?

The study includes both independent and dependent variable.

Demographics of Sample

Were demographics of the sample included? If yes, providea few examples of demographics, i.e., 50% male, 50%female, etc.

Yes, the demographics of the sample are included. The first sectionof the questionnaires provided information relating to demographicsof the participants. The information collected included “theirprofessional education, job title, length of nursing experience,specialty and training in EBP”. The demographic results indicatedthat 41 percent of the participating nurses have a diploma orcertificate level of education while 14.8 percent has post diploma oradvanced diploma qualifications. 41.4 percent has a bachelor’sdegree in nursing while 2.3 percent have a master’s degree. Thedemographics also indicated that 51.1 percent of the participantshave up o five years working experience while 82.7 percent has notparticipated in any training on evidence based practices.

Research Design

Identify the research design and define the design, i.e.,nonexperimental, descriptive survey, correlational, etc.

The research in this article used non-experimental research design.Specifically, the researchers used correlational research design toidentify the relationship between the dependent and independentvaluables. Non experimental research designs are designs that do notinvolve manipulation of circumstances in which the participantsoperates during the study. The most common non experimental researchdesigns are correlational studies which measures the relationshipbetween two or more valuables. The relationship between the valuablesshould however not be causative, although there must be dependent andindependent valuable (Kelly, 2012). These research designs areessential in the identification of relationship between variables,for example the relationship between adoptions of evidence basedpractices and nurse qualification. This research design was veryappropriate for this particular research.

Did the researchers conduct a pilot study? If so, what did theyhave to say about it—did they make changes based on the pilotstudy?

No. There was no pilot study conducted. However, the questionnairesused in the study were pilot tested in 20 nurses in differentdepartment on public hospitals in Singapore.

Sample/Setting

Sampling criteria—this is usually referred to as “inclusioncriteria”—meaning what characteristics did participants need inorder to be included in the study? i.e., female, 40–50 years ofage, pregnant with 1st child, etc.

Sampling criteria refers to the methods used by the researchers toinclude the participants in the study. It is also referred to as theinclusion criteria (Creswell, 2012). The main inclusion criteria usedin this study was being a registered nurse. Both part time and fulltime nurses in two selected metropolitan hospitals in Singapore wereinvolved in the study. Nurses who were on duty at the time thequestionnaires were being administered were requested to participatein the study.

Sampling method, how did researchers obtain participants, whatkind of approach was used—nonprobability [nonrandom] or probability[random]?

None of the sampling methods was used in the study. This is becauseall the registered nurses in the identified facilities were recruitedas participants in the study.

Sample size. Was response or attrition rate discussed?

The response or attrition rate was discussed in the article. Theresearchers distributed 2,100 copies of questionnaires to registerednurses in the two facilities. However, the response of theparticipants was not 100 percent. At the end of the study period,1,486 copies of questionnaires were returned through collection boxplaced in all the units and wards. Thus the yield of the questionerswas 70.8 percent.

Was informed consent obtained? Institutional Review Boardmentioned?

Yes. The researchers obtained ethical approval from the“Domain Specific Review Board” appointed by “National HealthGroup, Singapore”. Additionally, informed consent waiver wasgranted since the nurses involved in the study were completing thequestionnaires using their informed consent.

Identify the setting of the study—did the setting fit well withthe study’s objectives?

The setting of the study was in two health care facilities withnurses from diverse backgrounds. The setting fitted well in the studyobjectives.

Measurement, Methods &amp Instruments

Who developed the instruments used? The author(s) or someone else?

The main instruments of the study were the questionnaires. Thequestionnaires were not developed by the authors of the article. Thequestionnaires were developed by a team of experts from the NanyangTechnology University and National University Hospital nursingrepresentatives. Additionally, questionnaires used in other evidencebased surveys were consulted in this study. The questionnaires werealso reviewed by experts who included “informational studieslecturers, nursing managers, nurse researchers, and registerednurses”.

Identify the instruments [data collection tools] used.

The main instrument of data collection used in this study was copiesof questionnaires.

Did the authors discuss the reliability and validity of theinstruments used?

Yes, the validity and reliability of the questionnaires was discussedby the authors. The internal consistencies and validity of thequestionnaires content was evaluated using Cronbach alphacoefficients which indicated good reliability of 0.861-0.954 (0.7-0.9value indicates good reliability and above 0.9 indicates excellentreliability).

Data Collection

How were data collected?

The data was collected by the participants filling thequestionnaires distributed by the researchers. The participatingnurses were required to drop the completed questionnaires incollection boxes located in different parts of the health carefacilities. The sealed boxes were placed in strategic places in wardsand units to increase the response rate by aiding convenience amongparticipants.

Timing of data collection [one time [cross-sectional] collection,longitudinal?]

All the collection boxes were collected at one time, at the end ofdata collection period.

Where was data collected?

Data was collected in two metropolitan hospitals in Singapore.

Statistical Analyses

What statistical measures were used to analyze the data collected[the data that “answered” the research hypotheses or researchquestions]?

The main technique used in the analyses of the data collected wasstatistical package for social sciences (SPSS). This yielded measuressuch as percentages, mean scores, statistical relationship test,frequency and standard deviation.

Was the level of significance or alpha identified? If so indicatewhat it was [.05 .01 or .001]. Remember .05 means that theresearchers are 95% confident that there was cause and effect orcorrelation between variables, .01 means that they were 99%confident, and .001 means that the researchers were 99.9% confidentthat their intervention was effective and directly related to theoutcome—or effect.

No. the level of significance was not identified.

Implication of Findings

What implications for nursing were described?

The implications of the findings to nursing practice were extensivelydiscussed in the discussion part of the article. Some of theimplications of the findings include positive attitudes towardevidence based practices and their effects on its adoption in publichospitals in Singapore. It also discussed some of the factors thatwere identified to have an influence on adoption of evidence basedpractices. Another implication of the study was factors that limitthe adoption of evidence based practices in nursing.

Can you think of any implications that were not described?

None

Limitations

What limitations were identified?

The authors identified the limitations in the study. The firstlimitation was the fact that the data was collected from two publichospitals. Therefore, generalization of the findings of the studywould be inaccurate due to different circumstances in otherhospitals. Data from specialized and private health facilities couldyield different results. Another limitation of the study is based onthe fact that the questionnaires used in the study were selfadministered. Since there was no competency test, there is alikelihood of bias in the data collected. Also, the adoption ofevidence based practice and relative information is very sensitive. Acomprehensive study, rather than self administered questionnairewould therefore provide more appropriate data. Finally, the use“questionnaire based quantitative data collection approach” wasalso a limitation. A triangulation approach would have been moreappropriate in addressing this research question.

Can you identify any other limitations?

No.

Generalization of Findings

Did the author(s) generalize the findings? [Did they apply thefindings of their study beyond the sample studied—and makeapplication to the population in general?] Remember that a random[probability] sample is considered to be generalizable whereas anonrandom [nonprobability] sample is not.

The authors did not generalize the findings of the study. Theauthors identified lack of this property of the findings as alimitation to the study. The study used nonrandom sample derived fromtwo public hospitals. The sample did not represent nurses fromdiverse environments and backgrounds. Based on this fact,generalization of the findings would be incorrect.

Suggestions for Further Study

What were the suggestions for further study?

Yes. Suggestions for future studied were based on limitations of thestudy. The authors suggest a cross country study to give a nationalview of the relationship between the valuables. They also suggested amore comprehensive investigation of literacy skills and theirinfluence on adoption of evidence based practice in nursing. Theyalso suggested triangulation of the research approaches in futurestudies.

Format

Was APA [or other type of format] used accurately? Did youdiscover any spelling, punctuation, or grammatical errors? What aboutsentence structure, organization, clarity?

The formatting of the article was accurate. There were no spellingerrors, punctuation errors or grammatical errors discovered in thearticle. The structure and clarity of the sentences was good.

Part II. Comparison and Analysis

Design

Is the design used in the study the most appropriate design toobtain the needed data?

The design used in this study was not the most appropriate forobtaining the data required. A research design that could have used arandom sample to allow generalization of the findings could have beenmore appropriate. This could have made the findings more applicablein improving nursing practice.

If applicable, is the treatment/intervention clearly described?

The interventions are briefly mentioned in the conclusion. However,they are not explained clearly and objectively. For example, one ofthe interventions mentioned is management of health care institutionsfacilitation the ability of nurses to overcome the barriers. However,the authors do not discuss these interventions in details.

What are the strengths and limitations of the research designused?

The main strength of the research design is ease in data collection.The questionnaires were self administered within two publichospitals. Thus, it was cheap and convenient to collect the desireddata. However, these were some limitations in the research design.The main limitation was in the selection of participant.

Do you think that another research design would have been moreappropriate?

Yes. There is a more appropriate research design that could have beenused in the study. A random selection of participants across thecountry could have been more appropriate.

Data Analysis

Are data analysis procedures appropriate for the type of datacollected? Explain.

Yes. The data analysis procedures such as percentage, frequencydistribution and mean are appropriate for the data collected. This isbecause the data mainly contained correlation between variables. Forexample, percentage and frequency distribution is appropriate foridentifying

Are data analysis procedures clearly described? Explain.

No. The procedures used in data analysis were not described in thearticle.

Overall Evaluation

The following questions provide guidance in identifying strengthsand weaknesses of the study.

Were the steps of the research process logically linked together?[Did the authors’ research questions or hypotheses make sense basedon the review of literature? Did the methods employed, i.e.,quantitative/qualitative, fit well with the intent of the study?]

The research process in the article was logically arranged andlinked. The research questions and hypothesis were based on theinformation obtained from the literature review.

Do the findings build on the findings of previous studies [referto the studies cited and discussed in the literature review and inthe discussion section of the article].

The finding of the study was similar to findings of previous studies.For example, literature review indicated that nurses in other partsof the world have positive attitude towards adoption of evidencebased practices. The study indicated that nurses in Singapore havesimilar positive attitudes.

What are your impressions about the overall quality of the study?

The overall quality of the article is fair. The main weakness is theresign design used in the study.

Your impressions regarding applicability of the study nursingpractice and how it contributes to nursing knowledge.

The article and its finding are applicable in nursing practice. Itprovides nursing leaders and health care organizations with essentialinformation on the implementation of evidence based practices innursing practice.

References

Andrade, P. (2011). How to write a good abstract for a scientificpaper or conference presentation. Indian J Psychiatry. 53(2):172–175.

Anfara, V. (2015). Theoretical frameworks in qualitative research,Los Angeles: SAGE.

Creswell, J.W. (2012). Educational research: Planning, conducting,and evaluating quantitative and qualitative research. UpperSaddle River, NJ: Prentice Hall.

Kelly, A. (2012). Handbook of Research Design in Mathematics andScience Education, New York, Routledge.

Majid, S. et al (2011). Adopting evidence-based practice in clinicaldecision making: nurses’ perceptions, knowledge, and barriers. JMed Libr Assoc 99(3): 229-236.

Montgomery, D. (2013). Design and analysis of experiments (8thed.). Hoboken, NJ: John Wiley &amp Sons, Inc.

Vogt, W. et al (2012). When to use what research design. NewYork: Guilford Press.