APPRAISING EVIDENCE-BASED PRACTICE
Contents
Critical Analysis and Review of a selected paper
Research Problem/Purpose of study
Introduction
The role of nurses in intercepting public health concerns and challenges are well recognized globally by the “World Health Organisation” as well as by the “National Health Service.” WHO explicitly states that nurses collectively, in association with other healthcare professionals, are responsible for delivering efficient, standard, acceptable, equitable, patient-centered care to the population and to competently serve the needs of the service user. WHO notes that it is necessary to base each clinical decision upon undismissable evidence. Such emphasis on evidence is given to ensure appropriate disbursal of essential services to individuals in dire need of medical attention, care, and support.
The concept of “Evidence-Based HealthCare” assumes that the care development and delivery plan of each patient are determined after taking into consideration the effectiveness, appropriateness, safety, and feasibility of the approach, as proven by extensive research work on the subject (euro.who.int, 2017). Or, simplified, healthcare practices including both traditional and novel approaches to be in practice recommended by physicians must have proper research and clinical to substantiate their clinical appropriateness; otherwise, if found lacking ineffectiveness or unfeasible be discontinued from use effective immediately. A fundamental benefit of preaching EBP is its role in reducing the burden of unsafe medical practice. According to the “Global State of Patient Safety” report, 42 billion cases of medication errors occur globally each year. In the UK alone, 200 million cases of medication errors are reported to the NHS, resulting in losses to the tune of 98 Million Pounds to the government. Despite being a developed resource-rich nation, 9 women in every 100000 women die in childbirth, or considerable inequality exists with regards to maternity care, a sentiment that is also shared equally by the nurses working in the maternity sector (imperial.ac.uk, 2015). The condition of patients afflicted with mental illness is even worse. In a survey conducted by the “Royal College of Psychiatrist,” it was revealed that the majority of mentally ill patients receive no adequate treatment. In most instances, nurses are neither emotionally equipped nor have the requisite knowledge of psychiatry and mental health to approach the treatment (Campbell, 2018). The term “crisis of care” is used to describe the lack of empathy, compassion, and sensitivity of nursing professionals for people receiving treatment. The article “Nurses experience of learning to care in practice environments: A Qualitative Study” addresses the cause and effect of this phenomenon on nurse’s emotional health and care quality. The objective would be to use the CASP critiquing tool to evaluate the article for three aspects, believability, robustness, and its practical implications.critiquingresearch work forms such a fundamental part of nursing since it is necessary for healthcare to objectively assess the strength and the weakness of proposed intervention policies. By conducting a critical review, it is also possible to systematically ascertain the validity and its possible practical purposes in the field of healthcare.
Critical Analysis and Review of a selected paper
Believability
A title is a brief statement that precedes the main article and purposefully communicates to the reader the substantial content of the article. Conventionally, it is regarded that an appropriate title is simple and concise, containing few keywords making it easier to identify and search from the database. The article is titled “Nurses experiences of learning to care in practice environments: A qualitative study,” and the authors have kept the title cautiously prim and complete. In the title, no literary jargon or complex terminology has been used, and instead, the authors have focussed on making it informative. Moreover, the title abides by the rules of creating articulate titles that state that research titles should be no longer than 20 substantial words, should highlight the research question, should be positive, informative, and abreast with contemporary knowledge. Following shortly after, the title is author information. It states the names, designation, and general qualifications of the authors for the benefit of the reader. Kate Young, Rosemary Godbolt, and Pat Wood are the authors of the article. They are from the department of adult nursing, and primary care, University of Hertfordshire, UK and are respectable faculty members with previous publications. Thus with certainty, it can be stated that the research work has been done by individuals who have knowledge and experience in conducting meaningful qualitative research. An abstract follows shortly after that summarises the important features of the work. In it, they have clearly defined the purpose and the nature of the work. From the abstract, it can be concluded that further research work on the “crisis of care” is required to address the shortcomings in policies that are not allowing nursing professionals to emotionally connect with patients despite studies showing that caring behavior impacts patient outcomes.
Robustness of the Study
Research Problem/Purpose of the study
Caring behavior in nursing is defined as each and every minor and major activities that a nursing professional takes to secure the health and wellbeing of the patient. However, explicitly it refers to attitude and behavior that define compassionate feelings in human beings such as empathy, sensitivity, honesty, trust, comforting, attentive listening, and many more (Salimi and Azimpour, 2013). In several studies, authors have noted that caring behavior improves satisfaction and patient outcome. Service users evaluate care quality on the basis of caring behavior demonstrated by nursing professionals, and in many instances, it has been seen that patients receiving compassionate care respond better to intervention strategies are more compliant, cooperative, more invested in their treatment procedures, are confident and in general have better recuperation probability. As such, there is a need for student nurses to learn and adopt a positive, caring attitude (Dalvandiet al. 2019; Gray et al. 2016). The article aims to evaluate the findings from a focus group study consisting of nursing students, mentors, educators, and lecturers discussing the meaning of compassion and caring behavior. There is no separate segment dedicated to research questions as such and are included in the introduction paragraph, where the authors have carefully highlighted the major aspect of the study. The purpose of the study is clear and unambiguous, and while conducting research, it is important to summarise the purpose of the study since it enables the reviewer to understand the aim and objective of the researcher. It makes it relatively easier for unrelated persons to follow the work and evaluate its significance.
Literature Review
A literature review is an integral part of undertaking a research study. It involves proving a synthesized summary of previously published work upon which the current work is founded. Therefore, for the benefit of the study, it is important that researchers conduct a thorough literature review taking into consideration recent works on the subject. A candid evaluation of the literature review section of the article will reveal that the authors have based their study on a range of recently published bodies of work. The authors, to justify the need for conducting the research, have referred to articles that were published not earlier than 2008 and have included peer reviewed articles that are as recent as 2017. Using these criteria, they have been able to exclude works that have lost relevance or include extremely recent works that are yet to be reviewed and accredited. However, the length of the literature review is a veritable drawback. Consisting of only two paragraphs, the literature review is too short considering the broad scope of the subject under study. The authors have annotated compassion as fundamental to nursing, and in recent times much work has been done to elaborate upon the entities of compassion and their role in determining the quality of healthcare. Authors could have elaborated further on the subject, which would have established the necessity of undertaking the research with better clarity, especially in defining the ways in which the findings can be integrated into learning modules and promote simulation based education procedure (Horntvedtet al. 2018).
Study Design
According to the authors, the study is based on the philosophy of appreciative inquiry that was developed by David Cooperrider and one which beliefs in appreciating the existing positives rather than mulling over the deficits (Taylor et al. 2015). It is a contemporary approach to organizational change and is quite different from other theories on the same subject. The methodology of the study has been developed, also keeping in consideration the philosophy underpinning the research, and hence the authors have used focus group discussion and interviews that would allow participants to engage in an in-depth discussion.
Study Sample
The study was sampled using the convenience sampling technique and involved six cohorts of nursing students and 35 participants. The study population, as described by the authors, is diverse with regards to age, sex, race, ethnicity, and qualification.
Study Aim
The aim of the study cumulatively states the aspiration or the expected outcome of the study. Often it is used synonymously with the purpose of the study; however, even though both the aspects of research perform a similar function, yet study aim is the intention of the research work phrased in a single sentence while the purpose is a brief summary. In the present article, the study aim is not explicitly mentioned as it should have been and is a concern since study aims tend to link the research work with its objectives, and without the study aim, it becomes difficult to identify the logic and reason compelling the author to take on the research work.
Data Collection
The data collection method involved interviews, focus group discussions, and field notes. Authors have justified their method of data collection, stating that since the aim of the study was to observe the phenomenon of caring behavior and its influence among nursing students with the intent to theoretically define the phenomenon for the benefit of education and learning utilizing focus group discussion and interview gave the researchers the opportunity to perceive the occurrence from a close viewpoint and therefore analyze non-verbal gestures of the participants along with their inputs. Focus groups and interviews are more personalized than structured questionnaires or surveys. As mentioned by the authors, it is also possible to keenly observe participants in focus groups and interviews than that would be permitted by other methods and, as such, are preferred methods of choice for describing, exploring, and elucidating subjective observations. A particular disadvantage of using the method, however, is that people can become self-conscious and less honest about their opinions fearing repercussions despite the best effort at anonymity that can limit the scope of the findings of the study (Research-management.mq.edu.au, 2018).
Ethical Consideration
Research work involving human participants is subject to approval from the concerned ethical body of the University. Ethical approval for this study, as reported by the authors, was obtained from the “University Research Ethics Committee.” Care was taken to secure the confidentiality and anonymity of the participants. Interviews were done in isolated settings, and prior to the process, each participant was informed of the particulars of participation and was made aware of their rights and obligations. Collected data were protected according to the rules and guidelines of the “Data Protection Act, 1998,” and non-academic personals attached to the project were not allowed access to the data.
Study Results
Qualitative data differs significantly from quantitative data. Instead of numbers, transcripts, audio recordings, images, documents, questionnaire results, and accounts are analyzed to identify a central theme across the study. As such, the convention of evaluating and presenting qualitative data is unique to the process itself, and often, different forms of data are processed and presented separately. For instance, it is customary to include transcripts that best represent the central or sub-central themes while presenting interview data. In compliance with the convention, in the articles, the authors have highlighted transcripts such as “It wasn’t just what you were taught to do……the feeling you have that inside you is the empathy” that align with any of the four themes that they have identified from the findings (Camargo et al. 2018). The purpose of including the transcripts is to enrich the examination process and benefit the reader to gain a perspective of the work under consideration. The findings section of the article is well articulated and is segmented into four sections, each of which represents a particular theme making it convenient and simpler for learners to interpret and follow.
Data Analysis
Raw data is not an effective instrument, and it does not completely satisfy the objective of the study. For that purpose, data must be cleaned, arranged, transformed, and processed to scour useful information from the accumulated data. This process of processing data with an intent to use the information encoded in the data to reach a rational conclusion that also satisfies the research question, aim, and objective of the study is termed as data analysis. It forms an essential part of both quantitative and qualitative research even though the process itself is unique and novel for each of these data collection processes. Since the data involved in the present study is of qualitative nature, hence the authors have deemed it necessary to mention that the data was collected through interviews and from field notes taken during observation and later transcribed verbatim. No software was used for the purpose of data coding, and thematic analysis was conducted manually utilizing the process developed by Braun and Clarke. Further, the authors have elaborately described the process of establishing the credibility of the data. Since qualitative data is subject to the internal bias of the researcher, it is necessary to aggressively cross-validate data to minimize researchers’ influence. In a qualitative study, the focus is always on the observation; however, despite best efforts, oftentimes, qualitative analysis is limited by the skill, beliefs, and attitude of the researcher. In this case, since the authors were veteran and well versed with the conventions of conducting qualitative research, they were able to use cooperative screening and evaluation as a technique to reduce the influence of individual preferences and also improve transparency, confirmability, and credibility of the data.
Conclusion and Recommendation
The article on the topic of the “crisis of care” and its theoretical framework is well constructed by the authors. In general, the article is simple and easy to read and interpret. The study findings corroborate with the research questions and satisfy the objectives well, and in the discussion segment, the authors explain in detail how the study findings fit in the field of nursing education.
The usefulness of the Study
Quantitative research in healthcare assumes a greater position, often eclipsing the functionality of qualitative work. As such, in recent years, there has been little work on elucidating the importance of behavior and caring attitude in determining patient outcome and care quality, which is fundamentally a qualitative assessment of individual experiences and is not possible to measure or statistically quantify using quantitative tools. As stated previously, the authors, through their work, had intended to address a prominent gap in healthcare knowledge that is pertinent, of great consequence, and yet most overlooked (Oflazoglu, 2017). There have been no attempts to explore the care crisis from theoretical perspectives. Attention more or less has been on elucidating the organizational barriers to developing compassion care, upbringing, and attitude deficits, and on more specifically on determining the impact of resource availability and scarcity. Developing theories have never been of any particular interest, and as such, there are no frameworks that can wholly explain and predict the variables that are associated or recognized as determinant factors of the phenomenon and correlate diverse concepts of the subject. This particular work on caring behavior and attitude will replenish the concept of compassion in nursing and healthcare. More specifically, the work will greatly impact the manner in which nursing education reinforces compassion among students.
A qualitative study has always been about elaborating upon experiences. It is about describing feelings, emotions, values, behavior, attitude, and how it relates to the phenomenon under consideration, which for this particular study was realizing care behavior in theory. As opposed to quantitative study that implies a great emphasis on correlating phenomenon or on quantifying cases, the qualitative study focuses on constructing theories or invests in developing frameworks for evaluating case studies (LoBiondo-Wood and Haber, 2017). For instance, the author states that from the study, four central themes related to compassion and caring emerged, namely Caring as a motivation to put in efforts to ensure the best care, personalized caring founded upon trust relationship, culture mediated caring, caring demonstrated through effective communication. The findings of the study suggest that the recurring themes have implications for future nursing education, especially the role of culture in defining traits of compassion among learners is an important finding of the study. For instance, a first-year student states, “Everybody has to genuinely care rather than have this attitude against people,” and another second-year nursing student stated, “She was crying in the night and the nurse stated ‘just ignore her, just leave her alone’…..’ I did ignore what the nurse told me and spoke to her and held her hand”. Both the account contradict each other while the first statement supports the argument that endorses the claim that within healthcare setups, compassion is a characteristic that is greatly valued and learners are encouraged to look up to responsible, empathetic nurses as role models; however the later statement highlights the knowledge gap that exists and that which prevents nurses from adequately treating patients who have mental issues and are not as cognizant of their condition and surroundings as the rest (Babaei and Taleghani, 2019). Authors have reported that it is the organizational culture itself that discourages students from forming relationships with distressed confused patients. A student recollected her experience of being perceived naive while she attempted to communicate with a confused patient. In her words, authors state that the feelings of the student and her actions were deemed juvenile by the senior nurses and brushed off as a phase that would pass off when she graduated. This implies that there are systematic issues within the healthcare setup that needs to be addressed. In a similar study, Itzhaki et al.2016, illustrated that among nursing students interventions in the form of lectures, visitings, simulations, and visual aids in the early years of training played an immense role in improving attitude and motivation to intercept mentally ill patients (Itzhaki et al. 2016). It also influenced perception of mentally ill patients perpetuated by conventional media and to an extent removed the stigma associated with mental illness. Ayanoet al.2017, continued the research on evaluating the impact of knowledge on practice and concluded that mental illness as it was neglected by the society has limited knowledge repertoire and by integrating mental healthcare into physical care curriculum it is possible to improve upon existing medical practices (Ayanoet al. 2017). Further, following the intervention procedure nurses were also able to differentiate between different neurological disorders such as psychosis, alcohol abuse, depression, schizophrenia. In mental health, diagnosis is an extremely important function however due to ambiguity of symptoms associated with mental health afflictions it has been difficult to proactively differentiate. The findings of the present work will enrich the nursing field and will add to the knowledge repertoire.
Conclusion
A fundamental concern associated with research work, discoveries, and novel interventions in the field of nursing is assessing its effectiveness in routine practice. Research articles are published in plenty however a minor portion of the work actually is translated into practice while the rest remains to enrich philosophies and theoretical concepts. Critiquing is a conventional method employed generously in nursing to evaluate quality and practical implication of published research work. For the purpose, several tools that are termed critiquing tools are available for use. In this assignment, the cohort critiquing tool developed by the CASP or critical appraisal skills programme has been used and by taking the checklist as a reference the article is reviewed for its believability, robustness, and usefulness. Every aspect of the article, from the title to the abstract to the methods, findings, discussion, and conclusion is evaluated and measured for stringency, validity, and compliance with the standard rules of conducting research. Emphasis was given on evaluating the findings of the research study specifically on assessing the usefulness of the work and its contribution to learning in nursing. It was found that from the accumulated account four central themes that pertain to caring behavior in nursing can be deduced from which the cultural aspect was determined from the study analysis as well as from literature as particularly significant.
Reference List
Books
Gray, J.R., Grove, S.K. and Sutherland, S., 2016. Burns and Grove’s The Practice of Nursing Research-E-Book: Appraisal, Synthesis, and Generation of Evidence. Elsevier Health Sciences.
LoBiondo-Wood, G. and Haber, J., 2017. Nursing research-e-book: methods and critical appraisal for evidence-based practice. Elsevier Health Sciences.
Oflazoglu, S. ed., 2017. Qualitative versus quantitative research.BoD–Books on Demand.
Taylor, S.J., Bogdan, R. and DeVault, M., 2015. Introduction to qualitative research methods: A guidebook and resource. John Wiley & Sons.
Journals
Ayano, G., Assefa, D., Haile, K., Chaka, A., Haile, K., Solomon, M., Yohannis, K., Adane, A.A. and Jemal, K., 2017. Mental health training for primary health care workers and implication for success of integration of mental health into primary care: evaluation of effect on knowledge, attitude and practices (KAP). International journal of mental health systems, 11(1), p.63. DOI: 10.1186/s13033-017-0169-8
Babaei, S. and Taleghani, F., 2019. Compassionate care challenges and barriers in clinical nurses: A qualitative study. Iranian journal of nursing and midwifery research, 24(3), p.213. DOI: 10.4103/ijnmr.IJNMR_100_18
Camargo, F.C., Iwamoto, H.H., Galvão, C.M., Pereira, G.D.A., Andrade, R.B. and Masso, G.C., 2018. Competences and Barriers for the Evidence-Based Practice in Nursing: an integrative review. Revistabrasileira de enfermagem, 71(4), pp.2030-2038. DOI: https://doi.org/10.1590/0034-7167-2016-0617
Dalvandi, A., Vaisi-Raygani, A., Nourozi, K., Ebadi, A. and Rahgozar, M., 2019. The importance and extent of providing compassionate nursing care from the viewpoint of patients hospitalized in educational hospitals in Kermanshah-Iran 2017. Open Access Macedonian Journal of Medical Sciences, 7(6), p.1047. DOI: 10.3889/oamjms.2019.204
Horntvedt, M.E.T., Nordsteien, A., Fermann, T. and Severinsson, E., 2018. Strategies for teaching evidence-based practice in nursing education: a thematic literature review. BMC medical education, 18(1), p.172. DOI: https://doi.org/10.1186/s12909-018-1278-z
Itzhaki, M., Meridan, O., Sagiv-Schifter, T. and Barnoy, S., 2017.Nursing students’ attitudes and intention to work with mentally ill patients before and after a planned intervention. Academic Psychiatry, 41(3), pp.337-344. DOI: https://doi.org/10.1007/s40596-016-0521-3
Salimi, S. and Azimpour, A., 2013. Determinants of nurses’ caring behaviors (DNCB): preliminary validation of a scale. Journal of Caring Sciences, 2(4), p.269. DOI: 10.5681/jcs.2013.032
Online Articles
euro.who.int, (2017), Evidence Based Practice Benefits and Importance, available at: https://www.euro.who.int/__data/assets/pdf_file/0017/348020/WH06_EBP_report_complete.pdf%3Fua%3D1 [Accessed on: 1-11-2020]
imperial.ac.uk, (2015), The Global State of Patient Safety, available at: https://www.imperial.ac.uk/media/imperial-college/institute-of-global-health-innovation/GlobalStateofPS_DIGITAL_16Sep19%5B2%5D.pdf [Accessed on: 1-11-2020]
Research-management.mq.edu.au, (2018), Qualitative Research in Healthcare: Mordern Methods and Clear Translation, available at: https://research-management.mq.edu.au/ws/portalfiles/portal/92373203/White_Paper_28.08.18_FINAL.pdf [Accessed on: 1-11-2020]
Websites
Campbell, D, (2018), Mental Health Patients Treatment Delays, available at: https://www.theguardian.com/society/2018/oct/09/mental-health-patients-waiting-nhs-treatment-delays [Accessed on: 1-11-2020]