Introduction
The authors of “Adopting evidence-based
practice in clinical decision making: Nurses’ perception’s, knowledge, &
barriers” are highly qualified to perform research they all hold a PhD and are
practicing associate professors of several academic disciplines to include, communications,
education and leadership (Majid, Foo, Luyt, Zhang, Theng, Chang, &
Mokhtair, 2014).Individual holding a PhD have training and mentoring in the
area of performing research (Grove, Burns, & Gray, 2013). The fact that it
is not acknowledge that any of the individuals doing the research have a background
in nursing is disconcerting. The research to benefit a particular profession
would be more advantageous if a member to the research team had a background in
the area they are researching. The title the authors gave for this research
paper was well suited for the information and content provided in the research.
One area that should be of concern for all
authors of research is the title of their work, because it allows others to
search for their research (Grove,etal., 2013). The title is very specific and
is a good indication of what is covered in the research (Grove, etal., 2013).
The title should also have several words that indicate the content of the
research to allow the search engines in the library to find it; this title does
this (Grove,etal.,2013). An abstract is a brief summary of the purpose of the
research, how it was performed and perhaps future implications for the research
( Grove,etal.,2013). Other researchers
to determine quickly in a vast amount of literature if this particle article is
of value to their research (Grove, etal., 2013) use an abstract. Without an
abstract others searching through research literature may overlook this article
because, of the lack of an abstract (Grove,etal.,2013). The abstract provided
by the authors does offer an informative overview of what the content of the
article, the research performed and the outcome (Majid, Foo, Luyt,Zhang,Theng,
Chang,& Mokhtair, 2014).
Problem/Purpose
A good research
article purpose and problem should be clear to the audience ( Critiquing
research studies ,2013). For the research to be sound, it should be significant
to current practice (Critiquing research studies,2013). The authors of
“Adopting evidence-based practice in clinical decision making: nurses’
perceptions, knowledge, & barriers,” explains the purpose of their research
is to find barriers to why nurses fail to use evidence based measures in
everyday practice, because care based on research is superior to care founded
on experience and opinion ( Majid etal.,2014). It is clearly articulated in the
introduction, the phenomenon of interest that lead to the research, this is
indication of quality in a research article (Critiquing research studies,
2013).
The problem of interest stated in the research
is medicine is changing and moving away from more traditional hierarchy of
care, to one where medical practice is a result of evidence base measures (Majid
etal.,2014). The authors fail to show evidence of this statement in the
research provided but do fill the definition of suitable research by defining
why their research is necessary for current practice (Critiquing research
studies,2013). The authors of this research article persuasively argue that
nurses are at the frontline of providing care and that it is necessary to find
explanations as to why more nurses at the bedside are not implementing
evidence-based measures (Majid,etal.,2014).
The research that
they are performing supports current view of practice, which is an indication
of sound research, although this is not directly stated, only inferred ( Groves
etal.,2013). The aim of this study is very clearly emphasized, that the
research being conducted is about the barriers of implementing evidence-based practice
(Majid,etal.,2014). Evidence of the problem that lead to the research
unmistakably illustrated in both the introduction and title and body of the
research article (Majid,etal.,2014).
The authors of the
research made it clear that nurse’s lack of knowledge on how to properly
research and understand current evidence based measures, was one of the
greatest barriers to using and implementing them ( Majid,etal.,2014). Another
area that was identified as an obstacle was lack of time of the bedside nurse (
Majid,etal.,2014). The authors of this research Cleary identified a purpose and
reason for their research. Without a clean identification of the purpose of
research, it is impossible to develop and implement a successful research study
(Groves,etal.,2013).
Some areas that
demonstrate the effectiveness of the author’s research methods are the
identification of the research setting, the process of choosing subjects and
the implantation of the study (Groves,etal.,2013). These areas are all clearly
identified in the introduction of the research article. The authors made it
clear that they randomly choose subjects (registered nurses) from, Singapore
community hospitals by sending out questioners (Majid,etal.,2014).
Literature
Review
The literature
review done by the researchers contains seven articles that are over ten years
old, but have relevance to the subject being studied. It is suggesting when
conducting a literary review that the article be within the last ten years, but
would be of more significant value if within the last five (American
Psychological Association,2010). Articles that would give relevance to the
study that are over ten years old can be included but, more recent data supporting
the research in the older articles
selected is suggested ( American Psychological Association, 2010). The articles
review in this study that are over ten years old, validate current findings (Majid,etal.,2014).
All the article included in the literature review are focused on the theme of
promotion of evidence based practice and help the authors gain understanding
into a specific subject area and promote a focused theme, as well as generate
further research question. These are all qualities of a properly conducted
literature review (Groves,etal.,2013).
The authors give a brief critique of the literature reviewed for their
study. They provide supporting evidence to justify their research findings in
previous literature, as well as define limitation (Majid,etal.,2014). These
areas include: nurses citing lack of understanding of the statistics in
evidence base practice, scarcity of time to implement new practices, and
insufficient knowledge on research methods and application( Majid etal.,2014).The
combination of relevant long-standing knowledge with novel information is the
hallmark of a correctly conducted literary review ( Groves,etal.,2013).This is
accomplished in the research study with the summation of the review of
knowledge discovered ( Groves,etal.,2013).
Framework/Theoretical
Perspective
The theoretical
framework in research begins with the researcher having an assumption as to why
a specific event, concept or situation occurs (Grove,etal.,2013). The
investigator then uses their hunch and reviews relevant literature to support
or refute their hypothesis ( Grove,etal.,2013). During this research, the
theoretical perspective is realized and the framework of the enquiry is created
(Grove,etal.,2013). The hypothesis of this investigation is that due to
obstacles and lack of knowledge by nurses evidence based measure are not being
implemented in health care settings at a rate that is protective to the public
(Majid,etal.,2014).
The author of this
study supports his claims by polling nurses on why implementing evidence-based
measure is difficult in their health care setting (Majid,etal.,2014). The
investigation revealed that lack of knowledge about evidence based measures,
lack of researching skills, absence of understanding on how to implement the
measures, lack of support by management, and time constraints (Majid,et.,2014).
Then the researcher demonstrated through the inquiry of others to support his
hypothesis (Majid,etal.,2014).
List
the Research Question(s) or Hypotheses
A research
question is a probe into a concept that a researcher wants to investigate, that
helps direct research, with the aim to determine the relationship between
fluctuating concepts in the hopes to predict and control outcomes (
Grove,etal,.2013). A hypothesis a
research question that can be tested in some way ( Grove,etal,.2013).
The researchers of this article are asking what attitudes, awareness,
information and barriers exist that prevents nurses from implementing
evidence-based measures (Majid,etal.,2014). The scholars used questioners to a
specific population of nurses working in the same type of health care setting
to inquire in regards to their research question (Majid,etal.,2014). The
investigators came to a hypothesis by testing their ideas of what the outcome
would be against the research of other scholars and the opinions of a collection
of nurses in the survey (Groves,etal,.2013).
Identify
and Define Variables
A
variable is an occurrence, concept, interval, sentiment, category or period that
a researcher is trying to measure (Groves, etal,.2013). An independent variable
stands alone and is not changed by the other variables (Groves,etal,.2013). In
this research article, the independent variable is the ability to undertake
evidence base measures (Majid,etal.,2014). The research then manipulates the
dependent variables ( variables that depend on other factors), education of
nurses, support by management, time constraints, nurses experience, nurses
research abilities and the confidence of the nurses, to see their effect on the
independent variable ( Grove etal.,2013). The investigator then measures the
number of times a dependent variable causes the expected outcome on the
independent variable in order to predict future outcomes ( Grove,etal.,2013).
By predicting consistent outcomes, the researcher can with reliability adjust
the dependent variable to have reliable outcomes with some certainty (
Groves,etal.,2013).
Demographics
of Sample
Demographic
are the unique characteristics given to a particular population
(Groves,etal.,2013).
The demographics
in this study were nurses working in public hospitals in Singapore. The nurses
were of all ages, experience levels and educational backgrounds.
Research Design
The
design for this research article is not explicitly stated. In the introduction
of the literary review, it can be inferred by the reader that the research
proposal is based on ideas, concept and theory gained from investigation of
knowledge pertaining to implementation of evidence based practice by nurses in
a health care setting. The enquiry is accomplished through the review of
literature and surveying nurses for their opinion on the topic of evidence
based practice (Groves,etal.,2013). The authors of this research article tie
the theory of other researchers into their enquiry by stating research that
support their study as well stating areas that could be used in future research
(Majid,etal.,2014).Often researchers investigate topics of interest but, do not
explicitly categorize or define their research into a specific area of query because it can be limiting ( Grove,
etal.,2013). The research design for this specific inquiry could best be
defined as exploratory-descriptive qualitative research (Grove,etal.,2013).
This type of research is conducted to study areas of interest, define a topic
and understand relationships in the findings (Grove,etal.,2013). Often these
types of studies are done to find a reason for a problem (Grove,etal.,2013).
The problem the researchers defined and demonstrated with their inquiry and
literature review was the barriers nurse face to implement evidence-based
measures. With this type of investigation the researcher is able to identify
problems of specific populations, with the hope of identifying areas that can
remove barriers and promote interventions that can be studied in the future
enquiry (Groves,etal.,2013).
The
qualitative portion of the research is the surveys of the nurses and why they
felt that they had barriers to implementing evidence based measures (Grove,etal.,2013).
Qualitative research is a rigorous, methodical, approach were an individual
gives his or her own individual meaning to an experience (Grove,etal.,2013).
The qualities portion of the research was the surveys sent to the nurses. The authors of the research then did a formal
investigation and review of previous knowledge in literature to integrate
findings into knowledge obtained through the surveys of the nurses to derive
hypothesis as to what barriers and variable exist to prevent the implementation
of evidence based care ( Grove,etal.,2013). This type of research is best
defined as exploratory- descriptive qualitative research (Grove,etal.,2013).
Sample/Setting
The setting for
this research was in Singapore community hospitals (Majid,etal.,2014). A sample
is a representation of the population (Grove,etal.,2013). The investigators in
this study obtained a depiction of the population by sending out random
anonymous surveys to all the nursing units in two community hospitals in
Singapore and requested for participation (Majid,etal.,2014). The researchers
sent out 2,100 questioners with 1,486 responses, this was an expectable
representation of the population of these two community hospitals (Majid,etal.,2014).
Because it was anonymous and no one was ask to participate this is a Radom
sampling ( Grove,etal.,2013).There was no need for an informed consent or
review board due to the fact the participants were anonymous, chose to
participate and in no way could be
harmed by the investigation ( Grove,etal.,2013). This sample size was a good
fit for the study if the researcher wanted to know barriers to implementation
of evidence based measure in these two community hospitals. Since all,
community’s and businesses have different cultures and subcultures to be more
exact for a particular ethos the inquiry of this research should be directed at
the area of interest.
Measurement,
Methods & Instruments
The authors of this research
article used the statistical package for social science to measure the results
of their inquiry (Majid,etal.,2014). The
method used to obtain the research was a survey questionnaire (Majid,etal.,2014). In the research article there was a brief
mention that due to the fact that the survey was of personal opinion it could
have some bias otherwise there is no mention of the validity of the statistical
tools used ( Majid,etal.,2014).
Data
Collection
The data was collected using a
brief questionnaire of the nurses in two community hospitals, in Singapore. The
nurses were asking to fill out the questioners privately and place them in a
box supplied to all the nursing units( Majid,etal.,2014).
Statistical
Analyses
A
five point semantic differential scale was used to statistically analyze, the
information obtained from the surveys (Majid,etal.,2014). The information
obtained was evaluated for statistical significance (Grove,etal.,2013). The
researches were trying to identify if the effects were cause by chance or
another event (Grove,etal.,2013). The researches had multiple areas in the
inquiry that they were looking for significance. An example was there was a
significant finding is the relationship between the nurse’s education level and
their confidence of implementing evidence-based measures (Majid,etal.,2014).
For
something to be considered not a random occurrence it has to have a level
identified of less than 0.05(Grove,etal.,2013).This was demonstrated in the
research in the area of education of nurses and confidence of implementing
evidence based practices ( Majid,etal.,2014). When measuring probability the
researchers must have an alpha level set prior to finding significance, it was
0.05 in this particular research study. When determining probability the alpha
level is fixed with the probability of an occurrence (Grove,etal.,2013). When
the probability is less than 0.05 then the event is not considered random in
occurrence( Grove,etal.,2013).Throughout the study the researchers are
calculating the probability that their
hypothesis about how multiple events, affect the use of evidence based measure and have any statistical significance(
Majid,etal.,2014).
Implication
of Findings
The
consensus by the nurses surveyed in this research study was that they had
limited knowledge about researching, interpreting and application of evidence
based measures in their everyday practice (Majid,etal.,2014). The study also
indicated that many of the nurses lacked skills in library literacy and researching
(Majid,etal.,and 2014). Another large barrier that was brought out in the study
was the lack of time constraints by the nursing staff (Majid,etal.,2014). The
research suggest that hospital management to improve the use of evidence based
practice needs to provide further education in library literacy, evidence based
measures and research ( Majid,etal.,2014).It is also important that management
provide sufficient time, opportunity and equipment necessary to implement
evidence based measures( Majid,etal.,2014).
This
article provides many areas that could direct future research in nursing. One
area is the need for advance degrees as entry-level positions into the nursing
field due to the expediential rate medicine, is growing. Another concern that
was revealed in the research is the lack of understanding of statistics. It may
be necessary that nursing majors have more math classes added to the
curriculum. The research also reveals that many nurses lack skills in using the
research databases in the library. With evidence-based measure here to stay, it
may also be beneficial to add this to the curriculum of a basic nursing degree.
If nurses were more versed in searching, understanding and implementing
evidence based measures the time constraints may be removed because, nursing
practice would be more standardized and evidence based measure would be part of
everyday practice.
Limitations
The
researcher identifies several limitations with their research. The greatest
limitation identified is the fact that it was quantitative question based
survey that could be affected by the personal bias of the individual taking the
survey( Majid,etal.,2014). To be able
provide consistence in outcomes the authors suggest a triangulation of research
approaches (Majid,etal.,2014). Another restraint identified was the fact that
you cannot generalize research in one population to all other populations (Majid,etal.,2014).
Another area of concern is the sample size is small. The culture also may not
be repressive of other ethos and this should be taken into consideration. For
example, maybe the nurses in Singapore have different educational preparation
then nurses in England. This would have a significant impact on the use and
implementation of evidence based practice at the bedside.
Generalization
of Findings
The authors of this study did a
random probability sample. This type of sample is considered a general sample
and can represent the overall larger population ( Grove,etal.,2013). Therefore,
it is implied that the findings of this research is a representation of the
greater populous and the findings could be duplicated on a large scale
(Grove,etal.,2013).
Suggestions
for Further Study
The
authors of this research article do not directly state suggested topics for
further research. The research does imply that further education is needed
library literacy, nurses understanding of research, time constraints place on
nurses and peer knowledge sharing( Majid,etal.,2014). All these topics would be
beneficial to improve nursing practice and add to the body of knowledge.
Format
The research used format was understandable, readable and the
concise. The references were correctly formatted in APA format but it would
have been helpful to have a more exhaustive references. By including a brief
summary under each reference discussing the literature being reviewed the
references would have aided future researchers. The spelling, punctuation and
grammar were impeccable. The format may have been easier to follow if the title
page was separated from the abstract.
Part
II. Comparison and Analysis
Design
The design used by the researchers was clearly
articulated. The design was a question based quantitative survey that is often
used to describe meaningful life events (Grove,etal.,2013). One value of the
design type chosen by the researches is it is cost effective (Grove,etal.,2013).
Another significant usefulness of the research design used in the article
evaluated is the fact that it has no questionable ethical concerns because the
subject chooses to participate and it is private (Grove,etal.,2013). As pointed
out by the authors the limitations to this design is that the data should not
be generalized because it may not be applicable to all cultures (Majid,etal.,2014).
A combination of research techniques may have been more useful, examples
include, interviews and focus groups (Majid,etal.,2014).
A combination of a
qualitative and quantitative approach may have given the data obtained greater
scientific value (Majid,etal.,2014). By creating a quantitative test to
measured nurses skills in searching library data bases, the researchers may
have a more significant understanding of what part of applying evidence based
measure was due to knowledge deficit and confidence levels. A drawback to this
combination approach would be time and money.
Data
Analysis
The
data analysis prepared for this investigation clearly expresses and gives
purpose to the data examined by the researchers (Grove,etal.,2013). The data
analyzed provides clear relationship between certain events on being able to
implement evidence based practice. An example for education of the nurses and
their perceived ability to initiate evidence based measures at the bedside. The
data analysis also showed a clear relationship, with comfort of applying
evidence based measures and prior training
given by the hospital to the floor nurses(Majid,etal.,2014). Another
area that was clearly portrayed as important through the statistical data was
the importance of mentoring
(Majid,etal.,2014).The
data that analyzed the variables affecting the use of evidence based
Measures on the floor made a strong case through data, why variables
such as education, Training and mentoring could significantly improve the use
of evidence-based measures on an nursing unit.
Overall
Evaluation
This
study is an asset to the body of knowledge of nursing. It was clearly written and
the authors used literature from previous research to support their claims. The
author’s theories were clearly demonstrated through statistics and previous
research. The qualitative research gave meaning to an abstract idea of why
evidence based measures were not currently being used. The overall quality of
the study was it was easy to read and interpret. It supplies supposition for
further research. One such premise may be to strengthen the research already
given with triangulation of research methods such as quantities approach. An
example would test nurses actual research ability verses their perceived
ability.
References
