Evidence Based Practice In Nursing
Introduction
Evidence-based practice is essential in nursing. It serves as the basis of nursing care being used today. To enable nurses further to improve such care, research becomes a necessity. One way of ensuring research study is useable and effective is by critically appraising it. This paper aims to correctly and systematically critique a chosen qualitative research article by scrutinizing its part one by one and providing a concluding comments at the end.
Title and abstract
A qualitative research article’s title should compose of a central phenomenon and a group under study. It should also contain the context of the study and the research design used. More importantly it should be short and concise but long enough to convey the …show more content…
very meaning or purpose of the article (Polit & Beck, 2006). In the chosen article, the central phenomenon which is ‘contemplating nuchal translucency screening’ can be clearly identified. Women as the group under study can also be easily identified. However, Hawthorne and Ahern (2009) could have improved the group under study by adding specification to it. Pregnant women as opposed to women as the group under study inform readers that the focus is on child-bearing women and not just ordinary women.
According to Polit and Beck, the purpose of an abstract is for the reader to review the entirety of an article and decide if it is worth reading or not (2006). They also point out that the abstract should be able to answer questions formed after reading the title. It should contain a brief background, aims, methods used, results, and conclusions of the research study (Polit& Beck, 2006). Hawthorne and Ahern (2009) did not include objectives and conclusions in their abstract but covered the other essential components. A brief description of the study was briefly presented and methods were also covered. Although findings were mentioned, it was presented insufficiently and can be confused with the study’s conclusion because it was stated only in one sentence. Furthermore, Polit and Beck (2006) state that an abstract could have 100 to 200 words. Hawthorne and Ahern’s article contains only 102 words which almost did not reach the minimum word count and can be argued as not having enough information for an abstract. The traditional laid-out paragraph is not persuasive enough to attract a reader. Although the abstract itself builds up to the title, it does clearly provide a quick synopsis of the study. Providing the purpose and setting, are clearly presenting the findings and conclusions of the study can better improve this section of the article. A new, structured format can also be used to make it look presentable and organized.
Literature review
Polit and Beck (2006) state that the purpose of a literature review is to provide in-depth knowledge on a topic unknown to the reader. It shows different views and stands backed by solid evidence and theories from other studies. It focuses on what works now and compares it to what worked before hence acknowledging a gap of knowledge. In Hawthorne and Ahern’s article, the definition and purpose of nuchal translucency were clearly presented. It also provided the reader of its advantages and disadvantages to the pregnant women population. However, a brief definition of Down Syndrome should have been elaborated by the authors. Evaluation of evidence based practice was also well presented by mentioning that antenatal screenings were done for more than 25 years and Hawthorne and Ahern (2009) also informs of how such screenings are carried out in the present. The reader can determinethe article’s main problem even though it was not formally acknowledged by the authors, covering the nature of the problem and its scope. The problem of women being pressured to decide ahead whether to continue or end a pregnancy with a high-risk baby is broad and stated well in the last sentences of the second paragraph of the introduction. The article’s theoretical framework was presented informatively and chronologically, comparing one standpoint with another without creating any bias and pointing out advantages and disadvantages of each. Ideas and theories used cover a variety of aspects on the topic like its ethical and emotional grounds and its impact on the population. The authors chose a significant number of primary sources to back these theories. Almost all came from peer-reviewed journal articles and are mostly up-to-date with a 14-year-old article as the oldest to be used as a reference. Research questions were also imposed in the body and although the hypothesis was not explicitly stated, the reader can determine its presence in which it can be picked up as‘as new technology advances, attitudes change on the decision of partaking in antenatal screening’. The gap of knowledge was also clearly presented at the end of the literature review. Hawthorne and Ahern (2009) argue it is not clearly known whether an early detection of Down Syndrome allow pregnant women to gain some control over the result of their pregnancy hence leading to its termination. The significance of the study was also not explicitly acknowledged but the reader can easily pick up after reading the whole review on the practical application of the screening method for pregnant women to decide on whether to partake it or not. It mainly targets pregnant women but it also is very applicable to spouses especially those who are aspiring parents.It applies to the general population as well, creating a new study on the ethical grounds relating early screening and abortion.
Study design
Hawthorne and Ahern (2009) clearly stated in their paper that hermeneutic analysis was used in the study. Phenomenology is a research design focusing in the lived experiences of human beings to rationalize phenomena (Polit& Beck, 2006). Polit and Beck (2006) state interpretive phenomenology is going into the world of a human being and witness the truths inside. Furthermore, they state that researchers centralizing on this tradition use conversations as the main form of data collection. This tradition fits appropriately based from lived experience, the researchers are able to grab personal information from the respondents that directly fulfils the aims of the study. The theoretical framework in the article’s literature review injects appropriateness in the chosen method of data collection. The researchers are able to formulate relevant questions based on the study’s solid literature review.
Methods
The main method used for data collection is what Polit and Beck (2006) regard as the common method used in qualitative research studies - the conversational interview.
Since the study focuses on human experiences, it is appropriate to use the semi structured interview as a means of collecting subjective data. Participants were 20 pregnant women in their first trimester and still contemplating on nuchal translucency screening. Polit and Beck (2006) argue that phenomenological studies usually use 10 or less people to serve as a sample. Hawthorne and Ahern’s sample contradicts having 10 more. The interview process took place on each of the participants’ homes for about 70 minutes. Some were interviewed in their workplace during lunch break. It could be argued that some interviews could be rushed and therefore may result in inaccuracy. Conducting an interview in a workplace also does not provide privacy and a decent environment and this may have irritated some of the respondents. Follow up interviews were also conducted which may indicate some of the respondents’ unwillingness to participate. Interviewers were also not described and training for the interviewers was also not mentioned. The semi structured interview starts off with the interviewers asking general and broad questions where the respondents come in and relate their own experience. The interviewers let them lead on, sharing past experiences, opening new aspects of the topic, and raising their own ideas on particular …show more content…
topics. This is the sole purpose of a phenomenological study (Polit & Beck, 2006). Phenomenological sampling was used in the study. The researchers chose participants who have gone through the antenatal screening experience and are able to articulate the said experiences. It was not mentioned in the article that the interviewers asked for the participants’ consent for data collection. It was not even mentioned in detail how the group under study had been selected. Data management was sufficiently described in which the reader is informed that the interview conversations were recorded and transcribed with the participants’ consent although it was not stated whether the audiotapes will be kept in storage. Data analysis was also sufficiently described in which the reader is informed that In Vivo codes were used to analyse the data. The paper clearly described the process where in the each transcript was thoroughly read and were grouped into similar categories and themes. Triangulation was also mentioned and was achieved by means of cocoding with other qualitative researchers and an experienced prenatal genetic counsellor.
Findings
The results of the interview were presented in an organised and systematic manner. Hawthorne and Ahern (2009) chose to present two categories after the data was analysed. One theme is the approval of taking the test while being confident about the result; the other is the approval of taking the test while knowing the risks one has. Each category sufficiently provides the reader different ideas and perceptions regarding the screening test in which directly relates the article’s objectives and hypothesis. Direct quotations were presented to solidify the evidence. Each idea was covered and backed up by the article’s theoretical framework. A few concepts like the likelihood of developing a significant emotional risk for those who choose to go with the scan, as perceived by six respondents who chose to go with the scan and terminate a high-risk baby because they are unable to cope with the result (Hawthorne & Ahern, 2009). Another concept is the capability of the scan to hand full control of a pregnancy to the one who is carrying it, as perceived by one respondent who felt very in control than before (Hawthorne & Ahern, 2009). Another interesting find was the ethical notion of whether terminating a high-risk baby makes a ‘good’ or ‘bad’ mother in which most of the respondents were for the latter (Hawthorne & Ahern, 2009). However, the issues of having a false positive or false negative result were not addressed by the researchers. There was even no mention of at least one participant responding to this issue. Another downside was the researchers decided to show the names of the participants although it was not mentioned whether these were their real names. A table showing a list of the participants’ names and their respective decisions to participate with the test was shown. Although it was informative and well-presented visually, this may result into privacy and confidentiality issues. There was no mention of the study’s limitations in the article.
Discussion
Hawthorne and Ahern (2009) compared the findings of their study with various and relevant studies as well.
One example is the finding in which mothers did not feel closer to their baby when seeing a visualization of their child during the scan was contradictory to a similar study conducted 7 years ago. Another finding is the mothers’ different views and definition of being a ‘good’ mother were seen being selfish than reaching out to their unborn child. Moreover, it reflects the respondents’ awareness of the developing the risk. This contradicts to another study as well. This section also presented a limitation of the study in which it explained that these contradictions arose because of the timing of the study, having it done before screening took place. One similarity with other studies was the finding in which formed friendships had a great impact on the decision of the respondents towards the
screening.
Recommendations
Hawthorne and Ahern (2009) present 4 recommendations in a structured and bulleted form indicating further research and investigation to be done on the topic. They further imply the different perception of the word ‘risk’ to both medical and midwifery practitioners and women and how this causes a great ordeal and stir of what action to be taken is deemed right for both parties.
Conclusion
In conclusion, this article was very informative and well presented. Although it has its share of weaknesses, ideas were solidly supported and were in a logical flow. The topic never fails to entice as results become very intriguing knowing that they were based on actual human experiences. In regards to the topic as a whole, it should be prompted that whatever a mother decides, the decision should be a selfless and personal choice free of guilt and intervention.
Evidence-based practice is essential in nursing. It serves as the basis of nursing care being used today. To enable nurses further to improve such care, research becomes a necessity. One way of ensuring research study is useable and effective is by critically appraising it. This paper aims to correctly and systematically critique a chosen qualitative research article by scrutinizing its part one by one and providing a concluding comments at the end.
Title and abstract
A qualitative research article’s title should compose of a central phenomenon and a group under study. It should also contain the context of the study and the research design used. More importantly it should be short and concise but long enough to convey the …show more content…
very meaning or purpose of the article (Polit & Beck, 2006). In the chosen article, the central phenomenon which is ‘contemplating nuchal translucency screening’ can be clearly identified. Women as the group under study can also be easily identified. However, Hawthorne and Ahern (2009) could have improved the group under study by adding specification to it. Pregnant women as opposed to women as the group under study inform readers that the focus is on child-bearing women and not just ordinary women.
According to Polit and Beck, the purpose of an abstract is for the reader to review the entirety of an article and decide if it is worth reading or not (2006). They also point out that the abstract should be able to answer questions formed after reading the title. It should contain a brief background, aims, methods used, results, and conclusions of the research study (Polit& Beck, 2006). Hawthorne and Ahern (2009) did not include objectives and conclusions in their abstract but covered the other essential components. A brief description of the study was briefly presented and methods were also covered. Although findings were mentioned, it was presented insufficiently and can be confused with the study’s conclusion because it was stated only in one sentence. Furthermore, Polit and Beck (2006) state that an abstract could have 100 to 200 words. Hawthorne and Ahern’s article contains only 102 words which almost did not reach the minimum word count and can be argued as not having enough information for an abstract. The traditional laid-out paragraph is not persuasive enough to attract a reader. Although the abstract itself builds up to the title, it does clearly provide a quick synopsis of the study. Providing the purpose and setting, are clearly presenting the findings and conclusions of the study can better improve this section of the article. A new, structured format can also be used to make it look presentable and organized.
Literature review
Polit and Beck (2006) state that the purpose of a literature review is to provide in-depth knowledge on a topic unknown to the reader. It shows different views and stands backed by solid evidence and theories from other studies. It focuses on what works now and compares it to what worked before hence acknowledging a gap of knowledge. In Hawthorne and Ahern’s article, the definition and purpose of nuchal translucency were clearly presented. It also provided the reader of its advantages and disadvantages to the pregnant women population. However, a brief definition of Down Syndrome should have been elaborated by the authors. Evaluation of evidence based practice was also well presented by mentioning that antenatal screenings were done for more than 25 years and Hawthorne and Ahern (2009) also informs of how such screenings are carried out in the present. The reader can determinethe article’s main problem even though it was not formally acknowledged by the authors, covering the nature of the problem and its scope. The problem of women being pressured to decide ahead whether to continue or end a pregnancy with a high-risk baby is broad and stated well in the last sentences of the second paragraph of the introduction. The article’s theoretical framework was presented informatively and chronologically, comparing one standpoint with another without creating any bias and pointing out advantages and disadvantages of each. Ideas and theories used cover a variety of aspects on the topic like its ethical and emotional grounds and its impact on the population. The authors chose a significant number of primary sources to back these theories. Almost all came from peer-reviewed journal articles and are mostly up-to-date with a 14-year-old article as the oldest to be used as a reference. Research questions were also imposed in the body and although the hypothesis was not explicitly stated, the reader can determine its presence in which it can be picked up as‘as new technology advances, attitudes change on the decision of partaking in antenatal screening’. The gap of knowledge was also clearly presented at the end of the literature review. Hawthorne and Ahern (2009) argue it is not clearly known whether an early detection of Down Syndrome allow pregnant women to gain some control over the result of their pregnancy hence leading to its termination. The significance of the study was also not explicitly acknowledged but the reader can easily pick up after reading the whole review on the practical application of the screening method for pregnant women to decide on whether to partake it or not. It mainly targets pregnant women but it also is very applicable to spouses especially those who are aspiring parents.It applies to the general population as well, creating a new study on the ethical grounds relating early screening and abortion.
Study design
Hawthorne and Ahern (2009) clearly stated in their paper that hermeneutic analysis was used in the study. Phenomenology is a research design focusing in the lived experiences of human beings to rationalize phenomena (Polit& Beck, 2006). Polit and Beck (2006) state interpretive phenomenology is going into the world of a human being and witness the truths inside. Furthermore, they state that researchers centralizing on this tradition use conversations as the main form of data collection. This tradition fits appropriately based from lived experience, the researchers are able to grab personal information from the respondents that directly fulfils the aims of the study. The theoretical framework in the article’s literature review injects appropriateness in the chosen method of data collection. The researchers are able to formulate relevant questions based on the study’s solid literature review.
Methods
The main method used for data collection is what Polit and Beck (2006) regard as the common method used in qualitative research studies - the conversational interview.
Since the study focuses on human experiences, it is appropriate to use the semi structured interview as a means of collecting subjective data. Participants were 20 pregnant women in their first trimester and still contemplating on nuchal translucency screening. Polit and Beck (2006) argue that phenomenological studies usually use 10 or less people to serve as a sample. Hawthorne and Ahern’s sample contradicts having 10 more. The interview process took place on each of the participants’ homes for about 70 minutes. Some were interviewed in their workplace during lunch break. It could be argued that some interviews could be rushed and therefore may result in inaccuracy. Conducting an interview in a workplace also does not provide privacy and a decent environment and this may have irritated some of the respondents. Follow up interviews were also conducted which may indicate some of the respondents’ unwillingness to participate. Interviewers were also not described and training for the interviewers was also not mentioned. The semi structured interview starts off with the interviewers asking general and broad questions where the respondents come in and relate their own experience. The interviewers let them lead on, sharing past experiences, opening new aspects of the topic, and raising their own ideas on particular …show more content…
topics. This is the sole purpose of a phenomenological study (Polit & Beck, 2006). Phenomenological sampling was used in the study. The researchers chose participants who have gone through the antenatal screening experience and are able to articulate the said experiences. It was not mentioned in the article that the interviewers asked for the participants’ consent for data collection. It was not even mentioned in detail how the group under study had been selected. Data management was sufficiently described in which the reader is informed that the interview conversations were recorded and transcribed with the participants’ consent although it was not stated whether the audiotapes will be kept in storage. Data analysis was also sufficiently described in which the reader is informed that In Vivo codes were used to analyse the data. The paper clearly described the process where in the each transcript was thoroughly read and were grouped into similar categories and themes. Triangulation was also mentioned and was achieved by means of cocoding with other qualitative researchers and an experienced prenatal genetic counsellor.
Findings
The results of the interview were presented in an organised and systematic manner. Hawthorne and Ahern (2009) chose to present two categories after the data was analysed. One theme is the approval of taking the test while being confident about the result; the other is the approval of taking the test while knowing the risks one has. Each category sufficiently provides the reader different ideas and perceptions regarding the screening test in which directly relates the article’s objectives and hypothesis. Direct quotations were presented to solidify the evidence. Each idea was covered and backed up by the article’s theoretical framework. A few concepts like the likelihood of developing a significant emotional risk for those who choose to go with the scan, as perceived by six respondents who chose to go with the scan and terminate a high-risk baby because they are unable to cope with the result (Hawthorne & Ahern, 2009). Another concept is the capability of the scan to hand full control of a pregnancy to the one who is carrying it, as perceived by one respondent who felt very in control than before (Hawthorne & Ahern, 2009). Another interesting find was the ethical notion of whether terminating a high-risk baby makes a ‘good’ or ‘bad’ mother in which most of the respondents were for the latter (Hawthorne & Ahern, 2009). However, the issues of having a false positive or false negative result were not addressed by the researchers. There was even no mention of at least one participant responding to this issue. Another downside was the researchers decided to show the names of the participants although it was not mentioned whether these were their real names. A table showing a list of the participants’ names and their respective decisions to participate with the test was shown. Although it was informative and well-presented visually, this may result into privacy and confidentiality issues. There was no mention of the study’s limitations in the article.
Discussion
Hawthorne and Ahern (2009) compared the findings of their study with various and relevant studies as well.
One example is the finding in which mothers did not feel closer to their baby when seeing a visualization of their child during the scan was contradictory to a similar study conducted 7 years ago. Another finding is the mothers’ different views and definition of being a ‘good’ mother were seen being selfish than reaching out to their unborn child. Moreover, it reflects the respondents’ awareness of the developing the risk. This contradicts to another study as well. This section also presented a limitation of the study in which it explained that these contradictions arose because of the timing of the study, having it done before screening took place. One similarity with other studies was the finding in which formed friendships had a great impact on the decision of the respondents towards the
screening.
Recommendations
Hawthorne and Ahern (2009) present 4 recommendations in a structured and bulleted form indicating further research and investigation to be done on the topic. They further imply the different perception of the word ‘risk’ to both medical and midwifery practitioners and women and how this causes a great ordeal and stir of what action to be taken is deemed right for both parties.
Conclusion
In conclusion, this article was very informative and well presented. Although it has its share of weaknesses, ideas were solidly supported and were in a logical flow. The topic never fails to entice as results become very intriguing knowing that they were based on actual human experiences. In regards to the topic as a whole, it should be prompted that whatever a mother decides, the decision should be a selfless and personal choice free of guilt and intervention.