Part I: Comprehension
The authors are experts within their field and possess the knowledge required to analyze and report on the chosen topic. A Doctoral student is also a co-author who gained experience in authoring publications with this exercise. Based upon the subject matter to be studied, the title of the article aligns with the desired purpose. The abstract provides a strong summary of the article content and the research protocol under consideration and does not leave out any important elements for the reader.
The problem in question is to evaluate nurses’ knowledge, perceptions, and awareness of evidence-based practice and its impact on solving important clinical problems and improving quality of care (Majid et.al, 2011). Even though evidence-based practice is generally a well-received concept, it is not always readily implemented in many nursing practice settings, as many barriers exist (Majid et.al, 2011). This disconnect must be explored in greater detail to determine its root cause and possible solutions. The authors refer to evidence produced in prior research studies and a number of important barriers to implementation in supporting the problem. The primary objectives of the study were addressed in the abstract section of the article.
In reviewing the references used, many are current, with 14 of the 24 references written within the last ten years and four within the last five years. However, a number of articles are older than 2000, which is beneficial for a historical comparison but is not likely to provide significant data to support current needs. The authors address these studies and their findings and note that some of the studies were not applicable to the subject area, Southeast Asia, as the majority of the studies were conducted in the United States and European countries (Majid et.al, 2011). The authors provide a summary of the review of the literature and demonstrate that additional research that is specific to Southeast Asia is required determine if nurses in a country such as Singapore but that this study is positive in understanding evidence-based practice attitudes and beliefs for nurses in Singapore (Majid et.al, 2010).
In the research study, the approach and method were addressed in the abstract section and also in the literature review. The authors address the framework of the study and its important variables, such as literature skills, experience, attitudes, and understanding of evidence-based practice (Majid et.al, 2010).The study method is aligned with prior beliefs regarding evidence-based practice and its impact on the quality of patient care, but does not reference a specific existing theory (Majid et.al, 2010).
The hypothesis that was considered in the research study was to determine the level of knowledge, experience, awareness, and attitudes towards evidence-based practice, which is one of the most important tools to integrate scientific research into patient care to improve quality and effectiveness (Majid et.al, 2010). The research article emphasizes nursing beliefs and attitudes; limitations in adopting evidence-based practice techniques; training opportunities, the ability to search and evaluate existing nursing research; and the type of information that is used (Majid et.al, 2010). This information is relevant because for the selected population group in Singapore, cultural differences and preferences have not been evaluated in the past in the area of evidence-based practice in nursing, and this information is appropriate to improve practice initiatives for this population group (Majid et.al, 2010).
Identify and Define Variables
The independent variable for this study is the application of evidence-based practice (EBP) to patient care and the quality of treatment provided by nurses. The dependent variables include the following: 1) knowledge and understanding of EBP; 2) beliefs and attitudes regarding EBP; 3) barriers to implementing EBP; 4) research skills to identify and evaluate EBP literature; and 5) available training in regards to EBP (Majid et.al, 2010). The dependent variables will be evaluated to determine how to best integrate EBP into modern nursing practice in Singapore to improve the quality of patient care and related outcomes (Majid et.al, 2010).
Demographics of Sample
The study sample included specific demographics, which included the following: 1) 41 percent of the sample earned a basic diploma or certificate in the nursing field; 2) 14.8 percent held a post-basic or advanced diploma, with 41.4 percent earning a bachelor’s degree and 2.3 earning a master’s degree; 3) 47.2 percent were employed in inpatient nursing units, 21 percent in ICUs, and 7.1 percent in outpatient nursing units; 4) 12.1 percent worked in operating rooms and 2.5 percent in emergency rooms; 5) 51.1 percent had at least five years of experience in the nursing profession, 21.9 percent had 6-10 years of experience, and 27 percent had 10 years of experience or more; and 6) 82.7 percent had not had any formal training regarding EBP and its application to patient care (Majid et.al, 2010).
The research design employed a questionnaire method, with a draft reviewed for content validity by a cross-section of nursing experts (Majid et.al, 2010). After the initial draft review, a pilot test was conducted with 20 nurses across different nursing units and departments in three separate hospitals and feedback was provided accordingly (Majid et.al, 2010). In conducting content validity and consistency, Cronbach alpha coefficients were used and determined that the study questions were reliable and appropriate (Majid et.al, 2010).
The study sample criteria were as follows: 1) all registered nurses, both full time and part time, who were employed at two separate urban hospitals in Singapore; 2) Nurses on the schedule during the two-week data collection period; and 3) those nurses on any type of leave were excluded from participation (Majid et.al, 2010). Nursing managers across all units in both hospitals were provided with copies of the questionnaire and were provided with detailed information regarding the survey and its purpose prior to dissemination (Majid et.al, 2010). Nurses who participated were asked to submit their completed questionnaires in a sealed collection box, which was placed in each unit (Majid et.al, 2010). To begin the data collection process, 2,100 questionnaires were distributed in the two locations, and 1,486 questionnaires were completed, giving a response rate of 70.8 percent (Majid et.al, 2010). All participants gave their informed consent merely by completing the questionnaire (Majid et.al, 2010). The setting and selection criteria were appropriate for the study objectives in question.
Measurement, Methods & Instruments
The researchers developed the study questionnaire as the research instrument which was disseminated to the desired study population group (Majid et.al, 2010). After the completed questionnaires were received, the statistical analysis was performed using the common tool known as SPSS (Majid et.al, 2010). Validity testing was performed using a draft form of the questionnaire and a pilot study was conducted to achieve further validity prior to widespread dissemination (Majid et.al, 2010). This instrument was effective in obtaining the desired information from study participants.
Data was collected using a questionnaire instrument which was comprised of a number of areas, including the following: 1) Attitudes and beliefs regarding EBP; 2) Self-efficacy and EBP skills; 3) Factors associated with the utilization of EBP; 4) Barriers in adopting EBP; 5) Expanded training in EBP; and 6) Research-based resource utilization for patient care (Majid et.al, 2010). Data collection was conducted on a one-time basis to support the study objectives, and was collected in the two urban hospitals in Singapore previously mentioned in the analysis (Majid et.al, 2010).
The popular statistical analysis program SPSS was used to extract and analyze data from the questionnaire, and the following results were derived: 1) In regards to beliefs and perceptions of EBP, 64.3 percent of respondents believed that traditional patient methods were less desirable than newer approaches and 52.1 percent did not find the research articles they found useful to their routine practice; 2) In regards to self-efficacy, an analysis known as the five-point semantic differential scale was adopted, with several statements asked regarding EBP utilization, and it was determined that across the nine statements, mean scores were higher for participants with higher education credentials; 3) Factors associated with the implementation of EBP included training, sufficient time to explore EBP, the support of nurses with experience in EBP, and access to EBP resources; 4) Barriers associated with EBP included the comprehension of statistical data and technical terminology, as well as the inability to determine the quality level of EBP research articles; 5) Areas of EBP training included relationship to practice, comprehension of statistical and technical terms, evaluating research evidence, and improving evaluation of research and related searches; 6) Information searches and implementation included electronic searches such as informational websites most commonly, with hospital-provided literature databases and e-books as secondary resources; 7) Search operator familiarity was low, such as Boolean; and 8) Search familiarity was generally basic, using simple keywords and phrases (Majid et.al, 2010). In the research study, no level of significance was identified.
Implication of Findings
In response to the data and analyses derived from the research study, it was determined that the large majority of respondents viewed EBP in a favorable manner, and in particular, those nurses who have knowledge and experience of EBP in the past and those with prior training in EBP (Majid et.al, 2010). In this context, younger and more experienced nurses were less comfortable with EBP on a general basis (Majid et.al, 2010). One of the key findings to consider is that many nurses do not have additional time to explore EBP as needed to better understand and implement these concepts into routine nursing practice, which requires management teams to determine how to improve EBP training and experience in the regular routine (Majid et.al, 2010). Additional implications included the lack of comprehension regarding statistical references and technical terminology which are typically used in EBP research; therefore, those nurses with lower levels of education are most likely to be confused or perplexed regarding EBP research because they have less education and training in more advanced statistical and technical analyses (Majid et.al, 2010). It is necessary to establish a training protocol to bridge these gaps and to provide additional knowledge regarding EBP research (Majid et.al, 2010).
Another important area of consideration is the lack of understanding of nurses in performing research inquiries regarding EBP practice, as they do not have the familiarity with Boolean and other terminology which is common in performing these searches (Majid et.al, 2010). Without this knowledge in place, it becomes very difficult for nurses to recognize patterns and to understand how to perform EBP research in an effective and comprehensive manner, thereby supporting the development of training in performing literature searches for all nurses (Majid et.al, 2010). In this section of the article, all primary areas in the questionnaire were addressed; therefore, no implications were absent from the discussion.
In the research study, there were a number of important limitations, including the following: 1) the study was conducted in only two urban hospitals in Singapore; therefore, the study results should not be generalized for hospitals in other areas of Singapore and beyond; 2) It is important to conduct this type of study in other hospitals with different geographics and demographics to ensure that these distinct nursing populations are also evaluated; 3) It is recommended that there should be a cross-country study to capture findings and results from a variety of hospitals in Singapore; 4) The study instrument was self-administered, which could pose problems in the form of personal bias, thereby distorting impact the study results in a negative manner; 5) Skill knowledge and competency in the area of literature searches could be better determined by using an independent competency evaluation; and 6) the research method could be more comprehensive in future studies, employing interviews and/or focus groups to better understand EBP and its utilization in nursing practice (Majid et.al, 2010). Each of these factors provides significant support for future needs in EBP as related to nursing practice, and it does not appear that any additional limitations were absent or forgotten from the analysis.
Generalization of Findings
The research study does not provide significant generalization of findings beyond the sample that was evaluated. The authors primarily focus on the study population in question and how they responded to the questions provided in the survey instrument. The author’s generalization of findings was weak and could have been improved in order to determine the study’s efficacy and applicability to other nursing populations.
Suggestions for Further Study
The authors address how future studies might benefit from additional criteria and research methods in different ways, such as the implementation of focus groups or interviews. These approaches would capture additional insight into nursing perceptions and experiences with EBP in the past and what is necessary in the future to improve the utilization of this research. In this context, it is important to recognize how nurses might benefit from EBP implementation if they possess the knowledge and experience that is necessary to complete these tasks in a timely and efficient manner.
In evaluating the research study from a formatting perspective, the grammatical approach was appropriate and no errors were discovered. Sentence structure, organization, and clarity were also sufficient and appropriate for the study content. A variety of terminology was used throughout the study and was implemented properly to improve the descriptive nature of the study and its findings.
Part II: Comparison and Analysis
In evaluating the research article further and the initial objectives of the research team, the study design that was chosen is appropriate in obtaining the required data. The authors provided significant detail in regards to the purpose of the study, the objectives to be determined, the study population, and the potential results and implications. The research design that was used was successful in obtaining basic data and information regarding nurse perceptions, knowledge, and attitudes of EBP and its application to nursing practice. In addition, the design was conducted at more than one facility, which provided a broader application of the study results. With a relatively high response rate, the survey provided a more accurate depiction of the study and its findings for nurses in terms of future ERP applications to patient care. In addition, the questionnaire method could be applied to nurses in other organizations throughout Singapore. On the other hand, the study was limited because the questionnaire was self-administered, which could lead to relevant bias in how the study questions were answered. This is a difficult and challenging task in providing sufficient and accurate evidence regarding nurse knowledge and perceptions of EBP. Some respondents might not have taken the questions as seriously as desired; therefore, their responses were perhaps not completely truthful and accurate. Furthermore, a self-administered questionnaire may not lead to high response rates in situations where the survey is not supported and participation is not enforced by nurse managers. It is important for the research team to develop a strategy which will best accommodate their needs by utilizing perhaps a different research design or a group of designs, such as a focus group and/or individual interviews. These methods will provide further support for the study objectives and overall purpose.
For the purposes of the research study, the data analysis that was conducted was appropriate. SPSS offers a wide range of applications for statistical analysis and is effective in evaluating the questionnaire instrument and the desired outcomes. In addition, the data analysis procedures were described in a clear and concise manner for the study. The statistical analysis is a key component of any research study; therefore, the method chosen and the manner in which it is conducted is critical to achieve optimal research results. The data analysis portion of the study provided a number of different statistics which supported the overall direction of the research study and its outcomes for future studies.
For this research study, there were a number of important considerations to make in regards to the development of an effective research protocol to achieve the desired objectives. With this practice in mind, it was necessary to develop an instrument, content, method, design, and analysis process which supported these objectives in an effective manner. The authors were successful in achieving these objectives through the expansion of existing ideas and concepts, but also in consolidating some of the beliefs and perceptions of EBP in two separate hospital locations. By using a questionnaire instrument, the authors were able to obtain insight into EBP and its utilization by the surveyed nurse population group. In addition, the authors were able to identify patterns within the research which supported the necessity for future training and knowledge acquisition in the area of EBP and its applicability to nursing practice. The study questionnaire was generally effective in asking the appropriate questions; however, the potential for bias was evident and should be considered prior to implementation in future studies. The literature review was appropriate in providing past evidence of EBP and its application to nursing practice. Furthermore, it appears that the questions and issues raised in the questionnaire instrument were appropriate for the desired objectives.
In general, the study provided an effective and applicable tool in evaluating nurse perceptions, knowledge, training, and attitudes regarding EBP and its application to nursing and patient care. The authors sought to achieve a series of objectives, and the study researchers were successful in completing these requirements. Although the study was strong in several areas, its applicability to a broader audience of nurses is unknown at this time. It is important for the researchers to evaluate the study results further and to make adjustments or modifications as necessary to ensure that potential bias is limited and other possible problems are eliminated as best as possible. This will enable the researchers to have a much greater focus on the availability and applicability of EBP throughout all areas of nursing practice in the future. The researchers have achieved their original objectives; however, additional research and evaluation is required to ensure that future studies are more comprehensive and have limited potential for bias or other types of interferences which could distort the final results in some capacity.
Majid, S., Foo, S., Luyt, D., Zhang, X., Theng, Y.L., Chang, Y.K., and Mokhtar, I.A. (2011). Adopting evidence-based practice in clinical decision making: nurses’ perceptions, knowledge, and barriers. Journal of the Medical Library Association, 99(3), 229-236.