Introduction
Quantitative research critiquing is an essential process in the synthesis of knowledge for use in the nursing practice. Hence it is fundamental to research utilization and evidence-based practice in nursing. The process of quantitative nursing research critique is an intellectual activity which will help one decide as to what extent research maybe useful in practice. In other words, this is to see if the findings of a study are trustworthy and if it is comparable with other related research. While the term “research” has been used rather freely in the past, there has also been a tendency to perceive research as an end in itself rather than as a means to an end, namely improvement in the quality of care provided to patients. As LoBiondo-Wood et al. (2002) mention, “the meaning of quality research in nursing should contribute to knowledge relevant to care and nursing service. Further, nursing research should provide a specialized scientific knowledge base that empowers the nursing profession to anticipate and meet these challenges and maintain our societal relevance”. This paper will critique the study, “Evaluation of a Program to Increase Evidence-Based Practice Change” using the guidelines for quantitative research critique provided by the University of Phoenix , College of Health and Human Services.
Research Problem and Purpose
The research problem is a “situation in need of a solution, improvement or alteration or a discrepancy in the way things are or the way they ought to be” (Burns & Grove, 1993). This article, “Evaluation of a Program to Increase Evidence-Based Practice Change by June H.
Larrabee, PhD, RN, Jacqueline Sions, MSN, RN, CNA, BC, CNOR, Mary Fanning, MSN, RN,
CCRN, CNAA, BC, Mary Lynne Withrow, MSN, RN, and Andrea Ferretti, MSN, RN (2007) is
a study to evaluate a nursing research program designed to achieve systematic evidence based
practice change (p.302). Specifically, the purpose of the study was to evaluate the change in nurse attitudes about the use of research and research conduct, the practice change projects, and nurse participation in research-related activities (p. 302). This study is important for nurse leaders as evidence indicates that successful evidence-based practice change in an organization
requires senior leadership support and a systematic program for practice change. In addition, evaluation of program effectiveness provides evidence about opportunities for further improvement (p.302).
Literature Review
The authors’ review of literature was incorporated in the introduction part of the article since they did not provide a review of literature part in their research. Previous studies were not referred to by specific articles and names but were provided in the references section of the study. As mentioned by Wood & Haber (1998), “a review of the literature is a broad, comprehensive, in-depth, systematic and critical review of scholarly publications, unpublished scholarly print materials, A- V materials, personal communications”.
This study on “Evaluation of a Program to Increase Evidence-Based Practice Change” used previous relevant studies but theories involved were not described in-depth. Among the more or less 20 references used, 6 sources were published within the last 5 years and around 14 sources were published in the last 10 years. Further, “Evaluation of a Program to Increase Evidence-Based Practice Change” was founded on the notion that successful evidence-based practice change in an organization requires senior leadership support and a systematic program for practice change and that a systematic nursing research program can yield improved better patient outcomes as demonstrated by hospitals that can attract and retain nurses ‘‘who are job satisfied because they can give high-quality care’’(Schmalenberg, 2005). But the authors added that “at the time that the nursing research program was designed (1999), no studies could be located that evaluated the impact of implementing a nursing research program on nurse attitudes and participation in research use and research conduct.” (p.304).
Hence, the effectiveness of a nursing research program must be evaluated so an evaluation plan must be developed to investigate the influence of nursing research program implementation on nurse attitudes and participation in research use and research conduct.
Study Framework or Theoretical Perspective
Since the authors did not have an in-depth review of literature, they did not identify a theoretical or conceptual framework. According to Wilson (1992), a theoretical framework for a study is an “essay that places the study in the context of existing related theory based on the literature that has been reviewed”. Hence, conceptual framework is implicit in this study.
Research Objectives, Questions and Hypothesis
The main objective of this study is to evaluate a nursing research program designed to achieve systematic evidence based practice change. Specifically, this study evaluated the change in nurse attitudes about use of research and research conduct, practice change projects, and nurse participation in research-related activities (p.302). Further, to realize the objective, the study addressed the following specific research questions: 1. Were there differences in mean attitude scores between time 1 (1999) and time 2 (2002)? 2. Are attitudes associated with knowledge about availability of support services and participation in RU or research conduct? As specifically stated in the study: Research Question 1. Are There Differences in
Attitude Mean Scores Between Time 1 and Time 2? And Research Question 2: Are Attitudes Associated With Knowledge About Availability of Support Services and Participation in Research Utilization or Research Conduct? Further, Larrabee et al. use a non directional hypothesis which indicates existence of a relationship between variables, but does not specify the anticipated direction of the relationship.
Study Variables
Examining the purpose, the objectives, questions, or hypotheses, and the results section of the research article, there were 59 variables measured in the study. There are 7 demographic variables, 7 variables measuring knowledge about available support services and the 5 Data for Subscales variables such as Value, Role, Interest, Climate, Experience, and Support Services Availability (consisting of 45 items).
The independent variable in this study was the attitudes of nurses about research use and participation while the dependent variables are the 7 demographic items which are the employment status, age, RN basic education, highest level of nursing education, highest level of education in nonnursing field and length of time in current position. The 7 items measuring the knowledge about available support services are: 1) There is a Research and Ethics Review
Committee in our agency. 2) There is nursing representation on our agency’s Research and Ethics Review Committee. 3) There are experienced researchers in our agency who will help nurses design and/or conduct research projects. 4) Secretarial services are available to nurses submitting research or grant proposals. 5) Library search services are accessible to nurses in our agency. 6) Computer facilities for data processing are available in our agency. 7) Someone to assist with the analysis of the data is available to nursing staff in our agency. The research variables on the other hand are the 5 data for subscales which include the Value subscale: RN education, Time in current job, Participation in past 3 y, Experience, and Support services availability; the Role subscale: Age, Experience, Support services availability, and Participation in past 3 y; the Interest subscale: Employment status, Age, Experience, Support services availability, and Participation in past 3 y; and the Climate subscale: Time after graduation, Time in current job, Unit, Support services availability, Unit and Participation in past 3 y.
Research Design
The pretest-posttest research design was used in the study. In this study, the anonymous survey of convenience samples from all inpatients units perioperative services, and the emergency department at 2 time points: first, before implementation of the nursing research program and second, 3 years after the program initiation were conducted. Further, a second postimplementation survey should have confirmed the results of the first postimplementation survey.
Sample and Setting
The study sample of Larrabee et al. (2007) was all the RNs of the West Virginia University Hospital (WVUH). The method of sampling used to obtain the sample was convenience sampling so there’s no inclusion and exclusion of the sample criteria as there’s only one criteria, all eligible RNs in the study site mentioned above. Sample power analysis shows a response rate of 56% (n=404) in 1999 and 49.6% (n=464) in 2002. This was conducted to determine the sample size as though the survey aimed for a census but was not achieved. The number and percentage of refusal to participate was not given. The characteristics of the sample were reported as mostly have worked full-time, were younger than 41 years, had completed nursing school less than 10 years earlier, and had a baccalaureate or higher degree. The 2 samples differed significantly in employment status, highest level of education, and length of time in current position. In 2002, fewer RNs reported working part-time, and more reported working on a casual basis than in 1999. In 2002, fewer RNs reported that their highest level of education was associate degree in nursing, and more reported having a diploma or baccalaureate or higher degree. In 2002, RNs had been in their current position for a shorter time than in 1999 (p.305).
The researchers identified the study site which is the WVUH and of course appropriate for the study purpose since it is to evaluate the nursing research program designed to achieve systematic evidence- based practice change. The researchers obtained the university institutional review board approval before conducting the study.
Measurement Instruments
Instruments used by Larrabee et al. (2007) was the Alcock et al’s Staff Nurses and Research Activities measurement of nursing attitudes about research use and participation. using a 59-item instrument consisting of 7 demographic items, 7 items measuring knowledge about available support services for research, and 45 items in 5 subscales (p.304). This instrument was used because the questions were based on criteria identified in the literature as important in promoting the involvement of staff nurses in nursing research. The Staff Nurses and Research Activities had face validity, according to the instrument developers and the nurse leaders at WVUH. The Internal consistency reliabilities of the subscales were acceptable in Alcock et al’s study. Further, for the purpose of the study, a scale was made for the subscales. The response scale for Value, Role, Interest, and Climate subscales was 1 = strongly agree, to 4 = strongly disagree. For these subscales, item scores are summed and averaged to yield a scale score from which mean, standard deviation, and median were calculated. The response scale for the Experience subscale was 1 = yes or 0 = no; item scores were summed to yield a scale score. The response scale for the Support Services subscale was 1 = yes, 0 = no, and don’t know = ‘‘9’’; item scores we summed to yield a scale score, after recoding ‘don’t know’’ responses to ‘‘missing data.”
Data Collection
Data collection was done through anonymous survey by distributing questionnaire packets to all employed RNs of the WVHU. The completed questionnaires were returned to the clinical investigator in sealed envelopes. A $2 cappuccino coupon for redemption at the WVUH espresso bar was used as an incentive to maximize response rate. Negatively worded items were reverse coded before analysis. Data analysis, using SAS, included descriptive and inferential statistics. The same procedure was used at time 2.
The anonymous survey was chosen to maximize response rate but has proven otherwise as the aimed census was not achieved.
Statistical Analyses
Larrabee et al. (2007) used various statistical analyses for this study. Descriptive statistics was used to show differences in the samples. Further, the frequency in percentage shows the difference between the two samples (X2, P .05). To compare the attitudes about the value of research and supportiveness of the hospital’s climate, the samples` descriptive statistics and analysis of variance between the 2 times was computed.
Moreover, comparison also showed less positive (P < .05) attitudes about the nurse’s role in research or use of research findings and personal interest in participating in research or using research to change practice in 2002.
Further, the researchers used the frequency data to compare the 1999 with 2002 and have revealed that, in 2002, RNs had significantly more knowledge about availability of services to support research related activities (P < .001). In addition, using the frequency data for Availability of Support Services, all items had higher scores at time 2 than time 1.
Interpretation of Findings
Analysis from data obtained revealed that that participating in EBP and knowing
about the availability of support services were associated with higher attitude scores suggest that nurse leaders may improve attitudes about research and RU by better marketing services available to support research-related activities and opportunities for participation. But still, according to the researchers, there are work environment factors, such as staffing, that may influence RNs’ attitudes about and participation in research and RU.
Hence this evidence documents the effectiveness of nursing research program implementation in engaging RNs at all levels in the organization in pursuit of EBP change. Further, the findings of this program evaluation provide some evidence that a systematic program aimed at changing practice can engage nurses in assuring that their practice is evidence-based (p. 307-308).
Limitations
Larrabee et al. (2007) recognized that their study has several limitations.
First, the employment of convenience sampling since the research team invited all eligible RNs to participate in the survey, aiming for a census, which was not achieved. Second, the design limits inferences about the impact of the introduction of a nursing research program on nurses’ attitudes about research and RU (p.308).
Suggestions for further Study
The researchers suggested that more robust designs, such as that in the multihospital experimental study of Titler et al, require external funding. One proposal is using the alternate designs, specifically time-series design and controlled before-after design, were advocated in those instances when external funding is not available. Another is using the time-series study, which is designed to obtain monthly data for the year before and the year after the intervention, could detect variation across time and the presence of trends in improvement. In addition, an alternative approach, if obtaining data at multiple time points is not feasible, is the controlled before-after design. In this design, data from other hospitals not implementing the intervention are compared with data from the hospital implementing the intervention. Because these 2 designs yield stronger internal validity than the simple before-after design used in this study. In general, future investigations of the effectiveness of program implementation should use such
designs, if an experimental design is infeasible.
References
Burns, N. & Grove, S.K. (1993). The practice of nursing research: conduct, critique and
utilisation. 4th edition. Philadelphia : W.B. Saunders. Havranek, E. P., Spertus, J.A.,
LoBiondo-Wood, G., & Haber, J. (1998) Nursing research: methods, critical appraisal, and
utilization. (5th edition). St. Louis : Mosby
LoBiondo-Wood, G., Haber, J. & Krainovich-Miller, B. (2002). Critical Reading Strategies:
Overview of the Research Process. Chapter 2 In LoBiondo-Wood, G. & Haber, J. (editors).
Nursing research: Methods, critical appraisal, and utilization. (5th Edition). St Louis: Mosby.
