Critiquing Nursing Research Articles: Safety Research

QSEN Critiquing Nursing Research Articles: Safety Research

Submitter Information Name: Zane Robinson Wolf Title: Dean and Professor Credentials: PhD, RN, FAAN Diane M. Breckenridge Credentials: PhD, RN Title: Associate Professor Organization: Nursing Programs, La Salle University School of Nursing and Health Sciences Address 1900 West Olney Avenue City: Philadelphia State: PA Zip: 19141

Teaching Strategy

Competency Domain:  Evidence-Based  Safety  Informatics

Learner Level:  Pre-Licensure BSN  RN-BSN

Learner Setting:  Classroom

Strategy type:  Test/evaluation/assessment strategies

Learning Objectives:  Critique selected nursing research studies. o Prior to taking the critique test, complete in-class critiques of three published nursing research studies using guidelines. o Complete a graded test, a critique of one published research study using guidelines.  Apply qualitative or quantitative critique guidelines to research study addressing patient safety.  Compare study to published research after consulting several databases, including Cochran, CINAHL, and Medline.  Describe two strengths of the study.  Describe two weaknesses of the study.  Discuss application of study results to a clinical setting. Strategy Overview: In this research assignment, students prepare to take a critique test scheduled during the latter part of an undergraduate nursing research course. Earlier in the course schedule, students complete in-class critiques of three research studies, including qualitative and quantitative examples. Students will receive the article before the test, so that they are able to prepare for the test and complete the learning objectives. They bring the article and their notes to the test. The articles represent current research on patient safety topics that faculty select such as:  Chiang, H-Y., & Pepper, G. A. (2006). Barriers to nurses’ reporting of medication administration errors in Taiwan, Journal of Nursing Scholarship, 38(4), 393-399. (A sample test has been constructed based on this study).  Ebright, P. R., Urden, L., Patterson, E., & Chalko, B. (2004). Themes surrounding novice nurse near-miss and adverse-event situations. JONA, 34, 531-538.  Eisenhauer, L. A., Hurley, A. C., & Dolan, N. (2007). Nurses’ reported thinking during medication administration. Journal of Nursing Scholarship, 39(1), 82-87.  Wolf, Z. R., Hicks, R., & Serembus, J. F. (2006). Characteristics of medication errors made by students during the administration phase: A descriptive study. Journal of Professional Nursing, 22(1), 39-51.  Dennison, R. B. (2007). A medication safety education program to reduce the risk of harm caused by medication errors. Journal of Continuing education in Nursing, 38(4), 176-184.  Meurier, C. E., Vincent, C. A., & Parmar, D. G. (1997). Learning from errors in nursing practice. Journal of Advanced Nursing, 26, 111-119.

Faculty distribute the study to be critiqued and the content domains of the test map at least two weeks before the scheduled critique exam.

Evaluation Description:

Test Map/Content Domain Number of Application Items Quantitative Study 1. Main concepts/constructs of study 1 Multiple choice question 2. Independent versus dependent variable 1 Multiple choice question 3. Quality of literature review 1 Multiple choice question 4. Theoretical/conceptual framework 1 Multiple choice question 5. Design 1 Multiple choice question 6. Setting characteristics 1 Multiple choice question 7. Sampling approach 1 Multiple choice question 8. Sample criteria, inclusion and exclusion 1 Multiple choice question 9. Part or section of research report 1 Multiple choice question 10. Human subjects consent procedure 1 Multiple choice question 11. Instrument characteristics 1 Multiple choice question 12. Instrument reliability or validity 1 Multiple choice question 13. Data levels or scales 1 Multiple choice question 14. Data quality 1 Multiple choice question 15. Procedures for data collection 1 Multiple choice question 16. Identification of hypothesis(ses) tested 1 Multiple choice question 17. Statistical testing of hypothesis(ses) 1 Multiple choice question 18. Interpretation descriptive statistical tests 1 Multiple choice question 19. Type of hypothesis 1 Multiple choice question 20. Interpretation inferential statistical tests 1 Multiple choice question 21. Strengths of study 1 Essay question 22. Weaknesses of study (2) 1 Essay question 23. Application of findings to clinical settings 1 Essay question 24. Comparison of study to related literature using Cochran, 1 Essay question CINAHL, and Medline databases Qualitative Study 1. Phenomenon/basic social process/culture, etc. of study 1 Multiple choice question 2. Quality of literature review 1 Multiple choice question 3. Framework 1 Multiple choice question 4. Research tradition 1 Multiple choice question 5. Design 1 Multiple choice question 6. Sources of data 1 Multiple choice question 7. Methodologist 1 Multiple choice question 8. Setting characteristics 1 Multiple choice question 9. Sampling approach 1 Multiple choice question 10. Sample criteria, inclusion and exclusion 1 Multiple choice question 11. Human subjects consent procedure 1 Multiple choice question 12. Part or section of research report 1 Multiple choice question 13. Data sources 1 Multiple choice question 14. Procedures for data collection 1 Multiple choice question 15. Data analysis approach 1 Multiple choice question 16. Rigor methods 1 Multiple choice question 17. Data quality 1 Multiple choice question 18. Presentation of findings (narrative, tables, and/or figures) 1 Multiple choice question 19. Conclusions 1 Multiple choice question 20. Implications 1 Multiple choice question 21. Strengths of study 1 Essay question 22. Weaknesses of study (2) 1 Essay question 23. Application of findings to clinical settings 1 Essay question 24. Comparison of study to related literature using Cochran, 1 Essay question CINAHL, and Medline databases Total number of items (24): Multiple choice and essay questions La Salle University School of Nursing and Health Sciences Undergraduate Nursing Program Critique Examination Example

Chiang, H-Y., & Pepper, G. A. (2006). Barriers to nurses’ reporting of medication administration errors in Taiwan. Journal of Nursing Scholarship, 38(4), 392-399.

Multiple choice questions scored at 4 points each

1. Identify the main construct or variable in the Chiang & Pepper study:

1. Peer relations 2. Power hierarchy 3. Work environment factors 4. Perceptions of reporting barriers

2. Which of the following exclusion criterion eliminated nurse subjects from the study:

A. Nurse manager B. Community nurse C. Experienced nurse D. Unemployed nurse

3. Which type of hypothesis is tested in Table 2 of Chiang & Pepper’s study?

A. statistical B. complex C. research D. simple

4. Identify the design(s) used in the Chiang & Pepper’s study.

1. cross-sectional 2. correlational or ex post facto 3. quasi experimental 4. experimental

A. 1 and 3 B. 2 and 4 C. 1 and 2 D. 1, 2, and 4 5. The section of the study describing the Reason Why MAEs Are Not Reported described an instrument that could be described as:

A. Reliable and valid B. Valid and formatted C. Open ended and summed D. Theoretical and close ended

6. Identify the setting from which the sample was obtained:

A. Long term care facility B. Short procedure unit C. Medical center D. Health care unit

7. In which specific section of the Chiang & Pepper’s study is found the instruments to measure the main study variables:

A. Method B. Analysis C. Purposes D. Measures

8. In addition to the main study construct, identify the following main constructs in the literature review that frame the study:

A. Cultural factors and work environment B. Healthcare systems and errors C. Power hierarchy and attitude D. Fear and authority

9. The demographic characteristics of respondents (N = 597) include the following levels or scales of data:

A. Nominal and interval B. Nominal and ordinal C. Ordinal and interval D. Ordinal and ratio

10. How many items are included in the Reason Why MAEs Are Not Reported instrument?

A. 15 B. 16 C. 20 D. 24 11. Identify the sampling approach of Chiang & Pepper’s study:

A. Cohort B. Purposive C. Total design D. Convenience

12. Select the human subjects’ consideration strategy used in the Barriers to nurses’ reporting of medication administration errors study:

A. Human subjects committee approval B. Protection of confidentiality C. Written consent to participate D. Verbal consent to participate

13. Why were some respondents’ questionnaires excluded from data analysis?

A. Nonresponders refusal B. Instrument translation problems C. Lack of response on selected items D. Missing values on questionnaire items

14. What was the dependent variable for the correlation coefficients calculated in Chiang & Pepper’s study?

A. Reporting process B. Power hierarchy C. Barriers D. Fear

15. Nurses were compared on perceived barriers to reporting by MAE reporting rate group (overreporting/underreporting group versus accurate reporting of Medication Administration Error [MAE] group). Identify the statistical test that tested the hypothesis?

A. T-test B. Percent C. Regression D. Correlation 16. How many association testing hypotheses were supported at statistically significant levels (p<.05, p<.01) for the perceptions of barrier study instruments? (Table 2)

A. 7 B. 22 C. 28 D. 33

17. Describe the content of the literature review:

A. Related B. Anecdotal C. Empirical D. Theoretical

18. How were demographic data analyzed?

A. sequentially B. descriptively C. systematically D. retrospectively

19. Identify the method used to encourage initial subject participation in the study.

A. Reminder B. Confidentiality C. Reply envelope D. Introductory letter

20. Describe the internal consistency reliability coefficient that established one aspect of reliability of the Reason Why MAEs Are Not Reported instrument?

A. Expert B. Test-retest C. Factor analysis D. Cronbach’s alpha

Answer the following questions on the back of your answer sheets using complete sentences. Write legibly or the answer will be marked as incorrect.

Describe two strengths of the study. (5 points)

Describe two weaknesses of the study. (5 points) Specify one strategy that would improve the study. (5 points)

Describe the related literature you located on Cochran, CINAHL, and Medline databases to this study? (5 points)

Critique Guidelines* Students are directed to use the following critique guidelines to assist them to analyze research articles. They must prepare for the in-class exam by applying the elements identified in the guideline to a critical analysis of the study. This should be done before the date of the scheduled critique exam.

Abstract Title of research article easily understood Title reflects content of research article Abstract includes problem and hypotheses if hypotheses are tested Methods are briefly described Findings are summarized Problem Problem/purpose/aims/objectives are introduced early in article Research questions as stated accurately Problem statement is clear Hypothesis(ses) is/are stated clearly to permit testing Study limitations are identified Phenomenon and variables are defined theoretically Variables are defined operationally Assumptions are identified Significance of problem is described Justification of study is described Review of Literature Literature is applicable to research problem Literature provides rationale for study Studies cited are critically examined Connection of problem to previous research is discussed Conceptual framework/theoretical framework is clearly stated Review ends with summary of related literature and its implications to research problem Methods Design (Quantitative) Type of design is described Adequate description of design is provided Random assignment or alternate assignment is discussed Operational definition of intervention (treatment) is described Operational definition of outcome variable is provided Design (Qualitative) Type of design is described Adequate description of design is provided Tradition from which design originated is discussed Peculiarities of design are discussed Methodologist used is identified and primary source is cited Source(s) of data or material is/are described Sample Population is identified Sampling technique is described Random selection is identified, if appropriate Subject recruitment is discussed Subjects/participants/informants are described Sample size is identified Number of subjects/group is identified, if appropriate Subject access is described Power Analysis is described, if appropriate Subject demographics are described Theoretical Sampling is discussed, if appropriate Inclusion Criteria are described Exclusion Criteria are described Reasons for subject attrition are described Setting Setting where subjects are obtained is described Setting access is described Ethical Considerations Request for IRB review of the study is described Anonymity is guaranteed, if appropriate Confidentiality is guaranteed Data storage is described Destruction of data is described Process of obtaining consent is discussed Characteristics of consent before entering study are discussed Incentives for participation are identified if used Instrumentation Instrument(s) (quantitative) or Interview Questions (qualitative) Description of Instrument(s) (number of subconcepts [dimensions, categories], number of items/subconcept, and scaling [including response set corrections]) are described Instructions for administration are provided Scoring or instrument is provided, if appropriate Average time to complete instrument is provided Apparatus manufacturer is identified, if appropriate Reliability of Instrument(s), including interrater; parallel forms; internal consistency; test- retest, is provided Construct validity of instrument(s), including various types, is provided Response rate is described Rigor or Scientific Adequacy of Qualitative Research Study Strategies of methodologist (rules) are described Credibility, including prolonged engagement in field, persistent observation, and triangulation (sources, methods, investigators, theories) is described consistent with methodologist Credibility, including peer check, member check (stakeholders), and negative cases in relation to findings, is described consistent with methodologist Transferability (others determine findings hold in different contexts) is described Dependability (audit trail: other investigator follows field notes, personal notes, transcribe interviews, coding schemes, codes and indicators, narrative description) is described Trustworthiness (confirmability [product confirms rigor]; audit trail followed) is described Reflexivity and validity (awareness of research of role in the process; relationship of investigator with informants, data, reader; how open was the investigator to inducing breakdowns in his or her understanding of the data; how was his or her confidence in interpretations challenged and tested over the course of study) are described Procedures for Data Collection Sequence of activity is described, e.g., how research approval was obtained; how informed consent was obtained; how procedures were explained to subjects Protocol is described (operationalization) for control and experimental groups: actions performed, if appropriate Timing of data collection is described Instructions for subjects are described Training of subjects is described Research assistants are described, along with training and periodic checking to determine consistency in the data collection process Site of data collection is described Reasons for attrition are discussed Data Analysis Findings are sufficient of answer research questions Software is identified Descriptive statistical results are reported Inferential statistical results are reported Descriptive and inferential statistics used are appropriate OR Qualitative findings are reported Tables are presented in an informative way Figures are presented in an informative way Conclusion Conclusions are clearly stated Conclusions are substantiated by evidence Methodological problems are described Findings are linked to conceptual/theoretical frameworks Implications of the findings are discussed Generalizations or transfers are discussed Recommendations for future research are described Form and Style The report is clearly written The report is logically organized The report is objective Application to Clinical Settings Describe the scientific merit of the study Describe the applicability of the findings Discuss specifically how the findings will fit practice settings

*Adapted from Duffy, M. E. (1985). A research appraisal checklist for evaluating nursing research reports. Nursing & Health Care, 6(10), 538-547.