Evidence-Based Practice Beliefs and Implementation. Article Critique

📄 Words:	926
📝 Subject:	Nursing
📑 Pages:	10
📚 Topics:	Evidence-Based Practice

Introduction

The present article addresses the problem of evidence-based practice (EBP) knowledge, beliefs, and implementation in oncology nurses. The problem is significant for nursing because following EBP protocols improves patient outcomes. Underhill et al. (2015) build an especially persuasive argument for launching EBP initiatives in oncology as it is the field where clinical management is constantly changing due to the emergence of new evidence. The researchers chose a quantitative approach due to its potential in measuring the objective effects of intervention in the study population. The purpose of this paper is to provide a critique of the chosen article, highlighting both its strengths and weaknesses.

Literature Review and Frameworks

The study by Underhill et al. (2015) does not contain an explicit hypothesis statement or research questions. Their absence is justified by the clear and straightforward formulation of research objectives, from which hypotheses and research questions may be easily inferred. In the literature review section, Underhill et al. (2015) mainly utilize recent (publication date no earlier than 2000) studies with experimental or cross-sectional design. In doing so, the researchers provide state-of-art synthesis, highlighting both the existing problem and the proposed solution. The literature sources describe the most significant barriers to implementing EBP and show the efficiency of EBP opportunities at the workplace in promoting the approach. Underhill et al. (2015) opened the article with a clear definition of evidence-based practice, drawing on several sources at once, Later on, they articulated the key framework: Advancing Research and Clinical practice through close Collaboration (ARCC) Model. The research objectives were consistent with the chosen framework as the ARCC is one of the most recognized models for EBP implementation.

Study Design and Methods

Participants have explained the purpose of the study and were allowed to skip any questions. The study was not externally reviewed by an IRB review board; though, Underhill et al. (2015) received permission from ARCC. Respondents were protected by ensuring confidentiality and benefitted from the EBP initiative as it was relevant to their practice. The pretest-posttest survey design fit the study purpose and allowed for comparisons between the results before and after the intervention. Regarding the sample, out of 350 nurses invited to participate in the study, only 30% accepted the invitation, which makes the sample size quite modest. Double-blinding was impossible due to the design of the study; the authors give no information on attrition minimization. All participants came from Dana-Farber Cancer Institute, but that is the only information available about the sample: gender, age, and other attributes are not clarified. The sampling design is fairly flawed as conventional sampling does not allow for representativeness. The sample size and the lack of power analysis add to the limitations of the study methodology.

As for data collection and measurement, Underhill et al. (2015) translated conceptual definitions of EBP into operational and measured the key variables using questionnaires. Aside from EBP-B (beliefs) and EBP-I (implementation) questionnaires, the authors used open-ended questions to investigate nurses’ interpretation of barriers to EBP. Underhill et al. (2015) assembled an EBP education subcommittee that identified the needs of the DFCI nursing community. The intervention is described in detail, including the adjustments that have been made to the selected models. The committee was run by two clinical nurse specialists with extensive experience in research and, specifically, data collection.

Results

Underhill et al. (2015) used IBM SPSS statistical software to run a descriptive statistical analysis (box-plots, mean, median, standard deviation, and range) and inferential analysis (t-test). However, there was no mention of controlling for confounding variables nor any measures undertaken to avoid Type I and Type II errors. The missing values were not handled in any particular way, nor is any information available on the intention-to-treat analysis. The results of the analysis were judged using a p-value set at p < 0.05 (confidence interval = 95%). The findings were adequately summarized, though the tables could use a bit higher level of detail. The statistical information can generally be used for meta-analysis, with some adjustments.

Discussion

Underhill et al. (2015) found that the major findings of their study were consistent with the existing body of research. In particular, nurses valued EBP but lacked education and mentorship. The clinical significance of the study is justified by the specifics of oncology nursing. The authors admitted to certain limitations such as the small sample size and incompleteness of some data, which compromised the generalizability of the findings. The researchers mentioned in the abstract that nurses should be provided the mentorship and support to receive relevant EBP education. The implications are reasonable since the level and quality of education correlate with EBP beliefs.

General Issues

In general, the study by Underhill et al. (2015) is well-written and easy to follow, despite the absence of a CONSORT flowchart. The authors show their ability to adhere to academic writing guidelines but create an accessible writing piece for practitioners. One of the highlights of the study structure-wise is its abstract that is broken down into sections for an easier information search. As for the authors’ credibility, four out of five authors hold Ph.D. degrees, all of them are registered, nurses.

Conclusion

Despite some limitations, the study offers valuable findings and practical implications regarding the local establishment of EBP practices. It contributes to the existing body of knowledge by emphasizing the importance of preparing the right environment for EBP implementation, as in promoting formal EBP education and developing advanced nursing roles. Individual nurses should also be aware of existing opportunities to improve their EBP knowledge and train themselves to be EBP advocates and change leaders.

Reference

Underhill, M., Roper, K., Siefert, M., Boucher, J., & Berry, D. (2015). Evidence-based practice beliefs and implementation before and after an initiative to promote evidence-based nursing in an ambulatory oncology setting. Worldviews on Evidence-Based Nursing, 12(2), 70-78.

Appendix A

Research Critique Framework: Quantitative Research 834

Aspect of the Report	Critiquing Questions	Answer Yes/No	Analysis
Title	Is the title a good one, succinctly suggesting key variables and the study population?	Yes	The title clearly suggests key variables, intervention, and study population.
Abstract	Did the abstract clearly and concisely summarize the main features of the report (problem, methods, results, conclusion)?	Yes	The abstract is well-organized and broken down into sections. It has an additional section “Linking Evidence to Action” for translating study implication into practice.
Introduction Statement of the Problem	Was the problem stated unambiguously, and was it easy to identify? Is the problem significant for nursing? Did the problem statement build a persuasive argument for the new study? Was there a good match between the research problem and the methods used – that is, was a quantitative approach appropriate?	Yes, Yes, Yes, Yes	The present article addresses the problem of evidence-based practice (EBP) knowledge, beliefs, and implementation in oncology nurses. The problem is significant for nursing because following EBP protocols improves patient outcomes; Underhill et al. (2015) build an especially persuasive argument for launching EBP initiatives in oncology as it is the field where clinical management is constantly changing due to the emergence of new evidence. The researchers chose a quantitative approach due to its potential in measuring the objective effects of intervention in study population.
Hypotheses or Research Questions	Were research questions and/or hypotheses explicitly stated? If not, was their absence justified? Were questions and hypotheses appropriately word, with clear specification of key variables and the study population? Were the questions/hypotheses consistent with existing knowledge?	No	The study by Underhill et al. (2015) does not contain an explicit hypothesis statement nor research questions. Their absence is justified by the clear and straightforward formulation of research objectives, from which hypotheses and research questions may be easily inferred.
Literature Review	Was the literature review up-to-date and based mainly on primary sources? Did the review provide a state-of-the-art synthesis of evidence on the problem? Did the literature review provide a strong basis for the new study?	Yes, Yes, Yes	In the literature review section, Underhill et al. (2015) mainly utilize recent (publication date no earlier than 2000) studies with experimental or cross-sectional design. In doing so, the researchers provide a state-of-art synthesis, highlighting both the existing problem and the proposed solution; The literature sources describe the most significant barriers to implementing EBP and show the efficiency of EBP opportunities at the workplace in promoting the approach.
Conceptual/Theoretical Framework	Were key concepts adequately defined conceptually? Was a conceptual/theoretical framework articulated – and, if so, was it appropriate? If not, is the absence of a framework justified? Were the questions/hypotheses consistent with the framework?	Yes, Yes, Yes	Underhill et al. (2015) opened the article with a clear definition of evidence-based practice, drawing on several sources at once; Later on, they articulated the key framework: Advancing Research and Clinical practice through close Collaboration (ARCC) Model. The research objectives were consistent with the chosen framework as the ARCC is one of the most recognized models for EBP implementation.
Method Protection of Human Rights	Were appropriate procedures used to safeguard the rights of study participants? Was the study externally reviewed by an IRB/ethics review board? Was the study designed to minimize risks and maximize benefits to participants?	Yes, No, Yes	Participants were explained the purpose of the study and allowed to skip any questions; The study was not externally reviewed by an IRB review board; though, Underhill et al. (2015) received permission from ARCC; Respondents were protected by ensuring confidentiality and benefitted from the EBP initiative as it was relevant to their practice.
Research Design	Was the most rigorous design used, given the study purpose? Were appropriate comparisons made to enhance interpretability of the findings? Was the number of data collection points appropriate? Did the design minimize biases and threats to the internal, construct, and external validity of the study (e.g., was blinding used, was attrition minimized)?	Yes, Yes, No, No	The pretest-posttest survey design fit the study purpose and allowed for comparisons between the results before and after the intervention. Regarding the sample, out of 350 nurses invited to participate in the study, only 30% accepted the invitation, which makes the sample size quite modest. Double-blinding was impossible due to the design of the study; the authors give no information on attrition minimization.
Population and Sample	Was the population identified? Was the sample described in sufficient detail? Was the best possible sampling design used to enhance the sample’s representativeness? Were sampling biases minimized? Was the sample size adequate? Was the sample size based on a power analysis?	No No No	All participants came from Dana-Farber Cancer Institute, but that is the only information available about the sample: gender, age, and other attributes are not clarified. The sampling design is fairly flawed as conventional sampling does not allow for representativeness. The sample size and the lack of power analysis add to the limitations of the study methodology.
Data Collection and Measurement	Were the operational and conceptual definitions congruent? Were key variables measured using an appropriate method (e.g. interviews, observations, and so on)? Were specific instruments adequately described and were they good choices, given the study population and the variables being studied? Did the report provide evidence that the data collection methods yielded data that were reliable, valid, and responsive?	Yes Yes Yes	Underhill et al. (2015) translated conceptual definitions of EBP into operational and measured the key variables using questionnaires. Aside from EBP-B (beliefs) and EBP-I (implementation) questionnaires, the authors used open-ended questions to investigate nurses’ interpretation of barriers to EBP.
Procedures	If there was an intervention, was it adequately described, and was it rigorously developed and implemented? Did most participants allocated to the intervention group actually receive it? Was there evidence of intervention fidelity? Were data collected in a manner that minimized bias? Were the staff who collected data appropriately trained?	Yes Yes	Underhill et al. (2015) assembled an EBP education sub committee that identified the needs of the DFCI nursing community. The intervention is described in detail, including the adjustments that have been made to the selected models. The committee was run by two clinical nurse specialists with extensive experience in research and, specifically, data collection.
Results Data Analysis	Were analyses undertaken to address each research question or test each hypothesis? Were appropriate statistical methods used given the level of measurement of the variables, number of groups being compared, and assumptions of the tests? Was a powerful analytic method used? (e.g. did the analysis help to control for confounding variables)? Were Type I and Type II errors avoided or minimized? In intervention studies, was an intention-to-treat analysis performed? Were problems of missing values evaluated and adequately addressed?	Yes, Yes, Yes, No, Yes	Underhill et al. (2015) used IBM SPSS statistical software to run a descriptive statistical analysis (box-plots, mean, median, standard deviation, and range) and inferential analysis (t-test). However, there was no mention of controlling for confounding variables nor any measures undertaken to avoid Type I and Type II errors. The missing values were not handled in any particular way, nor is any information available on the intention-to-treat analysis.
Findings	Was information about statistical significance presented? Was information about effect size and precision of estimates (confidence intervals) presented? Were the findings adequately summarized, with good use of tables and figures? Were findings reported in a manner that facilitates a meta-analysis, and with sufficient information needed for EBP?	Yes Yes Yes	The results of the analysis were judged using p-value set at p < 0.05 (confidence interval = 95%). The findings were adequately summarized, though the tables could use a bit higher level of detail. The statistical information can generally be used for meta-analysis, for with some adjustments.
Discussion Interpretation of the Findings	Were all major findings interpreted and discussed within the context of prior research and/or the study’s conceptual framework? Were causal inferences, if any, justified? Was the issue of clinical significance discussed? Were interpretations well-founded and consistent with the study’s limitations? Did the report address the issue of the generalizability of the findings?	Yes, Yes, Yes, Yes, Yes	Underhill et al. (2015) found that the major findings of their study were consistent with the existing body of research. In particular, nurses valued EBP but lacked education and mentorship. The clinical significance of the study is justified by the specifics of oncology nursing. The authors admitted to certain limitations such as the small sample size and incompleteness of some data, which compromised the generalizability of the findings.
Implications/ Recommendations	Did the researchers discuss the implication of the study for clinical practice or further research – and were those implications reasonable and completed?	Yes	The researchers mentioned in the abstract that nurses should be provided the mentorship and support to receive relevant EBP education. The implications are reasonable since the level and quality of education correlates with EBP beliefs.
General Issues Presentation	Was the report well-written, organized, and sufficiently detailed for critical analysis? In intervention studies, was a CONSORT flowchart provided to show the flow of participants in the study? Was the report written in a manner that makes the findings accessible to practicing nurses?	Yes No Yes	In general, the study by Underhill et al. (2015) is well-written and easy to follow, despite the absence of a CONSORT flowchart. The authors show their ability to adhere to academic writing guidelines but create an accessible writing piece for practitioners.
Researcher credibility	Do the researchers’ clinical, substantive, or methodologic qualifications and experience enhance confidence in the findings and their interpretation?	Yes	Four out of five authors hold PhD degrees, all of them are registered nurses.
Summary Assessment	Despite any limitations, do the study findings appear to be valid – do you have confidence in the truthvalue of the results? Does the study contribute any meaningful evidence that can be used in nursing practice or that is useful to the nursing discipline?	Yes, Yes	Despite some limitations, the study offers valuable findings and practical implications regarding the local establishment of EBP practices. It contributes to the existing body of knowledge by emphasizing the importance of preparing the right environment for EBP implementation, as in promoting formal EBP education and developing advanced nursing roles. Individual nurses should also be aware of existing opportunities to improve their EBP knowledge and train themselves to be EBP advocates and change leaders.