Critical Appraisal of Research Studies in Nursing
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When is a critical appraisal or critique of a research study implemented in nursing?
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-Research is critically appraised or critiqued to: -Broaden understanding -Improve or change practice -Provide a background for conducting a study.
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Why is it important to perform a research study critique?
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-A careful examination of all aspects of a study to judge: *Merits *Limitations *Meaning *Significance
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What are the key steps for conducting a critique a research study?
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-Read and critique the entire study. -Examine the organization and presentation of the research report. -Examine the significance of the problem being studied. -Determine the relevance for nursing practice. -Identify strengths and weaknesses of a study. -Be objective and realistic in identifying the study's strengths and weaknesses. -Provide specific examples of the strengths and weaknesses. -Provide a rationale for your critique. -Suggest modifications for future studies. -Discuss feasibility of replication of the study. -Discuss usefulness of findings for practice
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A critical appraisal or critique should be a(n): A. analysis of a study's internal validity problems. B. balanced appraisal of a study's strengths and weaknesses. C. criticism of the researcher's faulty decisions. D. inventory of problems in the study.
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balanced appraisal of a study's strengths and weaknesses (An intellectual critical appraisal involves careful examination of all aspects of a study to judge the strengths, weaknesses, meaning, and significance of a study. A. A thorough critical appraisal contains much more than an analysis of the study's internal validity problems. C. A critical appraisal points out both the strengths and weaknesses of a study. D. A simple "inventory" of the study's problems does not constitute a good critique.)
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What questions would you ask related to the research problem and purpose?
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Is the problem sufficiently delimited in scope without being trivial? Is the problem significant to nursing? Is there evidence of researcher biases? Does the purpose narrow and clarify the aim of the study? Was the study feasible in terms of funding, expertise, subjects, facility, equipment, and ethical considerations?
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About the Problem Statement
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-Identifies the nature of the problem -A situation in need of a solution, improvement, or alteration -Is the problem stated clearly? -What was conducted to resolve the problem? -Is the problem of significance to nursing and or healthcare?
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About the Purpose of a Study
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-Generated from the problem -Identifies the specific goal or aim of the study -Identify, describe, explain, predict a solution -Includes variables, population, setting
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-Does it demonstrate progressive development of ideas through previous research? -Is a theoretical knowledge base developed for the problem and purpose? -Does the literature review provide a rationale and direction for the study? -Is a clear, concise summary presented of the current empirical and theoretical knowledge in the area of study?
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The Literature Review (Recognize it, give it a name, and study it )
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-Compressed, summary usually in articles -References should be current and include classics, experts in the field -Supports the need for the study, gap in the knowledge -Presents previous work done in the area, builds on previous work -Needs to critique or evaluate, not just report -Identifies strengths and weaknesses of previous studies -Organized logically, objective -Should include theoretical or research articles, opinion or anecdotal
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About the Literature Review of a Study
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-Was the study linked to a larger theoretical nursing or other conceptual model? -Is the framework presented with clarity? -If a map or model is presented, is it adequate to explain the phenomenon of concern? -Is the framework linked to the research purpose? -Would another framework fit more logically with the study?
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How about the study framework?
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-Link needs to be logical -Permits organization of the study -Gives direction, provides a context for interpreting findings -Research question / hypothesis needs to flow from the framework -Guides the design and methodology -Most studies not based or linked to a theory or model -Nursing - humans, environment, nursing & health
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Conceptual / Theoretical Framework
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What questions are important for critical appraisal related to the research objectives, questions, or hypotheses?
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-Are the objectives, research questions, or hypotheses expressed clearly? -Are the objectives, questions, or hypotheses logically linked to the research purpose and framework? -Are the research objectives, questions, or hypotheses linked to concepts and relationships from the framework?
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-Concepts being explored -Relationships between and among concepts -Definitions important so that they can be measured -Needed for communication purposes
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Study Variables
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-Something that varies -Any quality or attribute of a person -Weight, B/P, temperature, pulse
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Variables
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__________________________ definition- the procedure performed to measure or manipulate the variables (the inability to administer 1 ml of flushing solution within 30 seconds)
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Operational
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_______________________ definition - broad and abstract; derived from a specific theory or nursing related literature (vein patency)
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Theoretical
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_______________________________ variable - presumed cause manipulated by the researcher to observe the cause and effect relationship _______________________ variable - The response or outcome the researcher wishes to explain or predict ________________ effect - variable under investigation Basic descriptive or correlational studies - variables not dependent or independent
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Independent Dependent Presumed
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-Is the design used the most appropriate to obtain the needed data? -Does the design provide a means to examine all of the objectives, questions, or hypotheses? -Have threats to design validity been minimized? -Is the design logically linked to the sampling method and statistical analyses? -Is the treatment clearly described? -Was a protocol developed to promote consistent implementation of the treatment? -Did the researcher monitor the implementation of the treatment to ensure consistency?
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How is the study design appraised?
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-A blueprint to conduct the study -Type of design directs the selection of a population; sampling procedure, methods of measurement, data collection and analysis -Pilot study - smaller version of a proposed study -Choice of design depends on researcher's expertise, problem and purpose, desire to generalize the findings -Designs have been developed to meet unique research needs -Guides the researcher in an organized fashion from the beginning of a problem statement to the conclusion -Permits the research question to be answered or the hypothesis to be tested -Significant decision in the research process -Various quantitative designs available -Often referred to as "the methods section" in a published study
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Study Design
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-Highly structured investigations -Yield numerical information amenable to statistical analysis
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Quantitative Studies
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What are some Quantitative Research Designs?
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~Descriptive Correlational Survey research Secondary analysis Clinical trials Longitudinal ~Quasi-experimental Needs assessment Evaluation Research Experimental Non-experimental Outcomes research
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-Setting -Population -Sample size -Identified situations for collecting data -Data collection methods -Data analysis methods -Dissemination
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Components of the Research Design
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How would you critique the sample, population, and setting?
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-Is the sampling method adequate to produce a representative sample? -What are the potential biases in the sampling method? -Are any subjects excluded from the study based on age, socioeconomic status, or race, without a sound rationale? -Were the sampling criteria appropriate for the type of study conducted? -Is the sample size sufficient to avoid a type II error? -If more than one group is used, do the groups appear equivalent? -Are the rights of human subjects protected? -Is the setting used in the study typical of clinical settings? -Was sample mortality a problem? If so, how might this influence the findings?
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Population - entire group of people or objects under study or investigation. -________________ - a subset of a population selected to participate in a research study. -Power analysis -Various sampling techniques
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Sample
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Sampling in which not every element of the population has an opportunity for selection -Convenience sampling -Quota sampling -Purposive sampling -Network sampling
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Nonprobability Sampling
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Sampling technique in which every member (element) of the population has a probability of being selected for the sample -Simple sampling -Stratified random sampling -Cluster sampling -Systematic sampling -Random assignment to groups
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Probability Sampling
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When critiquing qualitative research, it is important to: A. analyze the researcher's adherence to qualitative standards of investigation. B. avoid comparison of the study with other published studies to prevent bias. C. emphasize study strengths over weaknesses. D. use the same approach for both qualitative and quantitative study critiques.
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use the same approach for both qualitative and quantitative study critiques. (ANS: D The nursing profession is striving for evidence-based practice, which includes critiquing studies, synthesizing the findings, and applying the scientific evidence in practice. A: It is important to address the researcher's adherence to to standards; however, the critiquing of studies requires a comprehensive approach. B. To critique a research study the nurse would want to assess for research bias because a bias could affect the outcomes of the study because the researcher would likely want results to favor their view. C. When critiquing a research study the nurse would want to be sure the researcher places equal emphasis on both strengths and weaknesses.)
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-Tell us about your study instrument(s) -Was validity or reliability of the instruments addressed?
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Instrumentation (survey tool)
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How are instruments critiqued?
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-Do the instruments adequately measure the study variables? -Does the instrument have adequate validity and reliability?
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Instruments are used to measure study variables. -_________________ the degree to which an instrument measures what it is intended to measure. -______________________ - the degree of consistency or dependability with which an instrument measures the attribute it is designed to measure -Instrument used should be appropriate for population and setting
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Validity Reliability
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What are some commonly Used Instruments in Nursing Research?
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-Visual analogue in pain management -Likert scale -Braden Scale -Glaser Critical Thinking Scale -SOS Inventory (Symptoms of Stress Inventory) -QOL Index
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A researcher is critiquing the published study of another researcher. Which of the following questions is not an appropriate question to ask when examining the study? A. Can the study be replicated by other researchers? B. Did the researchers use sound methodology? C. Was the research problem significant? D. What preparation did the researcher have to conduct the study?
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What preparation did the researcher have to conduct the study? (An intellectual critical appraisal looks at the product, not the creator, making this the right choice. A. Evaluating if the study can be replicated is an appropriate question to ask when examining the study. B. Evaluating if the researchers use sound methodology is an appropriate question to ask when examining the study. C. Evaluating if the research problem is significant to nursing is an appropriate question to ask when examining the study.)
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-Data collection methods need to be _________________ for all subjects. -Methods need to be realistic for subjects and setting
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consistent
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(Rights of Human Subjects Protection) How were the subjects' rights protected? Were the steps taken to protect the subjects' rights described? Study needs to be approved by an IRB Researcher needs to be qualified to conduct the study -______________________ - None linking of study participants -Confidentiality - protection of personal information gathered against unnecessary divulgence
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Anonymity
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How would you critique the data analysis procedure?
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-Are data analysis procedures appropriate to the type of data collected? -Are data analysis procedures clearly described? -Are the results presented in an understandable way? -Do data analyses address each research objective, question, or hypothesis? -Are the analyses interpreted appropriately? -Are the statistical analyses logically linked to the design? -Is the sample size sufficient to detect significant differences? -Was power analysis used to determine sample size?
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{About Data Analysis Procedures} -_________________ - answer research question -Determine whether the hypothesis was supported -Descriptive statistics - used to describe and summarize data -________________________ statistics - permit inferences on whether relationships observed in a sample are likely to occur in a larger population
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Purpose Inferential
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What type of Statistical Procedures are these? -Mean -Standard deviation -Ranges -Correlations
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Descriptive Statistical Procedures
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What type of Statistical Procedures are these? -t-test -analysis of variance -chi-square -corrletions -multiple regression -analysis of covariance
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Inferential Statistical Procedures
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What questions are important for the interpretation of findings section?
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-Are findings discussed in relation to each objective, question, or hypothesis? -Are the findings clinically significant? -Do the conclusions fit the findings from the analyses? -Are conclusions based on statistically significant and clinically significant results? -Are there limitations the researcher did not identify?
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{Conclusions/Assumptions/Limitations} -__________________________ based on study findings need to recognize both the strengths and limitations -Implications for further work give much information about how scientifically strong the study actually is.
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Recommendations
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What questions would you want to answer when performing a critique of a study?
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-What rival hypotheses can be suggested for the findings? -How much confidence can be placed in the study findings? -To what populations can the findings be generalized? -What questions emerge from the findings, and are these identified by the researcher? -What future research can be envisioned? -Could the limitations of the study have been corrected? -When the findings are examined based on previous studies, what is now known and not known about the phenomenon under study?
