Introduction
This paper critically appraises a research paper by Cho & Jung titled Effects of an Existential Nursing Intervention for College Students in the COVID-19 Pandemic Situation, presenting a quasi-experimental intervention approach to reduce depression and stress in Korean students (2021). The structure of the work includes an analysis of the title, keywords and abstract, research problem, hypotheses, questions, literature review, and ethical considerations. This work is carried out with the aim of an in-depth study of the article and honing the skills of critical evaluation and thinking.
Title, Abstract, Key Words
The article’s title is the person embedded within the study and should be as concise as possible to identify the problem and purpose of the work. In this case, it is often necessary to indicate the various features of the study, including geographical, national, demographic, or other factors that significantly affect the course of the experiment or study. A scientist immersed in the topic should understand at a glance the interest in this article, and researchers with a broader range of specializations should estimate the work’s essence. Therefore, this article has a relatively medium-length title, Effects of an Existential Nursing Intervention for College Students in the COVID-19 Pandemic Situation, which reflects the context, sample characteristics, and intervention methods. At the same time, judging by the abstract, the title misses an extremely important point: only Korean students participated in the experiment.
The presence of a constant demographic factor may not be significant within the framework of one experiment, but when the entire sample consists of people of the same nationality, this moment must be indicated in the title. Cultural characteristics can significantly influence various indicators used in methods, surveys, interviews, practice, and even interventions (Jongen et al., 2018). Cultural intelligence has even become a separately required competence of medical professionals, demonstrating its importance in considering aspects of a medical nature (Jongen et al., 2018). Consequently, scholars who may be interested in this topic may mistakenly judge by the title that the sample was uneven in demographic characteristics of race and gender, as only “College Students” is indicated, which indicates age and occupation. Clarification about nationality is necessary and is a disadvantage of this name. Otherwise, even though “Effects of an Existential Nursing Intervention” can be interpreted quite broadly, the article’s title is quite informative and moderately concise and may be of interest to potential readers.
The abstract should reflect the purpose, methods, and results of the article concisely while leaving the potential reader interested in learning more about the article’s content, that is, without immediately revealing the essence of the results and analysis. Firstly, this annotation corrects the defect in the name and indicates more precisely the characteristics of the sample. Secondly, the topic of searching for the meaning of life sounds far from the professional medical language and is more characteristic of Asian studies in terms of opposing mental disorders in the form of depression and stress: a person who clearly identifies the meaning of existence has no symptoms and prerequisites for negative mental dynamics (Li et al., 2022). Thirdly, the undoubted advantage of this abstract is the availability of information about the sample size, the methodology used, the structure of the study, and the overall picture of the results without the details that can be disclosed in the article. This factor may interest the reader if it is necessary to understand potential deviations, errors, causes, and practical implementations of the developed intervention.
The researchers again extrapolate the results in the abstract to all college students without specifically targeting Koreans. At the same time, it should be noted that the nurses were directly involved in the experiment as experts conducting the interventions developed by the authors. The leading expert was a nurse with experience in both New York and Korea, which, on the one hand, may offset the problem of cultural differences mentioned above – under the supervision of a specialist, these factors are very likely to be taken into account (Cho & Jung, 2021). From an ethical point of view, the involvement of nurses in research is a contentious issue due to several factors.
First of all, experimental studies distract specialists from current practice. At the same time, specifically in Canada, as well as in some other developed countries, since before the pandemic, there has been a shortage of medical personnel, namely nurses (Boamah et al., 2021). As a result, fewer people will get help than if the expert were not distracted from their direct functionality. On the other hand, the promotion of scientific activity is a factor in the positive dynamics of interventions, optimization of medical interaction, and improving health outcomes for patients at the global level. Specialists with experience in different countries, including Korea, where the experiment was conducted, are the best suited for this role. As for the implications for nursing practice in Canada, it is difficult to say about a specific implementation – a similar experiment with a control and experimental group in the country itself is required, where unexpected distinctive cultural factors may appear that improved the dynamics in Asia but have the opposite effect on other continents.
A set of keywords is limited enough, although it can be expanded for this article. At a minimum, the keywords do not include the context of the problem, namely pandemics or “COVID-19”. However, otherwise, the set of keywords is quite indicative and complete; they reflect the thesis of the study, except for the term “meaning of life,” which was indicated above as not the closest to professional medical vocabulary. Therefore, it can be assumed that the interested reader will find this study; however, due to the brevity of the list, a researcher of related topics may also get here.
Research Problem, Question, Hypothesis
The research problem is easy enough to read in the introduction: the article postulates the importance of such interventions because of the many causes of stress and depression that can lead to suicide. The pandemic, in this case, acted as a catalyst for this problem, greatly exacerbating it and creating a new reality where many new challenges that contribute to depression and stress must be put up with: social distancing, lockdowns, and potentially dangerous health problems. In general, the introduction is built quite logically, and all aspects of the study are mentioned – from the type of therapy used to the development of mental disorders in the context of students (Cho & Jung, 2021). The problem is essential for nursing because it can provide recommendations for applied practice in working with Korean students, as well as consider some aspects of the intervention in dynamics. During and after the pandemic, any such research that can optimize the performance of the medical system is valuable because of the lack of staff and increased cases of depression and stress. At the same time, although the problem is easy to read, the goal can be restored according to the theses; the specific tasks of this study are not listed.
The research phenomenon is presented as a declarative statement that this type of intervention helps combat depression and stress. The research team is only creating a new background and context in the form of Korean students during the pandemic and beyond. The variables are clearly defined in the text and hypotheses, with a detailed explanation of the meaning of life, what it means, and how to measure it (Cho & Jung, 2021). The independent variable is the fact of undergoing the intervention, while the dependent variables are clearly postulated in three hypotheses: susceptibility to stress, predisposition to depression, and the “meaning of life” variable (Cho & Jung, 2021). The research question is not stated explicitly but indicates a relationship between variables and should confirm due to the presence of such statements in the introduction. At the same time, this section is not focused on the population – the cultural aspect of considering the Koreans is used only at the stage of describing the sample in the chapter on methods. The researchers emphasize the importance of college education, which is supported by a review of previous work in the field, although such an extrapolation is questionable in cultural and national contexts distinguished by political constraints during the pandemic and responses to them.
Hypotheses, as opposed to goals, problems and questions, are clearly stated in this work. They are exploratory in that they suggest a positive effect of the intervention compared to the control group. The direction of the relationship of variables is clearly indicated in the hypotheses; measurability is postulated in the introduction above and is described in detail in the chapter on the methodology. Particular emphasis is placed on the “meaning of life” variable, namely, its understanding and the possibility of measurement. Although this situation is presented as the opposite of a predisposition to stress and depression, there are specific prerequisites and factors behind it, which are revealed through interviews and surveys. Its correlation with many positive variables of mental and even physical health is a determinant of the use of this indicator in work.
Literature Review
The literature review is organized to familiarize the reader with the main aspects of this work. In fact, this section is not included in a separate chapter but only forms part of the Introduction. First of all, the literature review introduces the problem of stress and depression and asserts the aggravation due to the pandemic. The articles cited are current due to the context of COVID-19. The authors then present evidence-based studies of such interventions and detail their limitations, samples, and characteristics. In general, the literature presented presents the basic concepts and proves their applicability in the case of depression or stress.
The subheading Background follows a review of the already more specific literature, which focuses on three points. As already mentioned above, the first of them describes in more detail the “meaning of life” variable used in the experiment, in which studies it was encountered, how it was measured, what history it has, and why it is essential, supported by studies already conducted. After postulating interventions as an effective therapy mechanism for psychiatric disorders, the authors review logotherapy and logo-autobiographical therapy, their types, and the work that has also led to positive results, detailing the context, goals, and characteristics of the samples. Finally, the researchers present the characteristics of depression and stress in college life, delving deeper into the issue and showing studies where this type of intervention developed. After a detailed analysis, this chapter concludes with three hypotheses.
The review is relevant for several reasons. First, the new context of the pandemic, which has no analogs in history, is presented in sufficient detail precisely when considering students’ interventions and lives. COVID-19 has significantly impacted the usual way of life in the world, giving rise to many new restrictions and trends and forcing us to switch to various previously unusual measures. Consequently, the context of depression and stress in student life is now facing new challenges, including social distancing, lack of face-to-face classes, and more, which is precisely what the literature review highlights. Secondly, the intervention studies cited are dated no earlier than 2015, confirming their relevance. Therefore, an understanding is created that the authors are pursuing the goal of applying these interventions in a new context, which can be considered a scientific novelty with significant applied value.
Analysis of sources showed that most of them, except for the first few in the list, are primary sources with research. The first dates back to 2005 and is cited as confirmation of the importance and global nature of the problem of depression and stress under consideration. Some sources have a different context of the problem, but, as a rule, they have a sample of students: the influence of social networks, sedentary behavior, psychosocial factors, and suicidal tendencies are considered. Most of the research dates back to the last decade; older sources are not used for this purpose in work.
The literature review summarizes the work done in the considered studies, and a detailed comparison is given in the Discussion section, where the experiment results are compared with similar ones. In doing so, this chapter compares the results with a similar approach used in the Introduction: the characteristics of the samples, the initial data, the characteristics of the experimental groups compared to the control ones, and the methods used. In general, the successful therapy results for each of the hypotheses are confirmed in various aspects and with other cited works, which also took into account the context of the pandemic. At the end of the comparison, the authors postulate that the applied LAC has the same effect as autobiographical writing, expanding the practical implementation of the intervention and bringing understanding to the existential understanding of student life.
The authors do not explicitly indicate gaps in the literature and studies; the organization of the review is structured in such a way as to logically lead the reader to understand the importance of the problem and the effectiveness of the potential use of the proposed methodology. In fact, the authors delve deeper into the issues at hand, combining interventions, using the not-so-popular “meaning of life” variable, and focusing on the context of college students and Korean ethnicity. This problem is of a long-term nature, which is confirmed by the given date of the source in 2005, which postulates the globality and importance of combating depression and stress. In general, the organization of the literature review is comfortable and understandable for the reader and has a clear and concise structure for the detailed development of ideas.
Ethical Considerations
The institutional review board approved the university study from which students were recruited for the experiment. Moreover, the authors claim that the recommendations of the Helsinki Declaration were taken into account. Participants were recruited by various methods: through leaflets and social networks, and each was pre-informed about the study’s goals. The article does not specify the approval channel, but the selection criteria are indicated. Four participants could not agree on a personal schedule, which is why the sizes of the experimental and control groups differ. The students in the experimental group were protected from emotional and physical harm by being supervised by two experts. The LAC strategy used in the experiment has already been repeatedly tested and proven safe, as mentioned in the literature review.
All participants were informed about the study’s purpose, methods, the guarantee of anonymity, and the possibility to leave the experiment at will at any time. Anonymity was provided by anonymous return envelopes (Cho & Jung, 2021). This information was provided prior to obtaining consent to participate. There is no mention of other potential risks besides data privacy. However, the authors claim that the process was carried out following the most current version of the Declaration of Helsinki, which excludes any potential harm to the participants in the experiment.
Overall, this study was designed to maximize the positive impact of the interventions, as evidenced by the preliminary analysis of the method. The experimental group was under the control of specialists and improved all the indicators considered in the hypotheses compared to the control group, demonstrating the positive dynamics of the influence of the experiment. Participants could refuse to participate without penalty, which confirms the ethics of the work. Additional risk minimization measures are not mentioned in the article. Vulnerable participants were rejected at the selection stage based on several criteria.
The quality of the research ethics procedures is maintained at a reasonable level: the work was carried out per the current relevant standards without apparent violations. The article does not indicate potential individual recommendations for each student with tendencies towards mental disorders such as depression or stress. In addition, there is also no mention of consulting assistance to students from the control group, whose results, according to the corresponding chapter, were significantly lower than the experimental group. Since we are talking about mental illnesses that can lead to suicidal tendencies, as indicated in the introduction, some participants in the control group would likely benefit from such help. However, this practice is rarely seen or mentioned in scientific articles and tends to happen on a case-by-case basis.
Conclusion
As a detailed analysis of this article showed, the work turned out to be relevant and essential for nursing, both in theoretical terms and in the case of practical implementation. The authors explicitly indicated the influence of the demographic factor of nationality only in the study’s limitations but did not reflect it in the title or abstract. In addition, the abbreviated list of keywords does not indicate some of the critical points of the study. Otherwise, this article is relatively concise and indicative, and its experiment is ethical. As a result, the authors have done a decent job that has withstood detailed multidirectional criticism. For the interested and ordinary reader, the text is structured comfortably, not overloaded with unnecessary descriptions of aspects of the literature review, and reflects the current research in the modern context.
References
Boamah, S. A., Callen, M., & Cruz, E. (2021). Nursing faculty shortage in Canada: A scoping review of contributing factors. Nursing Outlook, 69(4), 574-588.
Cho, S., & Jang, S. J. (2021). Effects of an existential nursing intervention for college students in the COVID-19 pandemic situation. International Journal of Environmental Research and Public Health, 18(10), 5268.
Jongen, C., McCalman, J., & Bainbridge, R. (2018). Health workforce cultural competency interventions: a systematic scoping review. BMC Health Services Research, 18(1), 1-15.
Li, X., Li, P., Gao, Y., Wang, T., He, Y., & Li, X. (2022). Research on the relationship model between professional identity and life meaning of clinical medical freshmen based on artificial intelligence medical image detection. Contrast Media & Molecular Imaging, 2022.