Evidence-Based Practice: Systematic Implementation

Introduction

Research is a complex and multi-phased process that can utilize various methods and approaches. Qualitative studies are known to apply an emergent design that can vary depending on researcher reflections on the collected knowledge and data. Polit and Beck (2015) specify that qualitative studies are based on a wide range of traditions such as historical and discourse analysis, grounded theory, and ethnography. Qualitative research critique should include the aspects of research tradition, research question, and study design. The purpose of this paper is to provide a critique of the qualitative article named “Systematic implementation of evidence‐based practice in a clinical nursing setting: A participatory action research project” which was written by the experts in evidence-based practice.

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Article Analysis and Critique

A given article deals with the process and difficulties of evidence-based practice implementation in a nursing setting. The study is divided into sections according to research background, methods and design, findings, and result discussion. St. Pierre and Jackson (2014) claim that study analysis is inseparable from discussions related to data collection and involved participants which are a part of the research method. The design approach applied in this study involves participatory action research. Its main phases include observation, reflection, planning, and action.

Research Strengths

The research is based on the notions of trustworthiness and credibility. The participants of the study are the medical staff and patients of the lung unit. The data is collected by using interviews with the registered nurses and the patients, as well as focus-group discussions related to the research question. Some researchers state that the credibility of research is enhanced by the experience of the researcher in the study field (Cope, 2014). The researchers of the discussed study are the experts in evidence-based practice and struggle to find new approaches to its successful implementation.

To reach a satisfactory level of reliability, the triangulation method is used. It is noted that triangulation is defined as multiple resources and data used to achieve a comprehensive understanding of the problem in qualitative research (Carter, Bryant-Lukosius, DiCenso, Blythe, & Neville, 2014). This study includes such approaches to data collection as observations, interviews, discussions, and written reflections. Multiple sources used for data collection included nurses, patients, analytical notes, and written documents.

Research Weaknesses

Although several insights were developed to make an evidence-based practice more adaptive to implementation in the practical clinical setting, the main weakness of the conducted research is that it is limited to a specific lung unit. Some researchers emphasize that “reliability makes replication possible, although qualitative researchers themselves recognize induction is difficult (or even impossible) to maintain with replication” (Morse, 2015, p. 1216). The researchers also claim that they did not take into account the specific needs of the patients in a given clinical setting (Friesen‐Storms, Moser, Loo, Beurskens, & Bours, 2015). The discharge protocol was noted to make further obstacles in implementing evidence-based practice. Thus, many specific aspects related to EBP implementation remained uncovered.

Conclusion

The paper discussed the strengths and weaknesses of the article about difficulties in the implementation of evidence-based practice in the lung unit. The authors of the article seem to be competent specialists in a given field. Still, the research has some limitations as to the application of its results as the results of EBP implementation might vary depending on the clinical setting.

References

Carter, N., Bryant-Lukosius, D., DiCenso, A., Blythe, J., & Neville, A. J. (2014). The use of triangulation in qualitative research. Oncology Nursing Forum, 41(5), 545-547.

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Cope, D. G. (2014). Methods and meanings: Credibility and trustworthiness of qualitative research. Oncology Nursing Forum, 41(1), 89-91.

Friesen‐Storms, J. H., Moser, A., Loo, S., Beurskens, A. J., & Bours, G. J. (2015). Systematic implementation of evidence‐based practice in a clinical nursing setting: A participatory action research project. Journal of Clinical Nursing, 24(1-2), 57-68.

Morse, J. M. (2015). Critical analysis of strategies for determining rigor in qualitative inquiry. Qualitative Health Research, 25(9), 1212-1222.

Polit D. F., & Beck, C. T. (2016). Resource manual for nursing research: Generating and assessing evidence for nursing practice (10th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.

St. Pierre, E. A., & Jackson, A. Y. (2014). Qualitative data analysis after coding. Qualitative Inquiry, 20(6), 715-719.

Appendix 1. Research Critique Framework: Qualitative

Aspect of the Report Critiquing Questions Answer
Yes/No
Comment(s)
Title Is the title a good one, suggesting the phenomena and the group or community under study? Yes
  • Research topic specified
  • Phenomena and specific research setting included
Abstract Did the abstract clearly and concisely summarize the main features of the report (problem, methods, results, conclusion)? Yes
  • Subheadings are present
  • Objectives, design, method, results, and conclusion included
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 qualitative approach appropriate?
Yes
  • Difficulties in implementing evidence-based practice (EBP) observed
  • Background description provided
  • The arguments are persuasive and supported by other sources
  • The qualitative method is appropriate as this research involves the experience of the participants
Research Questions Were research questions explicitly stated? If not, was their absence justified?
Were questions consistent with the study’s philosophical basis, underlying tradition, or ideological orientation?
Were the questions/hypotheses consistent with existing knowledge?
Yes
  • Systematical implementation of EBP in clinical settings by front-line nurses researched
  • The question is consistent with main directions and traditions
  • The question is based on appropriate study of literature
Literature Review Did the report adequately summarize the existing body of knowledge related to the problem?
Did the literature review provide a strong basis for the new study?
Yes
  • Research background is based on existing knowledge
  • The literature review gives a basis for the research question development
Conceptual/Theoretical Underpinnings Were key concepts adequately defined conceptually?
Was the philosophical basis, underlying tradition, conceptual framework, r ideological orientation made explicit, and was it appropriate for the problem?
Yes
  • The phenomena of EBP is clearly defined
  • Traditions and conceptual framework related to EBP were defined
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
  • Informed consent of the participants used
  • Research granted by the institutional board of two organizations
  • EBP protocol developed
Research Design Was the identified research tradition congruent with the methods used to collect and analyze data?
Was an adequate amount of time spent with study participants?
Did the design unfold during the data collection, giving researchers opportunities to capitalize on early understandings?
Was there an adequate number of contacts with study participants?
minimized?
Yes
  • Interviews and protocol reviews used
  • A two-year period used for data collection
  • The researchers played the role of an advisory board
  • Reflections on findings were used to plan action phases
  • The research team closely collaborated with the participants
Sample and Setting Was the population adequately identified?
Was the sample described in sufficient detail?
Was the approach used to recruit participants or gain access to the site productive and appropriate?
Was the best possible method of sampling used to enhance information richness and address the needs of the study?
Yes
  • Population sampling was utilized for EBP implementation
  • The detailed process of sampling was described
  • The nurses and patients of the lung unit were included
Data Collection Were the methods of data gathering appropriate?
Were data collected through two or more methods to achieve triangulation?
Did the researcher ask the right questions or make the right observations, and were they recorded appropriately?
Was a sufficient amount of data gathered?
Yes
  • A multi-method data process was utilized
  • Sufficient methods of data collection
  • Focus group discussions and interviews are relevant to the research question
  • Enough information for reflection included
Procedures Were data collection and recording procedures adequately described and do they appear appropriate?
Were data collected in a manner that minimized bias? Were the staff who collected data appropriately trained?
Yes
  • Detailed description of the process
  • Focus-group discussions minimized bias
  • The researchers were experts in EBP
Enhancement of trustworthiness Did the researchers use effective strategies to enhance the trustworthiness and integrity of the study?
Were the methods for trustworthiness adequate?
Did the researcher document research procedures and decision processes sufficiently that findings are auditable and confirmable?
Yes
  • Research methods are clearly explained and documented
  • Used strategies include the method, researcher and data triangulation, member check, and thick description
Results
Data Analysis
Were the data management and data analysis methods adequately described?
Did the analysis yield an appropriate “product” (a theory, taxonomy, thematic pattern)?
Did the analytic procedures suggest the possibility of bias?
Yes
  • Method of data analysis includes a comparative and interpretive approach
  • Emerging themes were identified and explored
  • The possibility of bias was reduced by group discussions
Findings Were the findings effectively summarized, with good use of excerpts and supporting arguments?
Did the themes adequately capture the meaning of the data?
Did the analysis yield an insightful, provocative, authentic, and meaningful picture of the phenomenon under investigation?
Yes
  • The findings are summarized by subheadings with interview excerpts
  • Themes are developed according to observing, planning, and acting phases
  • The analysis contained provocative evidence of EBP negative attitude cases
Theoretical integration Were the themes or patterns logically connected to form a convincing and integrated whole?
Were figures, maps, or models used effectively to summarize conceptualizations?
If a conceptual framework or ideological orientation guided the study, were the themes or patterns linked to it in a cogent manner?
Yes
  • The themes are connected based on action research phases
  • The table is used to summarize barriers and facilitators
  • An action research framework was utilized
Discussion
Interpretation of the findings
Were the findings interpreted within an appropriate social or cultural context?
Were major findings interpreted and discussed within the context of prior studies?
Were the interpretations consistent with the study’s limitations?
No
  • Clinical expertise from one area was used
  • No sufficient evidence found to identify barriers and developing interventions
  • Data saturation sufficient for all the stakeholders cannot be reached
Implications/recommendations Did the researchers discuss the implications of the study for clinical practice or further research-and were those implications reasonable and complete? Yes
  • The scientific evidence which is important for clinical guidelines
  • Patients involved
General Issues
Presentation
Was the report well-written, organized, and sufficiently detailed for critical analysis?
Were the description of the methods, findings, and interpretations sufficiently rich and vivid?
Yes
  • Enough details for analysis
  • Full description in the sections
Researcher credibility Do the researchers’ clinical, substantive, or methodologic qualifications and experience enhance confidence in the findings and their interpretation? Yes
  • The researchers were qualified in the implementation of EBP
Summary Assessment Do the study findings appear to be trustworthy-do your confidence in the truth value 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
  • Trustworthy research findings for a selected area of study
  • Deep insight into the development and implementation of EBP
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