The Article to Critique:
Khammarnia, M., Mohammadi, M.H., Amani, Z., Rezaeian, S., & Fatemeh Setoodehzadeh, F. (2015). Barriers to implementation of evidence based practice in Zahedan teaching hospitals, Iran, 2014. Nursing Research and Practice, 2015, n.p. doi:10.1155/2015/357140
Nurses use research articles to receive answers regarding their scope of practice, decision-making, and the improvement of the quality of care. Typically, the articles in the peer-reviewed journals are properly examined to ensure that scholarly standards are adhered to. Nevertheless, standards may dramatically differ among reviewers, which is why careful attention should be paid to their analysis. The present paper aims to analyze the research article Barriers to Implementation of Evidence Based Practice in Zahedan Teaching Hospitals, Iran, 2014 written by Khammarnia, Mohammadi, Amani, Rezaeian, and Setoodehzadeh to improve the quality of patient care as well as better understand the subject in question.
A Critique of the Study
The purpose of the analyzed article is to determine the barriers to the use of evidence-based approach among the Iranian nurses. The research question is to examine all types of the barriers to EBP in Zahedan teaching hospitals. The research findings can help policy makers in better promotion of EBP among nurses and other health care providers. The sample included all nurses who worked in the six hospitals at the time of the research.
As the stratified sampling method was selected, the nurses in each Zahedan hospital were regarded as the study population. Given the fact that the proportion of barriers to the use of evidence-based approach is 78.6%, the sample of 270 nurses at the error level 0.05 and 95% significance level was computed and ten subjects were added to the sample size, so that the sample consisted of 280 nurses overall (Khammarnia et al., 2015). The exclusion criteria included the nurses who had worked in the hospitals during the data collection.
The questionnaire of the barriers to the use of EBP was employed to measure the data. More specifically, it consisted of 27 statements with organizational and personal categories, comprising 18 and 9 statements respectively (Khammarnia et al., 2015). The ordinal type of data was used, as the participants were asked to score the extent, to which they agreed with the argument regarding both categories. In the research, the discrete data was utilized to describe the demographic information such as sex, age, experience, education level, and employment status. It is worth admitting that the study does not include the intervention tested on patients. For the purpose of reliability, randomly selected respondents addressed the questionnaire. The proportional random sample was determined by the hospital size and the participants personnel list.
The main findings suggest that the majority of the nurses claim that 56% and 57% of barriers to the use of EBP are associated with human and organizational factors respectively (Khammarnia et al., 2015). The challenges at the organizational level involve the deficit of human resources (78.3%), the inability to remain connected to the Internet (72.2%), and a broad scope of work (70.0%) (Khammarnia et al., 2015). Barriers at the personal level are related to the lack of time to read professional literature (83.7%), computer incompetence (68.8%), and the limited proficiency in English language (62.0%) (Khammarnia et al., 2015).
The results show that education, age, experience, and status in employment are attributed to the organizational challenges, whereas at the personal level, only education is the main factor affecting the nurses ability to implement EBP at work. The authors conclude that challenges of the use of EBP occur at organizational as well as at personal levels.
The given study is published in the peer-review journal that contains the researches in all areas of nursing. The website of the journal includes the editorial statements that suggest that it is referred and credible. The quantitative research utilizes the descriptive statistics to summarize the results obtained from the Chi-square test that allows analyzing the opinions of the participants. Thus, the descriptive research design helps to determine the types of barriers, thereby comparing and evaluating the data. As a result, the frequency table, and mean and standard deviation present the list of the challenges of the EPB implementation. The random sampling can be viewed as the study strength as long as it is an unbiased surveying strategy (Burns & Grove, 2011).
The given technique adds credibility to the study because all nurses are randomly chosen and, hence they can accurately represent the entire population. Notably, the questionnaires, the frequency table, and mean and standard deviation increase the external validity of the study since the results can be generalized from the sample to the entire nurses population (Burns & Grove, 2011). Moreover, Cronbachs Alpha of 0.81 shows the high reliability of all 27 statements in the questionnaire (Khammarnia et al., 2015).
Nevertheless, sufficient care was not taken to avoid the potential bias associated with the use of the self-report questionnaire. The lack of time or individual interest may substantially affect the results, causing the answers to appear exaggerated and untruthful (Brown, 2013). Furthermore, the limited sample size can also influence the reliability of the findings (Brown, 2013). The sample size in the education subgroup can be illustrated as follows - 94.7% versus 5.3% (Khammarnia et al., 2015). However, the study is consistent with the previous researches that indicate that demographic variables do not affect the use of EBP in nurses. The analyzed research corroborates the ideas of the previous findings that individual and organizational factors are the major contributors to the implementation of EBP. Given the high response rate, the sample method, and reliable researcher-completed instruments, each main study finding is credible and it can be readily referred.
Overall, I share the viewpoint presented in the analyzed research that the challenges of the EBP implementation occur at both organizational and personal levels. Indeed, the Iranian nurses confront the problem of the lack of human resources daily due to the complicated political and economic situation in the country.
Consequently, nurses experience the lack of time and heavy workload at the personal level. The study findings would be different if the research were conducted with the American nurses since the U.S. hospitals are deprived of many problems such as the lack of Internet access and the lack of human resources. It is abundantly clear that the lack of proficiency in the English language and computer literacy do not represent the population of the nurses in the USA.
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