Reading Nursing Research to Critique a Study and to Summarize Findings for Use in Practice
Research must be used to develop the discipline and science of nursing. Learning how to critically read nursing research then is crucial in its application to practice. First, a review of some of the common research language and definitions of the sections seen in quantitative research articles are covered. As you go through the chapter, you will learn how to critically read each section of the research article. You are given many examples to help you get the most information from comparing what you have read to colleagues’ reviews of articles on the same topic. You will learn some questions to pose about the quality of the research as well as the appropriateness of using the findings in your own practice.
Nurses must learn how to read, understand, and critique research articles (Zanotti, 2000). Reading about nursing research should get you in the habit of posing questions about the quality of the research and about the appropriateness of using the research results in your own practice (Snyder-Halpern, 1991). As you go through this assignment, you will learn how to critically read each section of the research article. You are given many examples to help you get the most information from comparing what you have read to colleagues’ reviews of articles on the same topic. When using research findings in practice, it is best to find replication of results in several studies before using the research in your practice (Linquist, Brauer, Lekander, & Foster, 1990). After reading and summarizing the research literature, on a topic the nurse then develops a detailed plan for utilization of selected research findings in her practice. This plan included specific actions for communication of the research findings to other nurses and physicians, and a method of evaluation to be used after the research was put into practice. Thus, the examples given here are from reading several articles on the same research topic.
Reading Research Articles
This overview is an example illustrating how to read research articles. First, ascertain the problem being examined by reading the title and abstract to get a summary of the study. The introductory paragraphs of the article must clearly state the significance of the problem described in previous studies on this topic in the literature. Then, determine if the research design and methods used are appropriate for the problem under study. Next, the reader reads the data collection procedures described in the design and the data that were analyzed. The reader determines if appropriate statistical tests have been applied to the data collected in the particular study. There are typically graphs and tables that are visual interpretations of the data. These visuals should give you an understanding of measures of central tendency, such as the mean and standard deviation, and data distribution. The normal curve and measures of central tendency are essential to display. The process of inferring from a sample to a clinical situation in terms of conclusions should be discussed. Review the authors’ discussion comments and rate them as acceptable and important for clinical practice and as contributing to the subject matter. You must, however, read all of the sections and determine if the authors’ implications for practice are correct from the data they obtained. Examples in the Tables will help you critique the sections of the article.
Questions to Use When Reviewing Research Articles
To guide your critique of a research article, use the following questions when reading each section of a quantitative study. Reading an article while thinking about these questions, which are related to quality of the study, is important for determining if you should put the research into practice. Use the list of questions in Table 1 to help you understand the process of reading each section of the research article.
These examples are the author’s summary from reading five interdisciplinary, quantitative research articles on the same topic of congestive heart failure (CHF). The overall research objectives of these studies were to determine what factors relate to older persons with congestive heart failure (CHF) having to be readmitted to the hospital (Heidenreich, Ruggerio, & Massie, 1999; Rich, Beckham, Wittenberg, & Freedland, 1995; Shah, Der, Ruggerio, Heidenreich, & Massie, 1998; Smith, 1991).
Title and Abstract of the Article
Does the title indicate the research is important for nursing?
Does the abstract include information from each section of the article?
For example, all five studies had clear title and abstract statements. Information on the problem, theory and literature synthesis, research design and statistical analyses; and major findings are listed. However, the research questions or hypothesis were missing from 3 of the abstracts. Another common issue in reading abstracts is to distinguish the specific problem identified for the research, and how the actual data that is collected represents or matches the problem.
Statement of the Problem
Is the problem identified early and stated clearly and concisely?
Is the problem stated in terms, which are specific and narrow enough to study?
Is the problem important or significant for nursing practice?
For example, the descriptive studies provided evidence that re-admissions to hospitals of patients with congestive heart failure (CHF) were very frequent and thus, a very costly problem. The experimental studies state the problem as a need for teaching or follow-up home care by nursing, which can reduce readmission costs. Unfortunately, a limitation of the studies was that no cost data were collected.
Review of Literature and Theoretical or Conceptual Framework
Is the study problem described within the context of existing knowledge and previous research on the topic and has interdisciplinary literature been investigated?
Does the review of the literature provide supporting evidence to show the need for carrying out the research?
Is consultation with experts in the field apparent?
Are documentation and selection of references appropriate?
For example, the literature review for these studies all referenced recent interdisciplinary studies done on patient teaching for CHF. Explain how the literature review or theory was applied to this study. For example, 3 of the 5 studies used the cost effectiveness theory and one used adult learning theory. These theories were used to guide selection of questionnaires and outcome data. Theories were used to limit the research population to CHF patients who had repeated Emergency Room visits and re-hospitalizations. There should be discussion of a conceptual framework or theory appropriate to use for guiding the study. Two of the five studies had no theory or conceptual framework, and therefore were not specific in the questionnaires used or data gathered. Results from that study were too broad to be helpful for nursing practice. Unfortunately, a limitation was that only one of the authors had gerontology as a specialty area. Thus, the other research may not have the benefit of interventions tested, which were developed with older adults in mind.
Research Design
Is the design appropriate to answer the questions indicated by the problem?
Are correct statistics used to test the study hypotheses?
Were the measures of central tendency and descriptive/summary statistics before further analysis of data?
What do the terms clinical significance versus statistical significance mean?
How many survey responses do you need to demonstrate feasibility, and what is this measure of feasibility (e.g., if 50% of respondents say the message is interesting, is that enough, or do you need 80%?
What happens if the researchers don’t get enough responses?
For example, of the 5 studies reviewed, 3 were descriptive research design, and 2 were correlation research design. For example, the descriptive studies were explanatory; therefore, the age, education level, and severity of disease could be described along with the number of ER visits and returns to the hospital. The correlational designs were used to look for associations; therefore, the number of ER visits of CHF patients following hospital discharge could be compared to the number of nurse follow-up telephone calls and videotapes on home CHF care given to the family.
A portion of the research design review should explain how the research variables and the hypothesized relationships were selected (e.g., severity of illness of the patients in relation to the teaching methodology needed at discharge by the family). There should be links between variables in the conceptual framework and those measured in the data collection.
Note any probable sources of error that might influence the results; for example, the ordinal data was not the correct type to collect for the tests used in the correlational studies. There were strengths and weaknesses in the statistics that were used; for example, all studies had been conducted in hospitals with elderly patients being treated for CHF; none were conducted in patients’ homes where the researchers could observe day-by-day barriers to home CHF management.
As the joke below illustrates, when using statistics, assumptions about the appropriate statistic to analyze the data, cannot depend on miracles!
Results or Findings
Are the findings of this study relevant to your clinical practice?
Is there enough evidence base (data) to indicate this patient’s problem can be minimized by using the nursing interventions tested in the study?
For example, to determine the extent to which these findings currently are being used in practice. You can interview faculty and nurse graduates and examine relevant textbooks. Both experimental studies had evidence that indicated nurses telephoning or providing videotape patient education guidance decreased ER visits compared to control group patient samples.
The implications for nursing across all studies were that our profession needed to think in terms of populations of patients and what specific nursing interventions can contribute to improved outcomes including lower costs by decreasing hospital use. Then, you must decide on the application of the results to your own clinical practice (Kirchhoff, & Titler, 1994).
Journal Clubs for Research Reading
You may read research for clinical implications in journal clubs or workgroups of students, nurses, doctors, and even patients. You might facilitate a discussion around aspects of research on families managing complex home care, the research topic called caregiving. There are a vast number of quantitative articles on this topic (Dracup, & Breu, 1978). Thus, one of the first discussion questions of your group might be, "What are problems that family caregivers face when they are managing critically ill children, frail elders, or their terminal ill loved ones in their home?" Another discussion question might be, "What are the likely research designs to be used in describing these types of caregiving problems, or are there nursing interventions for caregivers that have been tested in experimental research?" Your group would decide what the benefit of either type of article would be for the groups reading once the various articles were read (one article by each person). Next, each person shares the review of their article.
A further question for discussion would be: "Did the research article operationally define a family caregiver" or “what problem statement identified the variables to study?” “Did the researchers determine what caregivers face when working with medical equipment needed in the home?" By the end of these workgroups research discussions, you will have a good overview of the research in the problem area you selected to read. You will also be able to learn from the opinions of the others in the group as well. This table has an example workgroup where each person shared their critique of a separate article on the topic of interest to nurse administrators.
Reading Research Articles for Using Research In Practice
Next, your critique should discuss "research utilization," a word used to describe the process of reading research critically to determine if there is enough scientific results of nursing research to put into practice (Butts, 1982; Fawcett, 1982; Sheridan, 1983; and Stetler, 1983, 1984). Research Utilization is "a process directed toward transfer of specific research-based knowledge into practice through the systematic use of a series of activities" (Dunn, 1983; Krueger, 1978). Activities for using research include: transformation of implications for practice from the research articles into what is known as a data based or evidence based clinical care plan (Horsley, Crane, Crabtree, & Wood 1983). Each care plan focuses on a researched problem and related nursing actions; and each uses the actual studies read to develop step-by-step instructions on how to introduce the new research based plan on a clinical unit (Barnard, 2000; King, Barnard, & Hoehn, 1981).
In other words, research can provide material for a new procedure or policy to support the need for change of services. In contrast, a nurse can use new research to improve her understanding of various situations (Stetler, & Marram, 1976; Stetler, 1983). The classic example is nurses implementing a structured preoperative teaching program that became standards that improved all surgical care (a 1971 study by Lindeman and Van Aernam). The discussion group readers can adapt the findings of the caregiving studies to develop a care plan that they tested now being used for including family. Remember to keep reading, asking critical questions, and using appropriate quantitative research in your nursing practice. Then, you will truly have defined nursing practice as “merging science with compassion.”
