Authorship and Research Question
Discuss about the Clinical Reasoning and Clinical Judgment.
Critical analysis is a skill that all the nurses should have because it can enable them to improve the quality of their service-delivery. A nurse who has excellent critical analysis competencies can use his or her creative mind to analyze, understand, and interpret any complex situation before coming up with an appropriate solution. Critical analysis can also be relied upon in nurturing the culture of Evidence-Based Practice (EBP) since it entails the reading and synthesis of scientific literature. However, it should be noted that the implementation of EBP is always not a success because it has been affected by a combination of specific and generic barriers. The purpose of this paper is, therefore, to critique an article and present a brief, but exhaustive analysis of the generic and specific barriers that hinder the implementation of EBP in nursing.
“The Combined Perceptions of People with Stroke and Their Carers Regarding Rehabilitation Needs 1 Year After Stroke: A Mixed Methods Study” is an article that was authored in 2015 by Ulla Johansson, Charlotte Ytterberg, Lisa Ekstam, Susanne Guidetti, and Gunilla Eriksson. The article presents a research that these scholars conducted to study the perception and experiences of the stroke patients as well as their caregivers on the level of services given to the patient during the rehabilitation process (Ekstam, Johansson, Guidetti, Eriksson & Ytterberg, 2015). This paper critiques the paper’s authorship, aims, design, methodology, and the findings.
As already hinted, this paper was written by Ulla Johansson, Charlotte Ytterberg, Lisa Ekstam, Susanne Guidetti, and Gunilla Eriksson. These are people who have made a tremendous contribution in the nursing field because, over the years, they have been engaged in research and publication. They are affiliated to reputable organizations and institutions which have been doing a great job in promoting health care. For example,while Lisa and Ulla are affiliated to the Karolinska Institutet’s Department of Neurology Care Sciences and Society, and Karolinska University Hospital’s Department of Occupational Therapy respectively, Sussane, Gunilla, and Charlotte are affiliated to the Uppsala University’s Department of Clinical Research, Uppsala University’s Department of Neuroscience and RehabilitationMedicine, Karolinska University Hospital’s Department of Clinical Neuroscience in that order. This is a clear proof that the article was written by credible authors who have no conflict of interest because they did a research and published the article on what they know best.
Methodology and Findings
The main research question was to study the perceptions of the stroke patients and the caregivers regarding the severity of stroke, burden, and the satisfaction of rehabilitation services given to the patients (Ekstam, Johansson, Guidetti, Eriksson & Ytterberg, 2015). The research question was indeed objective because it focused on the analysis of the views of the caregivers on the patients themselves, their condition and the kind of rehabilitation services offered to them at this critical time of need.
The study was conducted using the mixed research method. Meaning, the researchers brought together the qualitative and quantitative research methods (Ekstam, Johansson, Guidetti, Eriksson & Ytterberg, 2015). It was a bright idea because it resonates with the research question and objectives. The use of mixed methods enabled the researchers to generate valid and reliable numeric and descriptive data that could comprehensively-respond to the question (Richardson-Tench, Taylor, Kermode & Roberts, 2016).
Since the study involved the use of mixed methods, its data was collected and analyzed using a combination of qualitative and quantitative methods. For data gathering, the researchers used open-ended interviews which were conducted at the patient’s homes (Ekstam, Johansson, Guidetti, Eriksson & Ytterberg, 2015). It was a good strategy because it enabled the researchers to get detailed and comprehensive responses from the participants. Interview is a good instrument because it guarantees validity and reliability since it does not have any biasness (Greenhalgh, Bidewell, Crisp, Lambros & Warland, 2017).
The use of qualitative and quantitative research methods enabled the researchers to general reliable data. The findings showed that the patients and care givers had different perceptions, attitudes and experiences as far as the patient’s condition and the level of rehabilitation given is concerned. While some (52% of the participants) agreed that the needs were met, others (48% of the participants) disagreed and said that they were actually unmet (Ekstam, Johansson, Guidetti, Eriksson & Ytterberg, 2015). Generally, the research was well-done. The only limitation I can point out is that it used a small sample size of 86 participants-too small to be generalized for different settings.
Evidence-Based Practice (EBP) is, as its name suggests, a healthcare practice grounded on scientific evidence. A nurse who is adheres to the principles of EBP uses his own professional knowledge and combines it with scientific evidence generated from research (Alfaro-LeFevre, 2017). Meaning, for this to happen, a nurse must consult other publications from which the required information or evidence is found (Schneider, Whitehead, Lobiondo-Wood & Haber, 2016). EBP has become a popular practice because it is recommended for usage since it can guarantee the delivery of safe, quality, and satisfactory healthcare services to the patients. Nevertheless, the implementation of EBP has been affected by many generic and specific barriers.
Barriers to EBP Implementation
The specific barriers which have been hindering the implementation of EBP include lack of enough time, lack of reading materials, and poor adaptability to modern technology, negligence, and conservativeness. The healthcare practitioners who do not have adequate time cannot get room for engaging in research because they are busy. This usually happens in a place where employees are overworked and are not given enough time to use for research-related activities. Besides, lack of resources like library can hinder the employees from engaging in EBP (Melnyk & Fineout-Overholt, 2015). Without access to the library services, the employees might not get the books, articles, and other publications which contain latest information they need to improve their practice (Academic Skills Unit [Australian Catholic University], 2016). Poor adaptability to modern technological innovations in the field of Information and Communication Technology (ICT) can interfere with effective implementation of EBP. That happens because such employees who cannot use computers and the internet might be left out. Finally, the other generic obstacle that hinders the implementation of EBP is the employees’ levels of education. The less educated one is the more one does not appreciate EBP (Daly, Speedy & Jackson, 2017). That is why such employees tend to ignore and resist the practice because, in their understanding, it is unnecessarily burdensome.
The implementation of EBP has stalled not only because of personal, generic barriers. The generic are the general barriers that are beyond the control of individual employees because they are the responsibility of the organization or the employee to which each worker is attached (Liamputtong, 2016). Generally, the generic barriers can be summed as lack of support for EBP by the management. The culture of EBP cannot virtually thrive in a place where it is not supported by the management. The management can fail to support the practice by overworking its staff, failing to avail library services in the workplace, and empowering individual employees to adopt EBP (Polit & Beck, 2017). All these happen in the organizations which are not committed to EBP because they lack the policies which are geared towards supporting and nurturing it amongst its staff. In such organizations, the workers might face numerous challenges such lack of reading materials as well as accessibility to internet (Hoffmann, Bennett, Del Mar, 2017). These might happen because there is not developed ICT infrastructure and library. At the same time, the workers might be overworked and given no time to use for research. Such difficulties might make it impossible for employees to embrace and appreciate EBP.
Conclusion
Critical thinking is a competence that should be possessed by all the nurses. It can enable them to use their critical mind to analyze and critique different scenarios such as publications and case studies. Aunt Sue-Anne is one of the cases that require a critical mind to analyze, comprehend, and understand. Her situation is similar to other stroke patients whose rehabilitation process has been hindered by problems such as lack of provision of family-centered care as well as social support from the loved ones. Such challenges can be ultimately addressed is the healthcare practitioners take advantage of EBP. However, in such much as EBP is credited to be such an invaluable practice, the paper has proven that its effective implementation might not be achieved unless the generic and specific barriers are ultimately addressed.
References
Academic Skills Unit [Australian Catholic University]. (2016). ACU study guide: Skills for success (Revised 3rd ed.). Australian Catholic University: North Sydney, Australia. Retrieved from https://handbook.acu.edu.au/43380
Alfaro-LeFevre, R. (2017). Critical Thinking, Clinical Reasoning, and Clinical Judgment. Philadelphia, PA: Elsevier Inc. Retrieved from
https://www.clinicalkey.com.au/nursing/dura/browse/bookChapter/3-s2.0-C20140015225
Daly, J., Speedy, S., & Jackson, D. (2017). Contexts of Nursing (5th ed.). Chatswood, NSW: Elsevier Australia. Retrieved from https://www.clinicalkey.com.au/nursing/dura/browse/bookChapter/3-s2.0-C20120076892
Ekstam, L., Johansson, U., Guidetti, S., Eriksson, G., & Ytterberg, C. (2015). The combined
perceptions of people with stroke and their carers regarding rehabilitation needs 1 year after stroke: a mixed methods study. BMJ open, 5(2), e006784.
Greenhalgh, T.M., Bidewell, J., Crisp, E., Lambros, A., &Warland, J. (2017). Understanding research methods for evidence-based practice in health. (1st ed.). Milton, Qld:Wiley. Retrieved from https://ezproxy.acu.edu.au/login?url=https://ebookcentral.proquest.com/lib/acu/detail.action?docID=47 48116
Hoffmann, T., Bennett, S., Del Mar, C. (2017). Evidence-based practice: Across the health professions (3rd ed.). Chatswood, NSW: Churchill Livingstone Australia. Retrieved from https://www.clinicalkey.com.au/nursing/dura/browse/bookChapter/3-s2.0-C20110042990
Liamputtong, P. (Ed.). (2016). Research methods in health: Foundations for evidence-based
practice (3rd ed.). South Melbourne, Australia: Oxford University Press. Retrieved from https://ezproxy.acu.edu.au/login?url=https://ACU.eblib.com/patron/FullRecord.aspx?p=1986006
Melnyk, B., & Fineout-Overholt, E. (2015). Evidence-based practice in nursing & healthcare: A guide to best practice (3rdedn.). Philadelphia: Wolters Kluwer.
Polit, D., & Beck, C.T. (2017). Generating and assessing evidence for nursing practice (10th
ed.). Philadelphia, PA: Wolters Kluwer/ Lippincott Williams & Wilkins.
Richardson-Tench, M., Taylor, B., Kermode, S., & Roberts, K. (2016). Inquiry in health care (5th [ACU] ed.). South Melbourne, Australia: Cengage Learning.
Schneider, Z., Whitehead, D. L., Lobiondo-Wood, G., & Haber, J. (2016). Nursing and midwifery research: Methods and appraisal for evidence based practice (5th ed.). Chatswood, Australia: Elsevier. Retrieved from https://www.clinicalkey.com.au/nursing/dura/browse/bookChapter/3s2.0-C20140029061
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