Practical Application Of Evidence Based Practice Nursing Students Nursing Essay

In the modern era of health care services, most health care practices practiced by healthcare organizations are based on research. It gives a positive presentation of teaching and learning activities based on patient care needs and is also cost effective (Doebbeling et al. 2006, Higgs J., & Jones M., 2000). Applications with the absence of critical thinking proof might be risky to patients. The same can be said when relating to any situation where the evidence says otherwise (Zelm , 2006).

According to Rycroft – Malone et al (2004), evidence is a major study based on a systematic review that has been identified by researchers and subsequently included their views and results from the quality improvement and enhancement programs. s

Whilst and banning (2005) also claimed that evidence expanded and is widely used in practice because there are more educated individuals, the increase in public awareness and also the increasing rate in productivity and cost efficiency while providing high quality health services. This resulted in the need to access the latest scientific knowledge and also emerges the need for individual practitioners to be able to think critically in the effort to help optimizing patient care results.

The demand for evidence-based decisions has also risen because today’s healthcare services are also increasing beyond the existing resources of service providers. However, this does not speak for individuals working in health and social care environment because there is the need to be able to critically evaluate the latest research. Cormack (2000) said critical evaluation (critical appraisal) is the process of systematically evaluating and interpreting evidence by considering validity, the results and relevancy. Obviously it is important to be fair and not prejudicial to the research being done.

Critical assessment, which is sometimes referred to as criticizing, is more focus to find the advantages and disadvantages of a particular rsesearch and make a fair decision on what was presented in the publication. If all the studies with weaknesses and flaw are to be ignored, then there will be no evidence that can be relate to neither being used in future practics. The ability to wisely identify and study those research weaknesses and flaw would more likely to ensure the accuracy and validity of future research outcomes. Burns (2000) concluded that being critical means being able to make judgments about the value of a work or literature art in the context of how a critical evaluation of a study is to be done.

This paper focuses on a study of nursing students’ motivation towards their learning. The objective of this paper is to criticize a selective review of the Bio Medical central issue in the year of 2008. This study is found beneficial for health care sector workers, particularly nurses. The Nursing field is working to develop evidence-based practice, which involves finding, criticizing, and applying evidence in practices. According to Parahoo (1997) nurses are expected to be able to understand and critique research and work related to their practices as well as identifying the importance and relevance of the research to the current practice in order to improve and enhance the quality of patient care practices. Criticizing a study involves an in-depth and comprehensive examination of all the aspects included in the study with the intention to further consider the benefits or strengths, the limitations means and the significance of the study (ha, 1996).

Polite & Beck (2004) suggested that nurses are encouraged to use evidence in their profession to ensure that the best care given to patients is also cost effective. The proposal is supported by Regan (1998), whom stated that providing both excellent and effective care to patients is the basis for evidence-based practice.

I will further critically analyze this research paper and point out several recommendations and to apply the results and recommendations contained in it in my practice environment.

The title of the study is ‘Nursing Student Motivation Toward Their studies – a survey study’. The title clearly reflects the overall content of the study. It is to inform and acknowledge readers about what is being studied and the type of study which is survey study. The title of an article review should be concise and precisely reflect the content aside from being able to attract readers and encourage them to further read the content (Cormack, 1996; Parahoo, 1997). The selected topic is relevant to my work place, in terms of the factors that influence our choices, which forms the direction and strength and continuity in our thinking and behavior (Kelly, 2003). Research topic is considered appropriate if we take into account the importance of the relationship between motivation and results. By analyzing the estimated degree of students’ motivation during and in different semesters, this research could also enhance and improve their learning.

The study was conducted by two researchers, Kerstin EL Nilson from Medical School, University of Skovde Sweden and Margareta I Warren Stomberg from the Institute of Health and Care Science, Sahlgrenska Academy at Coteberg, Coteberg Sweden. Although both of the researchers are from the same country, their background is not described, only their department was mentioned.

Abstract provides consise yet precise summary of the study by including a glimpse of the objectives, methods, results and conclusions, which also attract readers to further read the entire article. According to ha & Moule (2006), the abstract is a brief summary that identifies the different stages of the review process. Abstract offers a good overview content of the research which can be seen in this paper. It explains how information accessed from selected participants, in terms of survey in the form of questionnaires. This allows readers to decide by themselves whether to continue reading or otherwise.

This study is found to be well designed and its objectives are clearly defined. When the objectives are clearly defined, other aspects of the design of the study will blend in nicely and smoothly (Cormack 1996). The objective of this study was stated in the abstract and in the body of the article. This shows that it has been well studied and a literature review was conducted carefully and with great concern to further equipped the work with credibility.

In this study, qualitative approach was carried out since research is commonly involving human behavior and changes within their behavior. Qualitative studies are often utilized when one does not possess adequate knowledge related to a particular issue or matter. Participants can express their feelings and experiences about certain issue or phenomenon in their own words.

According to Morse & Field (1999), qualitative research can help us better understand the reality, to reflect and explain the social world and develop models and also theoretical explanations. Baldwin and Nail (2000) defined qualitative research as a method of advertising research, which is to emphasize the meaning of quality in terms of views and perceptions of consumers, for example, in-depth interviews and focus groups.

Qualitative study is a systematic and subjective approach to describe and potray life experiences and the meaning within it. However, it also comes with a drawback in which researchers admitted the fact that when they have any subjective feelings related to a critical phenomenon, they would be inclined to reflect and include their personal perception and understanding of the phenomenon being studied (Jackson, Daly & Chang, 2003).

Literature review is an evaluation report of information found in the literature which related to the selected study. According to ha & Moule (2006), literature review is a written work to evaluate and conclude a specific subject in only a few details. Literature reviews are conducted in order to either determine the results of previous studies or to know whether the problems in previous studies were successfully overcame and then repeat the same steps to solve similar problems encountered in the current study (Dempsey & Dempsey, 1996).

These processes account for the strategies, methodologies, data collection, data analysis, discussion and recommendations for future practice. In addition, it also informs the reader that the author recognizes that there are other studies that may have similarities with their studies, nevertheless this study reinforce the relevance of their research implementation, and reflect the fact that if they repeat the same study, it will only be a waste of time , resources and effort (Parohoo, 1997).

This literature review mentioned a total of 24 references, of which 16 references are from primary sources, while the remaining six are secondary sources. As stated by Mc Burney & White (2004), a primary source is the original material. Primary sources are from the original time frame involved and have not filtered through translation. Secondary source is a detailed, written only after the fact interpreted. It is the evaluation and translation of the primary sources. These resources are not considered as evidence, but rather as comments and discussions related to evidence.

This study also deploy a variety of extensive literature sources, such as books, journals, articles and also statistical analysis performed during the period from April to May 2006. A literature review which are both latest and comprehensive presented in which researchers involved aware of the latest information and the need for additional research.

Research design involved the planning of implementation of a specific study (ha & Moule, 2006). The research design deployed in this study is a survey study in which survey study is carried out in accordance with the expected reasons. Researchers will study their subjects and find the effects caused by the expected reasons. According to the Burn & Grove (2001), within the scope of scientific thinking, survey study applied in two ways. First, it is used in a broad sense as any descriptive studies or correlational studies. In this sense, the survey used to describe a data collection technique in which questionnaires or personal interviews are used to collect data about a specific identified population. Data collection was performed by two researchers. One researcher accompanied by a volunteer randomly attended a university nursing program at a medium-sized university in central Sweden with the intention to obtain related information from students who are willing to take part in the study. Completed questionnaires collected after lecture session ended.

Compilation of information about research procedures and the steps required are adequate to understand how data is collected and measured. Questionnaire distribution is a popular research method and used frequently by researchers (Leininger 1985). Morse (1999) says that questions which are very open and complex can be restructured and modified to be able to answer various research questions. Distribution of questionnaires is the medium through which data is collected. Open end questions can provide a variety of information but more time is required to respond and analyze compared to a closed end question (Kerlinger & Lee. 2000). Among the benefits of deploying questionnaire method to gather information are including cost reduction while have access to samples around the world, capable of providing large samples at a time and is more likely to reduce research bias (ha & Moule, 2006).

Although the researchers who conducted this study provide limited information as well as not providing information related to the selected questions, the methods used to collect data are appropriate.

Reliability and validity of data collection method deployed in the study is important because it contributes to the credibility of the data collected as well as the research outcomes. As proposed by Polit & Beck (2006), a valid and reliable instrument used to measure what is expected and is also able to provide consistent reading is considered as the ideal tool for measurement. Therefore, a valid instrument measures what it is supposed to measure and a reliable instrument measures what it is supposed to measure (Robson, 2002).

Participants of this study are divided into six groups which consisted of nursing students from 1st to 6th semester. Out of the total number of students who took part (597), only 315 randomly selected students who attended the lecture took part. As all students who were invited to participate in the study consensusly agreed, the response rate was 100%. However, the response rate of the overall student population was 53%, of which 18% consisted of male and 82% of female. Questionnaires were distributed to students from first semester, second semester, third semester, fourth semester, fifth semester to sixth semester. The mean age for first to third semester students are 27 years old, 29 years for fourth semester students, 28 years for fifth semester and 32 years for sixth semester. Mean score for the motivation of the entire semester is 6.3. Figure 1 shows the motivation score for each semester.

The researchers have taken the necessary effort to comply with basic ethical principles while conducting research by obtaining written permission from participants. One of the crucial obligations when conducting human related research is to obtain written permission. Written permission means that the subjects have adequate information about the study, the ability to understand the information and provided with optional choices which mean that it is up to the subject whether to volunteer or reject the invitation to participate in the study (Polit & Hungler, 1993). As stated by Lahmeyer (2006), the process of getting the written permission including which all participants are obligated to go through all the stages presented in the clinical study. The written permission processes inform the participants about the objectives of the study, procedures involved, risks that may exist and also benefit of the study.

No measure was taken to ensure the privacy of participants involved in the study. Each participant is only given a letter of written permission. However, no physical danger, discomfort or psychological stress might interfere in the study. Participants are not deceived in any way possible because they are fully aware and conscious while participating in the study. The study was approved by the Institute of the University which involved in the study but it is not monitored by any Institutional Review Board or any ethics committee of its kind.

Based on the research article, the results of the study was clearly and systematically presented. It is both reliable and valid. According to Gerrish and Lacey (2006), reliability is a term that reflects the consistency and reproducibility of a measurement, while validity is the actual level of instruments and procedures to ensure what is measured. The researchers conducted a specific discussion about their study and clearly outline the significance of the findings of the study. Table 1 provide information on categories of data. A category can be measured as either positive value category or negative value category.

The study is considered as valid and reliable because during the analysis phase the two researchers have taken their effort to independently perform analysis and later compare the analysis. Thus, the influence of personal perception of the researchers related to the study can be avoided and they are also fully aware of the risks found in the research process. All data is stored in an information base and analyzed by using the Statistical Package for the Sciences (SPSS version 14.0). Data are divided into categories similar to the categories in the questionnaire where statistical calculation performed were including frequency counts, mean, percentages and other standard statistical counts.

Non-parametric Kruskal Wallis Test was used when comparing the graded motivation between semesters. Mantel test was applied for comparison between gender and motivation where background variables included. Further data were analyzed according to gender perspective with motivation score between <4 and> 6 as well as the extreme scores of 0 or 10. Reliability of the accuracy of these instruments reflects the true nature of the review score. Open end questions in the questionnaires were analyzed systematically by analyzing oral or written data so that a specific phenomenon can be pictured and quantified into categories of low content but interrelated in terms of similar meaning.

The results of the study were presented in table format. One figure and three tables presented for each different result. The results of the study are considered as well presented since the results were clearly indicated and supported by figures and tables. Apart from that, statistical analysis is also done well. In Figure 1, researchers focused on motivational score for each semester where scores were found to be significantly different for each semester. In Table 1, the researchers focused on the formulation of existing categories of data after the analysis was performed. A category is measured as either positive value or negative value. Each subject of the study may provide more than one reason for their graded motivational scores. In Table 2, researchers have identified a low rate of motivation with a frequency score of <4. Meanwhile Table 3 describes the categories that emerged with strong motivation score with a frequency response of > 6.

The authors also stated the limitations found while conducting the study. As stated by Polit & Beck (2006), a reviewer should be careful if the discussion fails to state any limitation of the study. Conducting a research is the best party to detect and assess the impact of the lack of sampling, practical constraints, quality problems and so on and it is indeed a professional reliability to inform readers about these problems. The researchers included both report of the expected results and unexpected results. Limitations of study are the use of scale in positioning. It can be seen as a limitation because it only grade views on the motivation of students. The limitations in comparing students from different semesters lies within the students themselves, such as undertaking the same curriculum, studying at the same university and there was no change in the organization during the period of learning.

The results of this study show potential, but further research is required in order to yield more positive results before any dramatic changes regarding nursing student performance recommendations can take place in Malaysia. The objective was to analyze the degree of motivation of nursing students from different semesters of learning and identify the reasons behind the motivation grade. This study has shown that most nursing students grade their motivations differently yet positively. However, during the first three semesters of learning, their grades show a positive and quite similar in pattern. Afterwards there was a slight difference between the fourth semester to sixth semester. Figure 1 shows the mean distribution quite well. Mc Evan & Goldenberg (1999) considers motivation is to be given high grades for first and last semester, which marks their fresh college entry and also right before they start entering the working environment.

This study draws attention to the needs of the students to understand the situation and their needs for tutorial support. Nurses who made clinical decisions based on scientific information document is professionally reliable and also help nurses to establish their professional identity. In view of the students being the subject of the study, it is more likely to influence them in a more positive attitude and encourage them to give positive statements when responding to open-ended questions. According to Bandura A (1982), the ability of students to assess their own competence and capability is a motivational factor which gives a positive impact.

The study shows the importance of providing tutorial support for students in a broader perspective other than academic achievement. This can be implemented by promoting flexibility in planning personal learning program (Janhonen & Vanhanan, 2000). It also emphasizes the responsibilities of lecturers and universities to provide support to students, especially when they are less motivated to study which consequently affect their academic performance. However, the publication of the research findings does not guarantee that practitioners will use the techniques described in the study (Gerrish & Lacey, 2006). Achieving evidence-based practice is a complex responsibility.

With the presence of strong evidence to support any changes in practice, the reason behind it being difficult to implement the findings should be explored. According to ha & Moule (2006), practical reasons act as a barrier to the implementation of the study, including not working in a similar culture where debate, review and critical awareness is something that is encouraged, and also a working culture that does not encourage any changes. Certain terms and conditions are essential for the implementation of successful evidence-based practice. It includes the establishment of practices that encourage knowledge application, a system that supports practitioners’ access to knowledge and practitioners who are willing to review their practices and consider other alternatives to it. Individuals who work within the establishment and environment of such practices will be able to see that knowledge-based practices will increase positive outcomes, proving a sense of professionalism and enhance job satisfaction (Barsteiner, 1996).

However, various studies have also reported strong barriers that limit utilization of research. Barsteiner (1996) has said that the most often reported constraint is the insufficient level of authority to implement changes in practice, inadequate administrative support, difficulty in obtaining access to the results of the study and the discomfort of staff to critique research findings in determining the clinical relevance of the study.

According to the authors, their study shows that there is a need to increase nursing students’ motivation. There were also nursing students who merely graded their motivation as being positive and distributed the similar grades evenly during their entire education period. The most important motivational factor is the intrinsic factor and goal-oriented, which is to become a nurse. Nursing students did mentioned intrinsic factor motivation as an explanation to their degree of motivation. These results emphasize the need to understand their situation and needs for students’ tutorial support. Restructuring programs should be designed in partnership with students to match the course content with the degree of motivation during different academic years. In our prospective study, we will monitor and observe the degree of motivation on a group of students in one class during their three years of learning.

In future, we expect nurses to be more motivated, being comfortable and dedicated to their job, being concerned with sincerity, able to identify the underlying problem or problems that may suffered by client and subsequently develop research-based strategies. There is a strong motivation among nurses to apply research findings into evidence-based nursing practice. In the effort of reducing cost, the result which is client-oriented is increasingly becoming the focus of health care. Whenever health care is given and provided based on the most excellent current evidence, intervention will become more effective and improve client results. Without a doubt, controversy in inevitable, but we have to practice what we believe without feeling guilty. According to Klosser T. (2005), a combination of good evidence paired with a broad experience would produce a good practice. This is also the reason why the findings of this study is important to be analyzed as well as trying to understand the level of nursing students’ motivation , especially at the location where study was conducted by researchers.

In my view as a provider of health services, we are encouraged to read more journals and conduct online searching to find reliable and valid research and evidence based articles. Health care professionals and nurses should find solutions, options and results to achieve an effective patient care. Polit, Beck & Hungers (2001) said that a professional health worker should read more and able to think critically, able to apply theories based on reliable evidence and must attend professional seminars in the effort to promote utilizations of the research results. Thus, the Nursing Association can start promoting evidence-based practice in nursing practice through continuing professional development, such as Continuous Medical Education and Continuous Nursing Education (CME and CNE).

Paradigm shift in health care is now more focused on evidence based practice (EBP) and act as guidance in reaching healthcare decisions. Rycroft-Malone et al. (2004) emphasized that the best evidence intergrated knowledge from various sources including research, clinical experience, patients’ and clients’ testimonials and also the local context. The need to integrate knowledge from various sources is essential because research evidence should be aligned with the experience and preference of patient.

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