CRITIQUING A JOURNAL ARTICLE

TITLE

Critique question: Is the title a good one, succinctly suggesting key variables and the study

population?

The title of the journal article labelled Final year student nurses experiences of wound

care: an evaluation, summed up in ten (10) words, clearly identifies the nature of the study and

falls within the desired word limit which according to (Polit & Beck, 2010) should be fifteen

(15) words or less. Furthermore, since the article is considered a quantitative study, the title

should consist of the independent and dependent variables along with the target population. In

this study, the dependent variable is identified as final year student nurses experiences, the

independent variable as wound care and the study population as final year student nurses.

For that reason, in answering the question it is safe to say that the title is indeed a good one as the

key variables and the study population are clear and justifiable. Also the purpose and nature of

the study is reflected in short wordings making it easier and less perplexing for the reader to

understand.
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ABSTRACT

Critique question: Does the abstract clearly and concisely summarize the main features of

the report (problem, methods, results, conclusions)?

The abstract should provide a succinct overview of the research and should include

information regarding the purpose of the study, method, sample size and selection, the main

findings and conclusions (Dale, 2005). To boot, according to (Polit & Beck, 2010), the abstract

should also answer in 100 to 150 words, the questions concerning the main features. These

questions include: What were the research questions? What methods did the researcher use to

address those questions? What did the researcher find? What are the implications for nursing

practice? However, it is important to note the abstract found at the beginning of the article

exceeded the word limit; as it summed up to a total of 343 words.

Moving on, while research questions were not included in the abstract, the author did

include the problem statement which stated This article reports on research to explore if pre

registration nursing students felt prepared to manage patients skin integrity effectively on

registration. The method utilized was not clearly identified however the data collection

technique was mentioned in the fourth (4th) line of the abstract as questionnaires; which 217 final

year students (196 females; 21 males) were invited to complete. These students completing adult,

child and mental health fields of nursing were selected from two Higher Education Institutions in

the North of England.

Also highlighted were the results from the study. It revealed that the majority of

respondents (146; 67.9%) reported receiving less than 10 hours formal teaching at both

Universities on the subject of skin integrity over their 3-year courses. 198 (98.6%) of
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respondents reported that their clinical teaching was undertaken by registered nurses all or some

of the time. Other health professionals were reported to provide substantially less clinical

teaching; with the next largest contribution reported to be provided by specialist nurses, who

provided all clinical teaching to 36 respondents (18.6%) and some clinical teaching to 115

respondents (59.3%). Respondents claimed that teaching received had developed their

knowledge and skills, reporting an average of 16.9 hours spent in directed study; whereas those

who did not claim that teaching they had received had developed their knowledge and skills

reported an average of 7.64 hours spent in directed study. This difference was found to be

significant using an independent samples t-test corrected for unequal variances. As a result, the

conclusion at the end of the abstract stated that diplomat nurses are likely to feel more confident

and competent than their graduate counterparts, despite spending the same amount of time with

mentors and their peers.

All together, while the abstract did not solutions to decrease retentions, it was clear and

comprehensive making it easy to justify. Although it crossed the word limit and research

questions were not present, it did summarize the other main features as well as answered some of

the questions concerning these features.

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INTRODUCTION

Statement of the Problem

Critique question: Is the problem stated unambiguously, and is it easy to identify?

A research problem is often first presented to the reader in the introduction to the study

(Bassett, 2003). In the article, although the introduction section was not labelled, after reading

the article a few times, the introduction was identified as the first four (4) paragraphs following

the abstract. It was from this the problem There have been reports that pre registration nurses

do not receive adequate tissue viability education, was made mention of in the third (3rd)

paragraph. The authors further cited Ayello et al. (2005) reports of 70% of nurses feeling that

they did not receive sufficient education on chronic wounds in their basic nurse training.

Additionally, it was also suggested by Fletcher (2007) that education provision for clinicians

could be haphazard, with little if any information on wound care delivered in pre-registration

programmes and access to post registration programmes being restricted by availability and

funding. Therefore, the research gives an insight into the problem by providing data relating to

the level and amount of wound care/management of skin integrity education delivered in pre

registration nursing curricula.

To answer the question, I would say although the Introduction section was not labelled,

the problem was stated unambiguously and provided knowledge specific to the topic.
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Critique question: Does the problem statement build a cogent and persuasive argument for

the new study?

A good problem statement is a well structured declaration of what the problem is,

what it is that needs fixing, or what it is that is poorly understood. It should be focused on the

topic, state the nature of the problem, how big a problem it is, how many people are affected and

it sometimes provides solutions to the problem.

Clearly identified in the introduction, the problem statement focused on its subject of

matter. It provided background information in paragraph two (2) to make certain that the

audience is aware of both the general problem as well as the specific issue or issues the writer is

addressing (for instance, not just the problem of tissue viability but the specific problem of pre

registration nurses education on tissue viability). This background information identified some

consequences as a result of the problem and it offered compelling statistical data to support the

topic of discussion. A solution was also made mention by The Department of Health (DH)

(2008) which stated that it is imperative that in order to achieve high quality care for all we must

build on existing local governance. It identified steps to achieve this that included the recognition

of benchmarks to raise standards, safeguard quality and to stay ahead. It is therefore important

that student nurses are prepared for, and aware of, research and evidence underpinning effective

prevention and management strategies of preserving skin integrity, to maintain and promote

quality of care upon completion of their nurse education programmes.

All together, all of the components were clearly articulated, it therefore provided a basis

for the new study, definitions and statistics were shown to support the topic with a solution

mentioned every one building a cogent and persuasive argument for the new study.
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Critique question: Does the problem have significance for nursing?

In the article being critiqued, although the researchers did not out rightly mention the

problem being linked to ways in which the study can be significant to nursing, in my opinion I

think it can be of some worth. Reason being is since research is essential for continued

development of knowledge in nursing; the data manifested in the study can be used to further

enhance the educational experiences of upcoming nursing students in the area of wound care.

The Department of Health (DH) (2008) stated, It is important that student nurses are prepared

for, and aware of, research and evidence underpinning effective prevention and management

strategies of preserving skin integrity, to maintain and promote quality of care upon completion

of their nurse education programmes. Therefore, improving nursing students education of

wound care in pre registration curricula can lead to a positive impact on the continuum of

health being of significance to nursing.

Critique question: Is there a good match between the research problem and the paradigm

and methods used? Is a quantitative approach appropriate?

To answer the question, I would say that a good match between the research problem and

the paradigm and methods used was evident. Since the article involved the representation and

analysis of data in the form of numbers, it is safe to say a quantitative approach was used which

is generally associated with the positivist paradigm. Additionally, quantitative research methods

require the scientific method of investigation in which measurement is necessary. It involves an

empirical or theoretical basis for the investigation of populations and samples. In this study, the

researcher tried to delve into the level and amount of wound care/management of skin integrity
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education that is delivered in pre registration nursing curricula at two (2) institutions. This was

done through the use of a questionnaire which was related to final year nursing students intuition

on managing patients skin integrity effectively. Since these variables cannot be directly

observed, an instrument was used which asked the subjects to self report on these variables;

and so a questionnaire did the job. Therefore the quantitative approach was appropriate.

Hypothesis or research questions

Critique question: Are research questions and/or hypotheses explicitly stated? If not, is their

absence justied?

The research questions are specific queries researchers want to answer in addressing the

research problem (Polit & Beck, 2010) while the hypothesis describes the relationship between

two or more complex concepts. A good research question/hypothesis should include the

following: the participants, the clinical context, the phenomenon of concern, intervention,

comparison group and outcomes (Johnson & Sims, 2011). In the study, the research questions

neither the hypothesis were mentioned in the introduction. There were no justifications for their

absence, but a study aim and project objectives were seen at the end of the introduction. While

the hypothesis and research questions are needed to form a link between the initially stated

purpose of the study or research problem, the aim and objectives can play the role of these to

some extent. The aim which is to explore if pre registration nursing students felt prepared to

manage patients skin integrity effectively on registration can be used as a guide to the problem

that needs to be solved. On the other hand, the objectives: - 1. To ascertain how many formal

teaching sessions pre registration nursing students receive in relation to managing skin integrity
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during their 3-year training programme 2. To discover if pre registration nursing students receive

supplementary management of skin integrity teaching in the clinical areas 3. To explore which

member of staff in the clinical areas supports the students learning in the area of skin integrity

are normally used in conjunction with the research questions to identify its goals.

Critique question: Are questions and hypotheses appropriately worded, with clear

specication of key variables and the study population?

Since there were neither of each evident in the study, this question will not be applicable.

Critique question: Are the questions/hypotheses consistent with the literature review and the

conceptual framework?
Since there were neither of each evident in the study, this question will not be applicable.

Literature Review

Critique question: Is the literature review up-to-date and based mainly on primary sources?

A good review usually begins with an introduction which identifies the key words used to

conduct the search and information about which databases were used. It provides the reader with

a comprehensive review of the literature related to the problem under investigation. The article

provided key words such as Pre registration, education, wound and clinical practice used to

conduct the research. A date provided as March, 2013 I would believe was the publication date of
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the article. The review of related literature was divided into subsections throughout the article as

to logically organize the information presented and it greatly expanded upon the background

information already incorporated in the introduction section. The review was accompanied by

comprehensive references consisting of twenty two (22) citations of which sixteen (16) were

the earliest publications (2001 2009) and the other six (6) being the most recent (2010 2012).

Another important observation was the type and source of literature represented, which was

identified as mainly primary sources since the researcher provided original empirical evidence in

the article. From my point of view, I would say the review was up to date given that some of

studies included were of recent origin and were within an appropriate time frame.

Critique question: Does the literature review provide a state-of-the-art synthesis of evidence

on the research problem?

According to Polit & Beck (2010), a written research review should provide readers with

an objective, well organized synthesis of current evidence on a topic. In my opinion, the article

does provide a state of the art synthesis of evidence on the research problem provided that

selective citations were presented to discuss the relevance of the study and gave a fair evaluation

of them. While it may have contained some older citations, they were of great credibility being

sourced from valuable educational journals and other applied sciences. The findings were

summarized clarifying the need for the research, presenting and analyzing the available data

framing the results so they can be translated. All were of contribution to the problem and related

well to nursing.
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Critique question: Does the literature review provide a solid basis for the new study?

A literature review helps to lay the foundation and provide context for a new study and

the literature review of the article did just that by providing a solid basis for the study. It should

also help to identify any gaps in the literature relating to the problem and to suggest how those

gaps might be filled. The background information expanded upon offered a conclusion which

identified the gap of tissue viability care educational needs in the nursing students between the

degree undergraduate programmes and the diplomate programme. As a result, the study

identified the need for curriculum development in tissue viability for the degree programme as

compared to the diplomate approach to learning.

Conceptual/theoretical framework

Critique question: Are key concepts adequately dened conceptually?

In the article, the researchers only provided a conceptual definition for the key concept of wound

care i.e. tissue viability in the introduction. The definition according to UKs Tissue Viability

Society (2012), defines it as a growing speciality that primarily considers all aspects of skin and

soft tissue wounds, including acute surgical wounds, pressure ulcers and all forms of leg

ulceration. This helps the reader understand what is referred to as wound care. However

conceptual definitions for the other variables final year student nurses experiences, were not

adequately defined.
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Critique question: Is there a conceptual/theoretical framework, rationale, and/or map, and (if

so) is it appropriate? If not, is the absence of one justied?

While a sound framework is needed to identify the various concepts being studied and the

relationship between those concepts, from my point of view, it appeared that the authors did

not make any conceptual/theoretical framework for this study. To boot, the absence for any

theoretical or conceptual basis was not justified.

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METHOD

Protection of participants rights

Critique question: Were appropriate procedures used to safeguard the rights of study

participants? Was the study subject to external review by an IRB/ethics review board?

In conducting studies, it is necessary that the participants are safeguarded. This should be

done by applying the four fundamental principles i.e. autonomy, non maleficence, beneficence

and justice. From reading the article several times, in my opinion the only principle identified in

the study was that of autonomy. Autonomy infers that an individual has the right to freely

decide to participate in a research study without fear of coercion and with a full knowledge of

what is being investigated (Beauchamp, 2001). This was evident in the first four (4) lines in the

first (1st) paragraph under data collection. Rather than receiving an informed consent, the article

stated, all participants received a comprehensive letter of invitation explaining the study

objectives. Potential participants were given time to consider the information and to decide if

they were willing to take part. Later on, the researcher also mentioned that Students were not

obliged to participate and there was no coercion for them to do so. In addition, the study should

have been reviewed by an Institutional Review Board to receive approval before research can be

undertaken; instead ethical approval was successfully received from each schools research and

ethics panel to undertake the study.

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Critique question: Was the study designed to minimize risks and maximize benefits to

participants?

In my opinion, I dont think the study was designed to minimize the risks. While the

questionnaires should not utilize the students names, those who completed the questionnaire the

same day as mentioned in the study, could have possibly been under the influence of their

module leaders since they were the ones who distributed the questionnaires. In comparison to

the participants who probably took advantage of the option to complete the questionnaire and

post it at a later date to the principal investigator. The module leaders I would assume were the

ones to conduct the teaching sessions. Therefore, since their role is significant to the educational

expertise of the students, with them distributing the questionnaires the participants may have

been intimidated, given that there is a relation to their experiences of learning about managing

patients skin integrity needs in the questionnaires. From my point of view, this could have

resulted in imprecise data being collected. While the study did not indicate how it can maximize

benefits to the participants, I would say that to the upcoming students their clinical competence

would be developed and they should be able to feel more confident in performing clinical skills.

The study can maximize the participants benefits seeing that the article stated it was

reassuring to note, that all respondents stated they would ensure their knowledge was kept

up to date on registration through attendance at study days and accessing specialist courses

at university. There was also recognition that skills could be developed and updated by

working and learning from specialist staff.

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Research Design

Critique question: Was the most rigorous possible design used, given the purpose of the

research?

The research design is the overall plan that guides the way the study is conducted and

analyzed. From reading the article, I must first indicate that the use of any specific research

design was not mentioned by the researchers. Nevertheless, seeing that the article is utilizing an

exploratory research method identified by its problem statement which stated To explore . . . I

would say the presence of a pre determined design is often not found. The reason for that

statement is due to the fact that being an exploratory/formulative study; its main purpose would

be to formulate the research problem. These types of studies are conducted in order to determine

the nature of the problem and are not intended to provide conclusive evidence; but assists in

having a better understanding of the problem merely exploring the research topic with varying

levels of depth. In other words, it helps to do the exploratory study as methodically as possible, if

it is going to be used to establish an understanding of how best to proceed in studying the issue

or what methodology would effectively apply to gathering information about the issue for later

investigation (Nargundkar, 2003).

According to Polit & Beck (2010), substantively the issue is whether the researcher

selected a design that matches the aims of the research. If the research purpose is descriptive or

exploratory, an experimental design is not appropriate. Therefore, since an experimental design is

not appropriate in the case of this research, I would believe a non experimental research design

in the form of a survey research was utilized. A survey research study is an investigation in

which self reported data is collected from sample with the purpose of describing population on
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some variables of interest (Suresh, 2014). This was achieved through the utilization of

questionnaires in the study. Also, a non experimental design uses what is already occurring in a

particular setting with a particular group of subjects to describe certain variables or to explore

relationships between certain variables. This was also evident in the article when it was reported

by Ayello et al (2005) that 70% of nurses felt they did not receive sufficient education on

chronic wounds in their basic nurse training while Fletcher (2007) suggested that education

provision for clinicians could be haphazard, with little if any information on wound care

delivered in pre-registration programmes, and access to post-registration programmes being

restricted by availability and funding. I think this portrays what the abovementioned claim on

non experimental design stated.

As a result, although a pre determined design was not mentioned, I believe that if the

researcher did really use a non experimental design in the form of a survey; it still would be the

most rigorous possible design used. Given that the purpose of the research was to explore the

aim would be to obtain new ideas relating to the research problem and I assume this was

achieved.

Critique question: Were appropriate comparisons made to enhance interpretability of the

findings?

Yes, there were appropriate comparisons made by the researchers to enhance the

interpretability of the findings. The researchers further evaluate the data collected to give a

visual interpretation through the use of tables, box plots and bar graphs from pages 10 16;

which provided insight on the various features/areas of interest in relation to the research.
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Adequate statistical tests were also utilized to show the association and significance between

some of these features. For instance, to portray the significance between the associations of

course type and university hours of teaching the 2 test for association 2(2)=9.76 ; p=0.008

was exercised. Also, later down in the article an independent samples t-test

t 197=2.079 ; p=0.039 was used to show the significance between the mean total hours of

directed study time relating to skin integrity. Meanwhile, the association between course type

and knowledge/skills development were interpreted using the 2 test for association

2(1)=9.50 ; p=0.002 .

Critique question: Was the number of data collection points appropriate?

Data collection points refer to moments in the life of the phenomenon for which data are

to be collected. They do not necessarily coincide with the moments the researcher collects data.

In exploratory studies, the total duration for data collection might be specified at the outset, but

the decision about the number of occasions on which to collect data is often made after the initial

data have been collected and analysed (Sim, 2000). While the timeline for the study along with

the points at which data were collected was not mentioned in the article, since the study was

undertaken in two (2) higher education institutions, I still believe the number of data collection

points was appropriate.

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Critique question: Did the design minimize biases and threats to the internal construct, and

external validity of the study (e.g., was blinding used, was attrition minimized)?

No, I do not think the design minimized biases and threats to the internal construct, and

external validity of the study because some of the participants may have failed to provide

accurate information due to feeling of being pressurized as the module leaders distributed the

questionnaires. Also, since the participants received the letter of invitation explaining the study

objectives, they could have realized the aims guessing the intent of the research leading to an

alteration in their behaviour towards the questions. However, the measurement procedure (QPP

questionnaire) is shown to have strong construct validity, because this questionnaire is something

that was developed gradually over time.

Patients were also consecutively asked if they wanted to participate in the study and were

also made aware of the fact that they were able to leave the study at any point in time. There

were no indications in the article to suggest that blinding or attrition occurred; and I believe

because of the questions contained in the questionnaire blinding could not have been used.

Population and Sample

Critique questions: Was the population identified and described? Was the sample described

in sufficient detail?
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The population and sample size are identified and described in excessive detail as being

217 final year students recruited from two (2) Higher Education Institutions in the North of

England. Data was presented on the 217 students (196 females [90%] and 21 males [9.7%])

while other characteristics were further presented in Table 1 of the article. These characteristics

included their course types of which 26 participants were from the Diploma programme; whilst

the other 191 were from the Degree programme. The table also profiled the different fields of

nursing the participants were selected from (Adult, Child, Mental Heath) which was further

identified as 152, 25, 40 participants respectively. Since the target population were final year

student nurses the researchers invited them via a letter to take part in the study as part of the

final evaluation of their degree or diploma nurse education programme.

Critique question: Was the best possible sampling design used to enhance the samples

representativeness? Were sample biases minimized?

Despite the fact that the authors did not state the sample design they used, from my own

speculations I believe the sampling design chosen for the study was a convenience sample of

final year student nurses in either the degree or diploma programme at two (2) higher education

institutions in the North of England numbering 217 in total. Convenience sampling entails using

the most conveniently available people as participants. (Polit & Beck, 2010, p. 309). However, I

dont believe the samples representativeness was enhanced by using this type of sampling

design. Whilst the degree to which a sample reflects the population it was drawn from

determines its representativeness, a convenience sampling is not representative of the entire

population. Therefore, results can only be applied to the sample and cannot be generalized to the
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population. Also, since this was an exploratory study, I believe the principal focus of the authors

would have been on identifying and exploring the results from the data rather than seeking to

arrive at any definitive conclusions; and so the whole idea of representativeness may not have

been among the purposes of the study. In other words, they would have been seeking to construct

an in depth picture on the topic for further studies.

Consequently, the use of convenience sampling in my opinion would have made the

study highly vulnerable to sample biases. The authors did not give an idea of how they selected

the students between the two (2) institutions or rather the sample size from either institutions to

make up the 217 participants. For this reason, because the sample was not representative of the

entire population, sampling probabilities across the two (2) institutions would not have been

equal and because sampling may have been too much in one area skewed data may have

occurred.

Critique question: Was the sample size adequate? Was a power analysis used to estimate

sample size needs?

According to Gray et. al (2013), as the numbers of variables under study grows, the

needed sample size may also increase. They should be essential to the research purpose or should

have a relationship with the dependent variable. Since the study also involved the use of

extraneous variables such as course type, directed study time, teaching methods, confidence with

knowledge, and skills updating; which all influence the experiences of the student nurses the

size of 217 participants was adequate. However, given that there were more females (196) than
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males (21), there was not an equal division amongst them. Also, the use of a power analysis to

determine the necessary sampling size was not mentioned or evident.

Data collection and measurement

Critique question: Are the operational and conceptual definitions congruent?

As mentioned before, the only concept that was defined in the introduction was tissue

viability i.e wound care; and there were no conceptual definitions for final year, student nurses

and experiences. However, the only identification of an indicator or operation being used to

define the attributes of knowledge, feelings and attitudes was a questionnaire (relating to their

experience of learning about managing patients skin integrity needs).

Critique question: Were key variables operationalized using the best possible method (e.g.,

interviews, observations, and so on) and with adequate justification?

The variables were operationalized using the questionnaire as stated in the data collection

of the article. Additionally, the researcher stated there was room for qualitative comments from

the participants which allowed the participants to self report on these variables. I believe since

this is an exploratory study and utilizing a questionnaire was easy to administer and relatively

inexpensive, I think it was the best possible method. Meanwhile, adequate justification was not

provided.
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Critique question: Are the specific instruments adequately described and were they good

choices, given the study purpose and study population?

The instrument used was a questionnaire and seeing that the study was based on

knowledge, feelings and attitudes it believe it was a good choice; given that questionnaires are

used when psychological data is needed to be measured. The researcher stated Students were

invited to take part in the study as part of the final evaluation of their Degree or Diploma nurse

education programme, and to complete a questionnaire consisting of demographic data and ten

questions relating to their experience of learning about managing patients skin integrity needs.

Additionally there was room for qualitative comments from the participants. The researcher

used statements such as . . . the students were asked to estimate . . . and . . . the students

reported . . . In analyzing the data, statistical tests were utilized. However, I believe if

researchers wanted to achieve more description, another method of data collection would be

interviews.

Critique question: Does the report provide evidence that the data collection methods yielded

data that were high on reliability and validity?

In general, validity is described as the ability of the instrument to measure what it is

supposed to measure and reliability the instrument's ability to consistently and accurately

measure the concept under study. With this being said, I do believe valid results were yielded by
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the questionnaire in an unwavering way. Each response from the questionnaire related to the

concepts of the study was well analyzed and various statistical tests (as mentioned earlier on)

were used to provide further statistical analysis. However, since the researchers did not provide

any information concerning the questionnaire i.e. whether it was a well established off the shelf

instrument and not adapted in any way or was being used for a new population it was difficult

to determine how consistent or dependable it was. Therefore, I believe the researchers should

have indicated how the reliability was established.

Procedures

Critique question: If there was an intervention, is it adequately described, and was it

properly implemented? Did most participants allocated to the intervention group actually

receive the intervention? Was there evidence of intervention fidelity?

There were no interventions used in this study because it was a non-experimental study

thus making the other questions inapplicable.