The purpose of this study is to evaluate an effective intervention that would facilitate successful implementation of Evidence Based Practice (EPB) in the Singapore’s clinical settings (Majid et al. 2011). In this article, the purpose of the study broadens and clarifies the aim of the study, as it endeavors to identify the dependent variables, including knowledge, awareness, and barriers experienced by the medical practitioners while adopting the EBP in Singapore’s public hospitals. More so, the study examines the independent variable, including the literature searching skills and information sources found in the library, among others, in a bid to evaluate the research problem. The moderating variables for the study also come into play as the study affirms that EBP can be facilitated through training and mentoring the nurse practitioners.
Majid et al. (2011) have delved into the relevant previous research and meta- analysis studies, which have enabled them to come up a clear view of what is known about EBP, what is not known, as well as the approach that should be taken by the current researchers on the topic. The authors have articulated the need of EBP on nursing practitioner’s skills. In this article, the authors have identified and carefully described the relevant nursing practices that serve the role of hindering the implementation of EBP despite the nurses’ willingness to adopt the practice. Thus, the authors have specified diverse factors that have hindered the implementation of EBP over the years, citing nursing Scope of practice and work place structure as the common factors amongst the Western countries as well as South Africa. Additionally, the authors have credited the variables used in the past literature as they have delved into studying them for effective adoption of EBP in Singapore’s clinical settings. However, the authors have also criticised the past studies, claiming that interventions have not been carried out appropriately, as it has concentrated on the Western countries, thus raising the need for adopting another approach towards this research study (Polgar & Thomas 2007, p. 34). One of the issues of the topic that is not well known is the fact that research studies on EBP within the South East Asia have not been covered yet. Such kind of research is crucial in clinical practice since it addresses the EBP in region characterised by diverse cultural practices and working patterns (Robson 2011, p. 113).
As such, the authors have described that even though majority of clinical practitioners may demonstrate a positive approach towards adopting the EBP within this Singapore, the finding may prove to be interesting, meaning that they expected the findings to be distinctive from the rest of the research findings across the globe. Thus, the literature review carried out by the authors is consistent with Aveyard (2010, p. 47) recommendation : that a credible research can only be derived from assessing a number of literature to identify the gaps therein and applying credible evidence from findings to determine the authenticity of the studies carried out. The authors have articulated what is known within the literature- EBP within the Western countries as well as factors hindering its implementation, as well as what is not yet known- EBP in South East Asia as well the factors that hinder its implementation, and this makes them affirm that the findings will be interesting.
Thus, this literature review can be justified because it demonstrates a progressive development of EBP ideas by articulating the problems in past literature within the western countries; therefore, it gives room for tangible ideas aimed at improving the study (Thomas 2009, p. 78). A theoretical knowledge base for evaluating EBP has been formulated, and this has created room for credible research question that is able to facilitate an evaluation of the purpose of the study. And even though the literature has not assessed the degree to which the patients should influence the practice, it is credible to affirm that it has provided a direction for the purpose of the study as it is able to question on whether adopting EBP is influenced by diverse cultural groupings with different working patterns (Bowling & Ebrahim 2005, p, 129).
Approach & Methodology
The study has adopted the positivist paradigm, which takes the approach of developing an intervention method after reviewing the empirical studies within the topic under discussion (Majid et al 2011). Thus, the study comes up with a conceptual framework, which focuses on assessing the knowledge, barriers, and awareness level of the nursing practitioners within the heath care settings in Singapore, taking into account that the population comprises of people who depict different backgrounds from the western world.
The quantitative design adopted in this study is in a position of presenting the relationship among the ideas as it articulates how the nursing practitioners can effectively adopt the EBP programs through eliminating the barriers in the process and ,consequently, attaining knowledge and confidence in the practice. Thus, the study is designed in a manner that is able to articulate as well as link the clinical research question with the design, as it is able to test the role of knowledge, barriers, and the awareness level with regard to EBP using the mean values and standard deviations (Brettle & Grant 2004, p. 243). This design is of paramount importance within this study because a high mean value of the study helps the nursing practitioners acquire information on the current affairs affecting implementation of EBP within the health care setting, thus quickening the spirits of the management to adopting measures that facilitate adoption of the practice (Clegg 1990, p. 195).
However, the fact that the question on the implementation of EBP is not well known from the previous research studies means that the study could have adopted a qualitative design, giving room for case study data collection method. This is attributed to the fact that the purpose of the study is not only to emulate the previous research studies carried out in Western countries but to evaluate how EBP can be adopted within the health care institutions in the South East Asian public hospital, which are characterised by different cultural backgrounds and working patterns (Majid et al 2011).
More over, the qualitative design would also be appropriate for this kind of study because the opinion of the workers should not be ruled out, as they are able to help evaluate the impact of different cultural beliefs and practices toward EBP (Clough & Nutbrown 2007, p. 39). In this regard, the research study would be more appropriate if it handled both quantitative and qualitative study design, and the research question would be as follows: To what extent would barriers, knowledge, and awareness level affect the adoption of EBP in Singapore, given that the clinical officers have different working patterns from their Western countries counterparts?
The study design presented in this article focuses on assessing the challenges of implementing EBP within health care settings in Singapore’s public hospitals. However, the design depicts a bias with regard to drawing inferences of the study, as it indicates that majority of the nursing practitioners’ beliefs and attitudes towards EBP are positive, and yet majority of them do not know what EBP entails (Majid et al 2011). Thus, even though the design is characterised by prominent variables, the research study could have reduced this biased inference, as most people would not have a positive attitude towards something they are not aware of.
The authors have identified a big sample size that is relevant for providing substantial results for the study. Among the 2,100 sample papers that were distributed to in two public hospitals, 1486 people managed to respond positively to the study. This study portrays a difference between two groups, with one comprising of nurse practitioners holding a certificate and a diploma, while the other comprising a group holding a bachelor’s and postgraduate degree. But since the two groups are able to distinguish the effects of the study in the same direction, they can be regarded as similar (Finlay & Ballinger 2006, p. 67). Nevertheless, the fact that the sample size was obtained from two public hospitals in Singapore shows that the sample size is based on non-probability sampling, demonstrating a biased sampling method, which has failed to represent other hospitals within the country (Frankel & Devers 2000). More over, the exclusion criteria is biased since it eliminated nurses that were not on duty roster during the study period, and this creates further room for a biased study.
A viable research study in nursing does not only make sure that the rights of the patients are protected but also the rights of the nursing practitioners if they are the subjects of the study (Greenhalgh 2006, p. 26). In this regard, this study is consistent with viable clinical research study as it ascertains that it protects the participants’ rights of anonymity through the Domain Specific Review Board of Singapore (Majid et al. 2011). More so, the researchers made sure that no participant was compelled to participate in the study and that all participants showed positive interest towards the study. However, the study did not entice the participants to tokens, as this may pose threat to validity of the study since the participants may be tempted to act in a manner aimed at pleasing the researchers.
The data collection was collected through survey, which was easy to administer because it is was undemanding while comparing the findings between the nurse practitioners, it can be administered effectively to a large sample size, and it is able to acquire a lot of information regarding the knowledge, the awareness, and barriers to implementation of EBP (Hansen 2006, p. 91). More so, the researchers were able to get full range of information since surveys help to develop a good relationship between the data collectors and the participants, thus applying flexibility where necessary (Hicks 2004, p. 83).
However, considering the study question and design, the data collection methods were not appropriate because such kind of a study, which involves emotions, might not be in a position of evaluating research skills from the nurses, as they may bias their response since the responses are limited to the questions posed by the researchers (Oppenheim 2000, p. 64). More so, surveys call for additional expertise when it comes to sampling the responses. Thus, the study would be more appropriate if it adopted case study data collection method. This stems from the fact that using case study methods helps the researchers get in-depth information of the nurses in a casual way that attempts to understand the nurses’ experiences with regard to their attitude towards EBP (Pope & Mays 2006, p. 22). This design is more appropriate because the research study aims at assessing two public hospitals rather than all public hospitals in Singapore; thus, acquiring the depth of adopting EBP in these hospitals was more relevant than the breadth of the information.
The authors describe the knowledge, the level of awareness, and the barriers of implementation of EBP by presenting the findings through a number of tables, which clearly distinguish different viewpoints between the clinical officers with regard to these variables. Thus, the instrument used in the study [questionnaire], as well as the SPSS data analysis package, proved to be viable since it was in a position of giving the differences in mean values of variables based on a semantic differential scale. The clinical importance of the results is portrayed by the fact that the study has addressed the theoretical problems affecting the nurses in the hospital settings within Singapore by highlighting the correlation between higher education and EBP skills, demonstrating the need of not only providing training to nurse practitioners but also encouraging higher education in clinical education. In doing so, the health care institutions will be in a position of reducing the high number of nursing practitioners who were in the group of ‘ neither agree or disagree,’ since they were not aware of what EBP entails (Silverman 2005, p. 51). The most interesting thing about this study is the fact that even though all participants had the autonomy of dropping out of the study, all of them completed the study successfully.
Reliability & Validity
A research study is termed as reliable when it depicts consistency with regard to the instrument used and findings of the research (Creswell 203, p. 25). The reliability of a research study can be measured through internal consistency, which assesses whether all items in a scale are measuring the same attribute, or through an inter-rater test. The research study depicts reliability, as the Cronbach Alpha tests shows an internal consistency of alpha coefficient of 0.7 to 0.9, which is an exceptionally appropriate scale for this research study (Majid et al 2011). More so, the significance level for majority of the findings proved to be consistent, indicating that there is a very high possibility for all the findings to be regarded as reliable. The validity of the study, on the other hand, can be assessed by establishing the degree at which the study is able to measure the knowledge, the awareness level, as well as the barriers to implementation of the EBP effectively (Creswell 203, p. 31). A pilot study was used to ensure that the research study is characterised by content validity. More over, the construct validity of the study was enhanced through a large sample size [1,486], which forms basis of generalisation in cases where probability sampling has been applied (Wright & London 2009 p. 19). However, since the sample size was based on non-probability sampling, the chances of ascertaining that the study achieved external validity were minimal (Creswell 203, p. 38)
Conclusion & Clinical Implications
Majid et al (2011) have presented this article in a manner that underscores diverse limitation as they affirm that the research study cannot be generalised due to the sampling method adopted. As a result, the authors have admitted that the findings of the study cannot be generalised across South East Asia since the health care setting within the region are diverse, hence characterised by differences in resources. However, even though the study is characterised by a biased sampling method, the authors have presented the study in a manner that depicts proficiency in ascertaining the factors that should be put in place to facilitate effective adoption of EBP in clinical settings (Turner 2009). More so, the authors have recommended a further study that does not adopt questionnaire as the data collection method, but one that uses casual investigation of the research problem. This conclusion has implication on the nursing practice as it presents new challenges of carrying out clinical research studies.
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