Importance of evidence-based practice to nursing
Evidence-based practice is a form of healthcare whereby nursing practices are shaped by the key findings from major research (Polit and Beck, 2008). Solid research is usually identified and implemented in nursing practice. The goal is usually to increase the quality of patient care. It may also ensure cost-effectiveness in nursing. The research that is trusted to provide information that would transform the nursing field varies among institutions.
Some only consider randomized clinical trials as valid research. However, others may use expert opinions or case studies. The qualitative research process involves the collection of information through interviews and discussions in order to understand the patients’ experiences (Polit and Beck, 2011). For such research to be reliable, data collection and testing must be free of bias. Such research produces accurate information that may be used to shape evidence-based practice in nursing (Polit and Beck, 2006).
The research problem of the chosen article was to identify the key factor that influenced the individual’s ability to adopt the principles of ‘Dose Adjustment for Normal Eating’ (DAFNE). This research problem may be used for evidence-based nursing because it is a qualitative research aimed at investigating an issue faced by persons with diabetes type 1 (T1DM). The results may be used to improve nursing care for the diabetic.
Elements influencing believability of the research
The article, ‘A longitudinal qualitative study examining the factors impacting on the ability of persons with T1DM to assimilate the Dose Adjustment for Normal Eating (DAFNE) principles into daily living and how these factors change over time’, was well written. This may be seen in the way scientific words were well selected to fit the particular study and the field of nursing. The authors were also careful to avoid medical jargon by using language and vocabulary relevant to the medical field. Therefore, this promoted the understandability of the piece of work. The paper was also well organized in such a way that it followed the format of writing a research paper.
The sections that were expected to be present in the paper included the abstract, introduction, literature review (background), methodology, results, discussion and conclusion. The areas expected to be included in the methodology section were the various ways in which the sample was selected, the data collection methods, the data analysis procedures and rigor. In this paper, all these sections were present.
Another element influencing the believability of this research is the authors’ qualifications or positions. The authors of the paper were well knowledgeable and showed a degree of knowledge in the field of nursing and medicine in general. Dympna Casey and Kathy Murphy were working in the School of Nursing and Midwifery. They had studied in the National University of Ireland (Galway, Ireland). Julia Lawton, on the other hand, was in the Public Health Science section and Center for Population Health Sciences. She had pursued her studied in the Medical School in the University of Edinburgh (Teviot Place). Florence White was in the Diabetes UK Northern Ireland, Bridgewood House.
Sean Dineen was in the Endocrinology and Diabetes Day Center in the University Hospital Galway and Department of Medicine. She had studied in the National University of Ireland (Galway, Ireland) (Casey, Murphy, Lawton, White, and Dineen, 2011). Judging from their educational background and their current place of work, it is evident that these authors seem to have a wide range of knowledge in the field of medicine and nursing.
The title of the report was quite long but was clear. It also encompassed the full description of the research so as to make the readers understand what was expected from the piece of research. It was also accurate and avoided ambiguity (Burns, Susan, and Grey, 2011). The abstract of the paper was a good representation of the whole study. It provided a summary of the background studies done on that particular field in order to show what other researchers found out.
It also summarized the methodology section of the paper. The results were clearly described and conclusions made. All these areas were summarized under their respective titles in order to enable the reader to follow easily. The authors were also careful to include the keywords so as to facilitate the searching of the paper in case the students and researchers were interested in finding it.
Elements influencing robustness of the research
The phenomenon to be studied was clearly identified by the authors. They had prior knowledge of the prevalence of diabetes in the island of Ireland. A huge proportion of the people with diabetes had the Type 1 Diabetes Mellitus (T1DM) (Funnell, Brown, and Childs, 2008). The authors were also aware that self-management skills were important for such patients since it was required for the management of the condition (Veg, Rosenqvist, and Sarkadi, 2007). The authors were also aware that Ireland was currently delivering the Dose Adjustment for Normal Eating (DAFNE) to persons with Type 1 diabetes (Dinneen and Byrne, 2009). The research questions were also consistent in the paper since the authors clearly identified what they were going to research about. Therefore, the aim of the study was clearly defined.
The purpose of the study was also clearly identified. The authors argued that the research was aimed at identifying the key factor that influenced the individuals’ ability to adopt the principles of ‘Dose Adjustment for Normal Eating’ into their daily lives (Edwall, Danielson, and Ohrn, 2009). The way this changed over time was also to be determined. The factors that were studied included empowerment, prior knowledge, continued support and enduring motivation (Brown, Harris, Webster-Bogaert, 2002). The results would show the best factors that would be put in place in order to ensure that the diabetic would adopt the DAFNE principles (Lawton and Rankin, 2010). With the adoption of the particular principles, the individuals were expected to properly manage their condition (Muhlhauser, Jorgens, and Berger, 1983).
The paper also contained a review of literature. The authors assessed the background information to compare what other authors found out about the subject. The background information provided in the paper reflects some of the major themes in the field and provides valuable information required for the shaping of the conceptual framework of the research study. The selection of the literature was systematic since they were able to fulfil the paper’s objectives.
It is likely that the literature was selected after the data had been collected. This is so because the theories brought about in the paper must have been generated from the data. It was also able to meet the philosophical underpinnings. However, the paper by Casey and her colleagues lacked a conceptual framework. This is mainly because the paper purposed to test a theory rather than to develop a new one. The authors used a known theory to direct the study. The principles behind the Dose Adjustment for Normal Eating (DAFNE) have already been tested and the authors were only interested in studying a different perspective of the same (Webb, 2010).
In the methodology section, the use of longitudinal analysis may not have been appropriate since it is not commonly used in qualitative analysis. Therefore, the procedures used may have affected the overall results. However, the authors identified the correct measures to undertaken. The authors decided that the most appropriate method to use for their study was the longitudinal qualitative research (Holland, Thomson, and Henderson, 2006). This was particularly because they intended to get a greater understanding of the individuals’ experiences and perspectives (Saldana, 2003). The approach chosen kept within the purpose of the study. Therefore, this helped to shape the methods used for sampling, data collection and data analysis.
The method used to identify and select the sample was indicated. The authors specified that five DAFNE centers in the study area participated in the study. The whole population consisted of 192 participants. The method used for selecting the sample may have been inappropriate for the study since it did not eliminate bias. The sample size was selected from the known centers and from a group of specific individuals. Therefore, it was not randomized.
The sample constituted of 40 participants. This number of participants was not enough to provide information that would provide a representation of the whole population. In addition to this, the representation in terms of age group might not have been appropriate. Judging from the number of participants in the various age groups, it is evident that the younger individuals were in larger numbers than the older ones. The elderly were not properly represented and yet many individuals in this age group are diabetic. Therefore, the participants selected were not appropriate for the study.
Ethical considerations were made by the authors before the data was collected. Firstly, the authors sought permission from the various DAFNE centers across the area. Of the centers approached, five of them agreed and were included in the study. Ethical approval was obtained before research was conducted. These included the Galway University Hospitals, the National University of Ireland, and the Galway Research Ethics Committee. From all the 40 participants who were selected for the study, a written consent was obtained from each. Confidentiality of the participants was also guaranteed. This was done by removing the identifying material.
The methods for collecting data were properly described by the authors. The authors specified that two researchers conducted semi-structured interviews. These interviews were guided by an interview guide. The exercise was done within thirty-six months. The authors provided a rationale for the method used for data collection and provided sufficient information about the process (Gerrish and Lacey, 2010).
The authors also described the methods used for data analysis. The authors completed three stages of analysis. The first one included a within-time analysis. Secondly, they conducted a cross-sectional analysis. Lastly, they conducted thematic analysis. Statistical software was also used in the management of data and for coding and retrieval (Lawton, Rankin, and Cooke, 2011). In particular, N-VIVO version 8 was used. The authors followed the steps described.
The authors discussed four criteria that were used in order to ensure rigor. These included confirmability and credibility. These were essential in ensuring that the process of research was plausible, credible and with integrity (Lewis, 2007). The research processes were properly described and followed. Confirmability was also ensured since the authors demonstrated how they arrived at their conclusions and discussions.
The authors presented their results (findings) in an appropriate manner. As expected of all qualitative studies, the results were represented in narrative format. The phenomenon under study was described and interpreted using the results obtained. The authors discussed the results in the context of what was already known before the study was conducted since the research was guided by previously known theories. This can also be seen in the way the results were similar to those of other researchers who did a related study. The study addressed the original purpose of the study since the authors were able to make the specific conclusions.
The significance and implications of the conclusions were described. They said that their study helped to bridge the gaps in the previous studies (Norris, Engelgau, and Narayan, 2001). This was seen in the way they identified that embedded knowledge, continued support and enduring motivation were important in empowering the diabetic patients to properly manage the condition over time (Trento, Passera, and Bajardi, 2002). The authors also suggested that further studies were required to examine certain issues. They also acknowledged that the study had certain limitations especially when it came to the use of longitudinal analysis.
Various sources were used for the study. The sources used (journals and textbooks) were accurately referenced. These references were also quite recent and not outdated. This shows that the information in the paper may be trusted since it is supported by those of other researchers (Paterson, Thorne, and Dewis, 1998). Proper referencing of all the sources used was also ensured. Therefore, the authors were careful to avoid plagiarism. In conclusion, this study was informative and would inform evidence-based practice. The authors were able to identify the main factors that influenced people’s ability to adopt the necessary principles into their daily lives. This would help such individuals to effectively manage their condition.
References
Brown, J, Harris, S, Webster-Bogaert, S, 2002, ‘The role of patient, physician and systemic factors in the management of type 2 diabetes mellitus’, Fam Pract, vol. 19, no. 1, pp. 344-349.
Burns, N, Susan, G & Grey, J 2011, Understanding Nursing research: Building an evidence-based practice, Elsevier, Arlington.
Casey, D, Murphy, K, Lawton, J, Florence, W & Dineen, S 2011, ‘A longitudinal qualitative study examining the factors impacting on the ability of persons with T1DM to assimilate the Dose Adjustment for Normal Eating (DAFNE) principles into daily living and how these factors change over time’, BMC Public Health, vol. 11, no. 1, pp. 2-13.
Dinneen, S, Byrne, M 2009, ‘The Irish DAFNE study protocol: a cluster randomised trial of group versus individual follow-up after structured education for type 1 diabetes’, Trials, vol.10, no. 1, p. 88.
Edwall, L, Danielson, E & Ohrn, I 2009, ‘The meaning of a consultation with the diabetes nurse specialist’, Scand J Caring Sci, vol. 24, pp. 341-348.
Funnell, M, Brown, L & Childs, P 2008, ‘National standards for diabetes self-management education’, Diabetes Care, vol. 31, no. 1, pp. 97-104.
Gerrish, K & Lacey, A 2010, The research process in nursing, Wiley-Blackwell, New York.
Holland, J, Thomson, R & Henderson, S 2006, Qualitative Longitudinal Research: A Discussion Paper, London South Bank University, London.
Lawton, J & Rankin, D 2010, ‘How do structured education programmes work? An ethnographic investigation of the dose adjustment for normal eating (DAFNE) programme for type 1 diabetes patients in the UK’, Soc Sci Med, vol. 71, no. 1, pp. 486-493.
Lewis, J 2007, ‘Analysing Qualitative Longitudinal Research in Evaluations’, Social Policy & Society, vol. 6, pp. 545-556.
Muhlhauser, I, Jorgens, V & Berger, M 1983, ‘Bicentric evaluation of a teaching and treatment programme for type 1 (insulin-dependent) diabetic patients: improvement of metabolic control and other measures of diabetes care for up to 22 months’, Diabetologia, vol. 25, pp. 470-476.
Norris, L, Engelgau, M & Narayan, K 2001, ‘Effectiveness of self-management training in type 2 diabetes: a systematic review of randomized controlled trials’, Diabetes Care, vol. 24, pp. 561-587.
Paterson, B, Thorne, S & Dewis, M 1998, ‘Adapting to and Managing Diabetes’, Journal of Nursing Scholarship, vol. 30, pp. 123-214.
Polit, D & Beck, C 2011, Nursing research: Principles and methods (Nursing research: Principles & practice), Lippincott Williams & Wilkins, Philadelphia.
Polit, D & Beck, C 2011, Nursing research: Principles and methods (Nursing research: Principles & practice), Lippincott Williams & Wilkins, Philadelphia.
Polit, D & Beck, C 2008, Nursing Research: Generating and Assessing Evidence for Nursing Practice (8th ed.), Lippincott Williams & Wilkins, Philadelphia.
Polit, D & Beck, C 2006, Essentials of Nursing Research: Appraising Evidence for Nursing Practice, Lippincott Williams & Wilkins, Philadelphia.
Saldana, J 2003, Longitudinal Qualitative Research: Analyzing Change Through Time, AltaMira Press, Walnut Creek.
Trento, M, Passera, P & Bajardi, M 2002, ‘Lifestyle intervention by group care prevents deterioration of Type II diabetes: a 4-year randomized controlled clinical trial’, Diabetologia, vol. 45, pp. 1231-1239.
Veg, A, Rosenqvist, U, & Sarkadi, A 2007, ‘Variation of patients views on Type 2 diabetes management over time, Diabet Med, vol. 24, no. 1, pp. 408-414.
Webb, M 2010, Dose adjustment for normal eating (DAFNE) programme for Type 1 diabetes – summary of evidence, Public Health Wales NHS Trust, Wales.