Contents

Introduction......................................................................................................................................2

Methodology....................................................................................................................................3

Results..............................................................................................................................................5

Discussion........................................................................................................................................6

Conclusion.......................................................................................................................................8

References......................................................................................................................................10

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 Abstract
Introduction

The results of quantitative research are presented using numerical data and graphical
representations. It puts hypotheses and theories to the test or confirms those that have already
been established. In order to establish facts about a subject that are applicable to the issue as a
whole, this kind of study may be conducted. Experiments, observations reduced to numbers, and
surveys with only yes-or-no questions are examples of common quantitative procedures.
Quantitative research runs the possibility of having research biases such as information bias,
omitted variable bias, sample bias, or selection bias (Howe, 1990).
The findings of qualitative research are typically presented in written format. The ability to grasp
concepts, thoughts, or experiences is gained through its application. Through conducting this
kind of study, you will be able to collect in-depth insights on subjects that are not widely
understood. Common qualitative methods consist of conducting interviews with free-form
questioning, making observations and describing them in written form, and conducting literature
studies that investigate various concepts and hypotheses. In qualitative research, there is also the
possibility of specific study biases, such as the Hawthorne effect and observer bias.

The purpose of this study is to critically two journal articles. Each one is a qualitative study and a
quantitative study. The introduction, methodology, discussion, results and the conclusion is
critically evaluated in this paper.

This assignment critically evaluates two articles. One article is qualitative. The topic is “Nurses
and ward managers’ perceptions of leadership in the evidence-based practice: A qualitative
study”. This article has 4 authors. All the authors are professors in the field. The other article
which will be critically evaluated is a quantitative article. The topic is “Effectiveness of
Evidence-Based Practice (EBP) Education on Emergency Nurses’ EBP Attitudes, Knowledge,
Self-Efficacy, Skills, and Behavior: A Randomized Controlled Trial”. The article has 5 authors.
Three authors are professors in the field of nursing while the other two authors have a masters in

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their field of study. Aside from the fundamental issues of honesty, ethics, and integrity,
appropriately naming authors enables ordinary readers and scientists to know the right attribution
of the article to a particular author. In the absence of adequate attribution, it is impossible to
determine who is responsible for the work that was published (Flanagin A et al, 1998). Hewitt
said it best when he said, "Authority cannot be granted; it may be undertaken by one who will
accept the responsibility that goes along with it." Therefore, the obligations that come along with
authorship rights are inextricably linked to those rights. An author should be able to defend the
content of the article if it is questioned in public, as this is good practice. Because of this, only
the writers themselves should be included on the author list. Even though this appears to be a
simple matter, both the consensus among people in general and the process of putting this idea
into practice are not entirely transparent (Cohen MB et al, 2004).
The title of this piece contains a total of 15 words, which are broken up into two phrases and
separated by a colon. Subtitles and multicomponent titles, which frequently include non-
alphanumeric characters like colons, are connected to high citation counts. (Buter and Van-Raan,
2011, referenced by Milojevi, 2017). The ideal length for the title of a scientific paper is no more
than 15 words, and it should make the purpose of the investigation abundantly evident. (Parahoo,
2006 & Connell Meehan, 1999, Cronin & Ryan, 2007). Because it explains both the research
problem and the subject matter that is being investigated, the title of this article is easy to
comprehend. It should come as no surprise that the title of this piece manages to successfully
combine attractiveness and informativeness, as addressed by Milojevi (2017).

Methodology

It is possible to gain a better understanding of people's views, experiences, attitudes, behaviors,

and interactions using qualitative research methods (DiCicco‐Bloom, 2006). It generates non-
numerical data. A research technique that is getting growing attention across disciplines is one
that incorporates qualitative research with intervention studies. Fifty-seven nurses (clinical
nurses and ward supervisors) from five different public hospitals participated in the study's eight
focus groups. Analysis was performed using a template, with the Promoting Action on Research
Implementation in Health Services framework applied. The article used the guidelines laid out in

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the book "Consolidated Criteria for Reporting Qualitative Research" when developing and
writing up this study.
It was determined that there are three distinct varieties of nursing leadership: transformative
leadership, medium leadership, and traditional nursing leadership. The most common form of
leadership was the traditional model, which resulted in a high proportion of administrative
responsibilities being assigned to ward managers; hence, the introduction of evidence-based
practice was challenging.
When it comes to conducting studies in the social sciences, quantitative methods are typically
used. Data science is the methodology of studying social, economic, and psychological processes
via the examination of numerical patterns. Quantitative studies collect numerous types of
numerical information (Hieu, et al, 2015).
Randomized controlled trials, also known as RCTs, are prospective investigations that test the
efficacy of a novel intervention or treatment. Randomization is an effective method for reducing
bias and providing a rigorous tool for examining the cause-effect links between an intervention
and an outcome. This is true even though no single study is likely to be able to prove causality on
its own. This is since the act of randomization balances participant characteristics (both observed
and unobserved) between the groups, which enables the attribution of any variations in result to
the research intervention. In no other type of research design is this even remotely imaginable.

When planning a randomized controlled trial (RCT), researchers need to select the population,
the therapies to be compared, and the outcomes of interest with great care. After these have been
identified, the number of participants who are required to determine with high levels of accuracy
whether a relationship of this kind exists is computed (power calculation). After that, participants
are sought out and placed in either the intervention group or the comparison group based on a
random drawing. 1 It is essential to make certain that at the time of recruitment, there is no
knowledge of which group the participant will be allocated to; this practice is known as
concealment. Utilizing automated randomization methods is a common method for ensuring this
(e.g., computer generated). Blinding is a common practice in randomized controlled trials
(RCTs), which means that neither the participants nor the doctors, nurses, or researchers working
on the study are aware of the treatments that any given participant is getting.

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RCTs can be analyzed in a number of different ways, including by intention-to-treat analysis
(ITT; subjects are analyzed in the groups to which they were randomized), per protocol (only
participants who completed the treatment they were initially allocated are analyzed), and other
variations; however, ITT is typically considered to be the method with the least amount of bias.
All randomized controlled trials (RCTs) ought to have primary outcomes that have been pre-
specified, ought to be registered with a clinical trials database, and ought to have proper ethical
permissions.

RCTs can have a few limitations, including a high cost in terms of both time and money,
problems with generalizability (participants that voluntarily enroll may not be representative of
the population being investigated), and a loss to follow up rate.

A randomized controlled trial with parallel groups and evaluations before the education,
immediately after it, and 6 and 12 months later after the education was carried out at four
emergency departments at two university hospitals. EBP education was provided to the
experimental group (N = 40), while the members of the control group (N = 40) were responsible
for completing their own self-directed EBP education. The attitudes, knowledge, self-efficacy,
abilities, and behavior of emergency nurses in relation to EBP were the major outcomes, while
satisfaction with the EBP education was the secondary result.

Results
A total of 35 people from the experimental group and 29 people from the control group finished
the study. There were no significant changes in attitude, self-efficacy, or behavior toward EBP
immediately following the EBP education (p >.05). All measures of EBP attitude, behavior,
knowledge, and self-efficacy were significantly higher in the experimental group than in the
control group at the 6-month assessment. The progress made in the first 12 months began to slow
down at the 12-month mark. Student satisfaction with the instructor's encouragement of clinical
questioning also varied greatly across the two groups.
In accordance with Carey and Asbury (2012), all the meetings for the planning and development
of the focus groups took place in conference rooms that were suitably furnished within the
hospitals. The researchers acted as their own stenographers, playing back the audio recordings of
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the sessions, and typing up the full transcripts. The length of time for each session varied
between sixty and one hundred minutes. At each of the focus groups, there was one researcher
who served as an observer, and another who presided over the discussion as the moderator.
Nobody else was there but the people who took part in the experiment and the people doing the
research. The observer made comprehensive notes on group interaction as well as non-verbal
communication, and the moderator posed questions and guided the conversation. It was
determined that doing any particular focus group in more than one session was not essential.
The following are some examples of open-ended questions that were asked: • To what extent are
clinical nurses involved in making choices on the implementation of EBP? • What tactics should
be pursued to incorporate evidence?
The research was carried out by 35 members of the experimental group and 29 members of the
control group who all saw it through to completion. There was not a statistically significant
improvement or difference between groups in EBP attitude, self-efficacy, or behavior
immediately after the EBP education. This was determined by using the p .05 statistical
significance level. At the six-month measurement point, the experimental group demonstrated
considerably improved EBP attitudes, behavior, knowledge, and self-efficacy than the control
group did. At the 12-month measuring point, there was a startling reversal in the advances. The
participants of the two groups reported quite different levels of satisfaction with the way the
instructor encouraged students to pose clinically relevant questions.
An electronic and manual survey was given to participating emergency nurses at four different
time intervals (T0–T3) from May 2018 through August 2019 to collect data. T0, the pre-
intervention survey, was given out in May of 2018, and T1, the post-intervention survey, was
given out as soon as the educational intervention was over (at the completion of the education).
The T2 was given to patients after the T1 had been in effect for a period of 6 months, and the T3
was given to patients after the T1 had been in effect for a period of 12 months.

Discussion
The purpose of this quantitative research is to investigate the EBP attitudes, behaviors,
knowledge, and self-efficacy of emergency nurses both before and twelve months after an EBP

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educational intervention. In addition, an investigation was carried out to determine the extent to
which pupils were satisfied with the training that was given to them.
In the qualitative research, it was found that the three forms of leadership that are represented by
the PARIHS model were present in some wards of the hospitals that were examined; however,
there were some differences that arose between the two sets of hospitals. Only a few wards in
both kinds of hospitals had a leadership style that was moderate, with traditional (weak)
leadership being the most common form discovered at Health Service hospitals. In conclusion, a
small number of Health Agency hospitals' wards were making the transition towards a
transformational (strong) leadership style. According to the PARIHS framework, conventional
leadership—which most of the nurses and ward managers polled describe as their preferred style
—is incompatible with the implementation of evidence-based practice (EBP). In settings that are
defined by this kind of leadership, nurses who do not feel as though they are included in the
decision-making process have the perception that changes are being imposed on them against
their will. In addition, because the ward managers serve more of a bureaucratic role in these
circumstances, the nurses do not consider them to be leaders.
It was determined that the transformational leadership style was the most effective for putting
evidence into practice. Its primary qualities are democratic decision-making, clearly defined
duties for ward managers, efficient teamwork, encouragement of the role of natural leaders, and
nurses' empowerment.

A participatory decision-making process was discovered, in which the nurses felt included, for
example, in the organization of new units such as the intensive care units or the delivery room.
This process was identified as having taken place at the hospital.
Some nurses who worked in smaller units, such as outpatient facilities, reported feeling
empowered to undertake changes in their clinical practice. These nurses claimed that they
believed they had the support of the ward managers to undertake changes, and they stated that
they believed they could move forward with their plans.

When it comes to the process of implementing change, a few of the ward managers highlighted
the significance of natural leaders. The ward managers who adhered to this style of leadership
believed that it was essential to persuade natural leaders to adopt a leadership strategy. In the

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hospitals run by the Health Agency, the ward managers who participated in the transformational
leadership program had a crystal clear idea of the role they were supposed to play. According to
what they said, the most important aspect of being a leader is managing teams effectively. This is
accomplished by encouraging collaboration among members of the team, cultivating close
connections with the nurses, and implementing projects that go in both directions.

The ward managers who worked in the hospitals run by the Health Agency had the impression
that they were more closely connected to the hospital management, and they made decisions that
were in accordance with the guidelines established by the institution. They maintained that all of
their recommendations are analyzed with the hospital's management team prior to the beginning
of the implementation process, despite the fact that they bet on the adoption of initiatives that
come from the nurses.
The nurses characterized the productive interdisciplinary teamwork as a form of
interprofessional work that was customized to the requirements of the patients. They are very
seldom and in relatively small clinical units reported having experienced effective forms of
collaboration. They reported that working as part of a team resulted in increased levels of
professional satisfaction, in addition to producing better outcomes for patients while expending
less effort.

Conclusion
The educational intervention in EBP that was carried out as a part of this study had a beneficial
impact on the EBP attitudes, knowledge, self-efficacy, skills, and behavior of emergency nurses.
The benefits of education shown themselves in the clearest way six months following the
instruction. After this moment, the results began to decline and eventually returned to their initial
levels. EBP educational interventions created for emergency nurses should employ a variety of
instructional methodologies to increase the nurses' EBP attitudes, knowledge, self-efficacy,
skills, behavior, and overall satisfaction with the education.
The nurses do not have a sense of empowerment, and many view the upcoming changes as an
imposition. There is a natural leader that emerges when there is a lack of strong leadership for
evidence-based practice. Clinical nurses are calling for further autonomy in decision-making,
and ward administrators want more clarity regarding their responsibilities. It is vital to take into
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consideration the function of the transformational leader in order to create an atmosphere that is
favorable to evidence-based practice.
Within the experimental group, the EBP educational intervention that had been tested appeared
to produce the best effects 6 months following the schooling. After a period of six months, the
results for the majority of EBP locations started to show a downward trend. By the time the
findings were measured again after a year, they had returned to the level of the baseline or, in
some cases, even dropped further. The knowledge exam stood out as an outlier since the
participants performed exceptionally well across all of the measuring criteria.
Following the educational intervention, the experimental group outperformed the control group
in every assessed element of EBP, whereas the control group's performance remained
unchanged. Additionally, the experimental group revealed significantly higher than typical levels
of contentment with the information received. Because the effects of the intervention did not
remain stable over time, further educational interventions ought to be on ways to keep EBP
competency. More specifically, the emphasis of these interventions should be placed on EBP
abilities as well as self-efficacy. In addition, the findings of our study revealed that self-directed
learning, when used on its own, was not as effective as the combination of other teaching
approaches, such as didactic lectures and small group discussion. When it comes to facilitating
learners' depth learning, conversations and reflections that take place during contact learning
may play a significant role.
In the hospitals that were investigated, researchers found that there were three distinct varieties
of nurse leadership: traditional leadership, medium leadership, and transformative leadership.
Transformational leadership and evidence-based practice are incompatible with the huge volume
of administrative work that ward managers must complete.
The registered nurses do not believe they have the authority to make judgments, and they view
the upcoming changes as an imposition. The absence of strong leadership within EBP has
resulted in the emergence of a new role—that of the natural leader—that must be accounted for
within the new organizational structure. The findings of this research provide the foundation for
determining the most effective way of facilitation for the adoption of evidence in the hospital
contexts that were investigated.
The fact that the focus group sessions took place in a hospital setting is one of the limitations of
the study. This setting may have prevented some contributions from being made by medical

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experts. In addition to that, the participants did not read our findings in order to examine the
descriptions and validate the meaning.

It is vital to examine the role of the transformational leader as a replacement for the ward
manager, who performs an excessive bureaucratic function, in order to establish an environment
that is favorable to EBP. The transformational leader should be built on the idea of empowering
nurses by giving them increased responsibility and a larger say in the decisions that are made. It
is imperative that nurse supervisors have a firm grasp on their responsibilities, particularly those
connected to the execution of EBP. In addition, both nurses and managers recognize the
importance of structure that is built on productive collaboration between multiple disciplines.

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