RESEARCH ARTICLE CRITIQUE

Research Article Critique

Research Article Critique

As a consumer of nursing knowledge, the medical-surgical nurse must appraise professional literature critically (especially nursing research) as he or she reads. This appraisal should include consideration of the topic's importance to the body of nursing knowledge, the appropriateness of the methodology, the clinical and statistical significance of the results, and whether the conclusions are supported by the data. (Polit, beck, 2004)

Importance of Topic

Patient autonomy has been a guiding ethical principle for Western medicine since the American Hospital Association (1973) proposed The Patient's Bill of Rights. Written advance directives, such as Living Wills, Durable Power of Attorney for Healthcare, and the Five Wishes provide individuals with the opportunity to document values and beliefs related to health care as well as end-of-life decisions in the event that the individual lacks decision-making capacity and is not able to participate in future health care decisions. Thus, advance directives are tools for promoting patient autonomy. (Polit, beck, 2004)

However, the Patient Self-Determination Act (PSDA) (Omnibus Reconciliation Act, 1990) does not standardize advance directive legislation/forms across all states. Each state remains empowered to legislate how advance directives are used in that state. The PSDA requires institutions that receive federal monies to provide patients with information about their right to complete an advance directive. How this requirement is to be met was left up to each institution. (Polit, beck, 2004) Often the initial questions “do you have an advance directive?” and “do you want to learn more about advance directives?” are assigned to business/ admitting personnel, with chaplains and/or social workers designated as the persons responsible for providing the follow- up education.

It is possible that nurses may not be identified in the institution's process for meeting the PSDA. In addition, the fact that “62% of the responding nurses stated their undergraduate preparation on advance directives was inadequate” (Connell & Mallory, 2007, p. 165) is not surprising because the average age of nurses was 45.2 years in 2000 (Heath Resources and Services Administration, 2000) and nursing programs did not begin to include advance directive content into the curriculum until the mid-1980s. (Connell, 2007)

Methodology

Design. This descriptive study utilized a survey questionnaire to collect data. A representative sampling of nursing educational programs in North Carolina was achieved. As noted, the findings from this study may not be generalizable to other educational programs. The researchers implemented a creative strategy (stamps) to track survey returns and minimize repeat submissions. (Connell, 2007)

A conceptual framework should provide the structure for the research design. Based on the concepts of transfer of learning and retention of information, this appears to be a preliminary study for a research program addressing retention of advance directive didactic content by nursing students and from continuing education programs by professional nurses, with subsequent studies investigating strategies for increasing nurses' comfort with using and discussing advance directives in the clinical setting. (Connell, 2007)

Statistical analysis. Data collection and statistical analysis are dictated by the type of research questions ...