Relationship of nursing research to evidence based nursing

Describe the
relationship of nursing research to evidence based nursing. Give at least one example of
nursing practice based on evidence from the research. Identify the components of
Evidence-Based Nursing (EBN) that apply to this example (PICO). Effectively discuss the
background of this research. Paraphrase very carefully!
Identify the sampling method and discuss its appropriateness for the study. How was
sample size determined? Was it appropriate? Address ethical considerations for the
sample. Discuss the article in terms of how the researcher(s) did or did not demonstrate
that the study was reliable and valid. Include information on the type of instruments used
to collect data and methods of data collection. Be sure to address errors of measurement,
reliability of measuring instruments, and internal consistency. Provide the
background/rationale for your answer to justify your response, using references.
Rate the level of evidence of your research article according to a reliable hierarchy of
evidence. You must provide the correct citation for the scale used chosen. Please see the
section “Hierarchy of Evidence” under assigned readings for sources to use for this
component of the paper. Remember to cite all sources used to develop this paper.
Address how the data were collected in this research study. Consider the quality of the data
in your research study. How was it presented?
Remember, you are critiquing, not reporting. For example: Was the sampling method
appropriate? Why or why not? What would have been more appropriate? Why?


Quantitative Critique

Various researchers have carried out different studies on different health issues that affect
patients. Most of these studies aim to find out various problems and their solutions in the medical
field. For these studies to be productive, it is imperative that they adhere to appropriate research
methodology. Their level of credibility is enhanced through the way they are carried out. This
paper focuses on the study conducted by Ryan and Hayden about baseline medication adherence
and blood pressure in a 24-month longitudinal hypertension study.
For a study to be carried out, it is important that it states its purpose and provides
background information as to why it is an important undertaking to be investigated. In this case,
the purpose of the study was to identify the feasibility of an easy and quick self reported
measure of medication adherence and to find out or identify a characteristic of people with
hypertension that requires increased attention by nurses to ensure that hypertensive self
management needs are addressed. Therefore, the purpose is clearly stated and it seeks to find
amicable solutions to the problem of high blood pressure among the patients (Shaw & Bosworth,
2012). Background information about the study is adequate; the researcher provides information
about the age at which people are at risk of becoming hypertensive. It also provides the possible
ways of dealing with this problem such as by taking antihypertensive drugs, modifying lifestyle
and adhering to their medication regimen.
The framing of the hypothesis of the study was not well done. In clinical research, it is
important for the researchers to focus on one aspect and carry out an intensive investigation
about the same. In this case, the hypothesis was to find out an easy and quick self-reported

measure of education adherence and identifying of people that require attention from nurses to
address their self-management needs. The research questions administered were few in number
and this limited the scope of the study to stimulate much information from the participants.
Furthermore, research questions were close-ended and this denied the respondents an opportunity
to provide detailed information. Even though closed questions enhanced the problem of data
coding and analysis, it could be appropriate if the study incorporated both the open and closed
ended questions (National Center for Health Statistics, 2008).
For a research study to be successful it requires identification the population being
studied, any interventions to ensure that the study does not deviate, it also needs to have
comparison and relate with previous studies and have an outcome that is based on logical and
systematic evidence (Cherry & Woodwell, 2002). The population in the study includes patients
that suffer from high blood pressure or hypertension. The interventions the researcher employed
to ensure that the study is on the right track are not highlighted. The study could have used pilot
study before embarking on the real study. There is also need to provide enough information that
closely compares with the area of study to be able to have facts and basis on the research that is
being conducted (Flack, Novikov & Ferrario, 1996). This information is not adequately provided
hence, it impacts on the findings. It is also important for the study to come up with the outcome
or the results or findings to be able to help those that depend on the study to understand the
problem and the amicable solutions to manage the situation.
Sampling design is one of the important ways of ensuring that appropriate sample size is
obtained. The sampling design adopted by the study was stratified sampling method. This design
has limitation even though it ensures that different categories of respondents are included in the
sample size. The study could have used simple random design to get its sample size. This is

because; there should be limited access of biasness and absence of representativeness. All the
patients with high blood pressure would have equal chance of being selected and therefore, it
could result into representative results. The sample size of 159 was also a little bit large. The
sample size should be selected depending on or in relation to the total estimated number of
people suffering from high blood pressure.
The study also lacks a conceptual framework. This framework could have helped the
researcher to understand various concepts and provided a way on how to go about with their
research this is a limitation of the study. The study area has various concepts, which require
further explanation for understanding, and yet this is absent. The instrument of data collection is
also important in ensuring that the study succeeds. There are various methods or instruments that
a researcher uses to collect data from the respondents. Some of the instruments used include
interviewers, questionnaires, and focus groups just to name but a few. In this study, data was
collected through administration of questionnaires. The questions were closed-ended and sought
to find out about adherent medication and blood pressure was measured using a digital
sphygmomanometer after every 6 months. This method of data collection was appropriate as it
helped them to get the level of blood pressure and get their views about medication adherence.
Interviews could also have been used especially among those patients that are illiterate to
substantiate the questionnaires.
In their statistical analysis, the researchers used a computer software to estimate
demographic variables that correlated to the blood pressure was the PROC CORR in SAS,
version 9.2; SAS Institute Inc., Cary, NC, USA (Shaw & Bosworth, 2012). A linear model a
PROC MIXED in SAS version 9.2 was also used to estimate the change in blood pressure of
patients over 24 months between adherent and non-adherent medication users at their baseline.

This statistical analysis software, helps to simplify the analysis but its authenticity is
questionable and it is likely to cause undetectable errors. Furthermore, it is a complex statistical
analysis process and many of the people may not understand how it functions.
Reliability and validity of a study is essential and it depends on the methods and the
errors of measurements. The instrument of measuring the blood pressure was valid and therefore
reliable. Furthermore, the Mortisky scale that was employed to find out whether the patients
were adhering to their medication or not was also reliable and this indicated that indeed the
findings of the study were reliable. Furthermore, there was consistency in the assessments and
this indicates that the study was carried out in a better way (LoBiondo-Wood & Haber, 2006).
The study was also valid because, it also used other people’s work to substantiate the argument.
Furthermore, the researcher is a professor and therefore due to this, it makes the study credible.
Ethics is important and must be adhered to by researchers to ensure both privacy and
responsiveness to the needs at hand. Before commencement of the study, the researcher obtained
an institutional review board from Duke University health subsystem. Furthermore, all the
patients that participated in the study provided written informed consent. Therefore, this action
illustrates that the study was ethical and therefore, met the threshold. Permission and informed
consent from the patients shows that the practice or the study was done without any malice but
that the audience knew about the study hence there was no malice.
Evidence based nursing concerns identification of solid research findings and
implementing them in the practice of nursing to increase the quality of patients’ care (Salmond,
2007). The main goal of evidence-based nursing is to provide highest quality services at cost
efficient nursing care possible (Royle & Blythe, 1998). This research is helpful as it provides

evidence on the best ways that nurses can improve the health status of patients with high blood
pressure. It provides evidence that it is possible for nurses to help the patients adhere to their
medication and self-management needs to improve their health status (Baroletti & Dell’Orfano,
2010). This finding is based on a research from the researchers who are also experts in their
areas. Therefore, this will help enhance the quality of healthcare provided.
Hierarchy of evidence is one way of rating the evidence provided in a research study
(Petrisor & Bhandari, 2007). Based on this literature, the hierarchy of evidence can be rated as
medium. The evidence in this study therefore illustrates that, indeed some of the patients do not
adhere to their medication because of their financial status.
Even though the study has these limitations, its findings and recommendations are
important in ensuring that nurses help their patients to take medicines and to develop self
management needs. They can also be in a position to identify non-adherent patients with their
antihypertensive medication regimes and those in need of intervention to improve blood pressure
self-management (Guyatt et al. 1995).
In conclusion, the study has provided fundamental findings and recommendations
concerning issues of high blood pressure. The conclusion that nurses are better placed to help
non-adherent patience to medication is not well supported. Nurses cannot be able to achieve if
they do not get support from the patients. Therefore, it is a responsibility that should be executed
by both the nurses and the patients.



Baroletti, S., & Dell’Orfano, H. (2010) Medication adherence in cardiovascular disease,
Circulation, 121, 1455–1458.
Cherry, D., & Woodwell, D. (2002). National ambulatory medical care survey: 2000, Advance
Data from Vital and Health Statistics. 328.
Flack, J., Novikov, S., & Ferrario, C. (1996). Benefits of adherence to antihypertensive drug
therapy, European Heart Journal, 17(Suppl. A), 16–20.
Guyatt, G. et al. (1995). Users’ guides to the medical literature. IX. A method for grading health
care recommendations. JAMA, 274:1800–4.
LoBiondo-Wood, G., & Haber, J. (2006). Nursing Research: Methods and Critical Appraisal for
Evidence-Based Practice. St. Louis, Missouri: Mosby Elsevier
National Center for Health Statistics (2008). Health, United States, 2008, National Center for
Health Statistics, Hyattsville, MD.

Petrisor, B., & Bhandari, M. (2007). The hierarchy of evidence: Levels and grades of
recommendation, Indian J Orthop, 41(1):11-15. Retrieved from:

Royle, J., & Blythe, J. (1998). Promoting research utilisation in nursing: the role of the
individual, organization, and environment, Evidence Based-Nursing, 1, 71-72.
Salmond, S. (2007). Advancing Evidence-Based Practice: A Primer. Orthopaedic Nursing,


Shaw, R., & Bosworth, H. (2012). Baseline medication adherence and blood pressure in a 24
month longitudinal hypertension study, Journal Of Clinical Nursing, 21(9/10), 1401-

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