Critical Appraisal - Journal Articles - Research Design - Assessmnet Answer

December 05, 2018
Author : Ashley Simons

Solution Code: 1AJBA

Question: Critical Appraisal

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Critical Appraisal Assignment

Assignment Task

Select one of the journal articles you used in Assignment 1 and conduct a critical appraisal of the article. You will be required to submit the article together with your appraisal. Identify the research design, methods and results, including a level of evidence. There are a number of sources to assist you with this assignment.

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Computerized operations in hospitals were introduced about thirty years ago to support administrative and financial functions. Currently the system is used to support healthcare activities including drug prescriptions. However, according to studies by Chow et al., 2011, the nurses in private hospitals have resisted the use of computers in offering medical services. This is despite numerous evidences have shown that computerization is likely to improve patient outcomes as well as practice. The article by Chow et al., 2011 was selected so as to help have an indepth understanding of the attitudes of nurses in regards to computerization of the health services. The abstract of the article contains a precise summary of the objectives, background information, study methods and the statistically analyzed results that were relevant.

Literature Review

In the literature review section, the author’s argument has been substantiated so as to justify why the research study was important. In this article, the author starts by outlining the impact of implementation of computerization on patient care, such as time saving, enhancing the sharing of information to improve on communication among the medical professionals and increasing the accessibility of healthcare information (Ray & Berger, 2010). Other advantages of computerization listed by the author include improved scientific baseline in medicine and the reduced cost of healthcare in the long run. This is actually justifying the research study since the multitasking ability of computers have been thoroughly reviewed, so as to attract the audience and even influence the audience to have a positive attitude towards computers.  In this article the authors have categorically targeted the nurses and clearly outlined that they were the specific workers in the medical profession who were yet to embrace computerization as part and parcel of health care provision. The authors were also categorized in a number of paragraphs that modern researchers have found out that computer literacy is important among the health workers (Chan, 2009). However, the authors have also cited a number of literatures that have indicated that nurses have negative attitudes toward computerization. Some of the reasons nurses have raised to support their resistivity include the fear of dehumanizing the nursing practice, increased workload and being computer illiterate.

It is worth to note that the authors did establish that among the younger generation computerization was readily accepted thereby suggesting that the future up-coming nurses will be computer–literate and experienced. The authors have provided all this information in order to show the trend that shows a variety of factors that are likely to influence the attitudes of nurses towards computerized systems (Liu et al., 2000). Most of the articles cited by the authors are recent except Strong and Brodt that was published in1986 even though these articles may appear old, they are used by the authors to link old research on computerization in healthcare with modern research (Stronge & Brodt, 1986). The authors say that the Technology Acceptance Model (TAM) as a model was adopted for this study to give desired results. However, the authors do not go deep to explain how this TAM model works. Moreover, from most of the literature cited, TAM ignores external variables like IT support and demographic characteristics, but in this study the two external variables have been included, thereby making the audience question the validity of the results from the study was based on TAM working principles (Moody et al., 2004). In this article, it is worth to note that the strength and weaknesses of studies conducted before were not analyzed implicitly. The literature has been reviewed explicitly without due regards of the objective of the study so as to come out with the problem and justify the study. Therefore, it is important to look at the reasons as to why nurses are not ready to accept computerization of the healthcare services in details. This is very important before pushing for mass implementation of computerization as observed in some countries in the Middle East. The argument of the authors is that for a successful implementation of computerization, the attitudes of the nurses must be factored and they must be encouraged through training to embrace technology (Ozbicakci et al., 2011). In summary, the reviewed literature chosen by the authors was very relevant to the study topic and this was actually a building block of the actual research in the field.


The research design was a stratified-random design whereby 342 nurses working at a private hospital in Hong Kong private clinics were sampled. This involved the use of Hospital Information System. The research design was of a quantitative approach as well as descriptive. Questionnaires were used in data collection, but no attempt was made to manipulate the attitude of the nurses. In the questionnaires, data collected included level of satisfaction, perceptions, as well as nurses' attitudes towards the use of Hospital Information System. Here, the authors were trying to assess the factors that influence nurses' attitudes toward computerization and actually linear regressions and correlation analysis were used in data analysis to determine the factors (Sassen, 2009). It's also important to note that the stratified sampling technique was employed by the authors so as to reduce biases and collect diverse samples that is normally distributed (Wilkins, 2009).  This assisted in acquiring a subset of the nurse population that were representative enough and could be generalized as a representation of the entire nurse community.  The stratification of the nurse population threats to data validity were greatly minimized while on the other hand internal data validity was increased (Hobbs, 2002). In addition, in the study questionnaires were used for data collection and they were designed to capture data on Perceived usefulness of computers, Perceived ease of use, Level of satisfaction and attitude of the nurses. The reliability of these questionnaires was supported by the authors by citing past research studies. The cited literature was referenced as required so as to acknowledge the best authors. It can be argued that questionnaires measured the attitudes of the nurses with precise sensitivity since it covered a wide range of factors that influence their attitudes. In this article, the method of study is clearly and precisely outlined and it can be easily repeated with ease in subsequent studies.

Ethical consideration

An ethics committee at the participating university and the study hospital in Hong Kong approved this study. In fact, all the participating nurses’ consents were obtained and they were also made aware that they were allowed to voluntarily participate in the study. This was done so that the participant are informed and adequately protected before the study begins as well as at the end of the research. The participant was informed that they had a right to withdraw from the research any time they feel they want to do so. In order to conceal the identity of the participants, the questionnaires were distributed anonymously to the selected nurses and their personal identification information was not required.

Significant results

During the research, a total of 204 questionnaires from the nurses were collected. This translated to a return rate of approximately 60%. The authors alluded that the rate of response was satisfactory since 50% was considered as the benchmark of the rate of response according to Yehuda and Brooks 2008. However, Portney and Watkins (2009) considers 60% rate of response as excellent. Screening of the data was done and two questionnaires were discarded because more than 20% of required data were missing. Perceived ease of Use by nurses (n=204) was 47%, Nurses’ satisfaction (n=204) was 38%, Nurses’ attitudes (n=204) was 44% and Perceived usefulness (n=204) was 35%. This was actually a crucial discovery since it showed that almost half of the entire nurse population had little experience of using IT or computers. This is the reason why there is a potential negativity of nurses towards computerization.

Discussion/reflective critique

In general, this research showed that most nurses have negative personal attitude towards computerization and the use of computers to improve on the provision of health care services. This consistent according to the problem statement of the authors that was stated in the literature review. It is important to note that this study is unique in terms of sample diversity. The nurses who participated were from different wards thus allowing the researchers to collect data from a broad spectrum of nurses with different work practice ranging from simple physiotherapy to complex nursing of surgical operations. This may allow for the generalization of the findings to the entire nursing population. This research findings contribute to the current knowledge database on nurses' attitudes toward computerization. It can therefore be used as an impetus to train nurses on the importance of accepting information technology and how to apply it in the provision healthcare services.


The author proposes further research for this study was limited to only one private hospital, hence reducing the aspect of generalization of the outcomes to different settings like public hospitals. Moreover, the questionnaires used in this study were “self-report” which may be subject to personal biases since individual nurses may be concerned about the actual response they give. The authors also acknowledge that other factors other than the ones discussed may influence the attitudes of the nurses. Finally, the critic, author of the appraisal suggests that qualitative approach in research design should also be adopted. In qualitative approach individual nurses can be interviewed to obtain the desired data.

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