Running head: REVIEW OF REFERENCES

Review of References
Nga Le
Ferris State University
Abstract
Evidence-based practice (EBP) has made a great impact across nursing practice, education, and
science. It underscores the needs for redesigning ways to evaluate research evidence, for not all
research is considered reliable evidence. Two articles were reviewed and reevaluated to
determine the level of evidence and credibility by focusing on the sources of the research,
defining the significance and distinction to the nursing profession and its quality and safety, and
to guide nursing practice. Upon examining these articles, it attested that it is imperative to
identify the quality and strength of the evidence when determining if research evidence is
reliable. It was also found that scientifically, nursing research will continue to be of great
relevance to the nursing profession in refining existing knowledge and employing new
knowledge. Therefore, it is imperative that nursing is able to critique research and evaluate
findings that are distinct to nursing, as nursing research aims to promote the best EBP possible,
ensuring nursing credibility and accountability as a profession.
Review of References

REVIEW OF REFERENCES

According to the American Nurses Association (ANA), evidence-based practice and

research is defined as the integration of evidence and research findings into practice, where
nursing theory and conceptual frameworks serve as the foundation that guides nursing practice
(2010, p. 51). Although there is an increased amount of research available, not all evidence is
equal and reliable. Therefore, it is important to be able to identify the quality and strength of the
evidence (AACN, 2009, p. 70). The purpose of this paper is to review and reevaluate references
and research credibility of the following two assigned articles.
Credibility
Not long ago, nursing was considered to be an occupation or vocation rather than a
profession. According to Chitty and Black (2011), an occupation is what occupies, or engages,
ones time; business; employment (p. 62). However, a profession is a calling, vocation or form
of employment that provides a needed service to society and possesses characteristics of
expertise, autonomy, long academic preparation, commitment, and responsibility (Chitty &
Black, 2011, p. 62). The struggle to gain professional status has been long and difficult
(Nieswiadomy, 2012, p. 5). In ensuring professionalism and credibility, nurses concentrate(d)
on establishing a unique body of knowledge (Nieswiadomy, 2012, p. 5). Evidence-based
practice (EBP) is known as the unique body of knowledge that stems from nursing research, and
in turn serves as the foundation to guide nursing practice. Nursing research is defined by Chitty
and Black (2011) as a systematic investigation of phenomena (events or circumstances) related
to improving patient care (p. 257). Similarly, Nieweiadomy (2012) defined nursing research as
the systematic objective process of analyzing phenomena of importance to nursing (p. 3).
According to Nieswiadomy (2012), EBP is defined as a scientific process that validates and

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refines existing knowledge and generates new knowledge that directly and indirectly influences
the delivery of evidence-based nursing practice (p. 3).
According to the American Association of Critical-Care Nurses (AACN, 2009), not all
research studies are equal in quality (p. 70). In answering the evidence evaluation issue, the
AACN developed the levels of evidence grading system. A grading system to rank research
studies and other forms of evidenceto offer practitioners a reliable hierarchy to determine the
strongest evidence (Armola et al,. 2009, p. 70). As evidence, the scale serves as an important
tool in assisting practitioners to determine whether statements about clinical practices were
based on research or other reliable evidence (AACN, 2009, p. 71). Furthermore, the nursing
research goal aims to promote the best EBP possible, ensuring nursing credibility and
accountability as a profession (Nieweiadomy, 2012, p. 5). Another process used in the
evaluation of scholarly credible sources is to identify if it is a refereed journal, non-refereed
journal, or a peer review journal. Peer review is considered the gold standard in the publishing
world. According to Chitty & Black, in the peer review process a manuscript is viewed for
accuracy and quality by at least three anonymous subject experts, giving the recommendation for
revision, publication, or to reject the manuscript altogether (Chitty & Black, 2011, p. 267). A
refereed journal is when subject experts, chosen by the journals editorial staff, evaluate
manuscripts (Nieweiadomy, 2012, p. 265). A non-refereed journal uses editorial staff members
or consultants to review manuscripts (Nieweiadomy, 2012, p. 265). Regardless if it is a
refereed or non-refereed journal, the editor has the final say whether the journal is to be
published or not (Nieweiadomy, 2012, p. 265).

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Article One
Article one is a statistical update report (American Heart Association (AHA), 2009). The
authors of this article consisted of mostly of doctors. No nursing personnel were identified. The
article is a peer-reviewed article, with an impact factor of 4.357 (AHA, 2014) and it best fits
Level A in the AACNs new evidence-leveling system (Armola et al., 2009). The AACN defined
Level A as a Meta-analysis of multiple controlled studies or meta-synthesis of qualitative
studies with results that consistently support a specific action, intervention or treatment (Armola
et al., 2009, p.72). To further support the given level of evidence, the AHA, in conjunction with
the National Institutes of Health, Centers for Disease Control and Prevention, and other
government agencies, provided an up to date statistical report summary. Summaries from most
up-to-date and past findings were collected through studies, research, and theories on specific
concepts such as heart disease, stroke, and vascular disease, and their risk factors for this report
(AHA, 2009, p. 481).
Nursing has only recently established a distinct body of knowledge to identify nursing as
a profession (Nieweiadomy, 2012, p. 5). Nursing is also considered a practice discipline.
Therefore, the use of knowledge from other disciplines is necessary, but frequently this
knowledge is not suitable to the needs of the nursing profession (Nieweiadomy, 2012, p. 91).
Once this knowledge is fostered, it is considered as shared knowledge rather than as borrowed
theories (Nieweiadomy, 2012, p. 91). Even though this article is not considered as nursing
research, but rather share knowledge from other disciplines, it is still of significance to nursing
profession and clinicians (Nieweiadomy, 2012, p. 91).

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Article Two
Article two is a peer reviewed research study that was approved by the human and ethics
committee, that is affiliated with the School of Healthcare, University of Leeds, United
Kingdom; and Department of Psychological Medicine, Clayton Campus Monash University,
Victoria, Australia (Astin & Jones, 2006). It has an impact factor of 0.955 (American
Association of Critical-Care Nurse, Elsevier., 2014). One of the two authors of this article is a
nurse, thereby making this article a nursing research article and one that is distinctly significant
to the nursing profession. The research helped shed light on the ways nurses can effectively
teach and promote self-management and compliance to patients with chronic heart disease (Astin
& Jones, 2006).
The AACN defined Level C as Qualitative studies, descriptive or correlational studies,
integrative reviews, systematic reviews, or randomized controlled trials with inconsistent results
(Armola et al., 2009, p. 72). The study was a descriptive qualitative study with randomized and
controlled trials, where data was derived from a questionnaire formulated to assess patients
perceptions and beliefs regarding their health status. Scatter plots and nonparametric tests were
used to integrate and evaluate non-normal distribution characteristics and outliers of data (Astin
& Jones, 2006). The population of this descriptive study included pre-percutaneous transluminal
coronary angioplasty (PTCA) and post-PTCA from sample studies that were primarily male.
They attended the PTCA clinic, ranged in age from 41-85 years old, had existing single or double
coronary vessel disease, a history of an acute myocardial infarction, and also had attended
cardiac rehab in the past (Astin & Jones, 2006, p. 295). In reviewing the article, it was found
that it best fit the Level C in the AACNs new evidence-leveling system (2009, p. 72).

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Significance to Nursing

One of the criteria for a profession is the existence of a body of knowledge that is
distinct from that of other disciplines (Nieweiadomy, 2012, p. 5). Therefore, it is of great
significance for nursing to use sources that are distinct to the nursing profession in order for
nursing to be viewed as a credible profession. These distinct sources that are current and best of
evidence are also referred to as EBP. As mentioned previously, ANA defined EBP as the
integration of evidence and research findings into practice (2010, p. 51). Nursing theoretical
and conceptual frameworks, then, serve as the foundation that guides nursing practice to provide
the best possible care.
Before EBP, nursing practice was more based on intuition, experience, clinical skills,
and guesswork, rather than science (Chitty & Black, 2011, p. 267). Thereafter, the need for
EBP was soon recognized and incorporated into the nursing practice. EBP is reliable research
knowledge that distinctly guides nursing practice and set standards by reducing wide variations
in practice, eliminate worst practices, and enhance best practices to improve quality and decrease
costs (Pender, Murdaugh, & Parsons, 2011, p. 246). Furthermore, EBP empowers nurses, by
enabling a better understanding and relation between what nurses do and why they do it. It
should be noted that EBP guides and sets standards for nursing practice, but it does not overrule
clinical expertise and judgment (Singleterry, 2014).
Even so, the best EBP and expert judgment alone will not warrant safe quality care if
nurses are unable to effectively communicate and collaborate with patients, family, support staff,
and the multidisciplinary healthcare team. Nursing as a profession carries out a number of roles
such as provider of care, educator, counselor, manager, researcher, collaborator, and as patient
advocate (Chitty & Black, 2011, p. 338-341). Communication and collaboration serve as the

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integral components in the promotion of safe and quality care. According to ANA (2010), the
registered nurse communicates effectively in a variety of formats in all areas of practice (p.
54). Moreover, ANA (2010) defined collaboration as where the registered nurse collaborates
with healthcare consumer, family, and others in the conduct of nursing practice (p. 57).
Professional nurses must be able to efficiently demonstrate open and clear communication and
professionally collaborate with patients, family, peers, and the multidisciplinary healthcare team
to ensure a safe and collegial environment. Furthermore, communication and collaboration are
vital in any profession, but in the healthcare field, it can literally mean the difference between
life and death. EBP serves as the blueprint that is continuously being redesigned to improve and
distinctly redefine the nursing practice as a profession. EBP promotes efficient and quality safe
care along with enhancing patient outcomes. According to ANA (2010), Institute of Medicine
(IOM) expressed important factors such as nursing work environments, organizational culture
and structure, nurses behavioral traits, and how they interact with the interdisciplinary team can
exponentially help or hinder the quality and safety of patient care (p. 21).
In addressing this quality and safety issue, the National Center for Biotechnology
Information (NCBI) (2014) views quality care as the overarching umbrella under which patient
safety resides (para 2). The National Center for Biotechnology Information (NCBI) (2014) also
shares similar views as IOM, defining safety as the prevention of harm to patients (para 6).
When thinking of quality and safety, three ANA scope and standards of practice come to mind.
According to ANA (2010), standard 8 is education, emphasizing the importance for nurses to
attain knowledge and competence that reflects current nursing practice (p. 49). Standard 9
defined EBP and research, encouraging nurses to incorporate evidence and research findings
into practice (ANA, 2010, p. 51). Lastly, standard 10 is quality of practice, defined by ANA

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(2010) as when nurses contribute to quality nursing care (p. 52). This means that nursing is a
lifelong learning process; it is vital for nurses to stay current and up-to-date on practice
knowledge and skills as nursing research evolves and redefines the nursing practice with new
evidence. It is equally important to accurately document findings, maintain accountability, and
be creative and innovative, analytical, and ethical in providing and improving patient care to
promote the best quality safe care.
All in all, expectations of nursing practice and knowledge has increased. With the
amount of research available today, it is important to be able to identify the quality and strength
of the evidence in order to determine if research evidence is reliable. This means determining
whether it is a scholarly refereed journal, a non-refereed journal, or a peer review, and
understanding what level it is. Nursing research will continue to be of great relevance to the
nursing profession. Nursing research aims to promote the best EBP possible. It refines existing
knowledge and employs new knowledge while ensuring nursing credibility and accountability.
As a profession, nursing strives for quality and safe care to our patients.

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References

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Heart Disease and Stroke Statistics2009 Update. Circulation, e20-e424.
http://dx.doi.org/10.1161/CIR.0b013e3182365a77
American Association of Critical-Care Nurse, Elsevier. (2014). Heart and Lung The Journal of
Acute and Critical Care (HEART LUNG). In ResearchGate. Retrieved from
http://www.researchgate.net/journal/01479563_Heart_and_Lung_The_Journal_of_Acute_and_Critical_Care
American Heart Association (AHA). (2014). American Heart Journal. In Researchgate.
Retrieved from http://www.researchgate.net/journal/0002-8703_American_Heart_Journal
American Nursing Association (ANA). (2010). Nursing: Scope and Standards of Practice (2
ed.). Silver Spring, Maryland: Nursesbooks.org.
Armola, R. R., Bourgault, A. M., Halm, M. A., Board, R. M., Bucher, L., Harrington, L., ...
Medina, J. (2009). AACN levels of evidence: Whats new?. CriticalCareNurse, 29(4),
70-72. http://dx.doi.org/10.4037/ccn20009969
Astin, F., & Jones, K. (2006). Changes in patients illness representations before and after
elective percutaneous transluminal coronary angioplasty. Heart & Lung, 33(5), 293-300.
http://dx.doi.org/10.1016/j.hrtlng.2005.09.006
Chitty, K. K., & Black, B. P. (2011). Professional Nursing (6 ed.). Maryland Heights, Missouri:
Saunders Elsevier.
Mitchell, P. H. (2008). Chapter 1. Defining Patient Safety and Quality Care. Patient Safety and
Quality: An Evidence-Based Handbook for Nurses
, 1-5. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK2681/

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Nieswiadomy, R. M. (2012). Foundations of Nursing Research (6 ed.). One Lake Street, Upper
Saddle River, New Jersey: Pearson Education, Inc.
Pender, N., Murdaugh, C., & Parsons, M. A. (2011). Health Promotion in Nursing Practice (6
ed.). Upper Saddle River, New Jersey: Pearson Education, Inc.