Rehabilitation nurses, in collaboration with the healthcare team, use a variety of clinical skills to make a difference in their patients' lives. These nurses work with patients of all ages, along with their families or caregivers, soon after a disabling injury (e.g., traumatic brain or spinal cord injury) or during the trajectory of a chronic condition (e.g., Parkinson's disease, multiple sclerosis, or stroke). Rehabilitation nursing practice is about restoring patients' lives with the goal of maintaining and promoting maximum health (Association of Rehabilitation Nurses, n.d.). Long known is that these nurses need high-quality information (i.e., data-driven reports that generate evidence) on which to base patient care management and clinical decisions (Chien, 2019; Pierce, 2007). The Rehabilitation Nursing journal (RNJ) serves as an exemplar of a quality publication that reports scientific or data-based studies that provide research evidence to guide nursing practice (see Rehabilitation Nursing Journal, https://journals.lww.com/rehabnursingjournal/pages/default.aspx).
Following graduation from an entry-level program, rehabilitation registered nurses occasionally view published scientific studies in professional journals as overwhelming to read and appraise or evaluate. Failure to examine these publications exposes a serious gap in using data-based studies to move nursing practice forward. Effectively reading these studies is an acquired skill. Critical appraisal identifies studies' strengths and weaknesses related to credibility and authenticity or their applicability to appropriate standards of practice. The importance of evidence-based practice (EBP) cannot be overstated as consistent application in healthcare results in higher levels of patient care and quality patient outcomes. Concurrently, nurses who base their practice on evidence report a sense of empowerment and experience greater job satisfaction while influencing healthcare cost reduction and care access inequities (Melnyk & Fineout-Overholt, 2019).
Background
The authors, a nursing doctor of philosophy (PhD) and a doctor of nursing practice (DNP) respectfully, have years of experience in research, quality improvement, and EBP; continue to publish articles in various professional journals and books; and serve on journal review panels. The first author edited a professional newsletter, as well as held an associate editor position with a professional journal. Both nurses have taught research for EBP entry-level courses for undergraduate nursing students focused on learning the research and quality improvement process. The authors have taught students basics for reading and reviewing scientific publications in a sequence as written in a publication from topic introduction and literature review, methods, results or findings, and discussion to conclusion/recommendations for practice. These courses were perfect paths for students to learn to read and review studies; however, with time constraints, these courses failed to transmit an in-depth desire for a deeper exploration into the benefits and the utility of reading to appraise data-based articles.
Reading to appraise scientific publications is an important area of expertise. For instance, in a 2-year period (2020 and 2021), RNJ published a total of 81 featured articles (RNJ, 2022b). Of these publications, 72 of 81 (89%) were scientific studies, that is, data-based research or quality improvement projects. The other 9 of 81 articles (11%) had a clinical focus and were not data-based projects (RNJ, 2022b). Although nurse graduates have basic article assessment skills, practicing nurses need to continue to apply these beginning skills; grow or learn to step on a different or more advanced path; and become a more critical, seasoned appraiser.
That said, no matter the journal, it is sensible to decide if the quality of the data-based publication merits reading. The aim of this article is to discover a different path where registered nurses and other professionals can apply the "six steps" in reading to appraise scientific publications. There are brief critical appraisal questions for each step recommended that provide a beginning or surface examination, with more in-depth questions suggested in Table 1 for data-based studies (e.g., research or quality improvement projects).
Steps Approach
Begin the appraisal journey by stepping onto the path of scientific publications and choose an article of interest from any journal. First, read by skimming the article from beginning to end as written. Second, if the article focuses on a problem of interest, read to appraise the article following the six steps approach, asking brief, surface evaluative questions for a basic appraisal of the content. This questioning strategy can help with overall comprehension and enhanced understanding of how the content relates (or does not relate) to the problem or topic under investigation (Aksnes et al., 2019; American Psychological Association [APA], 2020; Laubepin, 2013; Schmidt & Brown, 2019; Subramanyam, 2013; University of Southern California Libraries [USCL], 2020). Third, now read the article using in-depth evaluative questions presented in Table 1 for each of the six steps. This is a different path or strategy from learning the research process and reading data-based articles in the exact published sequence taught in basic nursing programs. These six steps, though out of order from how any scientific publication is organized, are a sound approach to comprehension of complex ideas, data, and concepts. Be sure to take notes throughout this reading to appraise the approach, as written answers to evaluative questions will help in reflecting upon the value of the article.
Step 1: Title, Abstract, and Key Words
Begin by reading the title, abstract, and key words of the scientific publication, as they are quick ways to learn about the article. Titles of publications are simple and succinct words that describe the topic and method of the study (APA, 2020). The abstract is a brief summary of the whole article that usually highlights the article's focus and purpose, data collection/analysis, and outcomes. Key words represent the main concepts of the topic and are the words used in everyday life to describe the topic (Schmidt & Brown, 2019; USCL, 2020).
Brief evaluative questions to ask about the title, abstract, and key words include the following:
1. Are these words clear, concise, and objective?
2. Are these words directly connected to the identified problem (APA, 2020; Schmidt & Brown, 2019)?
Table 1 provides in-depth evaluative questions for an under-the-surface, deeper examination of the title, abstract, and key words, along with authors' comments.
Step 2: Discussion and Conclusion
After Step 1, proceed to the second step, the discussion and conclusion sections. These sections are usually found at the end of a scientific publication and describe the study results or findings with recommendations for further research. It is helpful to read these sections after the abstract because they are easier to understand and prepare the reader for what to expect in the rest of the publication (Schmidt & Brown, 2019).
Discussion
The most relevant quantitative results or qualitative findings are reported in the discussion section and should answer the original aims, research questions, or hypotheses (APA, 2020). The hypothesis, found only in a quantitative study, is a clear expression about what the researchers expect to find in a statement that can be tested and argued (Young & Solomon, 2009). The discussion usually includes how the results or findings are interpreted, contribute to the existing body of knowledge, and are linked to the literature review and the theoretical framework. Study design limitations are also identified (Laubepin, 2013; Schmidt & Brown, 2019).
Conclusion
The conclusion is the final section of the article and provides a brief, concise summary of the study; relevant results or findings; and implications for education, research, and practice. Suggestions for future research studies are also usually included (Schmidt & Brown, 2019).
Brief evaluative questions about discussion and conclusion sections are as follows:
1. How are the results/findings interpreted based on the presented data, and are conclusions and generalizations clearly stated (APA, 2020)?
2. What recommendations or courses of actions are made based on these study results or findings (Laubepin, 2013)?
Table 1 lists more in-depth evaluative questions for appraising the discussion and conclusion content, along with authors' comments.
Step 3: Results or Findings
Locate and read study outcomes: results for quantitative studies, findings for qualitative studies, or both for mixed-methods studies. Outcomes are based on information gathered as a result of the data analysis method(s) applied in the study to answer the aim, purpose, or research questions or hypothesis without bias or interpretation and arranged in a logical sequence. Tables, graphs, charts, and/or figures present a large amount of information efficiently and make outcomes for data (numbers and/or words) more comprehensible (Schmidt & Brown, 2019; Subramanyam, 2013).
Methods used to analyze characteristics of the sample and data are reported. Sample characteristics are most often reported as a number count (and/or percent), for example, total sample, N = 150; men, n = 70 (47%). In answering the aim, purpose, or research question or hypothesis, numerical data values (a parametric statistic such as the Student's t test or a nonparametric statistic like the Wilcoxon) and/or textual information (word responses from participants) are described in a narrative and/or arranged in tables, graphs, charts, or figures. Indications of statistical or clinical significance for these outcomes are also reported.
Quick evaluative questions for appraising results/findings are as follows:
1. Assuming appropriate analysis method(s), do key outcomes discussed relate to the sample and problem?
2. If present, are tables, graphs, charts, and/or figures pertinent (Subramanyam, 2013; USCL, 2020)?
See Table 1 for in-depth evaluative questions concerning results and/or findings, as well as authors' comments for these outcomes.
Step 4: Introduction and Review of the Literature
Next, read and review the introduction and review of the literature. Pay close attention to the study design, purpose/aim, problem/questions, and author's hypothesis. These two sections lay a foundation for the study and should engage the reader by provoking interest and applicability to current practice.
Introduction
The introduction should persuade the reader that the study is important (the problem and the purpose of the study). It should include the project objectives and provide a broad overview of the problem by summarizing the background of the elements examined and reported in the study (APA, 2020; Schmidt & Brown, 2019). The study's applied theoretical framework is often included in the introduction.
Quick evaluative questions to ask about the introduction are as follows:
1. Does it provide the main background of and arguments for the study?
2. Is a theoretical framework included to guide the study design (Laubepin, 2013; Schmidt & Brown, 2019)?
Review of the Literature
The literature review is a comprehensive collection of recent and landmark (important, turning point) published studies. This review summarizes what is known about the problem, identifies problem knowledge gaps, and explains what the present study can add to what is already known in current literature on the topic (Laubepin, 2013; Schmidt & Brown, 2019).
Brief evaluative questions to ask about the review of literature are as follows:
1. Why is the study important?
2. Will the study build on what is already known (APA, 2020)?
Specific evaluative questions for a deeper examination of introduction and literature review plus authors' comments are displayed in Table 1.
Step 5: Data Collection and Analysis Methods
At this point, read and examine the data collection and analysis found in the methods section. Data collection methods involve planning and executing the collection of evidence and is dependent on the study design (qualitative, quantitative, or mixed methods). Much time and effort are required to support the framework of the study; therefore, the data collection and analysis methods should be appropriate for the research problem(s). These careful preparations help prevent serious problems for researchers that could lead to challenges to the study results (Schmidt & Brown, 2019).
Data Collection
Just because data collection is done frequently, many assume that this is an easy undertaking. Actually, it is both a science and an art. The science involves reading and studying the approach and data collection tools; the art is applying scientific principles to "real-life" situations (Carey & Lloyd, 2001, p. 28). Quantitative number data are collected for statistical testing, or qualitative word data are collected for content analysis where each method provides the foundation for solving clinical problems (Carey & Lloyd, 2001). Standardized instruments used in a quantitative study (assessment, physical equipment, and imaging procedures) or experiences in a qualitative study (words, pictures, and observations) must be described. Be aware that other terms that refer to data collection may be used, such as data identification, collection, or selection (APA, 2020).
Data Analysis
Data analysis terms refer to analytical approaches and processes. Sometimes alternate terms are used and can be confusing. These alternate terms include inferential statistics in quantitative studies and interpretation, unitization, eidetic analysis or coding in qualitative studies (APA, 2020). It is important to remember that the fundamental aspects of research are analysis of the data and accurate, complete, and insightful reporting of the analyses (APA, 2020).
Quick appraisal questions for data collection and analysis include the following:
1. Are the materials and procedures described for gathering information to examine the problem appropriate?
2. Did the study use quantitative (statistical analysis), qualitative (content word analysis), or a mixed-methods (qualitative and quantitative analysis) approach to examine the problem (Schmidt & Brown, 2019)?
Table 1 includes more extensive questions for data collection and analysis with authors' comments.
Step 6: In-Text Citations and References
Finally, assess the in-text citations and references. Reference citations are sources that the author(s) used to document what prior research and other information was used when conducting the published study. These sources provide a good idea if the scientific publication is authentic and meets the quality standards (Schmidt & Brown, 2019).
Reference citations are critical in building the case for why the study is needed and important. In other words, upon appraising the scientific publication, use these in-text citations and references to think about how they support the study undertaken.
Quick evaluative questions to ask about the in-text citations and references include the following:
1. Are in-text citations and references accurate?
2. Are the references up-to-date (Aksnes et al., 2019; Laubepin, 2013; Subramanyam, 2013; USCL, 2020)?
Other more in-depth evaluative questions with authors' comments to consider in reading in-text citations and references for any article are listed in Table 1.
Discussion and Clinical Relevance
Choosing a path less traveled and learning these six steps in reading to appraise scientific publications using surface or brief evaluative questions is a beginning skill for recent nurse graduates, including recently certified rehabilitation registered nurses with 2 years of practice experience. More seasoned nurses may find these six steps using both surface and in-depth evaluative questions useful to build an EBP project, whereas administrators and managers might use the steps to orient staff to research, EBP project ideas, education, management, or forming practice councils or journal clubs. Other expert nurses on journal review panels or boards can adapt the steps in critical appraisal of manuscripts. In addition, writers of manuscripts might use the six steps to appraise their content before submitting for possible publication in journals.
For a manuscript review, an introductory textbook for reading to appraise scientific publications is Evidence-Based Practice for Nurses by Schmidt and Brown (2019) as cited in this article. Additional books for basic information include (1) Essentials of Nursing Research by Polit and Beck (2021) and (2) Nursing Research: Reading, Using, and Creating Evidence by Houser (2021). The Joanna Briggs Institute also has basic critical appraisal resources at https://jbi.global/critical-appraisal-tools. More information for seasoned nurses about appraisal strategies for published studies is available in the book by Burns and Grove's The Practice of Nursing Research (Gray et al., 2020). Scientific publications can also be evaluated at a more complex level by advanced practice expert nurses using writing guidelines for systematic reviews and meta-analysis, randomized controlled trials, qualitative research, EBP projects, case studies, quality improvement projects, observational study reports, and diagnostic accuracy studies, as displayed in Table 2. These writing guidelines become evaluative questions to appraise scientific publications.
Successfully reading to appraise scientific publications about rehabilitation topics of interest (e.g., chronic illness and disability) informs insights; answers practice questions; and moves toward more efficient, effective EBP. As rehabilitation nurses and other professionals become more proficient at reviewing scientific publications, the process of understanding and critically evaluating the science becomes easier, as the content appraised coalescences around common themes and patterns of analysis (Schmidt & Brown, 2019; Subramanyam, 2013).
Conclusion
Discovering a different path with these six steps in reading to appraise scientific publications may seem like a daunting endeavor at first. With an organized routine, new and seasoned healthcare professionals can not only begin to appreciate the importance of this skill but also discover a desire to seek out and even enjoy the benefits of learning, growing, and contributing new practice ideas that benefit patient outcomes and healthcare practice. Applying these six steps will help close the gap in reading to appraise and understand data-based articles. Appraising and applying evidence from scientific published articles empower professional practice focused on patient-centered care. Through a six steps approach in reading to appraise scientific publications, rehabilitation registered nurses and other professionals can uncover the validity behind practice claims before wisely implementing research or quality improvement projects into their own practice environment.
Key Practice Points
* Rehabilitation registered nurses need to be inquisitive, questioning how and why interventions and care procedures support patient care management and clinical decision-making. Seeking out scientific literature and thoughtfully appraising topic-related publications are hallmarks of evidence-based practice (EBP).
* Reading to appraise data-based articles (research and quality improvement projects) can be a daunting experience for not only newer graduates but also more seasoned nurses.
* The six steps approach is a different path because it is out of order from how a published article is usually organized. These steps arrange components of an article into meaningful smaller pieces, with brief, in-depth evaluative questions that help comprehend ideas, data, and concepts.
* This six steps approach helps professionals discover a different path in reading to appraise data-based articles. These steps build on basic content learned in research for EBP courses and can be used as follows:to orient practicing rehabilitation registered nurses and colleagues to an organization's leadership, education, and EBP or research council;to stimulate interest in forming journal clubs;to aid potential authors to appraise a written manuscript prior to journal submission;to serve as a basic appraisal approach for a professional journal's editorial board or manuscript evaluation panel; andto assist any journal reader to uncover the truth behind the assertions made in scientific publications to build and guide a successful EBP.
Conflict of Interest
The authors declare no conflict of interest.
Funding
The authors declare that there is no funding associated with this article.
REFERENCES