Critique of the Study by Sohn and Colleagues, “Simulation-based smoking cessation intervention education for undergraduate nursing students” In this paper, Sohn and colleagues (2011) study Simulation-based smoking cessation intervention education for undergraduate nursing students will be critiqued with the assistance of Loiselle and Profetto-McGrath’s (2011) book Canadian Essentials of Nursing Research.
The title of the article is clear and concise. It is only ten words long and clearly states the nature of the study. The population under study is identified, and the issue being considered is included in the title as well. All of these factors contribute in making the title of the article effective. Abstract
The main features of this paper are summarized in the abstract of the article. The authors state the research problem, the design of the study, the population, and the results of the study. The abstract in this research report is 243 words, which is slightly lengthier than an abstract should be. It may have been more effective to organize the information under headings such as, “Background, Objectives, Method, Results, Conclusions, and Key Words” (Loiselle & Profetto-McGrath, 2011, p. 58), instead of clumping the information into one dense paragraph that is difficult to read. Introduction
Statement Problem
The problem statement is evidently specified in the introduction of the research article when the authors write, “despite the educational importance of smoking cessation intervention, the training provided to nursing students is inadequate for the daily reality of patient care. Many nursing schools provide education about health effects of smoking, yet few teach how to help smokers to quit” (Sohn, Ahn, Park & Lee, 2011, p. 868).
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This problem is significant in nursing as better education can help nurses improve the quality of health care provided to the public. The authors state, “More than half of the students indicated that they encountered patients who were smokers every week” (Sohn, et al., p. 870).
Smoking can cause many adverse effects to one’s health, and if nurses are able to enhance smoking cessation interventions to their clients, one’s general health can be improved. The authors describe the issue at hand and how to approach fixing said issue by offering simulation-based learning as a teaching method. Research Purpose
The authors state in the introduction that the population under study is nursing students and that the “study objectives were to describe nursing students’ experience, attitude and perceived barriers of smoking cessation intervention and to evaluate its effectiveness on nursing students’ self-efficacy in performing smoking cessation intervention” (Sohn, et al., p. 868).
No formal hypotheses were clearly stated in the introduction of the article; however, the aim of the study is obviously identified, as were the objectives of the study. Later in the results and discussion sections of the research report, statistical data was used to analyze and interpret the results, despite the absence of stated hypotheses. Conceptual Underpinnings
The authors of this study used Bandura’s social cognitive learning theory. Although this is a borrowed theory, its use is justifiable in the field of nursing research and is commonly used by nurse researchers to explanation human behavior in relation the notion of self-efficacy and outcome expectations. The researchers describe Bandura’s theory and relate it to their study by stating, “‘Mastery of performance is obtained by performing a task and experiencing success’ (Bandura, 1997a).
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There are so many different facets of nursing. Nurses are given so many tools to utilize in our role of educator to patients. It has to be kept in mind that we are doing this with our patients continuously. Every time a task is completed with patients and it is explained what is being doing, teaching is being conducted and hopefully they will take that with them in the future. Nurses need to be ...
Simulation can provide a very safe environment for students, compared to the real clinical environment” (Sohn, et al., p. 869).
The authors continue to explain in what ways simulation can enhance learning and relate to Bandura’s theory. The authors make it easy for readers to understand the major features of the theory and how it conveys the conceptual basis of the study. Literature Review
The authors used many resources to help supplement their study. The majority of the references are primary resources within five years of the research article being written; however, some of the references are outdated, being over 10 years old. Several articles were used to explain the underlying motive of the instruments being put in place, such as questionnaires including questions on beliefs about the health benefits of smoking cessation, experience and attitude of smoking cessation intervention, experience of smoking cessation intervention, perceived barriers of smoking cessation intervention, and self-efficacy of smoking cessation intervention. The researchers discovered that the results of this study were found to be consistent with another survey on smoking cessation. The literature in this article summarized existing knowledge on the topic of smoking cessation to complement the results of the study. The authors mention several similar studies, including a survey of 344 Korean nurses and deans or chairs of 44 Korean nursing schools on smoking cessation, and compare the results of previous studies to the results of the study at hand. However, the authors stated that they “were not able to find any previous study exploring the effectiveness of simulation education on smoking cessation intervention” (Sohn, et al., p. 872).
With this study being one of the first of its kind to focus specifically on simulation training and smoking cessation, it can help lay a solid basis for a new study.
Method
Research Design
The research design utilized in this report was a one group quasi-experimental study. The authors used an appropriate design, as the students were questioned before and after the intervention was put in place. A true random experimental study with a control group would not have been more effective than the design that was used. As previously stated, the authors compare the results of earlier reports to the results of the study at hand to enhance the interpretability of the findings.
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The design of the study minimized threats to internal validity by having students blindly pick up a card to randomly place themselves in a group. With the students only having to participate for five hours total, broken up into a two- and a three-hour session over one week, the maturation threat is relatively low as this is a short amount of time. The mortality rate was reasonably low, with only four students dropping out of the study; however, because of the small sample size, this could be viewed as a threat to internal validity.
The participants were recruited based on their enrollment in one course from one university. Due to this weak sampling method, the results are not very generalizable which decreases the study’s external validity. The Hawthorne effect may have altered the participants’ true reactions, as they were aware of being watched and videotaped by the researchers and fellow participants. This further decreases the external validity of the study.
This study used a longitudinal follow-up design, as data was collected twice over a one-week period. Only having two data collection points may have been appropriate given the research problem; however, the results could have been made stronger if a simulation and a debriefing session had been done prior to the lecture to better see how the intervention improved students’ self-efficacy in regards to smoking cessation teaching. Population and Sample
The population was identified and described as undergraduate nursing students several times throughout the study. The authors described the sample in sufficient detail, noting what year of the nursing program the participants were in, the mean age of students, the gender of participants, and also how many of the participants were current smokers.
The sample size was quite small for this type of a study, and it would have been more effective for the researchers to recruit participants in different courses from different universities and different cultures. There is no evidence of a power analysis being conducted to estimate how large the sample size should have been or how significant group differences may be on the outcome of the study. Using a larger sample size would have improved the representativeness and generalizability of the findings, as well as decreased possible sampling error. Data Collection and Measurement
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The operational definition and the conceptual definitions are congruent, as they both mention the importance of self-efficacy as a learning tool. Interviews and questionnaires were a suitable method for operationalizing the key variables, as self-efficacy is a subjective experience and cannot easily be measured using observation or other techniques.
The authors described the questionnaires in detail, stating specific questions used to collect data. Each participant was subject to the same intervention and questionnaires. The only difference in the methods was that some groups contained four students and some contained five. The authors identify this as a limitation, and also identify that the vignette used, a 5-point scale, is not as strong as using a 100-point scale to see differences in students’ perceived self-efficacy.
The researchers attempted to make the setting as natural as possible while still having control over the situation. A manikin was used instead of a real-life patient; however, the researchers were able to act as the patient using a microphone to answer questions that the students had. Speaking to a manikin may have affected the naturalness of the students’ behavior, altering how they would act or respond in an actual clinical setting. The researchers videotaped the simulations, which also may have altered the students’ reactions. A checklist or using field-notes in a real clinical setting may have been more appropriate to yield more genuine results.
Procedures
The intervention that the researchers conducted on the participants was described as “a 2 hour didactic session and a 3 hour simulation session” (Sohn, et al., p. 870).
The authors continued to explain what each didactic, simulation, and debriefing session contained. Each student was subject to the same intervention, and data was collected in a manner that minimized researcher bias. By having the students complete their own questionnaires, the researchers could not have instituted any bias on data collection. Ethical Considerations
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No research ethics board was used, but the authors explained, “the data collection process did not requite any approval process based on school policy” (Sohn, et al., p. 869).
Although participants were not subject to any physical harm or discomfort, coercion may have been used. The students were told that participation in the study was required for their grade, although the data collected would not affect their grade and they would remain anonymous by being identified using the initials of a former school. This coercion influenced the recruitment of participants because the right to refuse to participate or withdraw without penalty was revoked. Verbal consent was used, which was a valid form of consent for this study, and “the researchers followed principles in the Declaration of Helsinki during the whole process of this study” (Sohn, et al., p.869).
Participants were not deceived and they were fully aware that they were participating in a study. No vulnerable persons were identified; also, no groups were omitted from the inquiry without a justifiable rationale.
Results
Data Analysis
The authors state that, “Explorative descriptive analysis was performed to validate data entry and to describe beliefs about health benefits of smoking cessation, and experiences, attitude and perceived barriers of smoking cessation intervention” (Sohn, et al., p. 870).
The results found from the questionnaires were fairly consistent and substantial. Findings
The researchers make use of multiple tables to assist in summarizing the findings of the study in an organized manner. “Paired t-test was used to explore the mean differences of self-efficacy of the smoking cessation intervention between pre- and post-simulation session in two-tails with 0.05 of type 1 error” (Sohn, et al., p. 870).
This p-value of 0.05 means that the authors would accept that 95% of data collected were truly due to the intervention and not due to sampling error. Of the data collected, the total p-value in this study was 0.03, deeming the findings statistically significant. Discussion
Interpretation of the Findings .The data collected from the study is consistent with the conceptual framework the authors used. The authors interpret the results of the study and relate them to Bandura’s social cognitive theory. The authors expected that simulation-based training would increase undergraduate nursing students’ self-efficacy of smoking cessation interventions. The findings in the study correlate with that proposition. The authors discuss possible limitations to the study in a productive manner. It is also noted that the findings in this study echo the findings in another study of similar interest. Implications and Recommendations
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The significance of smoking and smoking cessation are clearly stated in the research report. The authors explain that, “Smoking is a single most important risk factor for cancer, cardiovascular diseases and chronic respiratory diseases” (Sohn, et al., p. 871).
The researchers discussed perceived barriers to smoking cessation interventions, such as lack of knowledge and inexperience of smoking cessation interventions. Suggestions to improve smoking cessation intervention education are made by the authors. Recommendations include providing nursing students with, “early exposure, communication, physical assessment and smoking cessation interventions” (Sohn, et al., p. 872).
Global issues
Presentation
The research report was very organized, well written, and contained sufficient detail for a critical analysis to be completed. The study was laid out in a manner that made it easy to read and understand. There were no key details missing from the report that should have been included, nor were overt researcher biases discerned. The report was presented objectively and did not convey any tentative results and avoided words such as demonstrated and proved. The report was relatively easy for novice researchers to comprehend. Summary assessment
Although there were some identified limitations to the study, the findings appear to be valid and statistically sound. The research problem outlined in this study is significant to nursing, and the evidence was provided in a meaningful way so that it can be used in nursing training to improve the efficacy of smoking cessation interventions. The nursing implications and education recommendations can help lay a basis for future studies.
