The primary role of nurses includes consultation, patient education, follow-up treatment, and prevention of illnesses. The realization of these objectives has resulted in increased availability of health-care services, the decline in symptoms of chronic diseases, and better cost-effectiveness of experiences of customers of health care services (Griffiths et al., 2007). Apart from these benefits, promotion of health by nurses has led to several positive health outcomes including adherence to the code of practice, improvement in the quality of life, and enhancement in patients knowledge about their illnesses and ways of self-management (Keleher et al., 2009). However, due to the broad field of health promotion, many nurses do not have the required knowledge and confidence at the moment of need which is argued to jeopardize the realization of the health care objectives. Knowledge and confidence significantly affect a nurses ability to provide education/health promotion in clinical practice. Therefore, more research is needed to explore the effect of confidence and knowledge in promotion of health care services by nurses.
The differences in health care provision are brought about by the understanding of principles and the clinical judgment that is inherent to the procedures of diagnosis, assessment, evaluation, and implementation. In such processes, knowledge forms the foundation of patient needs assessment and determines the appropriate actions to be taken to address those needs, the level of professional accountability for the actions taken and decisions made, including the decision to assign co-workers duties as well as the quality of the nurse-patient relationship that is founded on the professional code of ethics. That is exemplified in the modern nursing environment which has become more complex and dynamic than ever before (Brown et al., 2009). Due to the rapidly evolving nature of the profession, nurses need advanced cognitive skills. Importantly, clinical judgment and critical, creative thinking have become essential skills. In the recent past, clinical judgment has become a method of problem solving in the nursing profession. Many theorists have proposed theories linking clinical judgment and clinical practice. Such studies include those by Tanner (2006) that indicate that focusing on the method of problem solving does not adequately define the process needed for nursing judgment and to take into consideration that complexities affecting clinical judgment. Thus, there is the need to focus on enhancing the knowledge of the nurses to equip them with necessary skills required for clinical judgment.
A study by Cook et al. (2013) on the effect of educational intervention nurses knowledge on practice and care delivery revealed that increased nurses knowledge improved their confidence in applying the new skills into practice. The authors recognized that there lack sufficient nurse knowledge and confidence to care for patients with mild brain traumatic injury. Due to the high incidence of mild brain traumatic injury, nurses must be updated on the best treatment methods. Thus, educational programs increase nurses knowledge not only about mild brain traumatic injury but also about other illnesses hence increasing their confidence while administering services thus better care.
On the other hand, confidence has a significant impact on the quality of services delivered by nurses. Studies have shown that confidence is the most fundamental requirement in the development of organizational culture such that the health care workers achieve satisfaction in their work, are committed to their roles, and understand their individual roles clearly. A study by Laschinger and Sabiston (2000) revealed that empowerment has a direct impact on the confidence of nurses. Specifically, empowerment influences emotional employment obligations and the confidence of the personnel in the administration. In other words, administrators of hospitals who ensure a conducive working environment gain more trust than those that do not create friendly environments. The researchers established that there was a positive relationship between the level of confidence in the management and the perceived access to information and support. When nurses perceive that they have adequate support, information, and resources, they are more likely to have high confidence in the administration hence become more adamant and committed to achieving the objectives of the hospital.
A study conducted by Ray and Marion (2002) employed the grounded theory to explore ways in which hospitals affect the confidence of their employees. The scholars noted that continued absence of support, disrespect of the nurses, and lack of effective communication channels reduce the confidence levels of nurses. On the other hand, a study by Laschinger et al. (2012) revealed that autonomy and collaboration between the employees and the administration increased the levels of trust hence resulting in increased job satisfaction. The researchers noted that good working environments were associated with low emotional exhaustion, better job satisfaction levels, and positive perceptions of employees toward the quality of care offered. Low emotional exhaustion levels resulted in low levels of burnout hence increased confidence and better service delivery.
Further studies by Papathanasiou (2014) revealed that determination of an employees work and the nature of relationships in the work environment affect his access to job empowerment structures. Access to empowerment structures improves autonomy, job satisfaction, and minimizes burnout. Similar findings were established by Hatcher and Laschinger et al. (2012) that lower levels of burnout were associated with high levels of access to opportunities for employee development. Further, Laschinger et al. (2012) noted that lower stress levels and job satisfaction are attributable to the psychological empowerment of nurses. The scholars concluded that nurses who feel psychologically and structurally empowered have high confidence levels and low-stress levels hence better service delivery.
The significance of knowledge and confidence in nursing is evidenced by Lelorain et al. (2017) and Robson et al. (2013)s studies. Robson et al. (2013)s study focuses on the effect of knowledge on the attitudes of mental health nurses and how it affects their service delivery. On the other hand, Lelorain et al. (2013) research entail an investigation into the factors that impede the growth of nurses confidence, particularly motivation. Although the two articles investigate different variables, the relevance of their findings converges in that nurses knowledge affect their confidence. On the other hand, factors associated with confidence also help in the advancement of knowledge. Therefore, an investigation into the effects of the two factors in nursing practice is overly critical.
Critical Appraisal of the Articles
Critical appraisal of an article refers to the systematic process used to determine the weaknesses and strengths of a research publication with the aim of assessing the applicability and validity of the results (Du Prel, 2009). Typically, the assessment of the appropriateness of the study design to address the research question and a detailed evaluation of the main methodological characteristics is done (Young & Solomon, 2009). Therefore, these processes will be carried out to determine the usefulness of the outcome of Lelorain et al. (2015) and Robson et al. (2013)s studies. Also, the suitability of the statistical methods employed by the studies will be conducted. Importantly, the subsequent interpretation of the statistical methods, the relevance of the studies to the nursing field, and potential conflicts of interests will be evaluated.
Quantitative and Qualitative Research Approaches
According to Tracy (2012), qualitative research approach encompasses many methods of data collections such as interviews, observations, and textual analysis. In healthcare, the common methods used include focus groups and interviews (Tracy, 2012). Observations are effective in collecting data on natural behaviors in their normal contexts. Interviews are used to obtain data about peoples opinions, experiences, and perspectives about sensitive issues investigated by the study. On the other hand, focus groups are appropriate when collecting data about the norms of a group (Tracy, 2012).
Quantitative research approach focuses on objective measurements, numerical, mathematical, and statistical analysis of data obtained through questionnaires and surveys or through manipulation of pre-existing data by use of computational techniques (Creswell, 2013). In other words, quantitative research method emphasizes on obtaining statistical data and generalizing it across a population to explain a given phenomenon. Typically, quantitative studies are conducted to examine the relationship between an independent variable and a dependent variable within a population (Creswell, 2013).
The ability to appraise a research publication critically is an important tool for nurses that adopt a population perspective. While there are conventional procedures for reporting and assessing the quality of quantitative and epidemiological data, similar guidelines are uniquely absent in qualitative approach for several reasons. The reasons include many theories that could be used to carry out the research as well as the incompatibility of indicators of quality (Dixon-Woods et al., 2004). In this regard, of Lelorain et al. (2015) and Robson et al. (2013)s articles will be critically appraised using the frameworks described by Dixon-Woods et al. (2004) and Greenhalgh et al. (2008) respectively.
According to Dixon-Woods et al. (2004), the first step entails determining whether the purpose of the study is clearly stated. Lelorain et al. (2013)s research purpose is well defined. The scholars clearly identify the purpose of the study as identifying solutions for greater HCP involvement. However, the explanation is shallow and does not state the research question. In addition, the context in which the results will be interpreted is not provided. On the other hand, Greenhalgh et al. (2008) demonstrate that the first step of critically appraising Robson et al. (2013)s article which involves determining whether the research question is clear and if the questionnaire was the most appropriate research design. Although the purpose of the study is well-defined, the scholars do not clearly state the research question. This is one of the weaknesses of the article because a reader should understand what the study entails using the research question. The scholars state the aim of the research which was, to describe the attitudes, confidence, clinical practice, and perceived training needs among qualified mental health nurses in relation to the physical health care of people with severe and enduring mental illness, (Robson et al., 2013; 410). Also, the researchers provide a concise description of the context in which the results will be interpreted by stating the hypothesis. According to Creswell and Clark (2007), a research question is an inquiry into a specific issue. It forms the fundamental core of the study by focusing the research, determining the methodology to be used and guiding all the steps of analysis and reporting. Although the two articles do not have a research question, they, however, accomplish their purposes.
One of the strengths of Lelorain et al. (2017)s study is justification for the qualitative approach used. In particular, the scholars expertise is demonstrated by recognizing that HCPs would be more comfortable to participate in the study if individual interv...
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