Research Methods for Nursing Practice

This assignment focuses on the application of research methods in nursing practice. Students are expected to analyze different research methodologies, including qualitative and quantitative approaches, and discuss their suitability for addressing specific nursing problems. The assignment emphasizes the importance of ethical considerations in research and highlights key steps involved in data collection, analysis, and interpretation within a nursing context.

Running head: NURSING RESEARCH
Prevalence of Depression and Detoriation of QOL among patients undergoing
cancer treatment.
Name of the Student
Name of the University
Author Note

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NGEE ANN POLYTECHNIC
School of Health Sciences
Diploma of Health Sciences (Nursing)
Nursing Research 2
Research Critique (Written report)
Name
Student No.
Tutorial Group
Plagiarism Disclaimer
I declare that this submission is my own work and that in every case where I have drawn on
the work of any other author or source, this is fully and specifically acknowledged in the text
of my submission and the works cited in the appended reference list.
Student’s Signature : _______________
Marker’s Name: Marker’s Signature:
Grade:______________
Date:_________________
A+ 68-80 C+ 52-55.9
A 64-67.9 C 48-51.9
B+ 60-63.9 D+ 44-47.9
B 56-59.9 D 40-43.9

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F < 40
Moderator’s Name: Moderator’s Signature:
References:
Boswell, C. & Cannon, S. (2011). Introduction to Nursing Research: Incorporating Evidence
Based Practice. (2nd ed.). USA: Jones and Bartlett.
Coughlan, M., Cronin, P., & Ryan, F. (2007). Step-by-step guide to critiquing research. Part 1:
Quantitative research. British Journal of Nursing, 16, 658-663
Godshall, M. (2010). Fast Facts for Evidence-based practice : Implementing EBP in a
nutshell. New York: Springer.

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NGEE ANN POLYTECHNIC
School of Health Sciences
Diploma of Health Sciences (Nursing)
Nursing Research 2: Research Critique Template
Use only Quantitative study for this assignment
Author(s): Debasweta Purkayastha, Chitra Venkateswaran, Kesavankutty Nayar, UG
Unnikrishnan
Title: Prevalence of Depression in Breast Cancer Patients and
it’s Association with their Quality of Life: A Cross-sectional
Observational Study
Journal: Indian Journal of Palliative Care
Year: 2017 Volume: 23 Issue: _________ Page: 268-273
Part 1: Article Information
Title
Is the title clear, accurate and unambiguous?
Yes, the title of the article is almost as per the objective of the study. The only
divergence is in the fact that the research ties to link depression and a lowered quality of life
associated with the conventional treatment of cancer (like chemotherapy, radiotherapy and
surgery), instead of the disease itself. It also does not include other forms of treatment like
CRISPR (Clustered Regularly Interspaced Short Palindromic Repeats) CAS 9 genome editing
technology, and other therapies like pharmacotherapy and psychotherapies (Cong et al.,
2013; Chisholm-Burns, Wells & Schwinghammer., 2016; Fromm-Reichmann, 2015).

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Is it clearly related to content and appropriate?
Yes, it is related since it shows the incidence of depression among the sample
population. It studies the psychological effects of conventional treatment (mentioned
above) for breast cancer.
Is it of appropriate length?
The title seems to be of appropriate length and it identifies the topic clearly.
PICO?
P: Patients diagnosed with Breast Cancer
I: Incidence of depression and change in the quality of life.
C: Comparison of the study done by Hassan et al,. (2015) that showed a relation between
depression and cancer treatment, and how it negativey affects the patient’s quality of life.
O: A positive correlation between depression and treatment of breast cancer
(Chemotherapy, radiotherapy, surgery, or a combination), and a negative correlation to the
quality of life.
Abstract
Does the abstract offer a clear overview of the study including the research problem,
sample, methodology, finding and recommendations?
The abstract clearly outlines background and the overview of the study, highlighting
the prevalence of breast cancer, and findings of the depression screening among the sample

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population. It shows a relation between cancer and depression, and its effect on the quality
of life of the patients.
Sample size: A sample size of 270 patients (above 18 years) diagnosed with cancer have
been selected.
Methodology: Depression was screened using Patient Health Questionnaire 9 and
International Classification of Diseases Research Guidelines (10th edition). Quality of life and
related domains were measured using World Health Organization Quality of Life (WHOQOL-
BREF) (Moriarty, Gilbody, McMillan, & Manea, 2015; Su, Ng, Yang, & Lin, 2014).
Finding: Poor quality of life and depression is common among patients with breast cancer
Recommendations: Improvement in the sensitivity of depression screening tests, and
improves access to psychiatric services, allowing prompt intervention (like psychosocial
programs) and psychiatrist referrals if needed.
Is it clearly presented and well-organized?
The abstract has a clear representation, and is organized, with a clear flow of
thought and logic. The presentation is also accurate as per the current standards.
Is it of appropriate length?
Yes, the abstract seems to be of appropriately justifiable length, and points out the
vital information on the study.
Part 2: Introduction to article

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Background Introduction
Does the introduction provide enough information about the research topic?
Background information includes statistics on breast cancer, effect of cancer
treatment, incidence of depression among cancer patients and effect of treatment on the
quality of life. However, it mainly focuses on how the treatment affects these factors,
thereby suggesting the adverse effect of treatment and not the disease. The background
also fails to acknowledge that staging of the tumors were not considered in the study, and
therefore it does not measure the effect of the criticality or seriousness of the cancer on the
emotional well being of the patient and on the QOL.
Are statistics provided to support rationale?
Yes. Relevant statistics were provided to support the rationale from one of the
reviewed journal. However the rest of the reviewed journals have only qualitative
implications, and is not backed up by statistical data.
Rationale
Does the rationale clearly linked to the research topic?
The rationale of using depression screening methods for the selected patients
undergoing cancer treatment is justified to the research topic.
Is it clearly presented and well-explained?

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Concepts related to depression, quality of life and how they are affected by cancer
treatment on patients with breast cancer have been clearly explained.
Is the rationale strongly supported?
The Rationale is strongly supported by clinical findings from other studies that
suggest a relation between contemporary/ conventional cancer treatment and depression,
and a decline in quality of life due to it. It is justified therefore to screen the patients for
depression and also measuring how the depression can have an effect on the QOL of
patients.
Part 3: Literature Review
Literature review
Are all the relevant concepts and variables (conceptual or theoretical framework?)
included in the review?
The literature review is included in the introduction, and provides the statistics and
inferences of other studies that relate depression and decline in Quality of Life due to
cancer treatment. However, the information is not arranged as per their theoretical and
conceptual contributions to the study. Furthermore, literature reviews ascertaining the
efficacies of the used measurement protocols (like PHQ-9 and WHOQOL) were completely
ignored. It is therefore vital to show how the used tools are effective in accurate
measurement, and proper inference (Barroso, Melo, Silva & Guimares, 2015).
A good literature review should consider the following steps: Step 1- Topic Selection;
Step 2- Developing tools for Argument the topic; Step 3- Literature Search; Step 4- Survey on

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the literature; Step 5- Critique of Literature and Step 6- Writing the review (Machi &
McEvoy, 2016).
Does the summary follow a logical sequence?
No, the literature review is included into the introduction, and is fragmented by
involving other information like quality of life and research objective. The literature review
should be written separately, with adequate details provided on the journals or studies
reviewed for this topic. The review also needs to include studies done outside Asia, to
ensure any demographic and socioeconomic variable affecting the inference.
Are primary sources mainly used?
The primary data from the source is not included; instead an overall understanding
that is generated from the review is mentioned. However, the data included are from
primary research, and not a meta analysis, thereby adding validity to the information
provided.
Is there a balance of review and critique analysis of literature?
The analysis of literature only includes a brief understanding from the studies
conducted. It proposes no critique to the findings, and seamlessly integrates the information
into the article without providing any counter arguments. It is therefore pertinent to include
critical analysis of the reviewed literature, to identify any loophole in the study method, and
avoid any biasness. Also, the author(s) avoided utilizing counter arguments or an alternate
hypothesis (to reflect if the proposed prevalence of depression associated with breast
cancer treatment can be caused due to other factors) to the study, and considers only
proving the proposed hypothesis.

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Does the review follow the purpose of the study?
The review supports the fact that treatment of cancer can often cause depression
and decline in the quality of life. However, any literature reviews that can counter the
hypothesis have not been acknowledged.
Themes
Are the themes relevant to the research topic?
The research topic underlies an overall theme that conventional cancer treatment
can have a negative effect on the quality of life and is often associated with depression, and
therefore is relevant to the research topic.
Are they clearly presented and well-explained?
The theme is clearly explained in the objectives of the study and the reviewed
literature on the topic. However, the theme is included in the objectives part, and is not
presented separately. Outlining the theme for the study separately can be suggested to
avoid confusion.
Research gaps
Is the research gap clearly linked or related to the purpose of the study?
The research gap is also included with the introduction, along with the review of
literature, which could have been avoided to maintain clarity. However, the research gap
identified pertains to how the identification of the psychiatric disorders faced by patients
undergoing cancer treatment can help in providing better and more effective treatment

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protocols. The aim to identify the research gap is to prevent any gaps in knowledge in the
research process (Patten & Newhart, 2017).
Is it clearly stated?
The above mentioned objective is clearly mentioned.
Are they logically presented from the literature review?
The literature review presents the fact that depression is linked to cancer treatment,
and it diminishes the quality of living of the patients, and does not clearly reflect upon the
research gap which is the lack of understanding of common psychiatric dysfunctions
prevalent in breast cancer patients. Additional reviews can be recommended that can
highlight the current deficit of understanding and identification of these dependant
variables.
Part 4: Designing the Research I
Aim or Purpose of study
Is the aim or purpose of the study clearly linked or related to the research gap?
Yes, the purpose of the study is to analyze the incidence of depression and lowered
quality of life among cancer patients. However the research gap is about expanding the
current knowledge about depression for better identification and treatment for breast
cancer patients. It should still be pointed out that the study also proposes utilization of
sensitive protocols to screen depression, thereby allowing better identification of the
symptoms, which pertains to the proposed research gap. A research design needs to clearly
identify the grounded theory and consensual qualitative model (Lewis, 2015).

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Is it clearly stated?
The aims of the study is included in the introduction to the research, and is placed
after the stating the research gap. The aims should be separately mentioned.
Is it relevant to the nursing practice or research?
The aim is very relevant to nursing practice and research, since it allows better
understanding of the prevalence of depression among breast cancer patients, and how it
affects the quality of life. Better identification of depressive disorders among the target
group can enable better treatment, and prevent the lowering of the quality of life among
them.
Hypotheses or Research questions
Is it linked or related to the research gap and purpose?
The research questions pertains directly to the purpose of the study, and indirectly
aids the research gap by increasing the understanding of depressive disorders prevalent
among breast cancer patients, and the subsequent lowering of the quality of life.
Are the variables measurable in the statement?
Both the depression levels and Quality of Life scores are measured using standard
measurement protocols outlined in the methodology.
Is the study illustrating a difference or relationship between the variables?

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The study implicates a positive correlation between depression and breast cancer
treatment, and a subsequent lowering of the quality of life (negative correlation) with
treatment.
Can PICO be illustrated from the hypothesis or research question?
Yes, a clear PICO outline can be formulated from the Hypothesis.
Part 5: Designing the Research II
Independent and dependent variables
Are they clearly stated?
The independent and dependant variables are not clearly identified, instead on table
2, all the variables are considered together. It is important to identify the dependencies of
the variables, for example the variables QOL and Depression are dependent on depression,
while the variable of breast cancer can be considered independent.
Are the measurements of dependent and independent variables clearly described?
Table 2 identifies the measurements of the dependant and independent variables.
However these identification needs to be made separately, along with the designing
protocols followed by the research.
Are they clearly linked or related to the research question or hypothesis?
Yes, the table clearly signifies a lowered QOL (over 4 domains) when associated with
depression.

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Research design
Is the research design clearly identified?
The research design is included in the Materials and Methods. It does not identify
and mention the instruments for measurement of Depression and QOL.
Is the design appropriate for the study question/hypothesis?
The overall design is appropriate for the research topic. However it should mention
the tools or techniques used in the study.
Part 6: Methodology I
Sampling methods
Has the target population been clearly identified?
Yes, the target population was clearly identified.
How were the sample selected?
The sample was selected based on their age (above 18) and diagnosis status for
breast cancer (including only the patients of breast cancer undergoing treatment. Patients
(of breast cancer) who have a family history of psychiatric disorders were also included in
the sample; however, patients with current psychiatric disorder, cognitive dysfunctions, or
with visual or auditory impairments were excluded. As per Csikszentmihalyi, & Larson
(2014), experience sampling method can be useful to describe variations in the mental
health self reports.

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Was it a probability or non-probability sample?
The study utilizes non probability sampling.
Is the sampling method appropriate for the study?
Non-Probability (or Non Random) sampling is an appropriate method for the study
since it allows selection of the samples based on the criterion: Diagnosis of Breast Cancer
and Undergoing treatment for Breast Cancer (Vehovar, Toepoel, & Steinmetz., 2016).
Sample size
Is it of adequate size?
A sample size of 270 seems to be very limited to be able to allow wider
generalizations. It can therefore be suggested to include a larger sample size.
Does the sample size allow for representativeness of the population?
The representation of the population can be justified by the inclusion of patients
with family histories of mental health issues. However it excludes patients with current
psychiatric disorders, cognitive, auditory, or visual impairments, in order to remove
confusions. The study also removes patients undergoing alternative forms of therapy (apart
from chemotherapy, radiotherapy or a combination) and also patients undergoing newer
forms of treatment like CRISPR. The study is also done in the state of Kerala (India), and not
country wide, thereby restricting the respondents to a single geographic location. This can
potentially create a biased result as it does not consider potential differences caused due to
treatment practices and mental health issues pertaining to breast cancer patient in other
states.

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Inclusion and exclusion criteria
Are the inclusion/exclusion criteria clearly identified?
Yes the criterion for inclusion into the sample group have been clearly identified and
stated in the study design and sample. The exclusion of patients currently diagnosed of
psychiatric disorders, cognitive, auditory or visual impairments have been excluded.
However the exclusion list does not include patients who are undergoing alternate or new
forms of treatment.
Are the inclusion/exclusion criteria appropriate for the study?
Inclusion of breast cancer patients is an appropriate approach. However, exclusion of
patients undergoing CRISPR treatment or alternative therapies are not included in the study,
which can be a big drawback, as it can help to better identify if the depression and the
lowered QOL is caused more by the contemporary form of treatment, than the disease
itself.
Part 7: Methodology II
Ethics procedure
Were the participants fully informed about the nature of the research?
Written consent was obtained from the patients before the interview. This was an
essential step towards ensuring ethical standards were met (Millum, & Sina, 2014).
Was the autonomy/confidentiality of the participants guaranteed?

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The participant’s autonomy/ confidentiality were respected in the study, and no
personal information was published on the paper.
Were the participants protected from harm?
It seems likely that the participants were indeed protected from any potential harm
due to the study.
Was ethical permission granted for the study?
Ethical permission was granted by the Dissertation Review Committee of Amrita
Institute of Medical Sciences and the Ethics Committee.
Materials or Instrumentation
Are all data collection instruments clearly identified and described?
Yes. The PHQ-9 and WHOQOL-BREF used for collecting information were clearly
identified and described.
Is the instrument appropriate for the study?
PHQ-9 provides a sensitive instrument for structured interviews and case finding to
identify depression. The sensitivity of the instrument is also appropriate for the study.
Similarly WHOQOL-BREF to identify the QOL in 4 distinct domains is appropriate to measure
any changes (in QOL) perceived by the patient.
How was it developed?
PHQ-9 is a depression scale of PHQ (Patient Health Questionnaire) that consists of 9
questions relevant to the patient’s mood and is a self administered version of the Prime MD

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diagnostic instrument. The PHQ 9 is a depression module that puts scores on each of the
nine criterion listed on DSM-IV (score of 0-3).
Were reliability and validity testing discussed?
PHQ-9 was identified as both reliable and valid in the screening of depression. The
average sensitivity of the instrument was also stated, justifying how it can be effective in the
measurement, providing valid information.
However, neither the reliability nor the validity of the WHOQOL-BREF testing has
been discussed clearly. Hence it is important to take into account the validity of the
instruments/tools used to measure the variables, to ensure accurate measurement, and
account for deviations in observation. It is therefore suggestible that the sensitivities of
WHOQOL-BREF need to be properly stated, and how it can be effective and valid for the
current study.
Procedure
Were the steps to be clearly described in detail, logical, and easy to follow?
The steps of the research were not described properly. Instead, the method of the
study provided the tools used for the study and the article directly moved on to the results
and findings of the study. The method was however logical based on the background
provided on the topic. A step by step methodology is clearly missing in the article and
therefore is suggestible.
Was the steps provided such as the study could be replicated?

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The study can easily be replicated using the same instruments and protocols.
However the lack of a step by step approach can complicate the process of execution.
Were methods used appropriate to clinical situation?
The methods are appropriate considering the clinical findings.
Are data collection procedures similar for all subjects?
Yes, a uniform data collection method was used for all the subjects.
Part 8: Discussion
Conclusion
Were there concise summary statements based on findings?
Yes, the conclusion summarizes the findings of the study.
Are the findings linked back to the literature review?
The findings of the study are in agreement with the literature review, however such
was not pointed out in the conclusion.
Was the hypothesis supported and explained?
The proposed hypothesis that depression is prevalent among patients undergoing
treatment for breast cancer, and that the quality of life also shows detoriation, because of
the treatment. However, the study does not explain why this association exists, and does
not consider the effects of new or alternative treatment on depression or QOL.
Were the results able to be generalized to the population?

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Since the study was done on a small number of patients, and selected only those
patients undergoing conventional treatment, the generalization of the study can be limited,
and based on the study group in question.
Limitations
Were the strengths and limitations of the study discussed?
Only the limitations were explicitly discussed, and the strengths are not discussed as
such. However, the following can be acknowledged as strengths of the study: Utilization of
proper tools like PHQ-9, WHOQOL-BREF to collect data, focusing the study on a single
diagnosis (like breast cancer) and the fact that the results agree with other studies (referred
in the literature review) are strong indicators of strengths of the study.
Were the limitations linked to the methodology of the study?
The limitations of the study like the sampling method, influence of the treatment
modalities on depression, staging of the tumor in the cancer patients to ascertain the stage
of cancer not being considered and patients with depression who might have benefited
from psychotherapy or pharmacotherapy were mentioned clearly, and are all hurdles to the
methodology of the study.
Was a recommendation for further research made?
Scope for further research was identified and mentioned after the discussion of the
results.
Implications to practice and research
Were the implications possible to implement?

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The implication of the study is a clear one. It shows that the conventional treatment
of cancer can potentially cause depression and lowering of the QOL among breast cancer
patients, and implies that proper intervention techniques and access to adequate mental
healthcare for these people can help in managing the symptoms and lower the
psychological morbidity associated with the disease and/or its treatment. However, since
the effect of other modes of treatment and the stage of cancer was not considered, the
possibilities of implication are limited by these factors.
Do the implications have any clinical significance to nursing practice or research?
The implications are a significant one, as it emphasizes the dependency of
depression and a lowering of QOL with cancer treatment. It can therefore be understood
and generalized that patients undergoing cancer therapy can feel emotionally stressed and
anxious, and that the rigorous and demanding treatment modules can cause depression
among the patients, and a subsequent lowering in the perceived QOL of the patients. An
effective and evidence based nursing practice therefore ought to aim at reducing the
psychological stress experienced by the patients, and ensure proper access to psychological
interventions for managing the symptoms (DiCenso, Guyatt, & Ciliska., 2014). Also, since
depression has been implicated as the cause for lowering of the QOL, managing depression
can be effective in the improvement of QOL of the patients, and help in better treatment
and recovery.
Word count: ____________

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References:
Barroso, S. M., Melo, A. P. S., Silva, M. A., & Guimaraes, M. D. C. (2015). Efficacy of the
Patient Health Questionnaire (PHQ-9) for Screening Depression in the Quilombola
Population of Bahia State, Brazil. International Journal of Epidemiology, 44(suppl 1),
i165-i165.
Chisholm-Burns, M. A., Wells, B. G., & Schwinghammer, T. L. (2016). Pharmacotherapy
principles and practice. McGraw-Hill.
Cong, L., Ran, F. A., Cox, D., Lin, S., Barretto, R., Habib, N., & Zhang, F. (2013). Multiplex
genome engineering using CRISPR/Cas systems. Science, 339(6121), 819-823.
Csikszentmihalyi, M., & Larson, R. (2014). Validity and reliability of the experience-sampling
method. In Flow and the foundations of positive psychology. Springer Netherlands.
Pp 35-54
DiCenso, A., Guyatt, G., & Ciliska, D. (2014). Evidence-Based Nursing-E-Book: A Guide to
Clinical Practice. Elsevier Health Sciences.
Fromm-Reichmann, F. (2015). Principles of intensive psychotherapy. University of Chicago
Press. Pp 45-188.
Lewis, S. (2015). Qualitative inquiry and research design: Choosing among five
approaches. Health promotion practice, 16(4), 473-475.
Machi, L.A. and McEvoy, B.T., 2016. The literature review: Six steps to success. Corwin
Press.pp 17-156.

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Millum, J., & Sina, B. (2014). Introduction: international research ethics education. Journal of
Empirical Research on Human Research Ethics, 9(2), 1-2.
Moriarty, A. S., Gilbody, S., McMillan, D., & Manea, L. (2015). Screening and case finding for
major depressive disorder using the Patient Health Questionnaire (PHQ-9): a meta-
analysis. General hospital psychiatry, 37(6), 567-576.
Patten, M.L. and Newhart, M., 2017. Understanding research methods: An overview of the
essentials. Taylor & Francis.
Su, C. T., Ng, H. S., Yang, A. L., & Lin, C. Y. (2014). Psychometric evaluation of the Short Form
36 Health Survey (SF-36) and the World Health Organization Quality of Life Scale
Brief Version (WHOQOL-BREF) for patients with schizophrenia. Psychological
assessment, 26(3), 980.
Vehovar, V., Toepoel, V., & Steinmetz, S. (2016). Non-probability Sampling. The SAGE
Handbook of Survey Methodology, 329.
Venkateswaran, C., Purkayastha, D., Nayar, K., & Unnikrishnan, U. (2017). Prevalence of
depression in breast cancer patients and its association with their quality of life: A
cross-sectional observational study. Indian Journal Of Palliative Care, 23(3), 268.
http://dx.doi.org/10.4103/ijpc.ijpc_6_17