NR505- Critical Appraisal Research 2022

Running head: HEALTHCARE 1
NR505- Critical appraisal
Name of the Student
Name of the University
Author Note

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Introduction
The perspective of caregivers is essential in order to ensure a smooth transition of
patients from hospital to their home settings (Mitchell et al., 2018). This assignment will use the
Johns Hopkins tool for critically appraise a qualitative research that focused on exploring the
lived experiences of parenting children who suffer from the development disorder autism, and
reside in rural regions (Dang & Dearholt, 2017). The article was published by Lindsey
Hoogsteen and Roberta L. Woodgate (Hoogsteen & Woodgate, 2013).
Critique of the article
Type of qualitative method
This qualitative research was a phenomenological study since it was based on the
principles of hermeneutic phenomenology. The major strengths of this research approach are that
it provides a detailed and profound understanding of the phenomena and also helps in collection
of impressive and rich data from the individuals (Hennink, Hutter & Bailey, 2020).
Participant sampling
The researchers recruited 26 families having children with autism by following the
purposive sampling procedure across two urban centres. This sampling strategy relies on the
judgment of the researchers for selecting members of a particular population for participation in
research. The major advantage is that it allows generalisation of the obtained data to a wider
population and also saves considerable time and money during data collection (Sharma, 2017).
Questionnaires/tools
The data collection method focused on subjecting all 26 families to semi-structured and
open-ended interviews. Semi-structured interviews are typically not based on a pre-determined

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list of questions and help in discussion of new ideas based on the responses of the interviewee
(Kearney, Freeman & Bacon, 2019). Asking open-ended questions was a correct approach since
they allow infinite number of possible answers, help in gaining unexpected insights, and also
provide a clear understanding of the perception and thought process of the respondents
(Greenhalgh, 2014).
Ethics
Presence of ethical approval is imperative for any investigation that includes human
participants with the aim of safeguarding that the safety, rights, dignity, and wellbeing of the
contributors are the main consideration of the investigation. The researchers obtained both verbal
and written consent from the participants and also maintained confidentiality. This was a correct
step since all research participants must be aware of the purpose, advantages and potential
drawbacks of the research (if any), and must also be ensured that their personal data shall not be
disclosed under any circumstance (Ryen, 2016).
Analysis of findings
The findings were organised into three themes that were (i) doing it on own, (ii) lack of
understanding and knowledge of the society, and (iii) he is not rain man. It was found that
limited knowledge of parents made it difficult for them to accept the autism diagnosis. They also
identified the need of a support in the form of follow-up appointments.
Limitations
The two major limitations were that the researchers failed to interview parents and
professionals who implemented autism programs, and chiefly interviewed Caucasian mothers
(Hoogsteen & Woodgate, 2013). Moreover, purposive sampling consisting of only mothers
reduced reliability of the results.

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Discussion
Hence, the article correctly discussed that more provision and assistance are desirable for
rural parents having children with autism.
Summary and future implications
Findings presented in this article can help in autism management in rural regions by
creating the provision for adequate support and follow-up appointments for the parents. It will
also help in conducting parent education campaigns that will promote autism management.
Conclusion
To conclude, the critique of this research article helped in identifying the challenges and
lack of support that parents having children with autism have to encounter in rural regions.

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References
Dang, D., & Dearholt, S. L. (2017). Johns Hopkins nursing evidence-based practice: Model and
guidelines. Sigma Theta Tau.
https://sigma.nursingrepository.org/bitstream/handle/10755/17100/InstructorsGuideJohns
HopkinsNursingEBPModelGuidelines3E.pdf?sequence=1
Greenhalgh, T. (2014). How to read a paper: the basics of evidence-based medicine. John Wiley
& Sons. https://books.google.co.in/books?
hl=en&lr=&id=uL3RAgAAQBAJ&oi=fnd&pg=PR13&dq=How+to+Read+a+Paper+by
+Greenhalgh+&ots=hJJv12qjgl&sig=g1TuVBEmH9ckAdFQiRGZ_UATcDk#v=onepag
e&q=How%20to%20Read%20a%20Paper%20by%20Greenhalgh&f=false
Hennink, M., Hutter, I., & Bailey, A. (2020). Qualitative research methods. SAGE Publications
Limited. https://books.google.co.in/books?
hl=en&lr=&id=_InCDwAAQBAJ&oi=fnd&pg=PP1&dq=qualitative+research&ots=3tfK
iRv1hw&sig=v8yayPxy6yd4-I1pxWdoKLpwYO0#v=onepage&q=qualitative
%20research&f=false
Hoogsteen, L. & Woodgate, L. R. (2013). The lived experience of parenting a child with autism
in a rural area: Making the invisible, visible. Pediatric Nursing, 39(5), 232-237.
https://www.ncbi.nlm.nih.gov/pubmed/24308088
Kearney, C. A., Freeman, A., & Bacon, V. (2019). Structured and semistructured interviews for
children. In Handbook of Psychological Assessment (pp. 337-353). Academic Press.
https://doi.org/10.1016/B978-0-12-802203-0.00011-0

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Mitchell, S. E., Laurens, V., Weigel, G. M., Hirschman, K. B., Scott, A. M., Nguyen, H. Q., ... &
Gass, B. (2018). Care transitions from patient and caregiver perspectives. The Annals of
Family Medicine, 16(3), 225-231. doi: 10.1370/afm.2222.
Ryen, A. (2016). Research ethics and qualitative research. Qualitative research, 31-48.
https://books.google.co.in/books?
hl=en&lr=&id=9FALDAAAQBAJ&oi=fnd&pg=PA31&dq=ethics+in+research&ots=9nf
yhx7z9I&sig=yaD6jYcIk59XV1SVG0ktRg5u2EU#v=onepage&q=ethics%20in
%20research&f=false
Sharma, G. (2017). Pros and cons of different sampling techniques. International journal of
applied research, 3(7), 749-752.
https://s3.amazonaws.com/academia.edu.documents/58765080/Pros_and_cons_of_sampli
ng.pdf?response-content-disposition=inline%3B%20filename
%3DImpact_Factor_5.2_IJAR.pdf&X-Amz-Algorithm=AWS4-HMAC-SHA256&X-
Amz-Credential=AKIAIWOWYYGZ2Y53UL3A%2F20200207%2Fus-east-
1%2Fs3%2Faws4_request&X-Amz-Date=20200207T075820Z&X-Amz-
Expires=3600&X-Amz-SignedHeaders=host&X-Amz-
Signature=c12580d0c473cbefa3ea63276b35625a6854118347b5ec00d84d72343f83e6b9

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Appendix
Evidence Level and Quality: High
quality
Article Title: The Lived Experience of Parenting a Child With
Autism in a Rural Area: Making the Invisible, Visible
Number: 5
Author(s): Lindsey Hoogsteen, Roberta L. Woodgate Publication Date: September-
October 2013
Journal: Pediatric Nursing
Setting: Western Canadian province Sample
(Composition
& size): 26
families with
children
having autism
Does this evidence address my EBP
question?
 Yes  No
Do not proceed with appraisal of this
evidence
Level of Evidence (Study Design)
A. Is this a report of a single research study? If No, go to B.
 Yes  No

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1. Was there manipulation of an independent variable?
2. Was there a control group?
3. Were study participants randomly assigned to the
intervention and control groups?
 Yes
 Yes
 No
 No
 Yes  No
If Yes to all three, this is a Randomized Controlled Trial
(RCT) or Experimental Study
 LEVEL
I
If Yes to #1 and #2 and No to #3, OR Yes to #1 and No to #2
and #3, this is Quasi Experimental (some degree of
investigator control, some manipulation of
an independent variable, lacks random assignment to
groups, may have a control group)
 LEVEL
II
If No to #1, #2, and #3, this is Non-Experimental (no
manipulation of independent variable, can be descriptive,
comparative, or correlational, often uses secondary data) or
Qualitative (exploratory in nature such as interviews or
focus groups, a starting point for studies for which little

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research currently exists, has small
sample sizes, may use results to design empirical studies)
 LEVEL
III
NEXT, COMPLETE THE BOTTOM SECTION ON THE
FOLLOWING PAGE, “STUDY FINDINGS THAT HELP
YOU ANSWER THE EBP QUESTION”

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B. Is this a summary of multiple research studies? If No, go
to Non-Research Evidence Appraisal Form.
1. Does it employ a comprehensive search strategy and rigorous
appraisal method (Systematic Review)? If No, use Non-
Research Evidence Appraisal Tool; if Yes:
a. Does it combine and analyze results from the studies
to generate a new statistic (effect size)? (Systematic
review with meta-analysis)
b. Does it analyze and synthesize concepts from
qualitative studies? (Systematic review with
meta-synthesis)
If Yes to either a or b, go to #2B below.
2. For Systematic Reviews and Systematic Reviews with
meta-analysis or meta- synthesis:
a. Are all studies included RCTs?
 LEVEL
I
 LEVEL
II
 Yes
 Yes
 Yes
 Yes
 No
 No
 No
 No

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b. Are the studies a combination of RCTs and
quasi-experimental or quasi-experimental only?
c. Are the studies a combination of RCTs,
quasi-experimental and non-experimental or
non-experimental only?
d. Are any or all of the included studies qualitative?
COMPLETE THE NEXT SECTION, “STUDY FINDINGS
THAT HELP YOU ANSWER THE EBP QUESTION”
 LEVEL
IIl
 LEVEL
IIl
STUDY FINDINGS THAT HELP YOU ANSWER THE EBP QUESTION:
Parents and the society do not adequate knowledge and awareness about autism symptoms and
their manifestation. Parents generally deny the situation once their child has been diagnosed
with autism. Lack of support group of follow-up assistance makes the management of such
children even more difficult in rural regions.
NOW COMPLETE THE FOLLOWING PAGE, “QUALITY APPRAISAL OF
RESEARCH STUDIES”, AND ASSIGN A QUALITY SCORE TO YOUR
ARTICLE

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Quality Appraisal of Research Studies
 Does the researcher identify what is known and not known about the
problem and how the study will address any gaps in knowledge?
 Was the purpose of the study clearly presented?
 Was the literature review current (most sources within last 5 years or
classic)?
 Was sample size sufficient based on study design and rationale?
 If there is a control group:
o Were the characteristics and/or demographics similar in
both the control and intervention groups?
o If multiple settings were used, were the settings similar?
o Were all groups equally treated except for the intervention
group(s)?
 Are data collection methods described clearly?
 Were the instruments reliable (Cronbach's α [alpha] > 0.70)?
 Was instrument validity discussed?
 If surveys/questionnaires were used, was the response rate > 25%?
 Were the results presented clearly?
 If tables were presented, was the narrative consistent with the table
content?
 Were study limitations identified and addressed?
 Yes
 Yes
 Yes
 Yes
 Yes
 Yes
 Yes
 Yes
 Yes
 Yes
 Yes
 Yes
 Yes
 Yes
 Yes
 No
 No
 No
 No
 No
 No
 No
 No
 No
 No
 No
 No
 No
 No
 No
 NA
 NA
 NA
 NA
 NA
 NA
 NA

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 Were conclusions based on results?
Quality Appraisal of Systematic Review with or without Meta-Analysis or Meta-Synthesis
 Was the purpose of the systematic review clearly stated?
 Were reports comprehensive, with reproducible search strategy?
o Key search terms stated
o Multiple databases searched and identified
o Inclusion and exclusion criteria stated
 Was there a flow diagram showing the number of studies
eliminated at each level of review?
 Were details of included studies presented (design, sample,
methods, results, outcomes, strengths and limitations)?
 Were methods for appraising the strength of evidence (level and
quality) described?
 Were conclusions based on results?
o Results were interpreted
o Conclusions flowed logically from the interpretation and systematic
review question
 Did the systematic review include both a section addressing
limitations and how they were addressed?
 Yes
 Yes
 Yes
 Yes
 Yes
 Yes
 Yes
 Yes
 Yes
 Yes
 Yes
 Yes
 No
 No
 No
 No
 No
 No
 No
 No
 No
 No
 No
 No
QUALITY RATING BASED ON QUALITY APPRAISAL
A High quality: consistent, generalizable results; sufficient sample size for the study design;
adequate control; definitive conclusions; consistent recommendations based on
comprehensive literature review that includes thorough reference to scientific evidence

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B Good quality: reasonably consistent results; sufficient sample size for the study design;
some control, and fairly definitive conclusions; reasonably consistent recommendations
based on fairly comprehensive literature review that includes some reference to scientific
evidence
C Low quality or major flaws: little evidence with inconsistent results; insufficient
sample size for the study design; conclusions cannot be drawn