critique essay nursing

How to Critique a Nursing Research Article

• November 29, 2023

Welcome to NursingWriters.net, your go-to resource for all things related to nursing research article critique. In this comprehensive guide, we will walk you through the step-by-step process of critiquing a nursing research article. Whether you’re a nursing student or a seasoned professional, mastering the art of critiquing research is essential for evidence-based practice and contributing to the advancement of nursing knowledge.

Key Takeaways:

• Critiquing nursing research is crucial for nurses to enhance their understanding of the literature and improve their research skills.
• By critiquing research, nurses can evaluate the validity and applicability of findings to their practice.
• Following a systematic approach and considering practical tips are key to effective nursing research critique.
• Evaluating the scientific merit of a study and applying critiqued research to practice are essential steps in the critique process.
• Continuous learning and utilizing nursing writing services can support nurses in their critique and writing processes.

Why Critique Nursing Research?

Nurses rely on research to guide their practice, solve problems, improve patient care, and shape health policy. However, not all research studies are of equal quality. Critiquing nursing research allows nurses to evaluate the validity and reliability of the findings, assess the relevance to their practice, and determine the applicability of the results to their patient population. By engaging in the critique process, nurses can ensure that they are using the best available evidence to inform their practice.

“Critiquing nursing research allows nurses to evaluate the validity and reliability of the findings, assess the relevance to their practice, and determine the applicability of the results to their patient population.”

As part of the nursing critique process , nurses analyze various aspects of a research study, such as the study design, sample size, data collection methods, statistical analysis, and conclusions. By critically examining these elements, nurses can identify potential biases, flaws in methodology, or limitations that may impact the credibility and generalizability of the study’s findings. This rigorous evaluation helps nurses make informed decisions about incorporating research evidence into their practice and ensures that they are providing the highest quality care to their patients.

In addition to improving the quality of patient care, critiquing nursing research also enhances nurses’ own research skills. By critically evaluating the work of others, nurses develop a deeper understanding of research methodologies, statistical analysis techniques, and ways to effectively communicate research findings. This knowledge can then be applied to their own research projects, enabling nurses to contribute to the advancement of nursing knowledge and the improvement of patient outcomes.

“By critically evaluating the work of others, nurses develop a deeper understanding of research methodologies, statistical analysis techniques, and ways to effectively communicate research findings.”

In summary, critiquing nursing research is a vital skill for nurses to acquire. It ensures that nurses are using the best available evidence to inform their practice, improves their own research skills, and contributes to evidence-based care. By engaging in the critique process, nurses can enhance patient outcomes and actively contribute to the advancement of the nursing profession.

Steps for Critiquing Nursing Research

To effectively critique a nursing research article, it is important for nurses to follow a systematic approach. By carefully analyzing various aspects of the research paper, nurses can gain valuable insights and make informed judgments about the study. The following steps provide a comprehensive guide for critiquing nursing research:

Step 1: Identify the Research Question

Start by identifying the research question or objective of the study. This helps establish the purpose and relevance of the research, allowing nurses to assess its potential impact on patient care and nursing practice.

Step 2: Evaluate the Study Design

Examine the study design used in the research article. Different study designs have varying levels of reliability and validity, so it is crucial to evaluate whether the chosen design aligns with the research question and objectives. Consider factors such as sample size, data collection methods, and statistical analysis techniques used.

Step 3: Assess Data Collection and Analysis Methods

Review the data collection and analysis methods employed in the study. Look for transparency and accuracy in data collection procedures, ensuring that the methods used are appropriate for the research question. Evaluate the statistical analysis techniques applied and assess whether they are suitable for the type of data collected.

Step 4: Evaluate the Findings and Interpretation

Examine the findings of the research article and assess their significance. Consider whether the results support the research question and objectives. Evaluate the interpretation of the findings and assess whether they are justified based on the data collected and analyzed. Look for any potential biases or limitations that could impact the validity of the findings.

By following these steps, nurses can systematically evaluate the quality and relevance of nursing research articles. This helps ensure that evidence-based practice is informed by reliable and applicable research findings, ultimately leading to improved patient care and outcomes.

Practical Tips for Critiquing Nursing Research

When critiquing a nursing research article, there are several practical tips that can help nurses navigate the process effectively. By following these tips, nurses can enhance their understanding of the study and provide a comprehensive critique.

1. Read the article thoroughly

Before starting the critique, it is essential to read the entire research article carefully. Pay attention to the study’s objectives, methods, results, and conclusions. Take notes and highlight key points to reference later during the critiquing process.

2. Evaluate the study design

Assessing the study design is crucial in critiquing nursing research. Consider whether the chosen design aligns with the research question and objectives. Evaluate if the sample size is appropriate and if the study uses reliable and valid measures. Analyze any potential biases or confounding factors that may impact the study’s results.

3. Analyze the findings

Examine the research findings critically. Determine if the results are statistically significant and if the study’s conclusions are supported by the data. Consider any limitations and alternative explanations for the findings. Evaluate the clinical relevance of the results and their potential implications for nursing practice.

4. Consider the methodology

Take a closer look at the methodology used in the study. Evaluate the reliability and validity of the data collection methods. Assess the appropriateness of the statistical analyses performed. Consider any ethical concerns or potential conflicts of interest that may have an impact on the study’s validity and generalizability.

By following these practical tips, nurses can develop a comprehensive critique of nursing research articles. Remember that critiquing research is an ongoing process of learning and refining critical appraisal skills. Utilizing nursing writing services like NursingWriters.net can also provide valuable assistance and support in the critique and writing processes.

Leveraging Evidence-Based Practice

The process of critiquing nursing research is closely aligned with evidence-based practice (EBP). By critiquing research articles, nurses can evaluate the quality of the evidence and determine if it is applicable and relevant to their practice. Critiquing research also helps nurses develop critical thinking skills and enhances their ability to evaluate and integrate research findings into their clinical decision-making.

To facilitate the critique process, nurses can use templates or frameworks designed specifically for critiquing nursing research articles. These templates provide a structured approach to guide nurses through the critique process, ensuring that all relevant aspects of the research article are considered. Additionally, using a template helps nurses to organize their thoughts and findings in a systematic manner, making it easier to analyze and interpret the research.

One example of a nursing critique paper template is a table format, where key elements of the research article are identified and evaluated. This format allows nurses to compare and contrast different aspects of the study, such as the research design, sample characteristics, data analysis methods, and the validity and reliability of the findings. By using such a template, nurses can ensure that they are thoroughly evaluating all aspects of the research article and making informed judgments about its quality and applicability to their practice.

By leveraging evidence-based practice and utilizing nursing critique paper templates, nurses can enhance their ability to evaluate research, make informed decisions, and provide the best possible care to their patients.

Evaluating the Scientific Merit of a Study

When critiquing a nursing research article, it is crucial to assess the scientific merit of the study. This involves evaluating the level and quality of the evidence presented. There are various scales and criteria available that can help nurses assess the scientific rigor of a study, such as those provided in the American Nurses Association’s Research Toolkit.

Evaluating the scientific merit of a study requires careful consideration of several key factors:

• The study design: Nurses should evaluate whether the study design is appropriate for answering the research question and if it allows for the establishment of cause-and-effect relationships.
• The sample size and characteristics: Nurses should assess whether the study sample is representative of the target population and if the sample size is adequate to produce valid and reliable results.
• Data collection methods: Nurses should evaluate the validity and reliability of the data collection methods used in the study, ensuring that they are appropriate for the research question and that data collection was carried out consistently.
• Data analysis: Nurses should critically analyze the statistical methods used to analyze the data and determine if they are appropriate for the research question. It is important to consider whether the statistical analysis was conducted correctly and if the results are interpreted accurately.

By carefully evaluating the scientific merit of a study , nurses can determine its reliability and applicability to their practice.

The evaluation of scientific merit should also consider potential biases or conflicts of interest that may impact the study’s findings. Nurses should critically examine the funding sources, author affiliations, and any potential conflicts that may influence the study’s outcomes. By conducting a thorough evaluation of the scientific merit of a study, nurses can make informed decisions about the applicability and reliability of the research findings to their practice.

Applying Critiqued Research to Practice

Once a nursing research article has been critiqued and deemed to be of high quality and relevance, the findings can be applied to practice. Nurses can use the research to inform their decision-making, enhance patient care, and shape healthcare policies. It is important for nurses to critically evaluate the applicability of research findings to their specific patient population and practice setting to ensure the best possible outcomes.

By applying research to practice , nurses can improve the quality of care they provide to their patients. For example, if a research study shows that a particular intervention leads to better patient outcomes, nurses can incorporate that intervention into their practice to promote positive results. Similarly, if a study highlights potential risks or side effects of a particular treatment, nurses can be cautious and take appropriate steps to mitigate these risks.

Applying critiqued research to practice also allows nurses to contribute to evidence-based practice. By using evidence from well-conducted studies, nurses can ensure that their practice is based on the best available evidence rather than subjective opinions or outdated practices. This helps to improve the quality and safety of patient care, leading to better patient outcomes.

In summary, applying critiqued research to practice is a vital step for nurses to translate evidence into action. By critically evaluating research findings, nurses can determine the applicability of the research to their practice and make informed decisions that benefit their patients. Evidence-based practice is essential for providing high-quality care, and nurses play a crucial role in implementing research findings into their daily practice.

The Importance of Continuous Learning and Critiquing

Continuous learning and critiquing are essential for nurses to stay updated with the latest advancements in their field and contribute to evidence-based practice. The healthcare landscape is constantly evolving, and nurses must strive to enhance their knowledge and critical thinking skills to provide the best possible care to patients.

By engaging in continuous learning , nurses can deepen their understanding of the literature and stay informed about new research findings, innovative treatment approaches, and emerging healthcare trends. This ongoing education helps nurses to adapt their practice to the evolving needs of patients and implement evidence-based interventions that have been proven effective.

Critiquing nursing research articles is a valuable skill that allows nurses to evaluate the quality and applicability of research findings. It enables nurses to identify gaps in the literature and generate research questions for future studies. Through critiquing, nurses can contribute to the advancement of nursing knowledge, enhance their critical appraisal skills, and refine their ability to integrate research findings into their clinical practice.

Continuous learning and critiquing go hand in hand, as nurses who engage in ongoing education are better equipped to critically evaluate research studies and apply the findings to their practice. Nursing writing services , such as NursingWriters.net, provide valuable support to nurses in their critique and writing processes, offering expert information and resources to enhance their academic performance. By embracing continuous learning and actively critiquing nursing research, nurses can make significant contributions to the advancement of the nursing profession.

The Role of Nursing Writing Services

Nursing writing services play a vital role in supporting nurses with their critique and writing processes. A notable service in this domain is NursingWriters.net. This platform provides expert information, guidance, and resources specifically tailored to assist nurses in critiquing nursing research articles, developing well-structured critique papers, and enhancing their writing and comprehension skills.

NursingWriters.net empowers busy nurses to excel in BSN, MSN, and DNP programs by offering comprehensive support. The service ensures that nurses can save time while improving their academic performance and excelling in their nursing education and practice. The assistance provided by nursing writing services is particularly valuable to nurses who are balancing the demands of work, education, and personal commitments.

With NursingWriters.net, nurses gain access to a team of experts who understand the unique challenges of critiquing nursing research and writing academic papers in the field of nursing. The service covers a wide range of topics and provides customized guidance based on individual needs. Nurses can rely on NursingWriters.net to deliver high-quality, well-researched papers that demonstrate a thorough understanding of the subject matter and adherence to academic writing standards.

By utilizing nursing writing services like NursingWriters.net, nurses can elevate their critique and writing skills, ultimately contributing to the advancement of the nursing profession. Whether it’s clarifying complex concepts, providing timely feedback, or offering valuable resources, these services serve as critical partners in the pursuit of academic excellence and evidence-based practice.

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Critiquing nursing research articles is an essential skill for nurses to master. By following a systematic approach and considering practical tips, nurses can enhance their understanding of the literature and contribute to evidence-based practice. Evaluating the scientific merit of studies and applying critiqued research to practice further improves patient outcomes.

Continuous learning plays a crucial role in the critique process, allowing nurses to stay up-to-date with the latest evidence and refine their critical appraisal skills. Nursing writing services, such as NursingWriters.net, provide valuable assistance in the critique and writing processes, supporting nurses in their academic and professional endeavors.

By actively engaging in the critique of nursing research, nurses can make significant contributions to the advancement of the nursing profession. By utilizing resources like NursingWriters.net and continuously honing their skills, nurses can excel in their education and practice, ultimately improving the quality of patient care.

How do I critique a nursing research article?

To critique a nursing research article, follow a systematic approach by analyzing its scientific merit, evaluating the relevance to practice, and assessing the applicability of findings to your patient population. This comprehensive guide provides step-by-step instructions and tips on how to critique a nursing research article .

Why is critiquing nursing research important?

Critiquing nursing research allows nurses to evaluate the validity and reliability of findings, assess the relevance to practice, and determine the applicability of results to their patient population. By engaging in the critique process, nurses ensure they are using the best available evidence to inform their practice.

What are the steps for critiquing nursing research?

The steps for critiquing nursing research involve analyzing the research questions/hypotheses, evaluating the study design and methods, assessing the data collection and analysis procedures, and reviewing the findings and conclusions.

Are there any practical tips for critiquing nursing research?

Yes, some practical tips for critiquing nursing research include considering the research’s relevance to your practice, examining the sample size and population, assessing the data collection methods, analyzing the statistical analysis, and evaluating the limitations and implications of the study.

How does critiquing nursing research align with evidence-based practice?

Critiquing nursing research is closely aligned with evidence-based practice (EBP). By critiquing research articles, nurses can evaluate the quality of the evidence and determine if it is applicable and relevant to their practice. This process enhances critical thinking skills and the integration of research findings into clinical decision-making.

How do I evaluate the scientific merit of a study?

Evaluating the scientific merit involves assessing the level and quality of evidence presented in a nursing research article. Various scales and criteria are available to help nurses assess the scientific rigor, such as those provided in the American Nurses Association’s Research Toolkit.

How can I apply critiqued research to practice?

Once a nursing research article has been critiqued and deemed high quality and relevance, the findings can be applied to practice. Nurses can utilize the research to inform decision-making, enhance patient care, and shape healthcare policies. However, it’s crucial to evaluate the applicability of research findings to specific patient populations and practice settings.

Why is continuous learning and critiquing important for nurses?

Continuous learning and critiquing help nurses stay up-to-date with the latest evidence, refine critical appraisal skills, and contribute to the advancement of nursing knowledge. Ongoing critique also helps identify gaps in the literature and generate research questions for future studies.

How can nursing writing services help with critiquing nursing research?

Nursing writing services, such as NursingWriters.net, provide valuable assistance to nurses in the critique and writing processes. These services offer expert information, guidance, and resources to support nurses in critiquing nursing research articles, developing well-structured critique papers, and enhancing writing and comprehension skills.

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How to write a Critical Analysis in Nursing – Full Guide and Examples

Rachel andel rn, bsn.

• August 9, 2022
• Nursing Writing Guides

How to write a Critical Analysis in Nursing

Nursing is a demanding and highly specialized field that requires critical analysis. Whether you are a new nurse or have been working in the field for years, writing a critical analysis can be daunting. In this article, we will show you how to write a critical analysis in nursing using a step-by-step process.

What is a Critical Analysis in nursing?

A Critical Analysis is a comprehensive, in-depth analysis of a text or piece of media. It can be used to explore the author’s intentions, analyze the plot, assess the characters, and determine the overall impact of the work.

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Why is it important to do a Critical Analysis?

Critical Analysis skills are essential for nurses as they work in both clinical and academic settings. They are also important for students who want to develop analytical skills and read critically. In addition, Critical Analyses provide nursing staff with insights into how other people have viewed a particular text or piece of media. This information can help nurses make informed decisions about patient care.

How do I do a Critical Analysis?

There is no one way to do a Critical Analysis. However, there are some key steps that you should take into account when undertaking this type of analysis:

1) Read the text or piece of media carefully;

2) Identify the main themes and ideas presented in the text;

3) Analyze these themes and ideas in depth;

4) Weigh each theme and idea against one another;

5) Write your analysis in an objective manner;

If you are a nursing student looking to learn how to write a critical analysis, you have come to the right place. In this article, we will teach you the basics of writing a critical analysis, including what to include and why. We will also provide some tips for how to structure your essay so that it is clear and easy to read. Finally, we will provide a sample critical analysis of a fictional novel to help you get started.

There are a few steps in writing a critical analysis of literature. In this article, we will discuss the different steps involved in writing a critical analysis and give you an example of how to go about it.

Step One: Choose Your Literature

The first step is to choose the literature you would like to analyze. This could be anything from a journal article to a novel. Once you have chosen your work, it is time to read it with an open mind. When reading any piece of literature, try to focus on the author’s purpose and message. Note what is important to them and how they communicate their ideas. After reading the work, take some time to formulate your thoughts about it in writing.

Step Two: Analyze the Text

Once you have formed your thoughts about the text, it is time to begin analyzing it. In order to do this, you will need to pay close attention to the author’s use of language and structure. Do they use specific words or phrases frequently? Why or why not? How does their choice of words affect their meaning? Are there any specific passages which stand out as particularly effective or ineffective? Once you have analyzed the text,write down your thoughts in a clear and concise manner.

Step Three: Evaluate the Theme and Ideas

Once you have analyzed the text, it is time to look at the main themes and ideas. What are they? What does the author want readers to take away from the work? Are the themes consistent throughout the text? How do the different themes connect? Once you have identified the main themes and ideas, write about them in your analysis. Do you think they are effectively communicated? Are there any elements of the text that you don’t agree with?

Step Four: Consider Your Opinion

After analyzing and evaluating the text, it is important to share your thoughts with readers. In writing a critical analysis, it is important to be objective. This means that you should not express your own opinions or biases in your writing. Instead, focus on providing readers with an objective perspective on the work. Is it worth reading? Why or why not? Is there anything else you would like to say about it?

How to format a Critical Analysis in Nursing

Critical analysis template.

Introduction

• Develop a topic sentence in which you will define the purpose of the Research Critique • Formulate a thesis statement which briefly provides a broad indication of your point of view in composing this assignment . • Include a summary outline to describe the organization and main topics you will include in the body paragraphs of the assignments (see below sections). Protection of Human Participants • Identify the benefits and risks of participation addressed by the authors. Were there benefits or risks the authors do not identify? • Was informed consent obtained from the subjects or participants? • Did it seem that the subjects participated voluntarily in the study? • Was institutional review board approval obtained from the agency in which the study was conducted?

Data Collection • Are the major variables (independent and dependent variables) identified and defined? What were these variables? • How were data collected in this study? • What rationale did the author provide for using this data collection method? • Identify the time period for data collection of the study. • Describe the sequence of data collection events for a participant.

Data Management and Analysis • Describe the data management and analysis methods used in the study. • Did the author discuss how the rigor of the process was assured? For example, does the author describe maintaining a paper trail of critical decisions that were made during the analysis of the data? Was statistical software used to ensure accuracy of the analysis? • What measures were used to minimize the effects of researcher bias (their experiences and perspectives)? For example, did two researchers independently analyze the data and compare their analyses?

Findings / Interpretation of Findings: Implications for Practice and Future Research • What is the researcher’s interpretation of findings? • Are the findings valid or an accurate reflection of reality? Do you have confidence in the findings? • What limitations of the study were identified by researchers ? • Was there a coherent logic to the presentation of findings? • What implications do the findings have for nursing practice? For example, can the study findings be applied to general nursing practice, to a specific population, to a specific area of nursing? • What suggestions are made for further studies?

Conclusion • Emphasize the importance and congruity of the thesis statement • Provide a logical wrap-up to bring the appraisal to completion and to leave a lasting impression and take-away points useful in nursing practice. • Incorporate a critical appraisal and a brief analysis of the utility and applicability of the findings to nursing practice. • Integrate a summary of the knowledge learned. Place your order now for a similar paper and have exceptional work written by our team of experts to guarantee you A Results.

Critical Analysis Essay Example Outline

Title: A critical analysis of a health promotion intervention: Diabetes effecting Schizophrenia patients

• A 2000 word essay based on a health promotion on Diabetes effecting Schizophrenia patients
• Activity that you have undertaken (or closely participated in) whilst on clinical placement.
• A rationale for the importance/necessity of the health promotion (hp) intervention that includes relevant epidemiological data and relates to contemporary health and/or social policy
• Application of a suitable health promotion model and/ or behaviour change theory to the activity undertaken.
• Critical consideration of health literacy in both the delivery of the health promotion activity and any supporting materials used.
• An evaluation of your health promotion activity.

• You need to demonstrate sound understanding of health promotion policy, evidence and theory related to your topic area. • You will not be able to address every health promotion theory, choose one model only and apply this to your topic; • Your essay should have a logical structure and have a systematic approach to care based on the Nursing Process. • Consider a paragraph for each concept and aspect of your essay.

Critical analysis requires objectivity and a critical perspective. It allows nurses to assess their own practice as well as the practices of others. To be effective, critical analysis must be structured and organized . The following steps can help you format a critical analysis:

1) Identify the purpose of the critical analysis. 2) Identify the literature that will be used in the analysis. 3) distill the information from the literature into a clear, concise, and objective statement. 4) Evaluate the strengths and weaknesses of the theory or practice being analyzed. 5) Suggest ways that the theory or practice could be improved.

The purpose of this critical analysis is to improve understanding of the strengths and weaknesses of a particular theory or practice used in nursing. The literature that will be used in this analysis includes both academic sources and clinical practice .

The information from the literature will be distilled into a clear, concise, and objective statement. The strengths and weaknesses of the theory or practice being analyzed will be evaluated. Suggestions for improving the theory or practice will be made.

How to write the introduction of a critical analysis paper

In order to write a successful introduction to your critical analysis paper, you must first establish the purpose of the paper. The purpose of this paper should be clear from the title and introduction, and should help to orient the reader towards your main points.

Once you have determined the purpose of your paper, you must introduce the reader to your main argument. You should begin by explaining why you believe that your chosen topic is important, and then provide evidence to support your claim. You may also want to mention any relevant historical or literary context, in order to give your argument a greater sense of resonance.

Finally, you should wrap up your introduction by stating how readers can use your paper as a blueprint for their own critical analysis work.

In conclusion, make sure that your introduction is concise and well-organized, so that readers will easily understand what lies ahead in the paper.

If you have any questions or would like help with writing your introduction , please don’t hesitate to reach out to one of our professional writers .

How to write the conclusion of a critical analysis paper in Nursing

The conclusion of a critical analysis paper in nursing is an important part of the paper. It should provide a summary of the main points made in the body of the essay, as well as give readers a sense of what the writer believes about the subject matter.

Capella University Nursing Quality Key Indicator Discussion

It should also provide a suggestion for future research or teaching on the topic.

When writing a conclusion for a critical analysis paper, it is important to keep in mind the purpose of the essay.

The goal is not to provide an exhaustive review of all aspects of the subject matter, but rather to provide readers with an overview of what has been discussed and to offer some ideas for further exploration. This means that conclusions should be brief and to the point.

It is also important to remember that conclusions do not have to be original or unique. In fact, they can often be based on ideas that have been introduced throughout the essay.

Rather than coming up with new ideas on their own, it can be helpful to borrow from other sources when writing a conclusion.

This will help to ensure that your argument is sound and that readers will understand your position on the subject matter.

Nursing Concept Map example pdf on RSV Bronchiolitis/Bronchiolitis

When writing the conclusion of a critical analysis paper, it is important to be concise and to provide the reader with a clear understanding of your argument. Here are some tips on how to write a conclusion that meets these goals:

– Summarize your main points and support them with evidence. – State your conclusions clearly and concisely. – Offer a solution or recommendations for future research

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Critiquing a published healthcare research paper

Angela Grainger

Nurse Lecturer/Scholarship Lead, BPP University, and editorial board member

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Research is defined as a ‘systematic inquiry using orderly disciplined methods to answer questions or to solve problems' ( Polit and Beck, 2017 :743). Research requires academic discipline coupled with specific research competencies so that an appropriate study is designed and conducted, leading to the drawing of relevant conclusions relating to the explicit aim/s of the study.

For those embarking on a higher degree such as a master's, taught doctorate, or a doctor of philosophy, the relationship between research, knowledge production and knowledge utilisation becomes clear during their research tuition and guidance from their research supervisor. But why should other busy practitioners juggling a work/home life balance find time to be interested in healthcare research? The answer lies in the relationship between the outcomes of research and its relationship to the determination of evidence-based practice (EBP).

The Health and Care Professions Council (HCPC) and the Nursing and Midwifery Council (NMC) require registered practitioners to keep their knowledge and skills up to date. This requirement incorporates being aware of the current EBP relevant to the registrant's field of practice, and to consider its application in relation to the decisions made in the delivery of patient care.

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A guide to critical appraisal of evidence

Fineout-Overholt, Ellen PhD, RN, FNAP, FAAN

Ellen Fineout-Overholt is the Mary Coulter Dowdy Distinguished Professor of Nursing at the University of Texas at Tyler School of Nursing, Tyler, Tex.

The author has disclosed no financial relationships related to this article.

Critical appraisal is the assessment of research studies' worth to clinical practice. Critical appraisal—the heart of evidence-based practice—involves four phases: rapid critical appraisal, evaluation, synthesis, and recommendation. This article reviews each phase and provides examples, tips, and caveats to help evidence appraisers successfully determine what is known about a clinical issue. Patient outcomes are improved when clinicians apply a body of evidence to daily practice.

How do nurses assess the quality of clinical research? This article outlines a stepwise approach to critical appraisal of research studies' worth to clinical practice: rapid critical appraisal, evaluation, synthesis, and recommendation. When critical care nurses apply a body of valid, reliable, and applicable evidence to daily practice, patient outcomes are improved.

Critical care nurses can best explain the reasoning for their clinical actions when they understand the worth of the research supporting their practices. In c ritical appraisal , clinicians assess the worth of research studies to clinical practice. Given that achieving improved patient outcomes is the reason patients enter the healthcare system, nurses must be confident their care techniques will reliably achieve best outcomes.

Nurses must verify that the information supporting their clinical care is valid, reliable, and applicable. Validity of research refers to the quality of research methods used, or how good of a job researchers did conducting a study. Reliability of research means similar outcomes can be achieved when the care techniques of a study are replicated by clinicians. Applicability of research means it was conducted in a similar sample to the patients for whom the findings will be applied. These three criteria determine a study's worth in clinical practice.

Appraising the worth of research requires a standardized approach. This approach applies to both quantitative research (research that deals with counting things and comparing those counts) and qualitative research (research that describes experiences and perceptions). The word critique has a negative connotation. In the past, some clinicians were taught that studies with flaws should be discarded. Today, it is important to consider all valid and reliable research informative to what we understand as best practice. Therefore, the author developed the critical appraisal methodology that enables clinicians to determine quickly which evidence is worth keeping and which must be discarded because of poor validity, reliability, or applicability.

Evidence-based practice process

The evidence-based practice (EBP) process is a seven-step problem-solving approach that begins with data gathering (see Seven steps to EBP ). During daily practice, clinicians gather data supporting inquiry into a particular clinical issue (Step 0). The description is then framed as an answerable question (Step 1) using the PICOT question format ( P opulation of interest; I ssue of interest or intervention; C omparison to the intervention; desired O utcome; and T ime for the outcome to be achieved). 1 Consistently using the PICOT format helps ensure that all elements of the clinical issue are covered. Next, clinicians conduct a systematic search to gather data answering the PICOT question (Step 2). Using the PICOT framework, clinicians can systematically search multiple databases to find available studies to help determine the best practice to achieve the desired outcome for their patients. When the systematic search is completed, the work of critical appraisal begins (Step 3). The known group of valid and reliable studies that answers the PICOT question is called the body of evidence and is the foundation for the best practice implementation (Step 4). Next, clinicians evaluate integration of best evidence with clinical expertise and patient preferences and values to determine if the outcomes in the studies are realized in practice (Step 5). Because healthcare is a community of practice, it is important that experiences with evidence implementation be shared, whether the outcome is what was expected or not. This enables critical care nurses concerned with similar care issues to better understand what has been successful and what has not (Step 6).

Critical appraisal of evidence

The first phase of critical appraisal, rapid critical appraisal, begins with determining which studies will be kept in the body of evidence. All valid, reliable, and applicable studies on the topic should be included. This is accomplished using design-specific checklists with key markers of good research. When clinicians determine a study is one they want to keep (a “keeper” study) and that it belongs in the body of evidence, they move on to phase 2, evaluation. 2

In the evaluation phase, the keeper studies are put together in a table so that they can be compared as a body of evidence, rather than individual studies. This phase of critical appraisal helps clinicians identify what is already known about a clinical issue. In the third phase, synthesis, certain data that provide a snapshot of a particular aspect of the clinical issue are pulled out of the evaluation table to showcase what is known. These snapshots of information underpin clinicians' decision-making and lead to phase 4, recommendation. A recommendation is a specific statement based on the body of evidence indicating what should be done—best practice. Critical appraisal is not complete without a specific recommendation. Each of the phases is explained in more detail below.

Phase 1: Rapid critical appraisal . Rapid critical appraisal involves using two tools that help clinicians determine if a research study is worthy of keeping in the body of evidence. The first tool, General Appraisal Overview for All Studies (GAO), covers the basics of all research studies (see Elements of the General Appraisal Overview for All Studies ). Sometimes, clinicians find gaps in knowledge about certain elements of research studies (for example, sampling or statistics) and need to review some content. Conducting an internet search for resources that explain how to read a research paper, such as an instructional video or step-by-step guide, can be helpful. Finding basic definitions of research methods often helps resolve identified gaps.

To accomplish the GAO, it is best to begin with finding out why the study was conducted and how it answers the PICOT question (for example, does it provide information critical care nurses want to know from the literature). If the study purpose helps answer the PICOT question, then the type of study design is evaluated. The study design is compared with the hierarchy of evidence for the type of PICOT question. The higher the design falls within the hierarchy or levels of evidence, the more confidence nurses can have in its finding, if the study was conducted well. 3,4 Next, find out what the researchers wanted to learn from their study. These are called the research questions or hypotheses. Research questions are just what they imply; insufficient information from theories or the literature are available to guide an educated guess, so a question is asked. Hypotheses are reasonable expectations guided by understanding from theory and other research that predicts what will be found when the research is conducted. The research questions or hypotheses provide the purpose of the study.

Next, the sample size is evaluated. Expectations of sample size are present for every study design. As an example, consider as a rule that quantitative study designs operate best when there is a sample size large enough to establish that relationships do not exist by chance. In general, the more participants in a study, the more confidence in the findings. Qualitative designs operate best with fewer people in the sample because these designs represent a deeper dive into the understanding or experience of each person in the study. 5 It is always important to describe the sample, as clinicians need to know if the study sample resembles their patients. It is equally important to identify the major variables in the study and how they are defined because this helps clinicians best understand what the study is about.

The final step in the GAO is to consider the analyses that answer the study research questions or confirm the study hypothesis. This is another opportunity for clinicians to learn, as learning about statistics in healthcare education has traditionally focused on conducting statistical tests as opposed to interpreting statistical tests. Understanding what the statistics indicate about the study findings is an imperative of critical appraisal of quantitative evidence.

The second tool is one of the variety of rapid critical appraisal checklists that speak to validity, reliability, and applicability of specific study designs, which are available at varying locations (see Critical appraisal resources ). When choosing a checklist to implement with a group of critical care nurses, it is important to verify that the checklist is complete and simple to use. Be sure to check that the checklist has answers to three key questions. The first question is: Are the results of the study valid? Related subquestions should help nurses discern if certain markers of good research design are present within the study. For example, identifying that study participants were randomly assigned to study groups is an essential marker of good research for a randomized controlled trial. Checking these essential markers helps clinicians quickly review a study to check off these important requirements. Clinical judgment is required when the study lacks any of the identified quality markers. Clinicians must discern whether the absence of any of the essential markers negates the usefulness of the study findings. 6-9

The second question is: What are the study results? This is answered by reviewing whether the study found what it was expecting to and if those findings were meaningful to clinical practice. Basic knowledge of how to interpret statistics is important for understanding quantitative studies, and basic knowledge of qualitative analysis greatly facilitates understanding those results. 6-9

The third question is: Are the results applicable to my patients? Answering this question involves consideration of the feasibility of implementing the study findings into the clinicians' environment as well as any contraindication within the clinicians' patient populations. Consider issues such as organizational politics, financial feasibility, and patient preferences. 6-9

When these questions have been answered, clinicians must decide about whether to keep the particular study in the body of evidence. Once the final group of keeper studies is identified, clinicians are ready to move into the phase of critical appraisal. 6-9

Phase 2: Evaluation . The goal of evaluation is to determine how studies within the body of evidence agree or disagree by identifying common patterns of information across studies. For example, an evaluator may compare whether the same intervention is used or if the outcomes are measured in the same way across all studies. A useful tool to help clinicians accomplish this is an evaluation table. This table serves two purposes: first, it enables clinicians to extract data from the studies and place the information in one table for easy comparison with other studies; and second, it eliminates the need for further searching through piles of periodicals for the information. (See Bonus Content: Evaluation table headings .) Although the information for each of the columns may not be what clinicians consider as part of their daily work, the information is important for them to understand about the body of evidence so that they can explain the patterns of agreement or disagreement they identify across studies. Further, the in-depth understanding of the body of evidence from the evaluation table helps with discussing the relevant clinical issue to facilitate best practice. Their discussion comes from a place of knowledge and experience, which affords the most confidence. The patterns and in-depth understanding are what lead to the synthesis phase of critical appraisal.

The key to a successful evaluation table is simplicity. Entering data into the table in a simple, consistent manner offers more opportunity for comparing studies. 6-9 For example, using abbreviations versus complete sentences in all columns except the final one allows for ease of comparison. An example might be the dependent variable of depression defined as “feelings of severe despondency and dejection” in one study and as “feeling sad and lonely” in another study. 10 Because these are two different definitions, they need to be different dependent variables. Clinicians must use their clinical judgment to discern that these different dependent variables require different names and abbreviations and how these further their comparison across studies.

Sample and theoretical or conceptual underpinnings are important to understanding how studies compare. Similar samples and settings across studies increase agreement. Several studies with the same conceptual framework increase the likelihood of common independent variables and dependent variables. The findings of a study are dependent on the analyses conducted. That is why an analysis column is dedicated to recording the kind of analysis used (for example, the name of the statistical analyses for quantitative studies). Only statistics that help answer the clinical question belong in this column. The findings column must have a result for each of the analyses listed; however, in the actual results, not in words. For example, a clinician lists a t -test as a statistic in the analysis column, so a t -value should reflect whether the groups are different as well as probability ( P -value or confidence interval) that reflects statistical significance. The explanation for these results would go in the last column that describes worth of the research to practice. This column is much more flexible and contains other information such as the level of evidence, the studies' strengths and limitations, any caveats about the methodology, or other aspects of the study that would be helpful to its use in practice. The final piece of information in this column is a recommendation for how this study would be used in practice. Each of the studies in the body of evidence that addresses the clinical question is placed in one evaluation table to facilitate the ease of comparing across the studies. This comparison sets the stage for synthesis.

Phase 3: Synthesis . In the synthesis phase, clinicians pull out key information from the evaluation table to produce a snapshot of the body of evidence. A table also is used here to feature what is known and help all those viewing the synthesis table to come to the same conclusion. A hypothetical example table included here demonstrates that a music therapy intervention is effective in reducing the outcome of oxygen saturation (SaO 2 ) in six of the eight studies in the body of evidence that evaluated that outcome (see Sample synthesis table: Impact on outcomes ). Simply using arrows to indicate effect offers readers a collective view of the agreement across studies that prompts action. Action may be to change practice, affirm current practice, or conduct research to strengthen the body of evidence by collaborating with nurse scientists.

When synthesizing evidence, there are at least two recommended synthesis tables, including the level-of-evidence table and the impact-on-outcomes table for quantitative questions, such as therapy or relevant themes table for “meaning” questions about human experience. (See Bonus Content: Level of evidence for intervention studies: Synthesis of type .) The sample synthesis table also demonstrates that a final column labeled synthesis indicates agreement across the studies. Of the three outcomes, the most reliable for clinicians to see with music therapy is SaO 2 , with positive results in six out of eight studies. The second most reliable outcome would be reducing increased respiratory rate (RR). Parental engagement has the least support as a reliable outcome, with only two of five studies showing positive results. Synthesis tables make the recommendation clear to all those who are involved in caring for that patient population. Although the two synthesis tables mentioned are a great start, the evidence may require more synthesis tables to adequately explain what is known. These tables are the foundation that supports clinically meaningful recommendations.

Phase 4: Recommendation . Recommendations are definitive statements based on what is known from the body of evidence. For example, with an intervention question, clinicians should be able to discern from the evidence if they will reliably get the desired outcome when they deliver the intervention as it was in the studies. In the sample synthesis table, the recommendation would be to implement the music therapy intervention across all settings with the population, and measure SaO 2 and RR, with the expectation that both would be optimally improved with the intervention. When the synthesis demonstrates that studies consistently verify an outcome occurs as a result of an intervention, however that intervention is not currently practiced, care is not best practice. Therefore, a firm recommendation to deliver the intervention and measure the appropriate outcomes must be made, which concludes critical appraisal of the evidence.

A recommendation that is off limits is conducting more research, as this is not the focus of clinicians' critical appraisal. In the case of insufficient evidence to make a recommendation for practice change, the recommendation would be to continue current practice and monitor outcomes and processes until there are more reliable studies to be added to the body of evidence. Researchers who use the critical appraisal process may indeed identify gaps in knowledge, research methods, or analyses, for example, that they then recommend studies that would fill in the identified gaps. In this way, clinicians and nurse scientists work together to build relevant, efficient bodies of evidence that guide clinical practice.

Evidence into action

Critical appraisal helps clinicians understand the literature so they can implement it. Critical care nurses have a professional and ethical responsibility to make sure their care is based on a solid foundation of available evidence that is carefully appraised using the phases outlined here. Critical appraisal allows for decision-making based on evidence that demonstrates reliable outcomes. Any other approach to the literature is likely haphazard and may lead to misguided care and unreliable outcomes. 11 Evidence translated into practice should have the desired outcomes and their measurement defined from the body of evidence. It is also imperative that all critical care nurses carefully monitor care delivery outcomes to establish that best outcomes are sustained. With the EBP paradigm as the basis for decision-making and the EBP process as the basis for addressing clinical issues, critical care nurses can improve patient, provider, and system outcomes by providing best care.

Seven steps to EBP

Step 0–A spirit of inquiry to notice internal data that indicate an opportunity for positive change.

Step 1– Ask a clinical question using the PICOT question format.

Step 2–Conduct a systematic search to find out what is already known about a clinical issue.

Step 3–Conduct a critical appraisal (rapid critical appraisal, evaluation, synthesis, and recommendation).

Step 4–Implement best practices by blending external evidence with clinician expertise and patient preferences and values.

Step 5–Evaluate evidence implementation to see if study outcomes happened in practice and if the implementation went well.

Step 6–Share project results, good or bad, with others in healthcare.

Adapted from: Steps of the evidence-based practice (EBP) process leading to high-quality healthcare and best patient outcomes. © Melnyk & Fineout-Overholt, 2017. Used with permission.

Critical appraisal resources

• The Joanna Briggs Institute http://joannabriggs.org/research/critical-appraisal-tools.html
• Critical Appraisal Skills Programme (CASP) www.casp-uk.net/casp-tools-checklists
• Center for Evidence-Based Medicine www.cebm.net/critical-appraisal
• Melnyk BM, Fineout-Overholt E. Evidence-Based Practice in Nursing and Healthcare: A Guide to Best Practice . 3rd ed. Philadelphia, PA: Wolters Kluwer; 2015.

A full set of critical appraisal checklists are available in the appendices.

Bonus content!

This article includes supplementary online-exclusive material. Visit the online version of this article at www.nursingcriticalcare.com to access this content.

critical appraisal; decision-making; evaluation of research; evidence-based practice; synthesis

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Writing, reading, and critiquing reviews

Écrire, lire et revue critique, douglas archibald.

1 University of Ottawa, Ontario, Canada;

Maria Athina Martimianakis

2 University of Toronto, Ontario, Canada

Why reviews matter

What do all authors of the CMEJ have in common? For that matter what do all health professions education scholars have in common? We all engage with literature. When you have an idea or question the first thing you do is find out what has been published on the topic of interest. Literature reviews are foundational to any study. They describe what is known about given topic and lead us to identify a knowledge gap to study. All reviews require authors to be able accurately summarize, synthesize, interpret and even critique the research literature. 1 , 2 In fact, for this editorial we have had to review the literature on reviews . Knowledge and evidence are expanding in our field of health professions education at an ever increasing rate and so to help keep pace, well written reviews are essential. Though reviews may be difficult to write, they will always be read. In this editorial we survey the various forms review articles can take. As well we want to provide authors and reviewers at CMEJ with some guidance and resources to be able write and/or review a review article.

What are the types of reviews conducted in Health Professions Education?

Health professions education attracts scholars from across disciplines and professions. For this reason, there are numerous ways to conduct reviews and it is important to familiarize oneself with these different forms to be able to effectively situate your work and write a compelling rationale for choosing your review methodology. 1 , 2 To do this, authors must contend with an ever-increasing lexicon of review type articles. In 2009 Grant and colleagues conducted a typology of reviews to aid readers makes sense of the different review types, listing fourteen different ways of conducting reviews, not all of which are mutually exclusive. 3 Interestingly, in their typology they did not include narrative reviews which are often used by authors in health professions education. In Table 1 , we offer a short description of three common types of review articles submitted to CMEJ.

Three common types of review articles submitted to CMEJ

More recently, authors such as Greenhalgh 4 have drawn attention to the perceived hierarchy of systematic reviews over scoping and narrative reviews. Like Greenhalgh, 4 we argue that systematic reviews are not to be seen as the gold standard of all reviews. Instead, it is important to align the method of review to what the authors hope to achieve, and pursue the review rigorously, according to the tenets of the chosen review type. Sometimes it is helpful to read part of the literature on your topic before deciding on a methodology for organizing and assessing its usefulness. Importantly, whether you are conducting a review or reading reviews, appreciating the differences between different types of reviews can also help you weigh the author’s interpretation of their findings.

In the next section we summarize some general tips for conducting successful reviews.

How to write and review a review article

In 2016 David Cook wrote an editorial for Medical Education on tips for a great review article. 13 These tips are excellent suggestions for all types of articles you are considering to submit to the CMEJ. First, start with a clear question: focused or more general depending on the type of review you are conducting. Systematic reviews tend to address very focused questions often summarizing the evidence of your topic. Other types of reviews tend to have broader questions and are more exploratory in nature.

Following your question, choose an approach and plan your methods to match your question…just like you would for a research study. Fortunately, there are guidelines for many types of reviews. As Cook points out the most important consideration is to be sure that the methods you follow lead to a defensible answer to your review question. To help you prepare for a defensible answer there are many guides available. For systematic reviews consult PRISMA guidelines ; 13 for scoping reviews PRISMA-ScR ; 14 and SANRA 15 for narrative reviews. It is also important to explain to readers why you have chosen to conduct a review. You may be introducing a new way for addressing an old problem, drawing links across literatures, filling in gaps in our knowledge about a phenomenon or educational practice. Cook refers to this as setting the stage. Linking back to the literature is important. In systematic reviews for example, you must be clear in explaining how your review builds on existing literature and previous reviews. This is your opportunity to be critical. What are the gaps and limitations of previous reviews? So, how will your systematic review resolve the shortcomings of previous work? In other types of reviews, such as narrative reviews, its less about filling a specific knowledge gap, and more about generating new research topic areas, exposing blind spots in our thinking, or making creative new links across issues. Whatever, type of review paper you are working on, the next steps are ones that can be applied to any scholarly writing. Be clear and offer insight. What is your main message? A review is more than just listing studies or referencing literature on your topic. Lead your readers to a convincing message. Provide commentary and interpretation for the studies in your review that will help you to inform your conclusions. For systematic reviews, Cook’s final tip is most likely the most important– report completely. You need to explain all your methods and report enough detail that readers can verify the main findings of each study you review. The most common reasons CMEJ reviewers recommend to decline a review article is because authors do not follow these last tips. In these instances authors do not provide the readers with enough detail to substantiate their interpretations or the message is not clear. Our recommendation for writing a great review is to ensure you have followed the previous tips and to have colleagues read over your paper to ensure you have provided a clear, detailed description and interpretation.

Finally, we leave you with some resources to guide your review writing. 3 , 7 , 8 , 10 , 11 , 16 , 17 We look forward to seeing your future work. One thing is certain, a better appreciation of what different reviews provide to the field will contribute to more purposeful exploration of the literature and better manuscript writing in general.

In this issue we present many interesting and worthwhile papers, two of which are, in fact, reviews.

Major Contributions

A chance for reform: the environmental impact of travel for general surgery residency interviews by Fung et al. 18 estimated the CO 2 emissions associated with traveling for residency position interviews. Due to the high emissions levels (mean 1.82 tonnes per applicant), they called for the consideration of alternative options such as videoconference interviews.

Understanding community family medicine preceptors’ involvement in educational scholarship: perceptions, influencing factors and promising areas for action by Ward and team 19 identified barriers, enablers, and opportunities to grow educational scholarship at community-based teaching sites. They discovered a growing interest in educational scholarship among community-based family medicine preceptors and hope the identification of successful processes will be beneficial for other community-based Family Medicine preceptors.

Exploring the global impact of the COVID-19 pandemic on medical education: an international cross-sectional study of medical learners by Allison Brown and team 20 studied the impact of COVID-19 on medical learners around the world. There were different concerns depending on the levels of training, such as residents’ concerns with career timeline compared to trainees’ concerns with the quality of learning. Overall, the learners negatively perceived the disruption at all levels and geographic regions.

The impact of local health professions education grants: is it worth the investment? by Susan Humphrey-Murto and co-authors 21 considered factors that lead to the publication of studies supported by local medical education grants. They identified several factors associated with publication success, including previous oral or poster presentations. They hope their results will be valuable for Canadian centres with local grant programs.

Exploring the impact of the COVID-19 pandemic on medical learner wellness: a needs assessment for the development of learner wellness interventions by Stephana Cherak and team 22 studied learner-wellness in various training environments disrupted by the pandemic. They reported a negative impact on learner wellness at all stages of training. Their results can benefit the development of future wellness interventions.

Program directors’ reflections on national policy change in medical education: insights on decision-making, accreditation, and the CanMEDS framework by Dore, Bogie, et al. 23 invited program directors to reflect on the introduction of the CanMEDS framework into Canadian postgraduate medical education programs. Their survey revealed that while program directors (PDs) recognized the necessity of the accreditation process, they did not feel they had a voice when the change occurred. The authors concluded that collaborations with PDs would lead to more successful outcomes.

Experiential learning, collaboration and reflection: key ingredients in longitudinal faculty development by Laura Farrell and team 24 stressed several elements for effective longitudinal faculty development (LFD) initiatives. They found that participants benefited from a supportive and collaborative environment while trying to learn a new skill or concept.

Brief Reports

The effect of COVID-19 on medical students’ education and wellbeing: a cross-sectional survey by Stephanie Thibaudeau and team 25 assessed the impact of COVID-19 on medical students. They reported an overall perceived negative impact, including increased depressive symptoms, increased anxiety, and reduced quality of education.

In Do PGY-1 residents in Emergency Medicine have enough experiences in resuscitations and other clinical procedures to meet the requirements of a Competence by Design curriculum? Meshkat and co-authors 26 recorded the number of adult medical resuscitations and clinical procedures completed by PGY1 Fellow of the Royal College of Physicians in Emergency Medicine residents to compare them to the Competence by Design requirements. Their study underscored the importance of monitoring collection against pre-set targets. They concluded that residency program curricula should be regularly reviewed to allow for adequate clinical experiences.

Rehearsal simulation for antenatal consults by Anita Cheng and team 27 studied whether rehearsal simulation for antenatal consults helped residents prepare for difficult conversations with parents expecting complications with their baby before birth. They found that while rehearsal simulation improved residents’ confidence and communication techniques, it did not prepare them for unexpected parent responses.

Review Papers and Meta-Analyses

Peer support programs in the fields of medicine and nursing: a systematic search and narrative review by Haykal and co-authors 28 described and evaluated peer support programs in the medical field published in the literature. They found numerous diverse programs and concluded that including a variety of delivery methods to meet the needs of all participants is a key aspect for future peer-support initiatives.

Towards competency-based medical education in addictions psychiatry: a systematic review by Bahji et al. 6 identified addiction interventions to build competency for psychiatry residents and fellows. They found that current psychiatry entrustable professional activities need to be better identified and evaluated to ensure sustained competence in addictions.

Six ways to get a grip on leveraging the expertise of Instructional Design and Technology professionals by Chen and Kleinheksel 29 provided ways to improve technology implementation by clarifying the role that Instructional Design and Technology professionals can play in technology initiatives and technology-enhanced learning. They concluded that a strong collaboration is to the benefit of both the learners and their future patients.

In his article, Seven ways to get a grip on running a successful promotions process, 30 Simon Field provided guidelines for maximizing opportunities for successful promotion experiences. His seven tips included creating a rubric for both self-assessment of likeliness of success and adjudication by the committee.

Six ways to get a grip on your first health education leadership role by Stasiuk and Scott 31 provided tips for considering a health education leadership position. They advised readers to be intentional and methodical in accepting or rejecting positions.

Re-examining the value proposition for Competency-Based Medical Education by Dagnone and team 32 described the excitement and controversy surrounding the implementation of competency-based medical education (CBME) by Canadian postgraduate training programs. They proposed observing which elements of CBME had a positive impact on various outcomes.

You Should Try This

In their work, Interprofessional culinary education workshops at the University of Saskatchewan, Lieffers et al. 33 described the implementation of interprofessional culinary education workshops that were designed to provide health professions students with an experiential and cooperative learning experience while learning about important topics in nutrition. They reported an enthusiastic response and cooperation among students from different health professional programs.

In their article, Physiotherapist-led musculoskeletal education: an innovative approach to teach medical students musculoskeletal assessment techniques, Boulila and team 34 described the implementation of physiotherapist-led workshops, whether the workshops increased medical students’ musculoskeletal knowledge, and if they increased confidence in assessment techniques.

Instagram as a virtual art display for medical students by Karly Pippitt and team 35 used social media as a platform for showcasing artwork done by first-year medical students. They described this shift to online learning due to COVID-19. Using Instagram was cost-saving and widely accessible. They intend to continue with both online and in-person displays in the future.

Adapting clinical skills volunteer patient recruitment and retention during COVID-19 by Nazerali-Maitland et al. 36 proposed a SLIM-COVID framework as a solution to the problem of dwindling volunteer patients due to COVID-19. Their framework is intended to provide actionable solutions to recruit and engage volunteers in a challenging environment.

In Quick Response codes for virtual learner evaluation of teaching and attendance monitoring, Roxana Mo and co-authors 37 used Quick Response (QR) codes to monitor attendance and obtain evaluations for virtual teaching sessions. They found QR codes valuable for quick and simple feedback that could be used for many educational applications.

In Creation and implementation of the Ottawa Handbook of Emergency Medicine Kaitlin Endres and team 38 described the creation of a handbook they made as an academic resource for medical students as they shift to clerkship. It includes relevant content encountered in Emergency Medicine. While they intended it for medical students, they also see its value for nurses, paramedics, and other medical professionals.

Commentary and Opinions

The alarming situation of medical student mental health by D’Eon and team 39 appealed to medical education leaders to respond to the high numbers of mental health concerns among medical students. They urged leaders to address the underlying problems, such as the excessive demands of the curriculum.

In the shadows: medical student clinical observerships and career exploration in the face of COVID-19 by Law and co-authors 40 offered potential solutions to replace in-person shadowing that has been disrupted due to the COVID-19 pandemic. They hope the alternatives such as virtual shadowing will close the gap in learning caused by the pandemic.

Letters to the Editor

Canadian Federation of Medical Students' response to “ The alarming situation of medical student mental health” King et al. 41 on behalf of the Canadian Federation of Medical Students (CFMS) responded to the commentary by D’Eon and team 39 on medical students' mental health. King called upon the medical education community to join the CFMS in its commitment to improving medical student wellbeing.

Re: “Development of a medical education podcast in obstetrics and gynecology” 42 was written by Kirubarajan in response to the article by Development of a medical education podcast in obstetrics and gynecology by Black and team. 43 Kirubarajan applauded the development of the podcast to meet a need in medical education, and suggested potential future topics such as interventions to prevent learner burnout.

Response to “First year medical student experiences with a clinical skills seminar emphasizing sexual and gender minority population complexity” by Kumar and Hassan 44 acknowledged the previously published article by Biro et al. 45 that explored limitations in medical training for the LGBTQ2S community. However, Kumar and Hassen advocated for further progress and reform for medical training to address the health requirements for sexual and gender minorities.

In her letter, Journey to the unknown: road closed!, 46 Rosemary Pawliuk responded to the article, Journey into the unknown: considering the international medical graduate perspective on the road to Canadian residency during the COVID-19 pandemic, by Gutman et al. 47 Pawliuk agreed that international medical students (IMGs) do not have adequate formal representation when it comes to residency training decisions. Therefore, Pawliuk challenged health organizations to make changes to give a voice in decision-making to the organizations representing IMGs.

In Connections, 48 Sara Guzman created a digital painting to portray her approach to learning. Her image of a hand touching a neuron showed her desire to physically see and touch an active neuron in order to further understand the brain and its connections.

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• Volume 22, Issue 1
• How to appraise qualitative research
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• Calvin Moorley 1 ,
• Xabi Cathala 2
• 1 Nursing Research and Diversity in Care, School of Health and Social Care , London South Bank University , London , UK
• 2 Institute of Vocational Learning , School of Health and Social Care, London South Bank University , London , UK
• Correspondence to Dr Calvin Moorley, Nursing Research and Diversity in Care, School of Health and Social Care, London South Bank University, London SE1 0AA, UK; Moorleyc{at}lsbu.ac.uk

https://doi.org/10.1136/ebnurs-2018-103044

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Introduction

In order to make a decision about implementing evidence into practice, nurses need to be able to critically appraise research. Nurses also have a professional responsibility to maintain up-to-date practice. 1 This paper provides a guide on how to critically appraise a qualitative research paper.

What is qualitative research?

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Useful terms

Some of the qualitative approaches used in nursing research include grounded theory, phenomenology, ethnography, case study (can lend itself to mixed methods) and narrative analysis. The data collection methods used in qualitative research include in depth interviews, focus groups, observations and stories in the form of diaries or other documents. 3

Authenticity

Title, keywords, authors and abstract.

In a previous paper, we discussed how the title, keywords, authors’ positions and affiliations and abstract can influence the authenticity and readability of quantitative research papers, 4 the same applies to qualitative research. However, other areas such as the purpose of the study and the research question, theoretical and conceptual frameworks, sampling and methodology also need consideration when appraising a qualitative paper.

Purpose and question

The topic under investigation in the study should be guided by a clear research question or a statement of the problem or purpose. An example of a statement can be seen in table 2 . Unlike most quantitative studies, qualitative research does not seek to test a hypothesis. The research statement should be specific to the problem and should be reflected in the design. This will inform the reader of what will be studied and justify the purpose of the study. 5

Example of research question and problem statement

An appropriate literature review should have been conducted and summarised in the paper. It should be linked to the subject, using peer-reviewed primary research which is up to date. We suggest papers with a age limit of 5–8 years excluding original work. The literature review should give the reader a balanced view on what has been written on the subject. It is worth noting that for some qualitative approaches some literature reviews are conducted after the data collection to minimise bias, for example, in grounded theory studies. In phenomenological studies, the review sometimes occurs after the data analysis. If this is the case, the author(s) should make this clear.

Theoretical and conceptual frameworks

Most authors use the terms theoretical and conceptual frameworks interchangeably. Usually, a theoretical framework is used when research is underpinned by one theory that aims to help predict, explain and understand the topic investigated. A theoretical framework is the blueprint that can hold or scaffold a study’s theory. Conceptual frameworks are based on concepts from various theories and findings which help to guide the research. 6 It is the researcher’s understanding of how different variables are connected in the study, for example, the literature review and research question. Theoretical and conceptual frameworks connect the researcher to existing knowledge and these are used in a study to help to explain and understand what is being investigated. A framework is the design or map for a study. When you are appraising a qualitative paper, you should be able to see how the framework helped with (1) providing a rationale and (2) the development of research questions or statements. 7 You should be able to identify how the framework, research question, purpose and literature review all complement each other.

There remains an ongoing debate in relation to what an appropriate sample size should be for a qualitative study. We hold the view that qualitative research does not seek to power and a sample size can be as small as one (eg, a single case study) or any number above one (a grounded theory study) providing that it is appropriate and answers the research problem. Shorten and Moorley 8 explain that three main types of sampling exist in qualitative research: (1) convenience (2) judgement or (3) theoretical. In the paper , the sample size should be stated and a rationale for how it was decided should be clear.

Methodology

Qualitative research encompasses a variety of methods and designs. Based on the chosen method or design, the findings may be reported in a variety of different formats. Table 3 provides the main qualitative approaches used in nursing with a short description.

Different qualitative approaches

The authors should make it clear why they are using a qualitative methodology and the chosen theoretical approach or framework. The paper should provide details of participant inclusion and exclusion criteria as well as recruitment sites where the sample was drawn from, for example, urban, rural, hospital inpatient or community. Methods of data collection should be identified and be appropriate for the research statement/question.

Data collection

Overall there should be a clear trail of data collection. The paper should explain when and how the study was advertised, participants were recruited and consented. it should also state when and where the data collection took place. Data collection methods include interviews, this can be structured or unstructured and in depth one to one or group. 9 Group interviews are often referred to as focus group interviews these are often voice recorded and transcribed verbatim. It should be clear if these were conducted face to face, telephone or any other type of media used. Table 3 includes some data collection methods. Other collection methods not included in table 3 examples are observation, diaries, video recording, photographs, documents or objects (artefacts). The schedule of questions for interview or the protocol for non-interview data collection should be provided, available or discussed in the paper. Some authors may use the term ‘recruitment ended once data saturation was reached’. This simply mean that the researchers were not gaining any new information at subsequent interviews, so they stopped data collection.

The data collection section should include details of the ethical approval gained to carry out the study. For example, the strategies used to gain participants’ consent to take part in the study. The authors should make clear if any ethical issues arose and how these were resolved or managed.

The approach to data analysis (see ref  10 ) needs to be clearly articulated, for example, was there more than one person responsible for analysing the data? How were any discrepancies in findings resolved? An audit trail of how the data were analysed including its management should be documented. If member checking was used this should also be reported. This level of transparency contributes to the trustworthiness and credibility of qualitative research. Some researchers provide a diagram of how they approached data analysis to demonstrate the rigour applied ( figure 1 ).

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Example of data analysis diagram.

Validity and rigour

The study’s validity is reliant on the statement of the question/problem, theoretical/conceptual framework, design, method, sample and data analysis. When critiquing qualitative research, these elements will help you to determine the study’s reliability. Noble and Smith 11 explain that validity is the integrity of data methods applied and that findings should accurately reflect the data. Rigour should acknowledge the researcher’s role and involvement as well as any biases. Essentially it should focus on truth value, consistency and neutrality and applicability. 11 The authors should discuss if they used triangulation (see table 2 ) to develop the best possible understanding of the phenomena.

Themes and interpretations and implications for practice

In qualitative research no hypothesis is tested, therefore, there is no specific result. Instead, qualitative findings are often reported in themes based on the data analysed. The findings should be clearly linked to, and reflect, the data. This contributes to the soundness of the research. 11 The researchers should make it clear how they arrived at the interpretations of the findings. The theoretical or conceptual framework used should be discussed aiding the rigour of the study. The implications of the findings need to be made clear and where appropriate their applicability or transferability should be identified. 12

Discussions, recommendations and conclusions

The discussion should relate to the research findings as the authors seek to make connections with the literature reviewed earlier in the paper to contextualise their work. A strong discussion will connect the research aims and objectives to the findings and will be supported with literature if possible. A paper that seeks to influence nursing practice will have a recommendations section for clinical practice and research. A good conclusion will focus on the findings and discussion of the phenomena investigated.

Qualitative research has much to offer nursing and healthcare, in terms of understanding patients’ experience of illness, treatment and recovery, it can also help to understand better areas of healthcare practice. However, it must be done with rigour and this paper provides some guidance for appraising such research. To help you critique a qualitative research paper some guidance is provided in table 4 .

Some guidance for critiquing qualitative research

• ↵ Nursing and Midwifery Council . The code: Standard of conduct, performance and ethics for nurses and midwives . 2015 https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf ( accessed 21 Aug 18 ).
• Barrett D ,
• Cathala X ,
• Shorten A ,

Patient consent for publication Not required.

Competing interests None declared.

Provenance and peer review Commissioned; internally peer reviewed.

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Best Nursing Research Topics for Students

What is a nursing research paper.

• What They Include
• Choosing a Topic
• Best Nursing Research Topics
• Research Paper Writing Tips

Writing a research paper is a massive task that involves careful organization, critical analysis, and a lot of time. Some nursing students are natural writers, while others struggle to select a nursing research topic, let alone write about it.

If you're a nursing student who dreads writing research papers, this article may help ease your anxiety. We'll cover everything you need to know about writing nursing school research papers and the top topics for nursing research.  

Continue reading to make your paper-writing jitters a thing of the past.

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A nursing research paper is a work of academic writing composed by a nurse or nursing student. The paper may present information on a specific topic or answer a question.

During LPN/LVN and RN programs, most papers you write focus on learning to use research databases, evaluate appropriate resources, and format your writing with APA style. You'll then synthesize your research information to answer a question or analyze a topic.

BSN , MSN , Ph.D., and DNP programs also write nursing research papers. Students in these programs may also participate in conducting original research studies.

Writing papers during your academic program improves and develops many skills, including the ability to:

• Select nursing topics for research
• Conduct effective research
• Analyze published academic literature
• Format and cite sources
• Synthesize data
• Organize and articulate findings

About Nursing Research Papers

When do nursing students write research papers.

You may need to write a research paper for any of the nursing courses you take. Research papers help develop critical thinking and communication skills. They allow you to learn how to conduct research and critically review publications.

That said, not every class will require in-depth, 10-20-page papers. The more advanced your degree path, the more you can expect to write and conduct research. If you're in an associate or bachelor's program, you'll probably write a few papers each semester or term.

Do Nursing Students Conduct Original Research?

Most of the time, you won't be designing, conducting, and evaluating new research. Instead, your projects will focus on learning the research process and the scientific method. You'll achieve these objectives by evaluating existing nursing literature and sources and defending a thesis.

However, many nursing faculty members do conduct original research. So, you may get opportunities to participate in, and publish, research articles.

Example Research Project Scenario:

In your maternal child nursing class, the professor assigns the class a research paper regarding developmentally appropriate nursing interventions for the pediatric population. While that may sound specific, you have almost endless opportunities to narrow down the focus of your writing. 

You could choose pain intervention measures in toddlers. Conversely, you can research the effects of prolonged hospitalization on adolescents' social-emotional development.

What Does a Nursing Research Paper Include?

Your professor should provide a thorough guideline of the scope of the paper. In general, an undergraduate nursing research paper will consist of:

Introduction : A brief overview of the research question/thesis statement your paper will discuss. You can include why the topic is relevant.

Body : This section presents your research findings and allows you to synthesize the information and data you collected. You'll have a chance to articulate your evaluation and answer your research question. The length of this section depends on your assignment.

Conclusion : A brief review of the information and analysis you presented throughout the body of the paper. This section is a recap of your paper and another chance to reassert your thesis.

The best advice is to follow your instructor's rubric and guidelines. Remember to ask for help whenever needed, and avoid overcomplicating the assignment!

How to Choose a Nursing Research Topic

The sheer volume of prospective nursing research topics can become overwhelming for students. Additionally, you may get the misconception that all the 'good' research ideas are exhausted. However, a personal approach may help you narrow down a research topic and find a unique angle.

Writing your research paper about a topic you value or connect with makes the task easier. Additionally, you should consider the material's breadth. Topics with plenty of existing literature will make developing a research question and thesis smoother.

Finally, feel free to shift gears if necessary, especially if you're still early in the research process. If you start down one path and have trouble finding published information, ask your professor if you can choose another topic.

The Best Research Topics for Nursing Students

You have endless subject choices for nursing research papers. This non-exhaustive list just scratches the surface of some of the best nursing research topics.

1. Clinical Nursing Research Topics

• Analyze the use of telehealth/virtual nursing to reduce inpatient nurse duties.
• Discuss the impact of evidence-based respiratory interventions on patient outcomes in critical care settings.
• Explore the effectiveness of pain management protocols in pediatric patients.

2. Community Health Nursing Research Topics

• Assess the impact of nurse-led diabetes education in Type II Diabetics.
• Analyze the relationship between socioeconomic status and access to healthcare services.

3. Nurse Education Research Topics

• Review the effectiveness of simulation-based learning to improve nursing students' clinical skills.
• Identify methods that best prepare pre-licensure students for clinical practice.
• Investigate factors that influence nurses to pursue advanced degrees.
• Evaluate education methods that enhance cultural competence among nurses.
• Describe the role of mindfulness interventions in reducing stress and burnout among nurses.

4. Mental Health Nursing Research Topics

• Explore patient outcomes related to nurse staffing levels in acute behavioral health settings.
• Assess the effectiveness of mental health education among emergency room nurses .
• Explore de-escalation techniques that result in improved patient outcomes.
• Review the effectiveness of therapeutic communication in improving patient outcomes.

5. Pediatric Nursing Research Topics

• Assess the impact of parental involvement in pediatric asthma treatment adherence.
• Explore challenges related to chronic illness management in pediatric patients.
• Review the role of play therapy and other therapeutic interventions that alleviate anxiety among hospitalized children.

6. The Nursing Profession Research Topics

• Analyze the effects of short staffing on nurse burnout .
• Evaluate factors that facilitate resiliency among nursing professionals.
• Examine predictors of nurse dissatisfaction and burnout.
• Posit how nursing theories influence modern nursing practice.

Tips for Writing a Nursing Research Paper

The best nursing research advice we can provide is to follow your professor's rubric and instructions. However, here are a few study tips for nursing students to make paper writing less painful:

Avoid procrastination: Everyone says it, but few follow this advice. You can significantly lower your stress levels if you avoid procrastinating and start working on your project immediately.

Plan Ahead: Break down the writing process into smaller sections, especially if it seems overwhelming. Give yourself time for each step in the process.

Research: Use your resources and ask for help from the librarian or instructor. The rest should come together quickly once you find high-quality studies to analyze.

Outline: Create an outline to help you organize your thoughts. Then, you can plug in information throughout the research process. 

Clear Language: Use plain language as much as possible to get your point across. Jargon is inevitable when writing academic nursing papers, but keep it to a minimum.

Cite Properly: Accurately cite all sources using the appropriate citation style. Nursing research papers will almost always implement APA style. Check out the resources below for some excellent reference management options.

Revise and Edit: Once you finish your first draft, put it away for one to two hours or, preferably, a whole day. Once you've placed some space between you and your paper, read through and edit for clarity, coherence, and grammatical errors. Reading your essay out loud is an excellent way to check for the 'flow' of the paper.

Helpful Nursing Research Writing Resources:

Purdue OWL (Online writing lab) has a robust APA guide covering everything you need about APA style and rules.

Grammarly helps you edit grammar, spelling, and punctuation. Upgrading to a paid plan will get you plagiarism detection, formatting, and engagement suggestions. This tool is excellent to help you simplify complicated sentences.

Mendeley is a free reference management software. It stores, organizes, and cites references. It has a Microsoft plug-in that inserts and correctly formats APA citations.

Don't let nursing research papers scare you away from starting nursing school or furthering your education. Their purpose is to develop skills you'll need to be an effective nurse: critical thinking, communication, and the ability to review published information critically.

Choose a great topic and follow your teacher's instructions; you'll finish that paper in no time.

Joleen Sams is a certified Family Nurse Practitioner based in the Kansas City metro area. During her 10-year RN career, Joleen worked in NICU, inpatient pediatrics, and regulatory compliance. Since graduating with her MSN-FNP in 2019, she has worked in urgent care and nursing administration. Connect with Joleen on LinkedIn or see more of her writing on her website.

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Qualitative and Quantitative Research: A Critique

Qualitative critique, quantitative critique, general introduction.

This nursing article was intended to advance the knowledge on the barriers to effective central venous catheter (CVC) insertions and the role of facilitators in the process. Therefore, the purpose of this positive criticism is to identify and evaluate how the findings improve the field of clinical practice.

Introduction

The authors introduce the article in an elaborate manner, stating all the major facts and identifying the actual and the ideal situations in the practice of inserting CVCs.

Statement of the Problem

Purpose of the study, research questions.

The research questions are clearly stated and defined. They help the researchers meet the objective of the study.

Literature Review

Ethical consideration, limitations.

1. Brown, J. M., & Schmidt, N. A. (2012). Evidence-based practice for nurses: Appraisal and application of research.

2. Cameron, K. A., Cohen, E. R., Hertz, J. R., Wayne, D. B., Mitra, D., & Barsuk, J. H. (2018). Barriers and Facilitators to Central Venous Catheter Insertion: A Qualitative Study. Journal of patient safety.

3. Dahan, M., O’Donnell, S., Hebert, J., Gonzales, M., Lee, B., Chandran, A. U., … & Quach, C. (2016). CLABSI risk factors in the NICU: potential for prevention: a PICNIC study. infection control & hospital epidemiology, 37(12), 1446-1452.

4. Ellis, P. (2016). Understanding research for nursing students. Learning Matters.

5. Gerrish, K., & Lacey, A. (2010). The research process in nursing. John Wiley & Sons.

6. Houser, J. (2015). Nursing research: Reading, using and creating evidence. Jones & Bartlett Publishers.

7. LoBiondo-Wood, G., & Haber, J. (2010). Nursing Research-E-Book: Methods and Critical Appraisal for Evidence-Based Practice. Elsevier Health Sciences.

8. Melnyk, B. M., Fineout-Overholt, E., Stillwell, S. B., & Williamson, K. M. (2010). Evidence-based practice: step by step: the seven steps of evidence-based practice. AJN The American Journal of Nursing, 110(1), 51-53.

9. Polit, D. F., & Beck, C. T. (2010). Essentials of nursing research: Appraising evidence for nursing practice. Lippincott Williams & Wilkins.

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Critical Discussion of the Code of Professional Conduct for Nursing Practice

Info: 1483 words (6 pages) Nursing Essay Published: 10th Jun 2020

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• Carter, R. (2007) Quality and Clinical Governance. In: Brown, J., and Libberton, P. (eds), Principles of Professional Studies in Nursing. Basingstoke: Palgrave Macmillan.
• Carvalho, S., Reeves, M., and Orford, J. (2011) Fundamental Aspects of Legal, Ethical and Professional Issues in Nursing. 2 nd Edition. London: Quay Books Division.
• Craig, J.V., and Stevens., K.R. (2012) Evidence-based practice in nursing. In: Craig, J.V., and Smyth, R.L. (eds), The Evidence-Based Practice Manual for Nurses. 3 rd Edition. Churchill Livingstone Elsevier.
• Department of Health (2012) Compassion in Practice. Crown Copyright.
• Hall. C., and Ritchie, D. (2011) What is Nursing? Exploring Theory and Practice. 2 nd Edition. Exeter: Learning Matters.
• Maginnis, C., and Croxon, l. (2010) Transfer of learning to the nursing clinical practice setting. Rural Remote Health, 10 (2), 1313. [Online]. Available from http://www.rrh.org.au (Accessed 16 August 2019).
• Murray, R. (2017) Falling number of nurses in the NHS paints a worrying picture. The Kings Fund. Available at https://www.kingsfund.org.uk/blog/2017/10/falling-number-nurses-nhs-paints-worrying-picture (Accessed 16 August 2019).
• NHS Improvement (2018) NRLS national patient safety incident reports: commentary. London: NHS Improvement.
• Nursing and Midwifery Council (2018) The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates. London: NMC.
• Social Care Institute for Excellence (SCIE) (2013) The Dignity Factors. Available at https://www.scie.org.uk/publications/guides/guide15/factors/ (Accessed 16 August 2019).

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2 Moscow, Third Rome, and the Uses of Ressentiment: An Essay in Myth Criticism

• Published: November 2018
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Historical scrutiny of the myth of Moscow, Third Rome, exposes its being an ideological mainstay of Muscovite imperial autocratic pretentions since the fifteenth century. As Third Rome, Moscow alone inherits the universal authority of imperial Byzantium (Second Rome) over all Christians. In particular, it asserts the rule of autocracy over rule of law. The myth persists stubbornly in the popular Russian mind. There, it seems impervious to historical scrutiny. But, while the myth has withstood standard rational historical critiques, I conclude that it remains vulnerable to being replaced by an anti-autocratic counter-myth that asserts Byzantium’s role in the rise of rule of law.

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Literary Theory and Criticism

Home › Literature › Analysis of Boris Pasternak’s Doctor Zhivago

Analysis of Boris Pasternak’s Doctor Zhivago

By NASRULLAH MAMBROL on July 13, 2020 • ( 0 )

Considered by many the greatest Russian novel of the 20th century, Boris Pasternak’s (1890-1960) Doctor Zhivago is certainly the most famous fictional treatment of the defining moments of modern Russian history at the outset of the 20th century, inviting a comparison with Tolstoy ’s similar effort in War and Peace to dramatize the crucial events of the Napoleonic era. Doctor Zhivago shares with War and Peace an epic tonality; both attempt to encapsulate a national history, culture, and philosophy of human nature and experience in the stories of individuals caught up in the maelstrom of history. Depicting pre-revolutionary Russian culture, the revolution, and the ensuing civil war from a decidedly subjective viewpoint, Doctor Zhivago broke with the enforced literary dictates of socialist realism and party doctrine at a time when such a challenge demanded enormous courage and conviction. “A miracle of non-conformity,” the Russian scholar Victor Frank has called Pasternak’s novel, “full of supreme indifference to all the offi cial taboos.” Refused publication in the Soviet Union, the novel was surreptitiously sent to an Italian publisher who brought it out in 1957, with an English translation appearing in 1958. Hailed by the critic Edmund Wilson as “one of the great events in man’s literary and moral history . . . a great act of faith in art and the human spirit,” Doctor Zhivago became a worldwide popular and critical sensation that culminated in Pasternak being awarded the 1958 Nobel Prize in literature “for his notable achievement in both contemporary poetry and the field of the great Russian narrative tradition.” Regarded by the Soviet state as a political rather than a literary judgment on behalf of a novel it considered unpatriotic and subversive, Doctor Zhivago provoked a barrage of hostile reviews and resolutions in Russia that branded it “literary trash” and a “malicious lampoon of the socialist revolution.” Pasternak was expelled from the Writers’ Union and condemned as “worse than a pig” because “a pig never befouls where it eats or sleeps.” Pasternak’s deportation from the Soviet Union was averted only by the writer’s refusal of the Nobel Prize and by his impassioned appeal to Nikita Khrushchev in which Pasternak equated banishment from Russia to a death sentence. Doctor Zhivago would not be officially published in Russia until 1988 to great acclaim and acceptance into the post-Soviet literary canon as a landmark and unavoidable masterpiece.

Despite its undisputed importance as a social document chronicling a crucial period in Russian and world history, Doctor Zhivago continues to divide critics at the most basic level of how it works, its affinity to the novel tradition in the 19th and 20th centuries, and even the genre to which it belongs. Described as both one of the greatest political novels and one of literature’s great love stories, Doctor Zhivago has also been called “a fairy tale,” “a kind of morality play,” “an apocalyptic poem in the form of a novel,” “one of the most original works of modern times,” and “a nineteenth-century novel by a twentieth-century poet.” Compared to predecessors like Tolstoy and Dostoevsky in the great 19th-century Russian realistic novel tradition, Pasternak has been found wanting in his failure to provide believable, rounded characters. Compared to modernist innovators like Joyce, Woolf, and Faulkner, he has been viewed as old-fashioned and outmoded. To appreciate fully Pasternak’s achievement in Doctor Zhivago, it is necessary to recognize that its nonconformity extends beyond its unorthodox and unsanctioned ideas to its formal challenges to established narrative assumptions. Doctor Zhivago is neither a failed 19th-century nor a disappointing modernist novel, but a radical syn-thesis of both traditions in a daringly original construct.

Aspects of Pasternak’s life and career provide crucial contexts for his single novel published three years before his death. Born in Moscow in 1890, Boris Leonidovich Pasternak was the eldest child of the painter Leonid Pasternak and the concert pianist Rosa Kaufman and was raised in the midst of Moscow’s intellectual and artistic community. Tolstoy was a household visitor, and the distinguished composer Alexander Scarabin encouraged the 14-year-old Pasternak in his study of music. Convinced that he lacked the necessary technical skills, at age 19, Pasternak abandoned music for poetry and philosophy, eventually enrolling in Germany’s prestigious Marburg University until 1912 when he returned to Russia and committed himself exclusively to poetry. Associated with the Russian symbolist and futurist movements, Pasternak began to gain a reputation as a leading figure of a new generation of Russian poets who sought a greater freedom of poetic subjects and expression, more closely tied to actual experience and colloquial language. Declared exempt from military service during World War I because of a childhood leg injury, Pasternak managed a draft board in the Urals. When the revolution came, Pasternak was largely sympathetic, embracing the promise of needed social reform and liberation of the spirit that his poetry advocated. As the new Soviet regime grew increasingly conservative in cultural matters and repressive in silencing dissent, Pasternak, throughout the 1930s, published little, perfecting the delicate art of survival under Stalin, of maintaining core principles while avoiding the fate of fellow writers and artistic colleagues who faced death sentences and banishment to labor camps. Convinced that the Soviet state had betrayed the ideals of the revolution and that the drive for collectivism in Soviet society violated essential imperatives of human nature, sometime during the 1930s Pasternak decided to turn from poetry to prose to tell the story of his generation and its historical fate under the czar, during the Great War, and through the revolution and the establishment of the communist state, in part as an expression of survivor’s guilt. Writing in 1948, Pasternak admitted, “I am guilty before everyone. But what can I do? So here in the novel—it is part of this debt, proof that at least I tried.” Drawing on his earlier interests in musical composition, philosophy, and a career devoted to poetry, Pasternak conceived a novel capacious enough to contain his “views on art, the Gospels, human life in history and many other things.” Rejecting the “idiotic clichés” of socialist realism and an edited, sanitized view of the revolution and its aftermath, Pasternak embraced the role as truth teller in which “Everything is untangled, everything is named, simple, transparent, sad. Once again, afresh, in a new way, the most precious and important things, the earth and the sky, great warm feeling, the spirit of creation, life and death, have been delineated.” Doctor Zhivago began to take final shape during the late 1940s as Pasternak faced increasing government hostility for his “anti-Soviet” views. To punish him indirectly, Pasternak’s mistress, Olga Vsevolodovna Ivinskaia, was arrested in 1949 and sentenced to five years in a hard-labor camp “for close contact with persons suspected of espionage.” Pasternak would later confess that Olga was the Lara of his novel, which was finally completed in early 1956.

Pasternak’s comments about his work in his letters reveal key points about his intentions and methods for Doctor Zhivago. Throughout his correspondence, Pasternak refers to his “novel in prose,” a nod to Pushkin’s “novel in verse,” Eugene Onegin , and a connection to Pasternak’s following the same literary trajectory of Russia’s literary fountainhead, Pushkin, from poetry to prose. Regarding his poetry as preparatory work and incapable of supporting his historical and philosophical aspirations, Pasternak claimed, “a poem is to prose as a sketch is to a painting.” Yet at the core of Doctor Zhivago is Pasternak’s insistent lyricism in which narrative elements are joined through imagery, counterpoint, and symbolism. Pasternak’s poetic method explains why Doctor Zhivago, measured against the standard of the realistic novel, often falls short. Characters, rather than appearing distinct and original, tend to merge together, expressing shared preoccupations and feelings. Defending himself against charges of “not sufficient tracing of characters,” Pasternak insisted that “more than to delineate them I tried to efface them.” To the charge of the novel’s many violations of probability with coincidence, Pasternak claimed, “Realism of genre and language doesn’t interest me. That’s not what I value. In the novel there is a grandeur of another kind.” Underlying the novel’s blending of elements from poetry and prose and a manipulation of events that lends a fairy tale or providential aura to the book is Pasternak’s contention that “existence was more original, extraordinary and inexplicable than any of its separate astonishing incidents and facts. I was attracted by the unusualness of the usual.” Pasternak’s subjective, poeticized perspective aligns Doctor Zhivago in certain ways with magic realists like Márquez as much as with Tolstoy in his pursuit of “the atmosphere of being,” which he described as “the whole sequence of facts and beings and happenings like some moving entireness, like a developing, passing by, rolling and rushing inspiration, as if reality itself had freedom and choice and was composing itself out of numberless variants and versions.”

Pasternak’s “moving entireness” in Doctor Zhivago begins with the 10-year-old Yury Zhivago attending his mother’s funeral in a driving snowstorm, imagistically uniting human destiny and the vitality and power of nature that threaten to engulf and overwhelm the individual. This theme of the survival of the individual will be orchestrated throughout the novel, embedded even in the title character’s family name, an older Russian form of the word “alive.” It is the first of many scenes in which Zhivago’s isolation and vulnerability to both natural forces and human events aligned against his aspirations toward selfhood will be emphasized. The novel relies on several traditional structural principles including the novel of development and education of the artist as well as the quest novel in which the artist Zhivago eventually emerges after a succession of tests. Yet Doctor Zhivago is a tragically conceived modern Odyssey in which not home but isolation and separation from virtually every sustaining relationship and external consolation are his destination. Ultimately, Zhivago’s only reward or redemption is his art and the affirmation of the mystery and majesty of existence that his poems assert.

The first portion of the novel dramatizes the last decade of czarist rule and the events leading up to World War I and the revolutions of 1917. Following the suicide death of his father over the loss of his fortune, Yury is raised in the professorial home of Alexander and Anna Gromeko and their daughter Tonya. The novel’s catalyst and moral touchstone is the “Girl from a Different World,” Lara Guishar, the teenaged daughter of a Belgian hat-maker, whose story connects the comfortable bourgeois world of the Gromekos with Moscow’s labor class and incipient revolutionaries. Her seduction by the rich lawyer, Komarovsky, establishes a connection with Yury who is on hand after Lara’s mother’s failed suicide attempt and at the Christmas party where Lara tries and fails to shoot her lover. They next meet at the front during World War I where Yury, having married Tonya, is serving as a doctor and Lara is working as a nurse, having gone to the front in search of her husband, Pasha Antipov, who has abandoned her and their child, unable to reconcile himself to his wife’s past with Komarovsky. As Yury and Lara’s attachment grows, news of the revolution reaches them, and both return to their respective homes—Yury to Moscow, and Lara to Yuryatin in Siberia.

Having experienced the dehumanizing conditions of war, Yury returns to similar conditions in Moscow under the Bolsheviks where his family’s privileged existence has been transformed to a struggle for survival in which Yury’s integrity, individualism, and artistic sensibility are not just valueless but dangerously subversive. Seeking relief, the family travels east to Tonya’s former family estate in Siberia, near Yuryatin, Lara’s home. The train journey is one of the triumphs of the novel in which the immense Russian landscape is brilliantly evoked and a rich collection of the various classes of Russian soci-ety displaced by the revolution are brought together during the dangerous and lawless days of the civil war. Yury barely avoids execution in an encounter with the merciless revolutionary leader Strelnikov, Lara’s renamed husband Antipov. Settling at the Varykino estate and subsisting off the land, the fam-ily thrives for a year before a chance reunion between Yury and Lara leads to their love affair. Guilt-ridden and determined to reconcile with Tonya, Yury is kidnapped on his way home by Bolshevik partisan fighters in need of a doctor. Serving with them for over a year and experiencing the horrific violence and human debasement of the civil war, Yury finally escapes back to Yuryatin where he is nursed back to health by Lara and learns that Tonya, her father, and their children have returned to Moscow. (They will subsequently be deported to the West.)

The reunited lovers are interrupted by the appearance of Komarovsky who warns Lara of her danger as the wife of the now-condemned Strelnikov. They respond by leaving Yuryatin for Varykino and two weeks of happiness in which Yury resumes his poetry, inspired by Lara. Komarovsky offers Lara and her child safe passage to the East, and Yury, to convince her to take it, lies that he will join them. Left alone, Yury is visited by the hunted Strelnikov who, in despair over the failure of his revolutionary ideals and his betrayal of Lara’s love, shoots himself. The novel concludes with Yury’s life in Mos-cow, having been stripped of everything he had formerly relied on to sustain him—his wife, family, and lover. Resuming his medical career and his writing, Yury finally dies of a heart attack, ultimately vindicated by the poems that close the book, testimony of both his heroic resistance to the forces of death and despair and affirmation of the value of life, embodied by the essential human qualities of his muse, Lara. She arrives in Moscow in time for the funeral before disappearing: “She must have been arrested in the street, as so often happened in those days, and she died or vanished somewhere, forgotten as a nameless number on a list which later was mislaid, in one of the innumerable mixed or women’s concentration camps in the north.”

In the fates of both Lara and Yuri, the reader feels an overwhelming sense of human waste, having been instructed by the author in the value their lives and living has, set beside the necessities of history and ideology that has diminished both. Doctor Zhivago attempts to redress the balance, translating the “nameless number on a list” into memorable human terms that never neglects the “unusualness of the usual.”

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Turning to essays, Edwidge Danticat makes shrewd use of the form

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Book Review

We're Alone: Essays

By Edwidge Danticat Graywolf: 192 pages, $26 If you buy books linked on our site, The Times may earn a commission from Bookshop.org , whose fees support independent bookstores.

Essay collections appear infrequently on the lists of most popular nonfiction — memoirs and historical narratives dominate conversations about the genre. Those forms of nonfiction are wonderful in their own ways. They are also the versions that are closest to fiction. That’s not necessarily a bad thing, but it can exclude the unique offerings of the essay.

An essay collection presents a compressed reading experience, sometimes poetic, and often requiring the author to demonstrate the act of forming an opinion. In its most exalted form, the essay collection is about many things at once. Its goal is not to share information about a topic but to dramatize the formation of a perspective, the development of an informed point of view — a focus that makes the form much more dependent on the writer than the subject matter. “We’re Alone,” a collection of eight short essays by the celebrated Haitian American novelist and short story writer Edwidge Danticat, exemplifies that achievement.

Readers who have appreciated other voice-driven essay collections, such as Zadie Smith’s pandemic-inspired “Intimations,” Erica Caldwell’s “Wrong Is Not My Name,” Jordan Kisner’s “Thin Places,” Cathy Park Hong’s “Minor Feelings” or Elissa Gabbert’s “ The Unreality of Memory ,” will find something familiar with Danticat in “We’re Alone.” The thematic thread of this collection binds loosely around experiences of disconnection or isolation that are exacerbated by a sense of risk predicated on racial, political or social vulnerability. In the essay “A Rainbow in the Sky,” Danticat writes: “The less stable your house, the more terror you feel.” She has elegantly captured that those who face a storm with all foundations intact have a different relationship to the experience than those who were already struggling before it.

In the preface to the book, Danticat discloses that writing essays allows her to feel alone with herself and present with a reader. These pieces represent her outstretched hand, an invitation to spend shared time in reflection. Danticat took the book’s title from the French poem “Plage” by the Haitian writer Roland Chassagne, whose tragic history of imprisonment is also explored in the book. His poem envisions a night spent under palm trees, and the longing for the end of a deep disappointment. Here Danticat finds an early foothold into one of the book’s chief concerns: thresholds where someone’s feelings have been constricted for the sake of other people’s comfort. The title also invokes a plural self, a collective that shares in the writer’s experience of solitude and disaffection.

In the literary essay, a tradition that unites personal insight with anecdotes, evidence and reasoning, one of the most satisfying moments is finding where the writer’s logic breaks and she struggles to fully accommodate the proportions of her subject. Such moments make the inquiries appear vulnerable and honest, even when in reality they are simulations of sense-making. Not all essayists are invested in showing their struggle in understanding or are given the space to do so. But Danticat invites readers into the challenge of putting facts and feelings together. She excels at showing how hard it is to know what the right questions are to ask or how to answer them, and like many of us, she struggles to talk about difficult subjects, especially with her children.

For example, in “By the Time You Read This…,” Danticat debates how much and when to tell her children about how police violence affects the way Black people and immigrants think about safety. She writes, “Each time a young Black person is killed by a police officer or by a vigilante civilian, I ask myself if the time had come for me to write to my daughters a letter about Abner Louima and the long list of nonsurvivors who have come after him.” There is dignity in her doubt, which makes way for the kind of compassion that characterizes these essays.

Danticat’s insights are informed by accounts of the trials of friends and family: Her beloved mother wanders off in an airport; an uncle suffers from an irresolvable, progressive disorientation; Louima, a family friend, is attacked and raped by police; and two mentors, Toni Morrison and Paule Marshall, live through their final months. These experiences emphasize the possibility of loss and disconnection, reflecting a kind of hypervigilance that can be an inheritance of trauma. She approaches these accounts with the courage of an intentional witness, maintaining that perspective even when she looks beyond her own circle. In “Chronicles of a Death Foretold,” Danticat tells the story of a self-proclaimed prophetess who predicted the 2021 assassination of the Haitian President Jovenel Moïse, and the collection’s penultimate essay, “Wozo, Not Mawozo,” examines the weeks following the kidnapping of Christian missionaries in Haiti in 2021.

These are clearly the essays of an accomplished novelist. They move swiftly through detailed anecdotes and varied landscapes, even when the principal action the speaker engages in is “thinking.” There is room in an essay for dramatic action, for the expression of the body as it relates to thought, which was somewhat lacking here. At times, I struggled to see the author as a figure in the dramatic action she cited. Even so, it’s a testament to Danticat’s skill that these brief, intense works about serious matters do not feel heavy. She brings us close enough to the trouble at hand that we cannot mistake what we have seen.

But we are not alone in trying to make sense of feelings that come from becoming a witness to this world. No one is.

Wendy S. Walters is the author of the prose collection “Multiply/Divide” and an associate professor of nonfiction at Columbia University.

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