Critical Appraisal or Article Critique Guide for Nursing Students

A critical appraisal for nursing and medical students is what an article reviews or critiques in other subjects or fields of study.

Nurses and other healthcare professionals leverage research to answer questions about the practice, improve healthcare quality and patient satisfaction levels, generate new research questions, and shape the direction of healthcare policy.

To confront questions relating to policy and practice, nurses need robust, high-quality, valid, reliable, and evidence-based research.

Although research articles published in peer-reviewed nursing and medical journals undergo a rigorous review process to ensure they meet the strict scholarly standards, the fact that standards vary among journals and reviewers mandates independent critical appraisals, critiques, or reviews of the research articles.

Therefore, nurses and medical students need to gain critical appraisal skills as it helps to systematically read and critique research articles, which is the foundation for translating evidence into practice or policy.

In this guide, we take you through the step-by-step process of reviewing a nursing or medical journal so that you can inform your practice or facilitate an evidence-based research process culminating into a systematic review, change/quality improvement proposal, dissertation, or capstone project.

What is Critical Appraisal?

Critical appraisal otherwise referred to as critique or a critical review, is a systematic process that entails assessing the strengths and weaknesses of a specific research study to determine its usefulness and whether the findings are trustworthy, reliable, relevant, and applicable to a specific clinical decision or can be part of a research process.

Critical appraisal of health-related literature and journal articles by healthcare professionals and students is rather a multistep approach that has the following functions:

• It informs the formulation of research questions that are important in improving patient health outcomes and advancing scientific and medical knowledge;
• Applying evidence-based practice to a specific issue or healthcare setting;
• Determining the validity, reliability, quality, and applicability of the research to certain clinical issues or research questions;
• Monitoring interventions to ensure that the outcomes are reproducible and effective, and
• Searching relevant peer-reviewed scholarly evidence and literature to find the best available evidence.

The process is arduous, given that you must undergo specific steps to critically review a research paper that supports clinical decision-making and evidence-based practice.

Steps for Critically Appraising a Peer-Reviewed Journal (7 Steps)

Let us assume that you have been assigned to write a critical article review of a journal article or a critical appraisal, and you do not know where to begin. Well, you are not alone.

A critical appraisal, critique, or review of a nursing journal article is not the same as an annotated bibliography.

Most nursing and medical students find the process of appraising nursing journal articles tedious. And they are right. But with the steps below, you can ace the nursing assignment and slay what in the beginning seems like a giant.

If you need help to critique a nursing research article, our expert nursing writers can help. Place an order and get help. We can help you revamp your nursing grades because they matter the most in your career.

Otherwise, here are the seven steps to get you started on the assignment.

1. Read the Instructions

The most obvious step when writing a critical appraisal is to read the assignment instructions. Your professor or instructor will share their expectations, the word count or the number of pages, and the specific aspects to focus on.

Your instructions or prompt might be accompanied by a rubric specifying how the assignment will be assessed and graded. As you read the instructions, take notes to comprehensively critique the research article to the standards expected by your professor or instructor.

You will also know if you have been assigned to critique a specific journal article or if you can select one based on your interests.

2. Choose a Topic, Issue, or Practice Area

Usually, a critical appraisal or a journal article critique is part of a series of nursing or medical school assignments that lead to your final project or a capstone.

If no article has been given, you must narrow your focus to a specific clinical or medical issue, topic, or practice area.

Ensure that you select a topic, issue, or practice area that meets the criteria outlined in the instruction file.

Related Article:

• How to choose a good topic for your nursing senior project or capstone.
• Nursing Research topics and ideas.
• How to write a good abstract proposal.
• Argumentative nursing topics for essays and research papers

3. Formulate a Hypothesis, Research Question, or a PICOT

On rare occasions, you will be required to develop a hypothesis, formulate a research question, or come up with a PICOT before critiquing a research article identified based on the same.

You should be very keen to choose the hypothesis, research question, or PICOT question/statement that rhymes with the topic, issue, or practice area you had identified earlier in the previous step.

Ensure that the choice is not influenced by ease but by your comprehension and interest in the issue. Besides, choose something relevant to your career prospects and interest. If possible, you can focus on the most current issues in your area of specialization or practice. Most instructors will require you to share with them your PICOT, research questions, or hypotheses before proceeding to the next step. If there is a need for approval, ensure that you seek the necessary approvals before proceeding to the next step. If there is feedback and you need to tweak anything, ensure that you make the necessary changes and get feedback before you proceed.

4. Search for Peer-Reviewed Articles from a Journal

If everything is smooth thus far, you need to either use the peer-reviewed scholarly article provided or suggested by your instructor and proceed to the 6^th step or do a proper database search for a relevant article.

Remember, a critical appraisal will look at a research article's value, validity, credibility, and applicability to evidence-based practice or clinical decision-making. Therefore, select a journal from a nursing journal or database with a list of A-Z journals.

Set the specific search parameters in the search window, including date range (preferably articles published in the last five years), keywords, your topic or research question, and whether you want articles with abstracts or those in full text.

Your search will yield many articles, and you must use the levels of evidence to determine the article you want based on your instructions.

As you search for the article, please take note of filtered sources of information such as the Cochrane Database of Systematic Reviews, Joanna Briggs Institute, National Guideline Clearinghouse, and AHRQ Evidence Summaries to reduce the time it takes to choose and appraise studies as you make critical clinical decisions. These sources can yield Systematic Reviews, Evidence Summaries, Structured Abstracts, and evidence-based clinical practice guidelines that experts have written in the field who have critically appraised studies and summarized the results.

Also, look for unfiltered sources such as PubMed and CINAHL for primary studies such as RCTs, quantitative, and cohort studies. You can also check landmark studies that significantly influence nursing, allied health, or medicine.

Some specific nursing article databases you can focus on include ProQuest Nursing and Allied Health Source, PubMed, CINAHL with Full Text, BMJ, Cochrane Library, Rational Clinical Exam, Turning Research into Practice (TRIP), and Embase.

5. Narrow Down to a Given Study

Using exclusion and inclusion criteria, you should be able to narrow down to a specific number of articles and then peruse through each to determine if it fits the presented criteria. You can use the levels of evidence and the types of studies to determine the right article that suits your research needs.

If an article meets the criteria set in the instructions, do a full APA or Harvard Citation, download it, and share it with your professor or instructor for approval before moving to the next step.

6. Critically Appraise the Article Using a Recommended Tool

Perform a critical appraisal of the journal article using the critical appraisal tools we have included as part of this guide.

Critical appraisal entails the systematic identification of the strengths and weaknesses of an article so that you can predict the validity and usefulness of its findings in informing decision-making or good practice.

You must be very careful with how you present the different aspects of the critique. If anything, ensure that your written piece is critical, clear, concise, and logical. The arguments, analyses, and evaluations should portray higher critical thinking, creativity, and logical reasoning levels.  

When reviewing the article, here are specific aspects to focus on.

Determine whether the study addressed a clearly focused issue:

• What was the central aim/hypothesis of the study?
• What was the exposure or intervention?
• Was the research design appropriate?
• Was the study retrospective or prospective?

Identify the study population

• What were the inclusion/exclusion criteria?
• Was the sample selection an accurate representation of a defined population?
• Were the control and test groups selected from populations comparable in all respects except for the factor under investigation?
• Were there any losses of study participants?

Interpret the results

• What was the outcome, and how was it measured?
• Is there clear evidence between exposure and outcome?

Assess for Bias

• Were the main potential confounders identified and considered?
• How well was the study conducted to minimize the risk of bias and confounding?

Determine the applicability of the study to practice

• Are the results of the study directly applicable to patient groups in local practice?

7. Edit, Review, Polish, and Submit your Paper

After writing your critical review paper, you must take a break from writing. The break is intended to take your mind off the monotony of writing and researching. You will also have enough time to have an objective mindset to help you spot mistakes, omissions, and errors.

After the break, go through the paper from top to bottom, reading it aloud to yourself to spot errors and mistakes. Ensure that you pay close attention to the flow, punctuation, choice of words, tenses, and organization/structure.

You can then use editing and proofreading software such as Ginger, Grammarly, or Hemmingway Editor to address grammatical, punctuation, and stylistic errors and mistakes.

Nursing or medical students must possess high precision, and your instructor expects a spotless paper, to say the least. Therefore, ensure that before you hit the submit button, the format, style, and structure of the paper meet the required standards. If it is double-spaced, ensure that everything is double-spaced in Times New Roman or Arial font size 12 and that the titles and subtitles are well-represented.

Now that you know how to read and critique a nursing research paper let us delve into the structure of a critical appraisal paper.

Structure of a Critical Appraisal Paper

You will be critiquing qualitative and quantitative studies. Even though the structure will differ depending on the appraisal tool you choose, certain things remain standard and must feature in the critique.

Title

• Assess whether the title of the research article is catchy or whether it piques the interest of the reader.
• Is the title self-explanatory?
• Is it well described?
• Does it specify the type of study?
• Does it match the context of the article?
• Is the objective of the research clear from the title?

Abstract

• Has the abstract clearly and concisely summarized the main parts of the study, like background, objectives, participants, methods, design, setting, results, and conclusion?

Introduction

Does the article have a clear and concise introduction?

• Statement of the Problem
  • Is the problem statement easy to locate?
  • Is the problem significant to nursing practice?
  • Does the statement build a cogent and persuasive argument for the new study?
  • Does the research problem match the research paradigm and design?
• Research Questions
  • Is the research question clear?
  • Is the research question relevant?
  • Does the study add anything new?
  • What type of research questions does the study pose?
  • Does the research question specify the population, studied parameter (therapy, clinical intervention, causation, screening, diagnosis, or prognosis), or the outcomes of interest?
  • Is the question about the effectiveness of treatment or the frequency of events?
• Hypothesis
  • Does the study present the hypothesis?

A hypothesis is a clear statement of what the investigators expect to find and is critical to any research as it states the research question in the form of what can be tested and refuted.

Literature Review

• Does the article have an adequately summarized research based on the identified topic, issue, or problem?
• Does the literature review critically examine the issue?
• Are the articles used in the peer-review professional and scholarly?

Conceptual Underpinnings

• Does the researcher provide a conceptual definition of the key concepts?
• Is the philosophical basis of the study stated in the introduction?
• Is there a justified reason for using a conceptual model or framework?

Methods

• Protecting the Participants
  • Does the article present information on the protection of the participants?
  • Did the researchers seek approval from an ethics committee?
  • Does the study address ethical issues such as confidentiality, autonomy, privacy, benevolence, and maleficence?
  • Are the participants given the right to withdraw?
• Research Design
  • Does the research article present the study design?
  • Is the type of study specified?
  • Is there a rationale for choosing the specific design?
  • Is the design appropriate for that type of study?
• Sample and Setting
  • Does the article specify the sampling strategy, sample, and inclusion and exclusion criteria?
  • Does the article specify the relevant information about the participants?
• Data Collection
  • Is the method of collecting data appropriate given the design and research question?
  • Does the study reveal the challenges and strengths of the data collection methods?
  • Does the study use any tools? Is the use of the tool, scale, or measurement defined?
• Procedure
  • Does the study detail the procedure used to collect data?
  • Is the procedure justified?
• Data Analysis
  • Were the data management (e.g., coding) and data analysis methods sufficiently described?
  • What statistical tests or analyses are performed on the data?
  • Are the statistical tests done correctly?
  • Are confidence intervals or p-values given?
  • How strong is the association between intervention and outcome?
  • How precise is the estimate of the risk?
  • Does it mention the main finding(s), and does the data support them?
  • Does it mention the clinical significance of the result?
  • Is an adverse event or lack of it mentioned?
  • Are all relevant outcomes assessed?
  • Was the sample size adequate to detect a clinically/socially significant result?
  • Are the results presented in a way to help in health policy decisions?
  • Is there a measurement error?
  • Is measurement error an essential source of bias?
  • Did the analytic procedures suggest the possibility of biases?
  • Does the study address selection bias, information bias, and confounding?

Interpretations of the Findings

• Are the findings interpreted within the appropriate frame?
• Do the authors� findings relate to nursing practice or practice problems?
• Are the findings discussed in the context of previous studies?
• Do the authors compare their study to the previous studies?
• Is the issue of generalizability or transferability of the findings addressed?
• Does the study elucidate the limitations of its findings?

To determine if a study applies to practice, you need to:

• Compare its results to relevant clinical guidelines
• Appraise the various interventions studied that are relevant to the clinical trials and other studies;
• Check the discussion and recommendations for the applicability of the findings;
• Assess through your colleagues and peers;
• Identify whether local or national clinical policies supported by evidence-based practice agree with the findings.

Implications and Recommendations

• Presentation
  • How is the research article organized?
  • Is the choice of language adequate?
  • Does it use jargon?
  • Is vocabulary in the paper defined?
  • Are the abbreviations given in full?
  • Does the study refer to recent and relevant scholarly journals?
• Researcher Credibility
  • Does the research article specify the credentials of the researcher (s)?
  • Is the researcher qualified to handle such research?
  • Do the researchers� clinical, substantive, or methodological qualifications and experience enhance confidence in the findings and their interpretation?
• Summary Assessment
  • Does the study appear trustworthy?
  • Is the study relevant to nursing practice?
  • Can the study apply to your chosen issue, problem, or practice area? How?
• Conflicts of interest
  • Does the study address the issues of conflict of interest?
  • Does the study specify the source and role of funders?

Conclusion

• Are the questions posed in the study adequately addressed?
• Are the conclusions justified by the data?
• Do the authors extrapolate beyond the data?
• Are shortcomings of the study addressed, and are constructive suggestions given for future research?
• Is the conclusion convincing?
• Does the paper indicate ethics approval?
• Can you identify potential ethical issues?

Types of Studies to Consider for Critical Appraisal

Before undertaking a critical analysis, you must be very clear on the types of studies that can generate clinical evidence and how the data analyzed can provide standardized outcomes measurements.

• Cohort Studies. These observational studies can be retrospective (e.g., examining historical records) or prospective. A group of people who do not have an outcome of interest are selected for inclusion and observed over a period to see if they develop an outcome of interest when exposed to determine the relative risk compared with the control group. It is, however, prone to loss of participants, which can significantly affect the outcomes and results. They are the best for testing hypotheses without experimentation. An example is a study that explores the association between increased risk of advanced complications of type 2 Diabetes Mellitus and major depression.
• Case-Control Studies. This is also a type of observational study that is retrospective. It entails comparing patients in a group with a specific outcome to another group without the outcome but with the same degree of exposure as the test group. They are used to determine the relative exposure of a predictor variable in relation to the absence or presence of the diseases. A study investigating the link between low serum vitamin D levels with migraine is an example of a case-control study.
• Cross-Sectional Studies. These types of studies use questionnaires, surveys, and interviews to collect data. They are used to measure and assess clinical and medical interventions. They can also be used to determine the attitudes of a cross-section of a population that represents the outcomes of interest. A good example is a study to identify the attitudes of first-time mothers to exclusive breastfeeding to develop a training or educational program for new first-time mothers.
• Randomized Clinical Trials. RCTs are the most rigorous and robust research studies used to determine if a cause-effect relationship exists between an intervention or new treatment and its outcomes. RCTs reduce bias and are often blinded so that the patients, clinicians, and researchers are unaware of the identity of one another. They are the gold standard in clinical research and are on the top level of the evidence pyramid as the second highest level of evidence.
• Systematic Reviews. These are studies that are comprehensive, robust, and thorough as meta-analyses. They obtain accurate, valid, and evidence-based assessments of research questions. They involve comparing a body of data from various sources and concluding to assess reproducibility and consistency. They have inclusion and exclusion criteria for the studies but do not entail quantitative analysis for statistical significance. They help obtain current, relevant, and practical information on contemporary topics in healthcare. They are the highest level of evidence.
• Case studies and case series. These studies focus on individuals or collections of cases of interest to an author/researcher. However, they do not involve trying to find the answer to a hypothesis.
• Qualitative studies. These studies explore and understand people�s beliefs, attitudes, behavior, and experiences or interactions to generate non-numerical data. Examples include documents, passive observation, in-depth interviews, and focus groups. They investigate social and cultural norms and interpretations and relate them to healthcare practices and behavior.
• Diagnostic tests. These studies are meant to investigate a diagnostic test's accuracy or kit, comparing the gold standard, and measuring a test's specificity or sensitivity.

Please note that case reports, case series, case control studies, randomized control studies, meta-analyses, and systematic reviews are examples of quantitative studies as they generate numerical data that can be converted into numbers. Other examples include cross-sectional surveys, decision analysis, and economic analysis.

Critical Appraisal Tools or Templates

Several user-friendly tools are available online to assist with developing critical appraisal skills for nursing and medical students. Below is a summary of the tool with links to specific websites that have checklists and guides on critical appraisal. We have categorized the tools based on the type of studies for more straightforward navigation.

If you are critically appraising a clinical practice guideline, use the AGREE II tool. You can also confirm with your instructor what specific tools to critique a clinical research article.

Related: How to write a student nurse resume.

All Done, But Wait!

Writing an article critique should not be that challenging after defining it, reading the steps, and looking into the structure, template, and breakdown of every other aspect to factor into the journal article critique. As a nursing student, you can use the tools we have explored to make meaningful assessments and write an outstanding paper.

But even with the best advice, you will most likely find the process tedious, engaging, and time-consuming. And if you have shifts or part-time work and studies to balance with your life, you might get overwhelmed. Do not worry, though, because that is where we come in. Our Nursing Paper writers can help you ace or slay your nursing papers. They are experts in writing various papers.

You can trust the writers to help you write an article critique on any nursing article. So, do not hesitate to ask for help if you need it. Getting help with writing nursing papers does not need to cost more. Our nursing paper help is affordable and student-friendly.