Running head: RESEARCH CRITIQUE ARTICLE 1

A Research Article Critique of Chen, Yang, Yu, Yang, Liu and Zhu’s “Standardised

Simulation-based Emergency and Intensive Care Nursing Curriculum to Improve

Nursing Students’ Performance During Simulated Resuscitation”

Aaron R. Clevinger

University of Saint Mary

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Introduction

This paper will critique a research article about developing a standardized high

technology simulation based emergency and intensive care nursing curriculum and the evaluation

and impact this curriculum had on third year nursing student’s response time and teamwork

during simulated resuscitation scenarios. Elements of the research article that will be reviewed

and critiqued include the introduction and abstract, research methods, data analysis, discussion

and the conclusion.

Title

In the article “Standardised Simulation-based Emergency and Intensive Care Nursing

Curriculum to Improve Nursing Student’s Performance During Simulated Resuscitation” the title

does a basic job of clarifying the intent of the research but does not go into specifics in terms of

variables and populations. I believe that the authors did this on purpose to try and generate

additional interest and not to have the research easily dismissed if it did not meet the specific

requirements of the reader.

There are seven authors listed for this research article but there are no titles, positions or

degrees associated with the backgrounds or positions. The authors are all associated with Wuhan

University School of Health Sciences and the Nursing Department. However, Jie Chen is also

associated with the University of Connecticut School of Nursing but how she is affiliated

remains to be seen. I believe that not including more background and the credentials of the

researchers is a significant oversight and creates a degree of suspicion towards the authors on the

part of the reader. Even if the authors were all students and there was only one senior contributor

it would have given the reader a little more confidence in regard to the process and creation of
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the research. As such, there is no way to assess the qualifications of the authors outside of stated

nebulous affiliations.

Abstract

The abstract of the article is very clear and concise and does a nice job summarizing the

research despite being over the recommended 100 to 250 word limit (Burns, Gray & Grove,

2015, p. 51). The abstract contains 267 words and that does not include the significant numerical

values broken down in their results section of the abstract. The authors do a nice job of laying

out their problem and their purpose, as well as their objective. Their design, settings and

participants sections are very clear and concise but they seem to lose their brevity in regard to the

methods section. In this section, I believe the authors could have really whittled down some of

the content and made sure to expand upon the specifics in the methods section of the paper.

There is too much information in this section that is repeated elsewhere in the paper with no

apparent detriment to the quality of the research methods. The same can also be said for some of

the information given in the results section as well. The results section of the abstract was too

long and could have been streamlined a bit more given the degree of explanation that was

undertaken later in the paper. However, the conclusion was well done and seemed to be a return

to the clarity and brevity seen in the beginning of the abstract.

Research Problem

The research problem in this paper was clearly presented and explained early on.

However, the significance and prevalence of the problem is not specified and is left to the reader

to decipher. What the authors do explain appears to be both narrow in scope and to contain very

manageable variables that do not decrease the significance of the research findings. The

researchers identified that a simulation-based curriculum has been demonstrated as crucial to

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nursing education in the development of student’s critical thinking and complex clinical skills

during a resuscitation simulation. However, the problem the researchers identified is that few

studies have comprehensively examined the effectiveness of a standardized simulation based

emergency and intensive care nursing curriculum on the performance of students in a

resuscitation simulation. The way the authors managed the scope of the research allows for very

linear results and a significant degree of specificity in regard to the validity of the research. I

believe that this makes the research replicable.

Research Purpose

The stated purpose of the research was to develop a standardized high technology

simulation based emergency and intensive care nursing curriculum and to evaluate the impact of

this curriculum on third year nursing students’ response time and teamwork during simulated

resuscitation scenarios (p. 2). I believe the purpose of the research is significant based on the

specifics laid out within the problem statement. I also believe that the feasibility of the research

is significant because of the requirements outlined previously and the tight control over the

variables and the potential positive outcomes that this research could catalyze in nursing

programs in general. The researchers were able to achieve this by making sure that the scope of

research was refined and streamlined in such a way as to best assess the research outcomes. If

they had broadened the scope of the research and included additional variables, I believe the

significance of this research would have been more open to debate.

The only bias self-reported by the authors pertained to potential selection bias on the

parts of the students enrolling in the class in hopes of benefiting from the new curriculum.

Despite this admission, I do not believe that there is any inherent bias in this research and the

authors even went so far as to say that there were no competing interests or secondary
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motivations in the creation of this research project. However, because the researchers chose to

use a non-randomized quasi experimental study design there is some inherent sample bias

present.

Literature Review

In the introduction of the paper, there were 15 references cited. These 15 references

appeared to be a review of literature aimed at providing the reader with additional background on

what had been done towards the problem previously. There were 24 unique references cited in

the entirety of the paper, 14 from primary sources and 10 from secondary sources. These

references ranged from three years old to ten years old from the date of publication of the paper,

2018. The relevancy and currency of the references was very strong as evidenced by 19 out 24

references falling inside a five-year window of the article’s publication.

The primary sources were a combination of quantitative and qualitative research on

various learning styles, the efficacy of simulation-based training in healthcare education,

mechanisms of assessment in simulation environments and the effects of simulation-based

training on process retention. The secondary sources focused heavily on systematic reviews and

reviews of literature pertaining to simulations-based training and the positive and negative

impacts and motivations of students and faculty with practical experience in the area. I think the

level of research collected based on the works cited in the paper and the reference list, gave the

research team much needed clarity on the particular problem they were working to address and

provided the researchers the data to narrow the scope of what they should be looking at and

assessing. I also think that the secondary resources provided a solid baseline of previous

subjective and objective data on the feelings other students had in separate simulation-based
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learning environments. This data and understanding had a positive impact on parts of this

current research’s assessment mechanisms and tools.

Theoretical Framework

There was no mention of a theoretical framework for this research and one was not easily

deducible either. There were however several theories referenced in regard to how data was

going to be collected and the types and mechanisms of debriefings that the study participants

would undergo. The most thoroughly explained example from the research paper, and what I

believe to be the implied theoretical framework, was “Debriefing with Good Judgement” a

method which aims to close performance gaps in medical education (p. 2). The process of this

debriefing theory can be divided into four components. The first component involves noting the

performance gap related to learning objectives. The second component focuses on providing

feedback depicting those gaps. The third component aims to explore the basis of the previously

identified performance gaps. The fourth component assists with helping to close the gaps

through guided and focused discussion (p. 3).

While the lack of a stated framework detracts from the design of the study, the authors

did an excellent job of outlining the interventions and variables inherent to the modified

curriculum and painstakingly explained the differences in each. The authors defined and

explained the relationship between some of the concepts they were studying and how the shape

of the study will be focused around them. Although, I think a more formalized framework would

have provided them a more robust template in which to clarify some of these relationships.

Overall, I found what they did do to be valuable and the placement of this explanation early in

the methods section provided a greater degree of clarity and understanding as I navigated later

sections of the paper.

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Research Elements

Research Design

The authors clearly described their research design as a two group, non-randomized quasi

experimental design (p. 1). The authors chose a non-randomized sample for the study population

because they were looking for a very specific group of people, in this case nursing students. A

randomly selected sample is very difficult to obtain in nursing research so quantitative studies

are often conducted with non-random samples (Burns et al., 2015, p. 37). The purpose of quasi

experimental research is to examine causal relationships or determine the effect of one variable

on another (Burns et al., 2015, p. 34). In this research the authors were very specific in that they

were looking to control the intervention as well the research setting. I believe that this research

design is appropriate for the research and that changing it would involve a change or widening in

scope for the whole research project.

Research Questions and Hypothesis

In much the same way that the authors did not specifically mention a theoretical

framework they also failed to state a hypothesis for the research. I believe the implied

hypothesis is: A simulation based emergency and intensive care nursing curriculum will be well

received by third year nursing students and will demonstrate decreased response times in

resuscitation simulations. I believe that my implied hypothesis is a simple, causal, directional,

research hypothesis. I based my implied hypothesis on some of the research questions that were

stated in the early parts of the paper. Questions like, “What is the impact of standardized high

technology simulation based emergency and intensive care curriculums on third year nursing

students’ nursing management and nursing leadership” and “Will standardized high technology
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simulation based emergency and intensive care curriculums decrease median seconds to start

compressions and defibrillation times” (p. 2).

Despite having to theorize and imply some ideas and concepts to their research paper, I

believe that one can see some connective tissue between their predications and research

questions and the implied theoretical framework. It would have only strengthened their work

had they actually spelled these things out instead of leaving it up to the reader to deduce.

Variables

There were 39 total students in the study with 20 in the control group and 19 in the

experimental group. The dependent variable in the study was the unchanged curriculum. The

independent variable was the modified curriculum. The control variable in the study was the

structure and framework of the debriefing which was uniformed across both the control group

and experimental group.

Data Collection Methods

A group of third year nursing students who were enrolled in the course, Emergency and

Intensive Care, at Wuhan University were recruited into the study using convenience sampling

(p, 2). The participants in both groups completed an online survey about the teaching quality of

the course using a 100-point questionnaire. The statistical data collected can be broken down

into three components, demographics, pre and post curriculum performance and the time that

elapsed between the pre and post intervention periods. The data collected in the demographics

category was age, gender and place of residence. Data collected on the pre and post curriculum

performance and the time that elapsed in the pre and post intervention periods was collected and

calculated electronically.
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All the simulations labs were recorded on video and software was used for accurate

assessment of time and sequencing of actions. There were two separate reviews conducted for

every recorded simulation to ensure accurate and unbiased assessments. If there were any

discrepancies a third review was done with all three reviews being averaged for a final

assessment score.

I think the data collection methods used were appropriate for what the research goals

were. The researchers relied heavily on previously reviewed and accepted models of debriefing

and guided communications to gather the right information in regard to the student’s

performance and feelings about the modified and unmodified curriculums.

Ethics

Prior to commencing this study, the researchers received approval of the research design

from the ethics committee at Wuhan University’s Hope School of Nursing (p, 5). The research

paper states that the participants were “recruited” into the study as opposed to volunteered.

However, the outcomes of the study did not have any negative health consequences on the

participants and no participants were denied or refused any medical care as part of the study.

Replication

I believe this study would be fairly easy to replicate given that it is such a small

population size and the requirements are not overly complicated. You would however need

access to the data collection and assessment questionnaires and curriculum to test. The only

limiting factor I could see would be the student participants not wanting to take a chance on

getting the best training, education and grades for the class.

Descriptive Statistics
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The target population of the study was 39 third year nursing students but the overall

population who may benefit from the study is future nursing students and nursing school faculty.

Participants in the experimental group and the control group were between the ages of 19 and 22

with a standard deviation of 20.45 in the control group and 20.26 in the experimental group. In

the Experimental group there were 16 females and 3 males. The control group breakdown by

gender was 13 females and 7 males. Out of the students in the experimental group 12 identified

themselves as coming from urban areas and 7 from rural areas. In the control group 12 students

identified as coming from urban areas and 8 from rural areas (p, 4).

There was no mention in the article about any of the study participants dropping out and

the numbers of students in the sample remained constant through the entire research study.

There does seem to be some sampling bias in regard to gender since only 25% of the participants

were male. I do not believe that it was intentional bias but merely a fact of the disposition of the

class at the nursing school in general. However, I do believe that this percentage of males is

probably indicative of the current breakdown of males in nursing today.

There was a power analysis done for this research but it wasn’t labeled as such in the

research article. The article states, “that the required sample size for the study was determined

based on the assumption made for the improvement of nursing students’ performance in

simulated resuscitation scenarios” (p, 3). The authors state that they calculated the required

number of students based on a type 1 error probability at a minimum of 17 students in each

group.

Study Results

Inferential Statistics
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Statistical significance was set at 0.05 for the study. Statistical significance is defined as

the extent to which the results are probably not caused by chance (Burns et al., 2015, p. 512).

There was no significant statistical difference in resuscitation between experiment group and the

control at the beginning of the course. However, there was significant decreases in response

times after the completion of the curriculum and improvement and advancement was not only

statistically relevant but was shown to have improved the student’s own perceptions of their

skills and ability

The data analysis was done using Statistical Package for Social Scientists (SPSS) for

windows and categorical demographics were collected and analyzed in accordance with Fishers

Exact Test (p, 3). There was no specific mention of a validity and reliability tool being used but

based on the degree of explanation in the data analysis section I believe that it is implied. The

researchers did say that the difference in students’ perspectives between the control group and

the experimental group were compared using unpaired t tests (p, 3).

I found the statistics section of the paper to be a little vague and difficult to parse out.

The researchers did provide two statistical tables for the reader to review but the explanation

associated with them lacked enough detail to make them effective. Had they added more

information about the statistical findings I think they would have strengthened their argument

and the overall research paper. Despite this shortcoming, I was able to deduce through the

statistical representation confirmation of the findings and was able to see a decrease in response

times associated with the experimental group.

Discussion of Findings

The simulation based emergency and intensive care nursing curriculum incorporating

clinical responsibilities was well received by the nursing students and was associated with
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increased resuscitation performance. This was evidence by a decrease in time elapsing from the

call for assistance to initiation of chest compressions and successful defibrillation in less than

180 seconds in a simulation setting.

The students in the experimental group all had demonstrable levels of improvement in the

practical side of the class and were also very supportive and pleased with the modified

curriculum and felt that it was a much more effective delivery vehicle for the requirements of the

class they were enrolled in. The researchers noted that the experimental group exhibited much

more collaboration and mutual support as the class and study progressed then their counterparts

in the control group. The researchers ascribed this as a direct byproduct of the amount of time

they spent in simulations and debriefing (p, 5).

The findings seemed to support the implied theoretical framework and prove the implied

hypothesis to be correct but there is a lot that is asked from the reader to analyze and support the

researchers claims.

The researchers seemed to focus much more on students’ feelings about the study in the

discussion section of the paper despite focusing much more heavily on the functional

improvement aspects that appeared to be more of a priority and emphasis in the earlier parts of

the paper.

Study Conclusions

I believe this study proves the implied hypothesis and that there is definite value and

clinical significance in adopting more robust and revised curriculums that support and emphasize

a more hands on learning and simulation environments. I also believe that the study answered

the research questions I used in creating my implied hypothesis and the data supports the idea

that there were significant improvements in students’ nursing management and nursing
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leadership as well as a decrease median seconds to start compressions and defibrillation times (p,

2).

Limitations

There were several limitations listed by the researchers in paper. The first references the

selection bias present in the study. The researchers accepted the fact that the students were

informed ahead of time that this specific class was going to involve a research study and the

potential for a leg up or an improved curriculum may have motivated certain students to enroll in

the class and some students may have avoided it for the same reason. The researchers also

highlighted the fact that the environment used in the study was a clinical simulation lab and not

an actual clinical site. The point being made here is that the data collected can really only be

measured against ability in a simulated environment and thus lacks real world validity. I believe

both of these limitations are valid and understandable based on the way the study was conducted.

I don’t think these limitations detract from the overall value of the study.

There were several other limitations I noted in the research. The first is that there was no

stated theoretical framework given. I think the implied framework that I ascribed to the study is

accurate but having one stated would have only strengthened the overall research paper. Another

aspect I noted was the lack of a stated hypothesis. I believe the implied hypothesis I created

based on some of the research questions and the overall goal of the research is appropriate and

accurate but it would have been prudent for the researchers to take the extra step and state it

clearly. The study also lacked clarity on the validity and reliability tool used to analyze the data.

There were several references made to what was being used to analyze the data but again, the

researchers seemed to imply as opposed to clearly state and emphasize.

Confidence
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I think that the researchers missed some significant opportunities in clearly laying out

some of the foundational principles of writing a research paper. It almost appears that the

research paper was broken into sections each authored by a different member of the research

team. Their own research appears very thorough and I believe that they assumed that what they

were presenting and studying was just self-explanatory. Regardless of this assumption by the

authors, there were significant aspects of the paper that I listed in the limitations section that if

included, would have elevated the quality of the research paper.

The data analysis section and the results sections were not presented as clearly and

concisely as they should have been and required the reader to really dig into them. The lack of a

validity and reliability tool being clearly stated raises some concerns but the nature of the data

collected and how it was presented mitigated some of them but not all of them. I think the power

analysis they conducted was very important given the small sample size and that assuaged my

concerns with the sample size after seeing how they calculated it and how they exceeded the

minimum requirements

Despite significate shortcomings in the fundamentals, this was a well-run and managed

study that provided a very interesting insight into the importance of more hands-on clinical

training for nursing students. The researchers did a good managing the variables involved in the

study and provided some quality insights that have the potential to benefit student nurses and

nurse educators. The benefits to revaluating curriculum in an effort to make it more hands on

and simulation based is clearly supported by the outcomes and findings of the study and the

clinical and practical significance should not be overlooked despite some of the study’s

shortcomings.
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References

Burns, N., Gray, J., & Grove, S. K. (2015). Understanding nursing research: Building an

evidence-based practice, (6th ed.). St. Louis, MO: Elsevier Saunders.

Chen, J., Yang, J., Hu, F., Yu, S., Yang, B., Liu, Q., & Zhu, X. (2018). Standardised

simulation-based emergency and intensive care nursing curriculum to improve nursing

students’ performance during simulated resuscitation: A quasi-experimental study.

Intensive and Critical Care Nursing, 46, 51-56. doi:10.1016/j.iccn.2018.02.003