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CRITIQUING ARTICLE

Introduction

In nursing research, the critiquing of the article is important to objectively review the study for determining its level of strength and weakness which leads to identify the key points that have enhanced applicability to evidence-based practice (Stoffels et al., 2019; Cathala and Moorley, 2018). The study “Predictors of physical activity and barriers to exercise in nursing and medical students” by Blake et al. (2017) is to be currently critiqued which is a quantitative research article. In critiquing the article, the Holland and Rees (2010) critiquing framework is to be used. This is because the framework is the best tool for analysing quantitative studies and it is easily available online with the presence of detailed questions for each aspect of the study to be critically examined necessary for gathering valuable information to establish evidence-based practice (Holland and Rees, 2010).

Focus

In the article by Blake et al. (2017), the topic of concern is identifying the barriers and facilitators of physical activity or exercise in medical and nursing students. The topic is important to be focused on because the involvement of healthcare professionals in low level of exercise or physical activity is seen to create an adverse health risk for them such as enhanced stress and fatigue which negatively affects their performance and productivity at work (Ren et al., 2018). The measurable variables in the research statement or title relating their main interest is prominently presented. It is evident as measurable variable such as "exercise", "physical activity", "healthcare students" and others are all included in the title. The current topic is important in the medical practice because reduced level of physical activity in nurses and medical students is seen which interfere in making them develop low health leading to increased sickness absence, reduced efficiency at the workplace and others. The understand of the facilitators and barriers to physical activity among nurses and medical students would help to determine the actions needed to be implemented for the health professionals to actively involve them in exercise and promote their good health which is essential for the personal health and enhanced professional efficiency (Blake et al., 2017).

Background

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The study by Blake et al. (2017) argued the research topic to be worthwhile because it informs that physical activity is key factor for health and well-being and it may have a crucial impact on the health and care quality provided by them. However, there is lack of effective knowledge about the prediction of physical activity and way it is to be increased among healthcare professionals. The current study helps in in this regard by allowing determination of the perception of benefits and barriers to exercise among the healthcare students in improving their health and involvement in physical exercise (NHS, 2015). The topic is mentioned to be present globally by the WHO and the UK government mentioned many of NHS health professionals are not actively involved in physical activity for their enhanced health and well-being which has raised concern regarding their health and performance at work (WHO, 2021; NICE, 2015). The seriousness of the topic is reinforced by the previous studies through descriptive analysis without presenting any factual statistical results. It led to limit the efficiency to understand the level of spread of the problem. The key variables in the study by Blake et al. (2017) are appropriately identified, but they are not separately defined. This limits the common people who have lack of knolwdege regarding the medical terms to effectively understand the study.

Aim

The aim of the study by Blake et al. (2017) is to examine the physical activity levels along with influential benefit and barriers of exercise among the medical and nursing students. The clarified aim act as strength for the study because it allowed to express the key intention of the study and summarised the idea of key facts to be understood at the end of the research (Carrieri et al., 2018).

Methodology

In the study by Blake et al. (2017), quantitative approach is used to formulate the research. In the quantitative approach, the survey method is used which relevant to the research. This is because survey method is flexible and allows easy collection of data from participants based on their time and efficiency (Thomson et al., 2018). The healthcare professionals are often found to be busy caring for the patients due to which they may not be able to make time for face-to-face interview, but with presence of survey questionnaire they can flexibly manage time to provide data in time as per their time (Breslin et al., 2019). Moreover, the survey method is cost-effective and allows extensive characterisation of large population to ensure accurate sample are collected in the study. Further, the anonymity presence on the survey leads the respondent to be candid and present valid answers as they do not fear being exposed (Bennion et al., 2017). Thus, the medical and nursing students and professionals who are avoiding exposure of identity can easily participate in the study which makes the method appropriate for the execution of the research as it supports collecting enhanced data without hindrance from participants.

Data Collection Tool

The 4-point Likert scale (from 0 = never to 4 = very often) with relation to 10-item Perceived Stress Scale (PSS) is included in the study for collecting data. The validity and reliability of the tool is expressed through Cronbach’s alpha where the score of the scale is 0.90 ensuring effective reliability (Blake et al., 2017). This is because Cronbach's alpha is used for measuring the internal consistency of any tool with the items in a study and according to the general thumb rule any score at or above 0.90 ensure the best reliability (Zinckernagel et al., 2017). The Exercise Benefits and Barriers Scale is another tool used in the study which is found to show score of 0.94 on Cronbach’s alpha and found to be previously validated by the study of Ortabag et al. (2010). The other tools used are Social Support for Exercise Habits Scale and Self-Efficacy for Exercise Scale which represented Cronbach’s alpha score of 0.88 and 0.90 separately ensuring their high validity and reliability of being used in the current study. The International Physical Activity Questionnaire (IPAQ) is also used in collecting data from potential participants (Blake et al., 2017). An effective rationale was presented for the use of each tool and detailed information is mentioned in the study regarding the way they are used in the study. This promotes strength of the study to be used in evidence-based practice because it ensures enhanced consistency and accuracy been implemented in developing the study with minimum error (Duncan et al., 2020).

Data Analysis Method and Presentation

The IBM SPSS statistical version 22.0 is used for data analysis in the study by Blake et al. (2017). The advantage of using the tool is that it reduces error in statistical analysis of the data which leads to make improvement and productivity to present verified and reliable data (Rao et al., 2021). In the study, 10% data check is established, and mission data are excluded from analysis to avoid error. The use of ANOVA, linear regression, Pearson’s correlation test, T-test, chi-square test and descriptive statistical analysis is made in the study for data analysis of the collected data (Blake et al., 2017). The use of the statistical methods for data analysis is potential input in the study because each of the methods are effective in presenting enhanced correlation between different variables and enhances the ability to determine the extent of problem been discussed (Naudet et al., 2018).

Sample

In the study by Blake et al. (2017), a total of 2355 undergraduate medicine and nursing students from higher educational institute present in the UK were invited for participating in the research. Among them 361 participants (193 student nurses and 168 medicine students) were finally involved in the study. In the study, no inclusion and exclusion criteria for the participants are mentioned and self-selection for participation in the study is allowed. This limited the study to ensure consistency and uniform selection of sample as there was no control measures taken to ensure specific nature of sample most reliable for the study to be included by the researchers. The study by Blake et al. (2017) did not explain if there is any bias faced in the selection of sample. This creates gap to understand whether any error is been faced in recruitment of the sample in the study. The convenience sampling strategy is used in selecting the sample from May 2014 - May 2015 (Blake et al., 2017). The advantage of using convenience sampling strategy is that it is cos-effect and readily available, but the limitation that may be faced is lack of generalisability of the gathered data in the study (Lin et al., 2018).

Ethical Consideration

The study by Blake et al. (2017) accessed ethical approval from the Institute Research Committee Board in May 2014 and mentioned the reference number. The study mentioned the participants were provided free will to engage in the study and were provided link to the website for recording their responses anonymously. This ensures that ethical consideration is appropriately maintained because confidentiality is ensured as well as any forced participation is avoided.

Main Findings

The main findings inform that 38% of medicine and 48% of nursing students have not achieved the recommended level of physical activity required for their health benefit. The perceived benefit of physical activity identified by the student health professionals is relief from stress. This mentions that enhanced exercise among medical and nursing students would boost their mental health. Further, the findings mention that lack of adequate time from work, inconvenient work schedules and exercise not fitting with work or placement schedules are notable barriers in the study. The nursing students compared to the medical students reported having lower social support which led them to remain less active compared to the medical students. The results appropriately fulfilled the aim of the study as it explains the key barriers and benefit of exercise for health professionals and their perception regarding it.

Conclusion and Recommendations

In the study by Blake et al. (2017), a well-developed conclusion is present that relates and explain the aim. It is evident as the conclusion mentioned physical activity is to be promoted in medical and nursing students for their physical and mental health benefit and intervention for self-efficacy among them are to be built to help them involve in physical activity. However, clarified recommendations in detail are not mentioned in the study. therefore, the way the limitation and hindrance in the study to be resolved in future for its betterment is unable to be understood.

Strength and Limitation

The strength of the study is use of highly reliable and valid tools and research methods which ensure limited error been faced in collecting the results. However, the limitation faced is low overall response from the sample (15.3%) participants. The other limitation is lack of presence of fact regarding gender difference and physical activity in medical and nursing students. In the study, the participants are self-selected, and the responses gathered for physical activity level are self-reported which act as limitation for the study. This is because self-responses do not effectively correspond to the objective measures regarding physical activity which is essential to develop more accurate prediction regarding the phenomenon. Moreover, self-reporting leads to an overestimation of level of activity compared to under-reporting which leads to create severe concern regarding lower level of physical activity in selected sample. In addition, the use of cross-section study acted as a limitation because it led not to gather cause and effective relationship between key variables (Mok et al., 2019).

Application to Practice

The study can be applied to develop self-efficacy plan for healthcare professionals in boosting them to involve in active physical exercise. Moreover, it can be used in determining the policies to be framed at workplace for the nurses and medical personals so that they can remain physical active which would benefit them to deliver better quality care as well as ensure own health and well-being.

Conclusion

The above discussion mentioned that the study by Blake et al. (2017) is a quantitative research study executed to determine the benefits and barriers faced in exercise by medical and nursing students. For this purpose, the study used convenience sampling strategy to gather results. In the study, ethical considerations and reliability along with validity in data collection process and analysis are appropriately achieved. The study mentioned development of self-efficacy along with supportive social network is needed to promote exercise among healthcare professionals.

Self-Assessment of Academic Work

Areas for improvement identified from previous feedback on assignments from previous studies, including formative assessment from this module, that I have endeavoured to address.

One of the areas of improvement identified from previous feedback is that I need to improve my ability to mention effectively the implications of the information developed from the practise. This makes me incapable to relate others about the usefulness of the information and way it can be used as evidence to be involved in practise for improving it quality. The other area of improvement identified from formative feedback of this module is that I need to improve my argumentative skills. This is because hindered argumentative skills is leading me unable to critically inform facts with criticism to ensure better analytical presentation of data.

Aspects I think I have done well

The aspects I think I have done effectively is that I have effectively paraphrased each of the key points to be presented in the analysis for its enhanced development. Moreover, I was able to locate key topic sentences and highlight key points as per the critical analysis framework to present enhanced summarisation of the article from which its strength and weakness ca be easily identified. Further, I had been able to highlight both positive and negative points in the article to present judgement regarding the fact informed. I was also able to explain in detail most of the key points in the study.

Things which were difficult and I’m not too happy about and I would particularly like comments on:

The things on which I require further comment is that whether I was able to critically reflect each point in the study to highlight most of the strength and weakness of the study. Moreover, I want comments on my summarisation ability along with reflection of implication of the practise.

My self-assessment of this piece of work:

The self-assessment of the piece of work according to me was average. This is because I feel in some parts I failed to present effective argument in analytical manner to critically reflect the information. However, I feel overall, I was able to effectively present the reliability and validity of the study to be used in evidence-base practise.

Other comments:

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References

Bennion, M.R., Hardy, G., Moore, R.K. and Millings, A., 2017. E-therapies in England for stress, anxiety or depression: what is being used in the NHS? A survey of mental health services. BMJ open, 7(1), p.e014844.

Blake, H., Suggs, L.S., Coman, E., Aguirre, L. and Batt, M.E., 2017. Active8! Technology-based intervention to promote physical activity in hospital employees. American Journal of Health Promotion, 31(2), pp.109-118.

Breslin, G., Smith, A., Donohue, B., Donnelly, P., Shannon, S., Haughey, T.J., Vella, S.A., Swann, C., Cotterill, S., Macintyre, T. and Rogers, T., 2019. International consensus statement on the psychosocial and policy-related approaches to mental health awareness programmes in sport. BMJ open sport & exercise medicine, 5(1), p.e000585.

Carrieri, D., Briscoe, S., Jackson, M., Mattick, K., Papoutsi, C., Pearson, M. and Wong, G., 2018. ‘Care Under Pressure’: a realist review of interventions to tackle doctors’ mental ill-health and its impacts on the clinical workforce and patient care. BMJ open, 8(2).pp.89-123.

Cathala, X. and Moorley, C., 2018. How to appraise quantitative research.BMJ.pp.23-56.

Duncan, P., Murphy, M., Man, M.S., Chaplin, K., Gaunt, D. and Salisbury, C., 2020. Development and validation of the multimorbidity treatment burden questionnaire (MTBQ). BMJ open, 8(4), p.e019413.

Holland, K. and Rees, C., 2010. Nursing evidence-based practice skills. Oxford University Press.

Lin, M.L., Huang, J.J., Chuang, H.Y., Tsai, H.M. and Wang, H.H., 2018. Physical activities and influencing factors among public health nurses: a cross-sectional study. BMJ open, 8(4), p.e019959.

Mok, A., Khaw, K.T., Luben, R., Wareham, N. and Brage, S., 2019. Physical activity trajectories and mortality: population based cohort study. Bmj, 365.pp.90-100.

National Health Services (2015). NHS England appoints senior clinicians and frontline leaders to drive next phase of Five Year Forward View implementation. Available at: https:// www.england.nhs.uk/2015/10/fyfv-next-phase [Accessed on: 6 June 2021]

Naudet, F., Sakarovitch, C., Janiaud, P., Cristea, I., Fanelli, D., Moher, D. and Ioannidis, J.P., 2018. Data sharing and reanalysis of randomized controlled trials in leading biomedical journals with a full data sharing policy: survey of studies published in The BMJ and PLOS Medicine. Bmj, 360.pp.89-90.

NICE 2015, Physical activity: for NHS staff, patients and carers, Available at: https://www.nice.org.uk/guidance/qs84/resources/physical-activity-for-nhs-staff-patients-and-carers-pdf-2098908574405 [Accessed on: 6 June 2021]

Ortabag, T., Ceylan, S., Akyuz, A. and Bebis, H., 2010. The validity and reliability of the exercise benefits/barriers scale for Turkish Military nursing students. South African Journal for Research in Sport, Physical Education and Recreation, 32(2), pp.55-70.

Rao, R., Mueller, C. and Broadbent, M., 2021. Risky alcohol consumption in older people before and during the COVID-19 pandemic in the United Kingdom. Journal of Substance Use, pp.1-6.

Ren, Z.Q., Lu, G.D., Zhang, T.Z. and Xu, Q., 2018. Effect of physical exercise on weight loss and physical function following bariatric surgery: a meta-analysis of randomised controlled trials. BMJ open, 8(10), p.e023208.

Stoffels, M., Peerdeman, S.M., Daelmans, H.E., Ket, J.C. and Kusurkar, R.A., 2019. How do undergraduate nursing students learn in the hospital setting? A scoping review of conceptualisations, operationalisations and learning activities. BMJ open, 9(12), p.e029397.

Thomson, R.M., Niedzwiedz, C.L. and Katikireddi, S.V., 2018. Trends in gender and socioeconomic inequalities in mental health following the Great Recession and subsequent austerity policies: a repeat cross-sectional analysis of the Health Surveys for England. BMJ open, 8(8), p.e022924.

WHO 2021, Promoting Physical Activity in The Health Sector, Available at: https://www.euro.who.int/__data/assets/pdf_file/0008/382337/fs-health-eng.pdf [Accessed on: 6 June 2021]

Zinckernagel, L., Schneekloth, N., Zwisler, A.D.O., Ersbøll, A.K., Rod, M.H., Jensen, P.D., Timm, H. and Holmberg, T., 2017. How to measure experiences of healthcare quality in Denmark among patients with heart disease? the development and psychometric evaluation of a patient-reported instrument. BMJ open, 7(10).

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