Critical Review of Research Article

Introduction and summary of the paper

Evidence-based practice is a significant element of modern medical and nursing (Silva et al, 2017) and should be regarded as one of the standard approaches to care. Objective analysis published research is one of the key characteristics of evidence-based practice that can help to identify and ascertain effective interventions, for practical application based on the patient’s conditions and preferences (Gennari et al 2017). According to Silva et al (2017), the practitioner is responsible for ensuring an evidence-based approach to care is adopted throughout their practice, by appraising literature materials that are relevant to their professional duties and responsibilities. Against this backdrop, the purpose of this essay is to critically appraise the paper “Human figure drawings by children in hospital and mainstream schools” by Nyman et al (2011). The author will adopt Caldwell et al’s (2005) critiquing framework to ensure an objective appraisal. In the process, the essay will identify the strengths and weaknesses of the article.

The main aim of Nyman et al (2011) was to evaluate how children in hospital schools express their emotions through human figure drawings. In doing so, Nyman et al (2011) compared drawings of children in hospital schools and those in mainstream schools. Through a quasi-experimental research design, the researchers recruited 29 and 28 children from hospital and mainstream schools respectively, asking both groups to draw a whole picture of themselves and their friends.


After randomly counterbalancing the order of drawing, the researchers used human figure drawings emotional indicators to analyze the drawings. The analysis revealed that the hospital school children placed more emotional indicators on their drawings than mainstream school children. Similarly, the study found that long-stay hospital school children expressed more emotions in their drawings than short-stay hospital students. Apart from that, the results also showed a significant overall difference between the drawing’s size, each child drawing taller pictures of themselves that those of their friends. Based on these findings, the authors concluded that hospitalized children’s emotions can be analyzed through the drawings of themselves and those of their friends using emotional indicators

Research Critique

The title of the study gives a clear insight into the paper’s content, noting the population of interest (mainstream and hospital schools children) as well as the broad aim of the study. Abutabenjeh & Jaradat (2018) insist an academic paper should a brief have a title that adheres to the criteria of identifying the target population, comparisons, interventions, and targeted outcome (if any); the study by Nyman et al (2011) closely follows this format.

The study also has an abstract that gives a summary of the paper’s key elements such as the aim of the study, methodology, results as well as conclusions or implications of findings. Nyman et al (2011) utilize a structured abstract, providing a clear interpretation of the paper’s key elements (Dzwigol, 2018). Similarly, Nyman et al (2011) provide a suitable justification of the approach used, giving a brief overview of the study design, the study findings and their main implications.

As part of the background of the study, Nyman et al (2011) clearly describe the rationale of their study using comprehensive, even though not contemporary literature. Meanwhile, the authors provide a comprehensive introduction to the concept of children’s human figure drawings as a measure of cognitive development and intellectual ability. Furthermore, the authors expound on the concept of emotional indicators (EIs) as a means of measuring specific anxieties, traits or conflicts experienced by children at the time of drawing. Essentially, the literature review provides an elaborate justification of the study by highlighting the three characteristics of a drawing that can be used to identify the feelings and attitudes of a child namely: the drawing must have a clinical validity, the EI must occur infrequently or must be unusual in the human figure drawings and must not be related to maturation or age. Through the background and literature review, Nyman et al (2011) demonstrate the conceptual framework within which they conducted their study. Moreover, the authors clearly state that the objective of their study, which simultaneously justifying their use of experimental study design.

When conducting any form of research that involves human subjects, it is essential to acquire ethical approval Queiros et al (2017), and the researchers must make various ethical considerations throughout the study. Nyman et al (2011) have sought ethical approval from the university ethics committee, even though they failed to provide a wider discussion of the various ethical issues that might have arisen during the study, or before data collection. Nonetheless, Nyman et al (2011) does note that the study was conducted after parental consent, suggesting that they made appropriate ethical consideration of consent and capacity of participants.

The general methodological approach of the study is quantitative, consistent with the study objective. According to Safsten & Gustavsson (2020), quantitative studies rely on strong philosophical backgrounds to justify the data collection, analysis and interpretation methods. However, Nyman et al (2011) failed to offer a discussion of their philosophical stance, which is a significant limitation of the study. However, based on the observations by Asadullina et al (2020), it is not uncommon that published manuscripts omit such details for purposes of achieving brevity, and this should be considered as a justified reason for the absence of such explanation.

Despite not providing a philosophical explanation of their research method, Nyman et al (2011) clearly explain and justify their research design and associated processes. The general concepts Nyman et al (2011) explored have a strong correlation with those explored in the study’s literature review section, indicating that the authors used the correct means of literature selection for further reference and data triangulation (Hermes, 2019). The research design is based on experimental design, despite not expressly justified by the authors as their approach. However, this is an appropriate research design for the study because experimental design approaches allow for the use of statistical analysis to approve or disapprove a hypothesis; making the most accurate findings from a research study (Alavi et al, 2018). Through experimental research design, according to Alavi et al (2018), the researcher can easily manipulate the independent variable to establish the cause-effect relationship within a group. As such, Nyman et al (2011) comprehensively offered the details of their data collection process on within their study, indicating the length, nature as well as the data collection location, all which highlight the transparency of the study (Meister, 2018).

Nyman et al (2011) selected participants from a specific location and their inclusion into the study was based on a specific criterion. According to Jabbarova (2020), this is a sampling approach called ‘purposive sampling’, which helps to ensure that the researcher only gathers data from participants whose experiences are the study’s focus (Leatherdale, 2019). For instance, Nyman et al (2011) wanted to compare human figure drawings of hospital and mainstream school children. The authors were therefore right to have purposefully selected participants from hospitals and mainstream schools. Both male and female students participated in the study, presumably to expand the population of study. Moreover, Nyman et al (2011) enhanced the objectivity of their study by issuing no time limit nor further instructions to participants in both groups.

While the purposive sampling process might have limited the study’s generalizability to other children groups or geographical locations (Ragab & Arisha, 2018), it was the best sampling technique the study could have employed. Nonetheless, it is important to note that the purposive sampling technique may have contributed to selection bias because students with different hospital conditions and service quality experiences may have had different expressions of their emotions and attitudes (Daniel et al 2018). Moreover, the most unwell children, who could not participate may have different experiences and emotional expressions, which were not explored by the study (McKelvie & Standing, 2018).

The data analysis process was conducted through descriptive statistics, which is an appropriate approach for the study based on the need to compare human figure drawings between the two groups of children. According to Khupe & Keane (2017), descriptive statistics is a well-structured and suitable analysis approach for the identification and synthesis of differences between variables because it describes the basic features of the data. Furthermore, as per Sileyew (2019), descriptive statistics provide a summary of the samples and their respective measures, making the data easily comprehensible. In this scenario, Nyman et al (2011) used descriptive statistics to identify the mean and standard deviation for various emotional indicators for the children and their best friends according to their gender groups. This presented an easier and convenient way of making sense of the data.

Research Proposal

Background of the study

The use of children’s drawing as a means of measuring their cognitive development has been a subject of research for many scholars for many years, with pieces of research on this topic dating back to as early as 1927 when Luquet (1927) conducted extensive research on it. Ever since, the draw a human figure picture test has been useful for both psychologists and practitioners in the health sector to date. However, popular as it may, there are still some loose ends and unanswered questions on this topic that are worth further study. For instance, the is still no consensus on the right or wrong formats of drawing and no specific instructions on time limits for which the children should be allowed to draw. Instead, the researcher must identify what is absent or present according to a variety of aspects such as specific body parts, the promotion and the number of details the child adds to the drawing.

In such scenarios, various confounding factors might affect the validity or reliability of the study. For instance, the child could take a longer time to draw, making the study practically impossible to complete (Attia & Edge, 2017). Against this backdrop, more research is needed to identify the best practice. As such, the proposed study seeks to draw evidence from various academic journal articles: comparing them to identify the best practice in using human figure drawings as emotional indicators. The aim of the proposed study will be to investigate the effective means of using human figure drawings as emotional indicators.

Research Question

What is the effectiveness of using human figure drawings as emotional indicators in children?

Research Methods

To achieve this objective, the proposed study will take up the systematic literature review research methodology. According to Alavi et al (2018), a systematic literature review is a method of research that entails an acritical review of previous empirical literature relevant to the topic under study to draw the best evidence from them. The proposed study will adopt a clear and predetermined process of selected journal articles, before making a clear summary of the studies based on high-quality evidence.

There are several theoretical justifications for the use of systematic literature review methodology in the proposed study. for instance, according to Daniel et al (2018), systematic literature reviews are a form of desktop research that facilitates access to empirical evidence without spending much time and resources. Furthermore, conducting a systematic literature review will allow for easier identification of existing evidence inconsistencies including research gaps, conflicts between previous subjects and other open questions that may help with an in-depth understanding of the study topic (Ragab & Arisha, 2018).

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The proposed study will rely on online search engines and databases to retrieve academic journals. This is because online journal articles allow for an easier search and retrieval of literature materials compared to a physical search in a library (Ragab & Arisha, 2018). As such, the proposed study will rely on Medline, Psych Info, EBSCO and ProQuest databases as sources of academic journal articles. In doing so, the study will rely on various search patterns (e.g. Drawings, Children, School, Size; emotions). Data collected from the study will be analyzed through thematic content analysis to draw relevant conclusions.


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