nursing research article critique example

Reading and critiquing a research article

Nurses use research to answer questions about their practice, solve problems, improve the quality of patient care, generate new research questions, and shape health policy. Nurses who confront questions about practice and policy need strong, high-quality, evidence-based research. Research articles in peer-reviewed journals typically undergo a rigorous review process to ensure scholarly standards are met. Nonetheless, standards vary among reviewers and journals. This article presents a framework nurses can use to read and critique a research article.

When deciding to read an article, determine if it’s about a question you have an interest in or if it can be of use in your practice. You may want to have a research article available to read and critique as you consider the following questions.

Does the title accurately describe the article?

A good title will pique your interest but typically you will not know until you are done reading the article if the title is an accurate description. An informative title conveys the article’s key concepts, methods, and variables.

Is the abstract representative of the article?

The abstract provides a brief overview of the purpose of the study, research questions, methods, results, and conclusions. This helps you decide if it’s an article you want to read. Some people use the abstract to discuss a study and never read further. This is unwise because the abstract is just a preview of the article and may be misleading.

Does the introduction make the purpose of the article clear?

A good introduction provides the basis for the article. It includes a statement of the problem, a rationale for the study, and the research questions. When a hypothesis is being tested, it should be clearly stated and include the expected results.

Is a theoretical framework described?

When a theoretical framework is used, it should inform the study and provide a rationale. The concepts of the theoretical framework should relate to the topic and serve as a basis for interpreting the results. Some research doesn’t use a theoretical framework, such as health services research, which examines issues such as access to care, healthcare costs, and healthcare delivery. Clinical research such as comparing the effectiveness of two drugs won’t include a theoretical framework.

Is the literature review relevant to the study and comprehensive? Does it include recent research?

The literature review provides a context for the study. It establishes what is, and is not known about the research problem. Publication dates are important but there are caveats. Most literature reviews include articles published within the last 3 to 5 years. It can take more than a year for an article to be reviewed, revised, accepted, and published, causing some references to seem outdated.

Literature reviews may include older studies to demonstrate important changes in knowledge over time. In an area of study where little or no research has been conducted, there may be only a few relevant articles that are a decade or more old. In an emerging area of study there may be no published research, in which case related research should be referenced. If you are familiar with the area of research, review the references to determine if well-known and highly regarded studies are included.

Does the methods section explain how a research question was addressed?

The methods section provides enough information to allow the study to be replicated. Components of this section indicate if the design is appropriate to answer the research question(s).

  • Did the researcher select the correct sample to answer the research questions and was the size sufficient to obtain valid results?
  • If a data collection instrument was used, how was it created and validated?
  • If any materials were used, such as written guides or equipment, were they described?
  • How were data collected?
  • Was reliability and validity accounted for?
  • Were the procedures listed in a step-by-step manner?

Independent and dependent variables should be described and terms defined. For example, if patient falls in the hospital are considered the dependent variable, or outcome, what are the independent variables, or factors, being investigated that may influence the rate at which patient falls occur? In this example, independent variables might include nurse staffing, registered nurse composition (such as education and certification), and hospital Magnet &#174 status.

Is the analytical approach consistent with the study questions and research design?

The analytical approach relates to the study questions and research design. A quantitative study may use descriptive statistics to summarize the data and other tests, such as chi squares, t-tests, or regression analysis, to compare or evaluate the data. A qualitative study may use such approaches as coding, content analysis, or grounded theory analysis. A reader who is unfamiliar with the analytical approach may choose to rely on the expertise of the journal’s peer reviewers who assessed whether the analytical approach was correct.

Are the results presented clearly in the text and in tables and figures?

Results should be clearly summarized in the text, tables, and figures. Tables and figures are only a partial representation of the results and critical information may be only in the text. In a quantitative study, the significance of the statistical tests is important. The presentation of qualitative results should avoid interpretation, which is reserved for the discussion.

Are the limitations presented and their implications discussed?

It is essential that the limitations of the study be presented. These are the factors that explain why the results may need to be carefully interpreted, may only be generalized to certain situations, or may provide less robust results than anticipated. Examples of limitations include a low response rate to a survey, not being able to establish causality when a cross-sectional study design was used, and having key stakeholders refuse to be interviewed.

Does the discussion explain the results in relation to the theoretical framework, research questions, and significance of the study?

The discussion serves as an opportunity to explain the results in respect to the research questions and the theoretical framework. Authors use the discussion to interpret the results and explain the meaning and significance of the study. It’s also important to distinguish the study from others that preceded it and provide recommendations for future research.

Depending on the research, it may be equally important for the investigators to present the clinical and/or practical significance of the results. Relevant policy recommendations are also important. Evaluate if the recommendations are supported by the data or seem to be more of an opinion. A succinct conclusion typically completes the article.

Once you’re done reading the article, how do you decide if the research is something you want to use?

Determine the scientific merit of the study by evaluating the level and quality of the evidence. There are many scales to use, several of which can be found in the Research Toolkit on the American Nurses Association’s website . Consider what you learned and decide if the study is relevant to your practice or answered your question as well as whether you can implement the findings.

A new skill

A systematic approach to reading and critiquing a research article serves as a foundation for translating evidence into practice and policy. Every nurse can acquire this skill.

Louise Kaplan is director of the nursing program at Saint Martin’s University in Lacey, Washington. At the end of this article is a checklist for evaluating an article.

Selected references

Hudson-Barr D. How to read a research article. J Spec Pediatr Nurs . 2004;9(2):70-2.

King’s College D. Leonard Corgan Library. Reading a research article. . Accessed September 5, 2012.

Oliver D, Mahon SM. Reading a research article part I: Types of variables. Clin J Oncol Nurs . 2005;9(1):110-12.

Oliver D, Mahon SM. Reading a research article part II: Parametric and nonparametric statistics. Clin J Oncol Nurs . 2005;9(2):238-240.

Oliver D, Mahon SM. Reading a research article part III: The data collection instrument. Clin J Oncol Nurs . 2006;10(3):423-26.

Rumrill P, Fitzgerald S, Ware, M. Guidelines for evaluating research articles. Work . 2000;14(3):257-63.


very helpful resource to critique any research article

I like it helped me a lot in my critical appraisal. thank you very much.

This article will help me with my understanding of how to read and critique a research article. This article was helpful in breaking down this information very basic to get a clear, concise understanding. Now I can take this information and go to the next level in my discussions

Great information and I will use this article for future reference.

This checklist and explanation for a literature review and/or reading and critiquing a research article was very helpful. As I only have 2 more classes to get my degree, I wish I knew this info 2 semesters ago! I will also pass this along to coworkers that will be going back to school in the near future.

Great article, I enjoyed the information. Thank You for this resource. Carolyn Martinez

Fantastic guide to the interpretation of clinical trials. Found this so helpful!

Great information and article. Thank you for the information.

well explained. its sometimes hard for P.G students to understand the concept but these guidelines are helpful to learn for novice.

This is great,am looking for guilgline on how to do research critique and this is just the solution.Thnks weldone

Unsure how to appropriately critique an article, thank you for your infomation

I am currently taking a Health Service Research course and was not sure how to sturcture my assignment. Thanks for posting this article!

very informative…very helpful to students doing research work.

Great timing; have just been asked to review and article and you provide the guide! Will share with colleagues.

I will be passing this article on to a friend who is taking a nursing research class. This article is a great reference for nursing students.

Comments are closed.

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Lindsay-Smith G, O'Sullivan G, Eime R, Harvey J, van Ufflen JGZ A mixed methods case study exploring the impact of membership of a multi-activity, multi-centre community group on the social wellbeing of older adults. BMC Geriatrics. 2018; 18

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Critiquing a published healthcare research paper

Angela Grainger

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

View articles · Email Angela

nursing research article critique example

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.

Relevance of research to nursing and health care

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.

Advanced clinical practitioners (ACPs) are required to be involved in aspects of research activities ( Health Education England, 2017 ). It is for this reason that practitioners need to know how EBP is influenced by research findings and, moreover, need to be able to read and interpret a research study that relates to a particular evidence base. Reading professional peer-reviewed journals that have an impact factor (the yearly average number of citations of papers published in a previous 2-year period in a given journal is calculated by a scientometric index giving an impact factor) is evidence of continuing professional development (CPD).

CPD fulfils part of the HCPC's and the NMC's required professional revalidation process ( HCPC, 2021 ; NMC, 2019 ). For CPD in relation to revalidation, practitioners can give the publication details of a research paper, along with a critique of that paper, highlighting the relevance of the paper's findings to the registrant's field of practice.

Defining evidence-based practice

According to Barker et al (2016:4.1) EBP is the integration of research evidence and knowledge to current clinical practice and is to be used at a local level to ensure that patients receive the best quality care available. Because patients are at the receiving end of EBP it is important that the research evidence is credible. This is why a research study has to be designed and undertaken rigorously in accordance with academic and scientific discipline.

The elements of EBP

EBP comprises three elements ( Figure 1 ). The key element is research evidence, followed by the expert knowledge and professional opinion of the practitioner, which is important especially when there is no research evidence—for example, the most appropriate way to assist a patient out of bed, or perform a bed bath. Last, but in no way of least importance, is the patient's preference for a particular procedure. An example of this is the continued use of thermal screening dots for measuring a child's temperature on the forehead, or in the armpit because children find these options more acceptable than other temperature measuring devices, which, it is argued, might give a more accurate reading ( Grainger, 2013 ).

nursing research article critique example

Understanding key research principles

To interpret a published research study requires an understanding of key research principles. Research authors use specific research terms in their publications to describe and to explain what they have done and why. So without an awareness of the research principles underpinning the study, how can readers know if what they are reading is credible?

Validity and reliability have long been the two pillars on which the quality of a research study has been judged ( Gliner and Morgan, 2000 ). Validity refers to how accurately a method measures what it is intended to measure. If a research study has a high validity, it means that it produces results that correspond to real properties, characteristics, and variations in the part of the physical or social world that is being studied ( Jupp, 2006 ).

Reliability is the extent to which a measuring instrument, for example, a survey using closed questions, gives the same consistent results when that survey is repeated. The measurement is considered reliable if the same result can be consistently achieved by using the same methods under the same circumstances ( Parahoo, 2014 ).

The research topic is known as the phenomenon in a singular sense, or phenomena if what is to be researched is plural. It is a key principle of research that it is the nature of the phenomenon, in association with the study's explicit research aim/s, that determines the research design. The research design refers to the overall structure or plan of the research ( Bowling, 2014 :166).

Methodology means the philosophy underpinning how the research will be conducted. It is essential for the study's research design that an appropriate methodology for the conduct and execution of the study is selected, otherwise the research will not meet the requirements of being valid and reliable. The research methods will include the design for data sampling, how recruitment into the study will be undertaken, the method/s used for the actual data collection, and the subsequent data analysis from which conclusions will be drawn (see Figure 2 ).

nursing research article critique example

Quantitative, qualitative, and mixed-methods studies

A quantitative methodology is where the phenomenon lends itself to an investigation of data that can be numerically analysed using an appropriate statistical test/s. Quantitative research rests on the philosophical view that science has to be neutral and value-free, which is why precise measurement instruments are required ( Box 1 ). Quantitative research is influenced by the physical sciences such as mathematics, physics, and chemistry. The purpose of quantitative studies is to identify whether there are any causal relationships between variables present in the phenomenon. In short, a variable is an attribute that can vary and take on different values, such as the body temperature or the heart rate ( Polit and Beck, 2017 :748).

Quantitative studies can sometimes have a hypothesis. A hypothesis is a prediction of the study's outcome, and the aim of the study is to show either that the hypothesis is demonstrated as proven, or that it is not proven. Often a hypothesis is about a predicted relationship between variables. There are two types of variables, independent and dependent. An independent variable causes a change in the specific phenomenon being studied, while a dependent variable is the change in that phenomenon. The first example in Box 1 might help to clarify the difference.

An example of a hypothesis would be that older people who have a history of falls have a reduction in the incidence of falls due to exercise therapy. The causal relationship is between the independent variable— the exercise therapy—and the dependent variable—a falls reduction.

A qualitative methodology aims to explore a phenomenon with the aim of understanding the experience of the phenomenon from the perspective of those affected by it. Qualitative research is influenced by the social and not the physical sciences. Concepts and themes arise from the researcher/s interpretation of the data gained from observations and interviews. The collected data are non-numerical and this is the distinction from a quantitative study. The data collected are coded in accordance with the type of method being used in the research study, for example, discourse analysis; phenomenology; grounded theory. The researcher identifies themes from the data descriptions, and from the data analysis a theoretical understanding is seen to emerge.

A qualitative methodology rests on the philosophical view that science cannot be neutral and value-free because the researcher and the participants are part of the world that the research study aims to explore.

Unlike quantitative studies, the results of which can often be generalised due to the preciseness of the measuring instruments, qualitative studies are not usually generalisable. However, knowledge comparisons can be made between studies that have some similarity of focus. For example, the uncovering of causative or aggravating factors leading to the experiences of pain management for oncology patients, and for patients who have rheumatoid arthritis, or another long-term health problem for which pain is a characteristic feature. The validity of a qualitative study relates to the accurate representation of the data collected and analysed, and which shows that data has been saturated, meaning no new data or analysed findings are forthcoming. This is demonstrated in a clear data audit trail, and the study's findings are therefore seen as credible (see the second example in Box 1 ).

Box 1.Research study examples

  • An example of a quantitative research study Kennedy and Burnett (2011) conducted a survey to determine whether there were any discernible differences in knowledge and attitudes between second- and third-year pre-registration nursing students toward hand-hygiene practices. The collected data and its subsequent analysis is presented in numerical tables and graphs, but these are supported by text explaining the research findings and how these were ascertained. For full details, see 10.1177/1757177411411124
  • 2. An example of a qualitative research study Morse et al (2014) undertook an exploratory study to see what coping strategies were used by women awaiting a possible diagnosis of breast cancer. Direct quotes from the study participants appeared in the writing up of the research because it is a requirement of qualitative research that there be a transparent data audit trail. The research showed two things, both essential requirements of qualitative research. First, how the collected data were saturated to ensure that no data had been left inadequately explored, or that the data coding had been prematurely closed and, second, having captured the breadth and depth of the data findings, the researchers showed how the direct quotes were thematically coded to reveal the women's coping strategies. For full details, see 10.1188/14.ONF.350-359
  • 3. An example of a mixed-methods study Lindsay-Smith et al (2018) investigated and explored the impact on elderly people's social wellbeing when they were members of a community that provided multi-activities. The study combined a quantitative survey that recorded participants' sociodemographic characteristics and measured participation in activities with a focus group study to gauge participants' perceptions of the benefits of taking part in the activities. For full details, see

Sometimes a study cannot meet its stated research aims by using solely a quantitative or a qualitative methodology, so a mixed-methods approach combining both quantitative and qualitative methods for the collection and analysis of data are used. Cresswell (2013) explains that, depending on the aim and purpose of the study, it is possible to collect either the quantitative data first and analyse these, followed by the qualitative data and their analysis. This is an explanatory/exploratory sequence. Or the qualitative data may be collected first and analysed, followed by the quantitative; an exploratory/explanatory process. Whichever approach is used, the cumulative data analyses have to be synthesised to give a clear picture of the overall findings ( Box 1 ).

The issue of bias

Bias is a negative feature of research because it relates to either an error in the conceptualisation of the study due to the researcher/s adopting a skewed or idiosyncratic perspective, or to errors in the data analysis. Bias will affect the validity and reliability of a study, so it is important that any bias is eliminated in quantitative studies, or minimised and accounted for in qualitative studies.

Scientific and ethical approval

It should be noted that, before any research study proceeds, the research proposal for that study must have been reviewed and agreed to by a scientific and ethics committee. The purpose of a scientific and ethics committee is to see that those recruited into a study are not harmed or damaged, and that the study will contribute to the advancement of knowledge. The committee pays particular attention to whether any bias might have been introduced to a study. The researchers will have detailed the reason why the study is required, the explicit aim/s and purpose of the study, the methodology of the study, and its subsequent design, including the chosen research methods for the collection of the data (sampling and study recruitment), and what method/s will be used for data analysis.

A literature review is undertaken and the established (published) international literature on the research topic is summarised to highlight what is already known on the topic and/or to show any topic gaps that have not yet been researched. The British Educational Research Association (BERA) (2018) also gives guidance for research proposals that are deemed to be educational evaluation studies, including ‘close-practice’ research studies. Any ethical issues such as how people will be recruited into the study, the gaining of informed voluntary consent, any conflict of interest between the researcher/s and the proposed research topic, and whether the research is being funded or financially supported by a particular source will also have been considered.

Critiquing a published research paper

It is important to remember that a published paper is not the research report. It is a sample of the research report. The research author/s are presenting their research findings as a succinct summary. Only a passing mention might be made that ethical approval and voluntary informed consent were obtained. However, readers can be assured that all publications in leading journals with a good reputation are subject to an external peer review process. Any concerns about a paper's content will have been ironed out prior to publication.

It will be apparent that there are several particular research designs. The Critical Skills Appraisal Programme (CASP) provides online information to help the interpretation of each type of study, and does this by providing questions to help the reader consider and critique the paper ( CASP, 2021 ).

General points for critiquing a paper include the following:

  • The paper should be readable and have explicit statements on the purpose of the research, its chosen methodology and design
  • Read the paper thoroughly to get a feel for what the paper is saying
  • Consider what the researcher/s says about any ethical issues and how these have been handled
  • Look at how the data were collected and analysed. Are the explanations for these aspects clear? In a quantitative study, are any graphs or charts easy to understand and is there supporting text to aid the interpretation of the data? In a qualitative study, are direct quotes from the research participants included, and do the researcher/s show how data collected from interviews and observations were coded into data categories and themes?
  • In a mixed-method study, how are the quantitative and qualitative analyses synthesised?
  • Do the conclusions seem to fit the handling of the data's analysis?
  • An important test of validity is whether the study's title relates well to the content of the paper and, conversely, whether the content reflect a corresponding match to the study's title.

Finally, remember that the research study could have been conducted using a different methodological design provided the research aims would still have been met, but a critique of the paper relates to what has been published and not what otherwise might have been done.

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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}

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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


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.


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 ( 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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Nursing, Article Critique Example

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The purpose of any professional research article is to add to the educational and professional knowledge of the field in order to ensure a continued enhancement and advancement of practice.  This same purpose was set forth by Miles and Vallish who determined to answer many of the fundamental questions surrounding the nursing practice.  The definitions, functions and use of nursing practitioners and health care were included throughout while using theoretical, conceptual and foundational research from other scholars throughout the nursing industry.  In sum, the authors relied heavily upon the research and publications of other researchers in order to draw appropriate conclusions so that these questions in the nursing industry could ultimately be answered.

To begin with, the authors attempted to define the system and functions within the nursing industry in order to better create a concept of managerial tasks.  For instance, the authors began by using Donabedian’s model in which the conceptual pieces of the nursing practice were defined and illustrated by clear-cut examples for applications-based nursing.  The authors found evidence to show that professionals in the field believed “Donabedian’s model [was] a guiding framework for nursing practice … defined … [as] a system (structure, process, and values) that supports registered nurse control over the delivery of nursing care and the environment in which care is delivered’” (Miles & Vallish, 2010).  Furthermore, the authors continued to explain the principles, values and processes by which new nursing professionals are educated on the principles and values at SJMC in order to further understand how they relate to the process for providing care and ultimately relating to the total quality of nursing care.  By laying out the framework of these fundamental principles and values, the chief nursing office (CNO) is able to effectively communicate the ways in which nursing care must be provided to the patients as well as the communicative and professional ways in which the nursing staff engages the interdepartmental relationships i.e. the doctor-nurse, nurse-patient, nurse-nurse relationships.

This breakdown helps the authors further illustrate the theoretic and conceptual components of the nursing practice by explaining the elements of the principles and values.  The four elements of the principles and values (C.A.R.E.) are further explained as the authors described the core councils that are comprised of head nurses and other nursing leaders on staff to determine proper treatment techniques and further foundational methodology within SJMC.  However, the authors neglected to explain exactly how these members are placed onto the CARE councils.  Nevertheless, the article explained the specific functions of the CARE councils and how their decisions and elaborations upon critical issues can be used to define ways in which nursing care is provided to patients and to eliminate multiple sources of conflict that would ultimately hinder the quality of care provided to the patient and his or her family.

Appropriately, the authors continued their discussion of the framework for the nursing system by explaining the type of care provided within SJMC and why it is important to utilize this specific care methodology.  According to the authors, “Patient-centered care (PCC) is defined by the Institute of Medicine (2001) as ‘providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions’” (Mills & Vallish, 2010).  The ultimate goal is to provide quality care while gearing it around the components that would determine the best clinical treatment for the patient.  This does not always mean that the best method of care is being utilized because it may not be within the patient’s personal preferences.  Therefore, the nurses are bound to maintain a code of conduct and perform treatment methodology around patient-centered care and place the needs and values of the patient first and foremost above all other considerations.  To ensure that PCC is maintained, a Steering Committee has been established within their institution that is led by the CNO in order to guide and watch over the nursing staff.  Furthermore, the Steering Committee holds annual training for all nurses to ensure that the PCC standards are educated and the knowledge of such standards is maintained for actual practice within SJMC.  This continues the ongoing trend that the authors maintain throughout the article that the conceptual and principle-based practices of the nursing field should be maintained, educated to the staff and overlooked by a board or council of peers and leaders to ensure that these methods are being followed appropriately.  In other words, the authors are inherently pointing out that it is not enough to simply educate nurses, but the entire staff must ensure that the practices follow the standards and principles to provide the best possible care for the patient.

Finally, the authors discussed the four different groups of priorities that are fundamental for proper nursing care.  People priorities are the first on the list and likely the most important as it discusses the needs and desires of the people who are most important.  This includes the patients, the patients’ family members, other medical staff and the like.  The quality of nursing care should consider people the first priority.  Secondly, quality priorities are set forth to ensure that the next major priority of an individual nurse and the entire nursing staff as a cumulative group is to provide the highest quality of care for the people involved.  This can include several intercultural, linguistic and values-based barriers that may cause several practice issues, but the priorities must remain constant to overcome all obstacles.  The finance priorities are also a serious consideration for both the hospital and the patient along with the family.  The authors engaged in brief discussion of this priority namely to avoid going into further detail as it can be a sensitive topic.  Finally, the growth priorities are set forth to ensure that the patient as well as the nursing practitioner is both allowed the opportunity to grow within the medical environment.  The practitioner must grow through increased knowledge, ethical and principle considerations and much more.  The patient must grow to overcome the physical illness as well as the mental considerations that could plague the patient during treatment and after treatment.  In summary, the authors utilized foundational knowledge and research to guide their explanations of the nursing practice so that the nursing field can use this model as a greater guide for continued practice and potential implementations throughout other nursing practice units.

Miles, K.S., & Vallish, R. (2010). Creating a personalized professional practice framework for nursing. Nursing Economics , 28 (3).

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  • Open Access
  • Published: 25 August 2023

Health education provided by nurses to children and young people: parents’ assessment

  • Anabela Fonseca Pereira   ORCID: 1 ,
  • Joaquim José Jacinto Escola   ORCID: 2 ,
  • Carlos Manuel Torres Almeida   ORCID: 3 &
  • Vítor Manuel Costa Pereira Rodrigues   ORCID: 4  

BMC Nursing volume  22 , Article number:  287 ( 2023 ) Cite this article

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Healthy literacy is a determinant key children/teenager’s health and health outcomes. The aim of this study to identify the parents’ assessment about Health Education practice to children and teenagers.

We opted for a descriptive, quantitative and cross-sectional research, with a non-probabilistic convenience sample. The inclusion criteria were: being a parent who uses attending children health appointments in primary health care; being a parent who has a child hospitalized and is accompanying him/her in the pediatric hospital inpatient ward. A questionnaire survey was built with three sections: sample characterization, Health Education practices performed by nurses (5 questions) and a scale that measured Health Education Assessment Scale (HEAS), which contained 48 items and was validated. It was applied from September to December 2018.

The survey was filled in by 113 parents. The results showed that 100% ( n  = 113) of the parents feel comfortable to talk with nurses about children/teenagers health; 79.6% ( n  = 90) consider that nurses have time availability for the doubts clarification; 61.9% ( n  = 70) point out that nurses identify child/teenager needs; Healthy eating” (60.2%; n  = 68), the “National Vaccination Plan” (53.1%; n  = 60) and “Harmful behaviors prevention” (46.9%; n  = 53) are the most important topics; 56.6% ( n  = 64) of the parents, when in doubt, turn first to the pediatrician, and 66.4% ( n  = 75) considered that this practice was equal important, compared with other nursing interventions.

This study shows that Health Education provided by nurses is based on the need’s identification, with a perspective of involvement and participation, promoting health and conscious changes which reinforces the nurses’ position as health educators.

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According to World Health Organization (WHO), Health Promotion (HP) directed to teenagers has great potential to promote the population health, leading to the promotion of healthy behaviors, which makes it an effective way for children, teenagers, and families to exercise a greater control over their health and contribute to its improvement [ 1 ]. WHO also promotes an integrated approach to managing childhood illness that considers all aspects of a child’s health, and a continuum of care throughout the early years to safeguard their developmental outcomes, including the reduction of risk factors for diseases that can arise later in life [ 2 ].

Thus, Health Education (HE) can be understood as a process in which individuals or groups learn to promote, maintain, or restore health [ 3 ], assuming itself as a practice that contains a set of consciously constructed opportunities, in which some form of communication is used, and which aims to promote health literacy, increase knowledge and attitudes that lead to individual and community health [ 4 ].

In this sense, it is important to consider that parents and caregivers play a key role in promoting their children’s health and well-being [ 5 ], and, therefore, nurses help them with the developing of their parenting skills and their ability to perform effective interventions on their children [ 6 ]. In turn, the literature also points the consensus that more health literacy, more reduction of erratic behaviors and, consequently, better health gains. On the other hand, this literacy helps parents and caregivers to use health services more effectively [ 5 ].

On this basis, the interventions’ effectiveness depends on their suitability to the target audience [ 3 ], and therefore, the literature points the nurse, as the health professional with a broad role that identifies problems, interrupts negative development trajectories, promotes healthy behaviors and lifestyles, and improves social inclusion using a strengthening community participation [ 7 ]. In this context, considering that nurses are the health professionals more involved in HE interventions, it’s important to point out the benefit of the individual/community along with their interventions [ 8 ] and the research that is also needed to identify or develop effective nursing practices to eliminate gaps and disparities in health care [ 9 ].

The HE practice usefulness is highlighted in several studies [ 1 , 3 , 5 , 6 ] and scientific literature, and nurses’ role in leading the HE strategies adoption is also highlighted, thus making a decisive contribution in increasing the population’s health literacy and promoting the ability of informed health decisions [ 7 ]. Although, according to a review, literature the evidence-based practice , from the 1990s, there are serious concerns that needs to be addressed, such as the practice wisdom and the nursing practice complexity, so it is important the reflection of nursing practices [ 10 ].

In parallel, parents’ perspectives are also seen as an important component of internationally evidence-based practices which ensure the health services quality [ 11 ], so it is important that nurses demonstrate develop quality care that meets safety standards with satisfactory patient results [ 12 ].

Thus, assuming that to build a better future, society has to invest in children [ 2 ]. The nurses are the foundation of all health systems in the world, and, therefore, in the best position to influence the individuals and community health well-being [ 13 ], and parents, as partners in care, can assess the relational skills and health professional’s knowledge [ 12 ].

Health promotion in Portugal

In the last decade, the Portuguese health status has improved considerably, although health inequalities are linked to a series of determinants of health (stress, people’s conditions, physical environment) and behavioral risk factors (tobacco, alcohol, diet and physical inactivity) [ 14 ]. For example, children up to 6 years of age, there are programs with intersectoral responsibility and interdisciplinary approaches performed by nurses [ 14 ]. There are also programs with the objective of promoting health decision making, self-confidence and the mental well-being of vulnerable pre-adolescents, also performed by nurses [ 14 ]. In this scenario, the HE practice stands out as a valuable tool, as nurses play an important role in empowering the individuals in their health promotion, thus, both the role of nurses as educators in the health promotion process and their technical and human capacity to meet the individuals and family’s needs are recognized [ 14 ].

Study design and study population

The present study has the general objective to identify the HE practice evaluation carried out by nurses to children, teenagers and parents. As a specific objective, we intended to identify the assessment made by parents about the HE practice, provided by nurses, to children, teenagers and parents. In this sense the aim of this study is clarify the contribution of HE practice carried out by nurses in children, teenagers and parent’s health.

This is a quantitative and cross-sectional research, developed in two different areas: differentiated health care and primary health care, from September to December 2018. For this purpose, we used pediatric services in a total of 4 hospitals and 29 health centers units in Northern Portugal. The inclusion criteria were: being a parent who uses attending children health appointments in primary health care (up to 18 years), or being a parent who has a child hospitalized and is accompanying him/her in the pediatric hospital inpatient ward (up to 18 years).

It should be noted that our first objective was to understand how parents evaluated HE practice in a global view. Since HE is carried out at the various levels of care (primary, differentiated) and parents can even have experience of the various aspects, we understand that we should have a global assessment of the importance attributed to HE regardless of the place where is done, trying to do a separate analysis afterwards. In this sence we had a non-probabilistic sampling of convenience, consisted of 113 parents who gave their consent.

Based on the objectives, and having as the main starting point, the conceptual context, the target population and the type of study, the hypotheses of this research are: the assessment that parents/family attribute to the HE practice provided by nurses to children and teenagers varies according to their academic/professional qualifications; the assessment that parents/family attribute to the HE practice provided by nurses to children and teenagers varies according to their age; the evaluation that parents/family attribute to the HE practice provided by nurses to children and teenagers varies according to their academic/professional qualifications; the evaluation that parents/family attribute to the HE practice provided by nurses to children and teenagers varies according to their age.

Data collection

To build the questionnaire survey an extensive literature review was carried out through bibliographic research related, to the theoretical and social context of the phenomenon under study.

An analysis of knowledge in nursing was also carried out based on scientific works archived in institutional repositories with free access, looking for scientific productions with a central focus on HE practice carried out by nurses to the children, teenagers, and parents in Portugal.

The databases used were: Online Knowledge Library (B-On); EBSCOhost Online Research Databases (EBSCO); Psychology and Social Science Journals on the Web (PSYCLINE); Medical Literature Analysis and Retrieval System Online (MEDLINE); Scientific Electonic Library Online (SciELO); ELSEVIER; PubMed Central (PMC); Portuguese Open Access Scientific Repository (RCAAP). The reading and analysis of relevant strategic documents was also carried out, such as: documents from official international (WHO, ICN, UNESCO, UNICEF) and national organizations.

The choice of this plurality of bibliographic references resulted from the search of the most representative for the context of this study, due to the scarce information in HE practice for the children, teenagers and parents disclosed in Portugal, and the lack of a research in Portugal with the same object of study. Finally, in order to prepare the data collection instrument, it was considered an important added value, to perform interviews to experts in the field of HE practice to hearing reflections and opinions, and parents to get their evaluation. In this sense, semi-structured interviews were conducted (using a grid of open and standardized questions) with 10 nurses and 20 parents, in order to obtain aspects that the researchers would not have thought of and complete the bibliographic review. We opted for a non-probabilistic convenience sample in order to have more access to people, and these answers were subjected to a content analysis, and also an analysis by five experts (two PhD Professors in Nursing, two researchers with extensive experience in building scales, and two Nursing professionals with wide experience in HE). Once the variables that allow responding to the study’s problem were defined, the questionnaire elaboration was completed.

The questionnaire was constituted by 3 sections: sample sociodemographic characterization (3 questions); HE practices provided by nurses’ characterization (5 questions); HE practice provided by nurses’ evaluation (1 question and 1 scale) (Table 1 ). Since no questionnaire was found that responded to the problem of this research, a scale which measures HE provided by nurses - Health Education Assessment Scale (HEAS) which contained 48 items, was built and validated [ 15 ].

Ethical statement

In data collection, in primary health care, the questionnaire was completed by parents in the consultation room, at the end of the children health appointments. At the pediatric hospital, the questionnaire was distributed by nurses and completed by parents in the ward.

In order to follow the ethical requirements, the research was validated by the institutions ethics committees involved, and the questionnaires were authorized by the directors (authorization n. 124/2018; n. 256/2018 and n. 00316/2018). When distributing the questionnaire to the participants, the informed consent document was provided to them, and it was explained and ensured the guarantee of their privacy, anonymity and confidentiality of the collected data.

Statistical analyses

The Statistical Package for the Social Sciences (SPSS) Version 22.0 was used for statistical analysis. A descriptive analysis was performed using central tendency measures, dispersion and frequency distribution. For inferential analysis, and, taking into account that the sample did not reveal normal distribution (Kolmogorov-Smirnov test), non-parametric tests were used (chi-square (χ) test [ 16 ] by Monte Carlo simulation, as well as Kruskal-Wallis test), assuming a significance level of 0.05 ( p < 0.05).

Professional and sociodemographic sharacterization

The sample is mainly composed by women (94.7%; n =107) and only 5.3% ( n =6) by men. The age range that enclosed the highest number of respondents (49.6%) was 30-40 years. The mode was the age interval of 30-40 years. Regarding academic/professional qualifications, 54 of the respondents (47.8%) had a "Degree", 12 (10.6%) had a "Master's Degree", 13 (11.5%) had a "3rd Cycle (9th year)", 20 (17.7%) had a "12th Year" and 14 (12.4%) had a "Professional Course" (Table 2 ).

HE practices performed by parents

The results showed that all parents (100%; n =113) said that they felt comfortable to talk with nurses about issues related to the children/teenager’s health; 79.6% ( n =90) of the parents considered that nurses were available to clarify all doubts related to the children/teenager’s health, and 20.4% ( n =23) considered that they were not.

When questioned about HE practice planning, 61.9% ( n =70) considered that nurses prepare the practice according to the needs, 23.9% ( n =27) considered that it is done according to prepared scripts/standards, and 14.2% ( n =16) considered that planning is based on improvisation.

When questioned about the most important issue to be discussed during the HE practice with children/teenagers, the following themes were highlighted: "Healthy eating” (60.2%; n =68),"National Vaccination Plan" (53.1%; n =60) and "Harmful behaviors prevention" (46.9%; n =53) (Fig. 1 ).

figure 1

Most important issues discussed by nurses in HE practice. Northern Portugal, 2018, ( N =133)

When questioned about the importance of the HE practice, in comparison with the other nursing interventions, 66.4% ( n =75) considered that it had the same importance as the other interventions; and 33.6% ( n =38) considered that it had greater importance than the other interventions.

From the cross-referencing of HE practice importance delivered by nurses to children, teenagers and parents with “academic/professional qualifications”, no differences with statistical significance were found (χ²=8.915; df=4; p =0.063) (Table 3 ).

When analyzed the relationship between the HE practice importance given by nurses to children, teenagers and parents with “age”, it wasn’t found any statistically significant differences (χ²=6.816; df=3; p =0.061) (Table 4 ).

It is important to mention that although there’s no statistically significant relationship with academic/professional qualifications and with age, the analysis of the adjusted residuals, points out that in the group of [40-50[ years, there is a higher classification of HE as very important, which seems to indicate a greater appreciation of this practice by this age group.

The scale's HEAS analysis showed a percentage of parental agreement above 55% in all items, which can be revealing of a HE practice that is viewed in a positive and effective way, also capable of conscious, voluntary and health-promoting behaviors. In HEAS the highest average results was obtained in items which were related with a HE practice based in partnership of care. This result reflects the recognition of close relationship, involvement and participation of parents, their active role in HE practice and the ability to adopt responsible and conscious health behaviors, that is, parents feel the HE performed by nurses as a practice which enhances parental performance, increased health literacy and responsible decision-making by the children, teenagers and parents. The item with 100% of agreement by parents, were related with the adoption of healthy lifestyles, which highlights the importance attributed by nurses to health determinants with a view in preventives interventions.

The analysis of the association of the HEAS also revealed no statistically significant differences with "academic/professional qualifications" ( p =0.126), nor with "age" ( p =0.512).

The WHO recognizes the fundamental nurse’s role as well, but HP must start early, even because children should learn to make healthy choices. However, many programs lack in evaluation [ 17 ]. Thus, the assessment of parents (target of nurse’s care) is extremely important, as it may be an instrument used by nurses, to make their interventions more effective, as well as can be a good care quality indicator [ 17 ]. In this study, all respondents reported a trust climate with nurses which allows them to exchange impressions or doubts about their children's health status.

This result reveals that, although an effective intervention of the HE practice may have its own setbacks and challenges [ 3 ], nurses developed a practice based on health-promoting environments capable of creating mediation, negotiation and build a relationship of partnership and trust, making children, teenagers and parents feel that they are an essential part of the process, which inherently promotes a practice aimed at their health needs. Also, in a study about nurses and parent’s collaboration, it was found that it was based in dialogue, action, flexibility and reciprocity [ 18 ]. In a study about nurses' perception of educating parents about obesity, despite pointing out the lack of knowledge about what to offer to the parents, it was reported that dialogue is facilitated if it was built on trust [ 19 ].

This study also seems to point the effectiveness of the verbal and non-verbal communication, developed by nurses, and contribute to the awareness of the professional's performance health, and the efficiency and quality of health communication [ 20 ]. It should be noted that the communication process is one of the essential competencies in HP, defined by the pan-European project Developing Competencies and Professional Standards for Health Promotion Capacity Building in Europe (CompHP), of the European Office of the International Union for Health Promotion and Education [ 21 ], and, because of this, the nurses' communication patterns have also been studied in the literature [ 22 ].

In turn, communication techniques were pointed out by nurses as a formative need [ 23 ]. It was also verified that nurses pointed out the lack of confidence in their communication skills [ 19 ], and, in a study based on the way people engage with the news, which requires a review of communication guidelines (especially during public health crises that bring unique challenges). There were identified three areas of health communication empowerment: proactivity, planning ahead and centrality of the individual [ 24 ]. Therefore, we can state that it would be beneficial and important to deepen the theoretical understanding of this issue, whether in the initial training of nursing or in continuous training processes.

Assuming that the perception of individuals, in relation to HE practice developed by nurses, has a positive impact on the overall satisfaction of individuals [ 22 ], and the fact that, in the present study, most parents (79.6%; n =90) felt that nurses were time available to clarify their doubts, may be an indication of good care organization and time management, thus providing better access to health care, increased demand for nursing care and, consequently, health gains. Also, in a study on neonatal nursing, it was found that mothers showed a moderate level of satisfaction with the social support provided by nurses [ 25 ].

The results of this study can also reinforce the idea that nurses are the health professionals closest to the community, which allows them to identify problems/needs, promote the maintenance of children, teenagers, and parents’ health status, and thus, develop interventions which promotes an efficient HE practice. In this sense, the " Programa Nacional de Saúde Infantil e Juvenil " (National Program for Child and Youth Health), assumes that, in attending children health appointments, nurses develop an important role in health education and disease prevention with children, teenagers and parents [ 7 ].

Regarding the planning of HE interventions, most parents (61.9%; n =70) identified the nurses' flexibility in meeting their needs. This clear perception of parents about the nurses' assessment of their health needs leads to evidence of an HE practice based on adequate lines of action, directed and adapted to the binomial children, teenagers and parent’s complexity, in each child/teenager life cycle, and, consequently, capable of acting on health determinants [ 14 ]. It was also found, in a study, that the importance of knowing the individuals' problems contributed to the success of nurses' interventions [ 22 ].

Considering that behaviors and attitudes are important HE focuses, regarding the most important topic to be addressed in HE, 60.2% of parents ( n =68) pointed out "Healthy eating". Other studies corroborate this result. When cross-referenced parent’s health literacy and children’s health behaviors, the children whose parents had high health literacy, ingested more salads, vegetables and fruit and practiced more physical exercise [ 5 ]. Regarding family influences on eating practices, it was demonstrated that these are preponderant in eating practices, hindering or facilitating healthy eating [ 26 ]. In a study about relationship between social support in social networks and risk factors for obesity, it was found that most adolescents did not eat properly, and the main cause indicated was the lack of motivation [ 27 ]. An international study with universities from several countries showed that the area where a large investment must be made was healthy eating [ 28 ].

Several studies show that the relationship between parents and health professionals is crucial for long-term weight maintenance in obese children [ 19 ]. Thus, the importance of promoting healthy lifestyles in partnership, performed by nurses, is evidenced, since it is not only important to promote the correct food choices (by the children/teenagers), but also empower parents, because childhood overweight is a public health problem, which has increased worldwide, and family influence is a conditioning factor [ 26 ]. In other words, there is a co-responsibility and conscious decision shaped by parents during the first 12 months of life, subsequently suffering the influence of external factors like friends, teachers and school environment [ 28 ].

It should be noted that, in this study, the "National Vaccination Plan" and the "Harmful behaviors prevention" were also considered important topics by 53.1% ( n =60) and 46.9% ( n =53) of parents, respectively. This result can also support the framework of the HE practice, performed by nurses with the children/teenagers and parents' health surveillance programs [ 7 ], with nursing interventions contributing to the empowerment of good practices and health decision-making by parents, since they are responsible for the children's health and well-being. Similarly, in other study, it was found a relationship between teenagers/children's health and parent’s health literacy [ 5 ].

In relation to the health professional to whom parents first resorted to clarify doubts, the "Pediatrician" was indicated by 56.6% ( n =64) of parents. Also, in a study about the parents’ perspective of their children education in preoperative preparation, it was found that the doctor was seen as the main educator of the child and parents, rather than other health professionals, including nurses [ 29 ]. Assuming that, all health institutions and health professionals offer understandable and usable health information from the individuals’ perspective [ 23 ]. This result may be due to the preference for the health professional with more qualifications in child health field, and that is the pediatrician. Although nurses also point out the insufficient cooperation with other health professionals and organizational barriers, as factors that affect the relationship and educational support of parents [ 19 ], in a study about collaboration between nurses and parents, the experience of nurses was considered an important goal for quality of pediatric nursing care [ 30 ].

To allow a better assessment of the HE practice, the parents were questioned about the comparison between HE and other nursing interventions. Although HP is focused on individual behaviors based on a wide range of interventions, on social and environmental determinants, as well as other health-related aspects [ 31 ], most parents in the present study (66.4%; n =75), considered the HE practice equally important like the other interventions. There was also no relationship between sociodemographic variables (academic/professional qualifications: χ²=8.915; df=4; p =0.063; age: χ²=6.816; df=3; p =0.061) with the importance attributed to the HE practice, so it can be concluded that academic qualifications and age do not influence the parents’ assessment of HE practice provided by nurses to children, teenagers and parents. This result may suggest that, even though the age or academic qualifications the HE interventions are seen, by individuals, as a practice very focused on the transmission of health-promoting behaviors, the acquisition of healthy lifestyles is allowed [ 12 ].

Although several recent studies pointed parents’ health literacy as a part of health intervention [ 5 ], it’s necessary that health systems throughout the world respond to the changing needs of health population, by motivating nurses and other health professionals to maintain their professional development [ 32 ], highlight the importance of HE.

Since the evaluations of the implementation processes in HP provide an understanding of the usefulness strategies and guide decisions that maximize the success of community programs [ 33 ], the evaluation portrayed by the HEAS translated the of the HE practice contribution, performed by nurses, in a more comprehensive way. Therefore, it was verified that the HE practice was positively evaluated and seen as effective and enhancing conscious, voluntary and health-promoting behaviors.

It should be noted that the items with the highest percentage of agreement ("It allows the respect of the health decision-making adopted by parents" and "It allows the appreciation of parents as a structure with functions and resources that affects the children/teenager’s health and disease processes") reflect the recognition of the close relationship, the parents' involvement and participation, and their active role in the HE practice, which corroborates other studies. Good teamwork with parents is considered very important by nurses, in HP ethics care of school health nurses [ 34 ]. In a study of hospitalized children parent’s and their partnership with nurses, it was found that, the greater partnership, the higher quality of nursing care provided to the hospitalized child [ 35 ]. Also, in a systematic review about nurses and other health professionals’ perceptions in relation to parent education practice, it was pointed out that family-focused approaches allowed parents to practice and improve skills over time [ 36 ].

In this sense, based on the idea that to have health literacy, the understanding and correct use of health information is necessary, the promotion is essential to adjust the social environment in a pertinent way for the use of health services by individuals [ 23 ], which is denoted in the result of this study, since parents feel the HE performed by nurses as a practice based on a care partnership that’s improving parental performance, and increase health literacy and responsible decision-making.

It should be noted that, an item obtained full agreement and the highest mean of the HEAS ("Allows the healthy lifestyles adoption by children/teenagers/parents"), which reinforces the idea that nurses prioritize the dissemination of healthy lifestyles, which, consequently, generates health-promoting behaviors and makes HE practice as a support for behavioral change on children/teenagers and parents. In fact, this result is in line with the priority topics that should be part of HE ("Healthy eating"; "National Vaccination plan" and "Harmful behaviors prevention"), which also have a health promoting nature, revealing the importance attributed by parents in the adoption of behaviors that generate healthy lifestyles. Thus, the strengthening of person-centered health with the aim of accountability can provide the necessary support for the promotion of healthy adults [ 34 ]. However, in a study on parents' perceptions of their 6-year-old children's eating behaviors and physical activity, the parents considered that the children's healthy efforts and behaviors may be influenced by contextual circumstances and barriers, such as social norms and structures [ 37 ].

At least, the present study considered the opinion of those who is addressed the nursing care. So, it brought the recognition of a practice that values the partnership between nurses and children, teenagers and parents, that recognizes their needs, that allows the healthy lifestyles promotion, the respect for decision-making in health matters, and the adoption of health protective behaviors through strategies that motivate the maximum health potential of the children, teenagers and parents.

Limitations of the study

The main limitation of this study results from the sample type (convenience), its geographical limitation and number of participants, that prevents the generalized results. Another limitation was the absence of already validated instruments, which forced us to build a new one, and although we tried to carry out validity and reliability studies (following the most current guidelines which pointed towards the validity of the instrument), we understand that it can be improved. On the other hand, taking into account the importance of the topic and the children's development, it would be interesting to apply the questionnaire (in the consultation room at the end of the health appointments), to teenagers, in order to provide the teenager’s assessment about HE practice carried out by nurses.

This study shows that parents, once they feel comfortable to talk with nurses and consider they make the preparation according to the identified needs, they perceive the HE practice as adaptable to the complexity of the children, teenagers and parents’ binomial. By identifying important subjects to be approached (healthy eating, National Vaccination Plan and harmful behaviors prevention), parents' collaboration is important for nurses because it facilitates the intervention on health determinants and the promotion of practices that protect, maintain and/or improve children, teenagers and parents’ health. Furthermore, this parents' assessment recognized the nurses' availability to provide proactive responses according to the needs, thus translating into health gains and the recognition of this practice. The results may serve as a reference because, in addition to assessing the impact of the HE strategies, they may be useful to reflect critically and strategically on this area and be able to (re)formulate and/or improve the HE interventions to children, teenagers and parents, even because the parents considered this practice as equal important compared with other nursing interventions.

Finally, we believe that this study produced results, which highlights the nurses' position as health educators, and the importance of other researches to continuing to give visibility to this practice, and its contribution in maintaining the continuous improvement of nurses’ practice quality.

Availability of data and materials

The authors did not want share raw data of the study, because it was obtained an informed consent from all subjects involved in the study, and it was guaranteed the anonymity and confidentiality.

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We sincerely thank all parents participating in this study.

This research was funded by National Funds through FCT-Foundation for Science and Technology financed by the project UID04045/2020.

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Higher School of Health, Portuguese Red Cross Alto Tâmega, Chaves, Portugal

Anabela Fonseca Pereira

Institute of Philosophy of the University of Porto, School of Human and Social Sciences, University of Trás-os-Montes e Alto Douro, Vila Real, Portugal

Joaquim José Jacinto Escola

Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD Clinical Academic Center of Trás-os-Montes e Alto Douro Doctor Nuno Grande-CACTMAD Vila Real, School of Health, University of Trás-os-Montes e Alto Douro, Vila Real, Portugal

Carlos Manuel Torres Almeida

Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, Clinical Academic Center of Trás-os-Montes e Alto Douro Doctor Nuno Grande-CACTMAD Vila Real, School of Health, University of Trás-os-Montes e Alto Douro, Vila Real, Portugal

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A.P: conceptualization, investigation, methodology, formal analysis, data curation, writing-original draft preparation, writing-review and editing. J.E: conceptualization, methodology, formal analysis, data curation, writing-review and editing. V.R: methodology, formal analy-sis, data curation, writing-review and editing. C.A: conceptualization, methodology, formal analysis, data curation; writing-review and editing. All authors reviewed the manuscript.

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The study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board (or Ethics Committee) of Northern Regional Health Administration (authorization No. 124/2018), Trás-os-Montes and Alto Douro Hospital Center, EPE (authorization No. 256/2018), and Northern Local Health Unit, EPE (authorization No. 00316/2018), from the second semester of 2018. Informed consent was obtained from all subjects involved in the study.

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Pereira, A.F., Escola, J.J.J., Almeida, C.M.T. et al. Health education provided by nurses to children and young people: parents’ assessment. BMC Nurs 22 , 287 (2023).

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Educational Levels of Hospital Nurses and Surgical Patient Mortality

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