Holistic Nursing Article Critique

HolisticNursing: Article Critique

HolisticNursing: Article Critique

Thefield of nursing is an area of study that has had a lot of researchon different subjects and more are still ongoing. One way of buildingon the already existing knowledge is by evaluation of other scholars’work in our area of study as noted by Allen&amp Earl (2010).To achieve this, application of logical methodologies in gathering,validating and developing on the already possessed information. Thisenables the employment of up to date information when it comes to theactual field application such as, when it entails to dealing withpatients if that kind of information is related to the nursing career(Helen,Helen,&amp Dona, 2010).According to Stebbins (2001), it is necessary to participate in theapplication and appraisal of study results dealing with the same areaof study to achieve this objective. This paper focuses on providing athorough review of a research article on developing of the holisticnursing competence scale, so as to generate a body of knowledge thatcould be useful to nurses in their field of practice. The paper’sobjective is to identify critically the different forms of evidence,strengths and limitations of the authors by the help of theassessment tools.

Thetitle of the article “Developmentof the Holistic Nursing Competence Scale”is simple and precise. It gives an overview of the main concern ofthe research article. However, it does not suggest the population tobe studied. Nevertheless, the tile is short, simple and precise.


Thearticle’s abstract is short and the authors are very selective ontheir use of words. Unlike typical abstracts in most researcharticles where all the sections of the article are summarized, thecurrent article gives a synopsis of the article’s findings andconclusions. This includes the development of a scale through thestudy to assess the nursing competence among registered nurses inJapan. The abstract further explains how the scale was established.It also gives a summary of the direct relationship between nursecompetence and experience. Generally, the abstract does not provideimportant information to the reader regarding the different parts ofthe article. As such, it is not easy to understand the direction ofthe article by reading though the abstract. Regardless, the authorsprovide the key words at the helm of the abstract which includecompetence, nursing, holistic nursing, scale development andprofessional development.

Theintroduction section is one of the most important parts in a researcharticle. It provides detailed information regarding the researchproblem and the concern for the current study. In the currentarticle, Takase &amp Teraoka (2011) provides an overview of theproblem to be studied, which is measure of nurse competence. Thepopulation under study is clearly pointed out by the authors in theintroduction. The authors state that, nurse competence is a majorconcern in nursing profession in the world as it is in Japan. Theproblem statement has strong correlation to nursing. According to theauthors, nursing competence is important due to the increasing demandfor nurses to offer competent services to their clients. Besides, theadvancement in medical technology has allowed patient treatment withcompound health issues. Furthermore, there is need to minimizehospital stays for patients to reduce medical costs which allrequires nurse’s competence.

Thearticle clearly outlines the shortcomings despite the increasing needfor nurse competence. Among these challenges is the lack ofopportunities for freshly graduated nurses to use their acquiredskills and abilities in nursing profession and limitation by theethical code which cautions patients against incompetent practicewhich keeps students away from express patient care (Ministry ofHealth, Labour and Welfare, 2007). Furthermore, the introductiongives the rationale for the current study. The authors highlight thecontribution of the Japanese government in promoting nurse competencethrough the introduction of a policy in 2010, which makes itmandatory for health care organizations to offer in-service trainingfor nurse professionals (Takase &amp Teraoka, 2011). The authorshave further pointed out the challenges that come with implementationof in service training, hence the need for the development of a scaleto measure competence among nurses, which is the interest of thecurrent article. However, there is no explanation of the relationshipbetween the research problem and research methodology.


Theliterature review is embedded in the background part of this article.Literature review basically looks at previous literally worksregarding the field of focus. Since the purpose of the current studyis to develop a competence scale. The authors have acknowledged theexistence of different competence scales both in Japan and in otherparts of the world. The literature review has concentrated on thedevelopment of competence scales in Japan. Moreover, the problemsthat are associated with competence tools have been clearly pointedout in the literature review.

Tobegin with, nursing competence lacks a clear definition. The articleuses other secondary sources to support the need for the developmentof a new competence scale. For example, in a literature assessment byKamihara,Arakawa, Satoet al. (2008), the descriptions of nursing competence used by variousscholars varied with most of them just encompassing the components ofcompetence. Overall, the lack of a strong definition led todevelopment of insufficient tools which evaluated a small area ofnursing competence. Hence, the literature review is directed tounearthing the limitations in the previous competence measures andjustifies the need for the current study. Besides, the existing toolslack validity and reliability as they have not been put throughthorough testing of these measures which include scholar devisedmeasures (Takase &amp Teraoka, 2011). The literature howeverprovides evidence that there have been other competence measuresdeveloped internationally which are reliable and valid, except thattheir suitability in Japanese context is not guaranteed.

Towarrant the current study, the literature review points out why theexisting international measures (which are valid and reliable) cannotbe applied in Japanese context. According to the authors, most ofthese scales are either too detailed or too short. In addition, thetools do not evaluate the common aptitude of nurses which is animportant measure in competence of nurses. Thus, the literaturereview provides a stable ground for the new study.

Theauthors of the current article Takase &amp Teraoka have written theliterature analysis critically. They have made use of both primaryand secondary sources to inform on their subject of study. Inaddition, most of the sources are current and published within thelast two decades.


Theauthors outline the theoretical framework in the development of thecurrent competence scale for nurses. The framework is clearly definedin four simple steps.

Step1: concept analysis and item development

Theabsence of a clear definition of competence in Japan instigated ananalysis of 60 global nursing publications to come up with adefinition and attributes. From the analysis, the authors definenursing competence as “….the ability of a nurse to effectivelydemonstrate a set of attributes, such as personal characteristics,professional attitude, values, knowledge, and skills, and to fulfillhis/her professional responsibility through their practice. Acompetent person must possess these attributes, have the motivationand ability to utilize them, and must effectively use them to providesafe, effective, and professional nursing care to his/her client.”(Takase &amp Teraoka, 2011, p.398). Ten attributes were alsoestablished and explained and included personal qualities, cognitiveability, collaboration with other co-workers, orientation tolegal/ethical practice, demonstrating management ability, engagementin professional development, providing training to patients andstaff, ensuring quality and safety in service, managing nursing care,and establishing individual relationships with staff and patients(Takase &amp Teraoka, 2011). 89 items were created which were usedin the development of a Holistic Nursing Competence Scale (HNCS).

Step2:Content Validity Test

Inthis step, the significance of the 89 items to the meaning of nursingcompetence was evaluated by six nurse experts with the help ofContent Validity Index.

Step3: Piloting

Thisstage involved evaluating the maintained items on twenty three nursesto assess their self evaluation of competence, the precision of thescale components and feasibility of collecting information. All thenurses used for the assessment worked in different hospitals inJapan.

Step4: determination of other forms of validity and reliability

Thisstep involved subjecting the modified HNCS to assessment of otherforms of validity and reliability. The presence of a solid and welloutlined conceptual framework provides the reader with anunderstanding of the direction of the study. It is thereforeappropriate for the study.


Theresearch design used in the current study was quantitative andqualitative research design. Questionnaires were used to help collectdata. The use of qualitative and quantitative study in nursingresearch complements each other making a study to be valid. Thus, themixed research design was appropriate in the study.

Populationand Sample

Thepopulation for the study has been identified in the article. Itincluded registered nurses (RN) serving in the training hospice wherethe test study was carried out. An exclusion criterion is also givenby the authors in sample selection. RN not concerned in patient care,those working in outpatient care, and those included in the pilotstudy were left out. In total, 599 RN were selected for the studywhich was an adequate sample size for the study. The authors howeverdid not make use of power analysis to determine the needs of thissample size.


Thecurrent study did not have any hypothesis as it sought in developinga holistic nursing competence scale. It was therefore unnecessary tohave research hypothesis in the article.


Datawas collected using questionnaire surveys. Questionnaires were sentthrough postage mail and included postage stamp for returningcompleted surveys. This method of data collection is reliable becausethe researcher cannot influence the participants unlike ininterviews. Questionnaires are also easy and cost effective toadminister unlike interviews which require large and trainedworkforce. Besides, the research does not need to incur travel coststo meet the scattered participants. The questionnaires were sent to599 participants. In addition, questionnaires can be used to collectdata from a large population (Cooper,Dewe &amp O`Driscoll, 2001).There was a 50 percent return rate of the surveys. The currentarticle clearly explains the specific tools used in data collection.However, the article does not provide proof that that the datacollection methods provided data that were highly reliable and valid.



Asuccessful research must have well outlined procedures to guide theresearch process. Procedures are the steps that are followed ingathering information, analysis and drawing conclusions. The currentresearch article has well stipulated procedures in the conceptualframework. The different steps that were described earlier in thiscritique report shows the step by step procedure for development ofnurse competence scale.

Nevertheless,there was no need to train data collection personnel as data wascollected using questionnaires which were sent by postage mail. Theparticipants were therefore not required to be assisted in the filingin of the questionnaires as they were self explanatory. Variousmeasures were assigned values to describe different aspects.


TheAmerican Nurse Association requires that all research studies beguided by ethical code developed by the association. The currentstudy considered ethics as evidenced by various practices. Consent tocarry out the research was sought from Hiroshima University School ofHealth Sciences Ethics Committee in Japan. In addition, the purposeand data gathering method was explicated to the hospital’s Directorof Nursing who gave approval. The study also observed the rights ofthe participants. The survey packages were sent to prospectiverespondents through the nurse unit manager. A cover letter wasincluded explaining the study’s purpose and procedures. Return ofthe questionnaires was assumed as consent to participate.



Dataanalysis was mainly quantitative. Analysis involved descriptivestatistics which was employed to assess the distribution of thescores on individual items. Besides, Pearson correlation coefficientswere evaluated to establish the relationship between the components.The data analysis employed in a study determines the outcome or theconclusions drawn from the research. The current study is keen onusing statistical methods to give meaning to the collected data.

Theauthors also realize the importance of increasing validity of resultsthrough data analysis. In the current study, the authors examined theconstruct validity of the scale with the help of confirmatory andexploratory factor analysis. Criterion validity and internalconsistency of holistic nursing competency scale were examined.Consequently, items were included using the cutoff point described byLee (1992).

Sincethe self assessment was administered, the authors have justified itsuse. They argue that, in Japanese culture, assessment by others couldnot work as a result of feeling ashamed about criticizing anotherperson. They also support self assessment arguing that assessment byothers could have discouraged some nurses from participation due tofear of being negatively evaluated. The authors belief that,individuals can reflect on their behavior and conduct logical selfevaluation, a belief backed by other studies like Meretoja &ampLeino-Kilpi (2003).


Datawas presented using tables to display the sample characteristicsespecially demographic data. Descriptive statistics including meansand standard deviations were also used in presenting data. This modeof presenting data is appropriate for the study. However, it requiresa person to have prior knowledge in statistics to understand theresults. Fortunately, the discussion part of the report hassimplified the results by giving meaning to the figures.


Interpretationof Result Findings

Thediscussion part of a research article further explains and givesmeaning to the findings. In the current article Takase &amp Teraoka(2011) have done a great job in discussing the research findings. Tobegin with, they were able to come up with HNCS that is moredeveloped than the previous versions. With only 36 items, the authorsargue that, the new scale is practical and enables habitualassessment of nurses’ competence without difficulties. Further, theestablished 10 nurse attributes were reduced to five, where theauthors explain clearly and clarify that the initial ten measures arestill applicable.

Toexpound on the results, the discussion also focus on the two sectionsof HNCS identified in the results. Section A which explains thecritical personal values of a nurse including critical thinking,compassion, and reflection on self which can influence nursesprofessional development. The authors clearly explain therelationship between the elements in section A and nurse competenceand development. This is in line with the theoretical frameworkdiscussed earlier on, prior the research. Section B on the other handassesses nurses’ professional attributes needed to assesscompetence in nursing practice. This section allows nurses ororganizations to use an even shorter scale to assess their owncompetence or those of their employees respectively.

Theauthors also explain why their new developed measure of HNCS isbeneficial as compared to the other scales discussed earlier. Hencejustifies the use of the current scale. According to the authors,HNCS has good validity and reliability. This is evidenced by the highinternal consistency measures in the results for both factor andscale levels. Besides, the construct and content validity weredetermined by nurse professionals and the factor evaluation. Thediscussion therefore is exhaustive of the results findings.

Limitationsand Recommendations

Agood research article must identify the limitations of its study andmake recommendations for future studies. The current article did notdisappoint. Despite lobbying with a lot of proof that HCNS is themost reliable measure for nurse competence as compared to the otherexisting measures, the authors recommend that it still requiresfurther vetting. An example is the test-retest reliability which theauthors say need further calculation to establish the scalestability. Besides, the scale needs a cross-validation with anothersample. The researchers also recommend a further evaluation ofcriterion-related validity to further improve the credibility of thescale. However, the researchers also point out that, this validationmay be difficult to achieve due to lack of valid criteria.

Theauthors have also given a further analysis of the various aspects inthe current study in relation to findings of other scholars. Withthis kind of understanding, further studies can be able to bridge thegaps that the current and previous studies have demonstrated. Theguidance on future studies shows that the development of the holisticnurse competence scale is inexhaustible.


Theimplication of the current study on nursing profession is profound.The findings on nursing competence exhibited that the elements in theHNCS were both somewhat or vehemently related to one another.According to the authors, this implies that the elements ofcompetence are interrelated and are inseparable (Takase &ampTeraoka, 2011). As such, this relationship suggests that, anenhancement in one aspect of competence results to an enhancement ofthe others. This explanation shows clearly that measuring nursecompetence may be a big problem. For example, the authors noted that,when nurses were required to assess themselves, they assessedthemselves as considerably competent. When it came to providingethically compliant care, they considered themselves as fullycompetent and they believed that they were fairly competent when itcame to management, staff education and professional development. Theconclusion are congruent with those of other studies. As such, theimplications of the current study to nursing are immense.


Theorganization of a research article is very important as it allows thereader to have an easy time identifying various areas of the researchstudy including research design, sample population among otherimportant aspects. The current report has a great structure in termsof organization. From the title to the conclusion, the article isdivided into distinct and well organized sections for easy perusal.In addition, the article is sufficiently detailed in all the sectionswith explanations of every aspect included in the report. This makesit easy to understand the content of the report given that it is aquantitative study. Consequently, it is not necessary for the readerto have deep understanding of statistical methods to understand thisreport as it is sufficiently detailed. Hence, the findings of thecurrent study are written in a manner that is accessible topracticing nurses.


Thecurrent research article seeks to develop a holistic nursingcompetence scale (HNCS). The research was justified as the previousnurse competence scales in Japan had shortcomings especially due tothe lack of a comprehensive definition of the term nurse competence.Besides, even other internationally valid scales could not be appliedin the Japanese context. For example, the current study has justifiedthe self assessment of nurses arguing that assessment by others isinappropriate in Japanese culture. As such, the current study wasjustified and succeeded in developing of HNCS. Nevertheless, theauthors did not recommend for the generalization of this study toglobal context even though there are recommendations for enhancingvalidity and reliability. The research design, the sample size anddata analysis methods and presentations were appropriate for theresearch and helped achieve the study’s objective which was todevelop a HNCS. The structure of presentation of the report is greattoo with various sections being explained in details for easyunderstanding of the report. Finally, the implications of this studyto nursing especially in Japan are profound as discussed in thereport. Generally, this is a perfectly written research article.


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