Substantive and Theoretical Dimensions

Relevance of research problem and significance

The study states the research problem as being the lack of enough training among nurses to incorporate cancer detection behavior into nursing practice, and thus they wish to get more education on skin cancer (Erkin & Aygün, 2020). The research problem is relevant to the research significance since the study discusses the role of health professions in the prevention of skin cancer. It states that community educational drives performed by nurses have been found to increase knowledge of the dangers and early symptoms of skin cancer, and the performance of SSE (Erkin & Aygün, 2020). That leads to the significance of the study, which is to equip nursing students with sufficient knowledge of SSE for them to be ready to execute their role as advisers and community educators.

Appropriateness of the conceptual framework

The conceptual framework is appropriate since the literature refers to the fact that nurses contribute to societal, family, and personal health by acting as examples (Polit & Beck, 2004). Previous studies have been cited that explain the concept of nurse involvement in the prevention of skin cancer.  

Congruence between the research questions and methods used

The research questions are congruent to the method used. The research questions were set to determine the attitudes and knowledge of the participants concerning skin cancer and steps applied in SSE before training, assess their improvement in knowledge concerning skin cancer dangers after education, and verify the proportion of participants who cold carry out SSE accurately and effectively after training (Erkin & Aygün, 2020). Questionnaires were used as a data collection method, where data was collected pretest and posttest. The data collected could thus be applied in answering the research questions. Since the questions deal with the effectiveness of interventions by nurses to prevent skin cancer, structured approaches were appropriate.

Literature review

The study does not conduct a literature review in relation to the topic of the study. A literature review would have been appropriate to determine what other studies have established regarding the intervention in the prevention of skin cancer (Polit & Beck, 2020). That would have helped in determining gaps and making comparisons with the current study.

Methodological Dimensions

Research design

The study used a quasi-experimental, single-group, pretest–posttest design (Erkin & Aygün, 2020), which corresponds with the research questions. Given the purpose of the research, the researcher had to determine the outcome of training nursing students’ skin cancer risk aspects and the steps applied in SSE for positive approaches in the prevention of skin cancer. The study design was thus the most appropriate one since it provides pretest and posttest measures to establish the effectiveness of the intervention. The design facilitated appropriate comparisons on the knowledge of skin cancer and the use of SSE before and after training (Erkin & Aygün, 2020). Data were collected twice, which was appropriate given the purpose of the study and research questions. The research design minimized threats to the study’s validity and biases. Blinding was used since the students were not provided with the scores of their first test before training.

Population and sample

The population was identified and described as all nursing students of Mugla Sitki Kocman University in southern Turkey (Erkin & Aygün, 2020). The population of the research was n=900 (Erkin & Aygün, 2020). It was determined that the sample size that would give a power of 95% would be 323 participants (Erkin & Aygün, 2020). Sample biases were minimized by determining the required sample for covariance analysis. The researcher selected 0.25 as the effect size and 0.05 as the sampling error within a 95% level of confidence (Erkin & Aygün, 2020). The sample size was thus adequate since it could generate a 95% confidence interval. However, the study does not state the eligibility criteria for sample selection and the nature of the setting. Out of the population of 900, the study indicates the sample size used. The participants were aged between 18 and 23 years, where 224 were females and 108 were males (Erkin & Aygün, 2020). Therefore, the number of participants meets the appropriate sample size for the study. The report gives the characteristics of the participants regarding their hair color, skin color, those with relatives with skin cancer, those who had received check up for screening of skin cancer. It does not state the number of potential participants who declined to participate in the study.

Collection of data

Key variables were operationalized by use of questionnaires that were believed to be the best possible method (Erkin & Aygün, 2020). The research data was to be collected in a structured way, where similar information was collected from all the subjects in a pre-specified and comparable manner (Erkin & Aygün, 2020). The questionnaires were based on past studies. The questionnaires are described in details. They contained two parts, whose questions are well described. The researcher also describes how points for the correct answers were awarded. Based on this description, the students’ answers were quantified regarding their scores (Erkin & Aygün, 2020). Data that is intended to be statistically analyzed has to be collected in a manner that it can be quantified. Questionnaires were good choices for the study given the purpose of the study since questions were used to obtain pretest and posttest data. To provide evidence that the data collection method applied produced data that were highly reliable and valid, Erkin and Aygün, (2020) state the content validity of 0.81 and Kuder-Richardson value of 0.85, which were calculated for the questionnaire. The questionnaire method used could generate subjective data from the participants lowering the level of validity and reliability.



The intervention used in the study was adequately described. The study’s intervention was designed to increase awareness among nurse students on SSE and the risks of skin cancer through educational resources, such as picture and posters, video, PowerPoint slideshow, and brochures (Erkin & Aygün, 2020). The intervention describes the information in each source of information, when it was used, duration, and the number of audience. Based on the report, most of the study participants in the intervention group accessed it. The intervention was stopped before administering of posttest evaluation.

Ethical Dimensions

Confidentiality or anonymity

The study report does not indicate how confidentiality and anonymity was upheld in the research. However, the questions asked in the questionnaire are an indication that the study was not more invasive in the participants’ privacy that was required to be and that the privacy of the subjects was maintained throughout the research (Woo, 2019). Participants were not asked for information regarding their names, indicating that anonymity was observed.

Informed consent

The Erkin and Aygün (2020) indicate that the study’s participants were provided with adequate information about the study, and they provided their written consent. However, it does not indicate whether it was ensured that the participants understood the information provided. The participants voluntarily accepted to be part of the research as were given a choice. Informed consent is based on full disclosure of information and self-determination (Woo, 2019). In this case, self-determination was not a challenge since the participants had the capacity to make well-informed judgments on the benefits and costs of their participation. However, full disclosure may pose a challenge as it may lead to biases resulting from inaccurate information and biases recruiting a appropriate sample.

Vulnerability of study subjects/participants

The study did not involve groups of participants, such as emotionally and mentally disabled persons and children, who can be considered to be vulnerable due to their diminished competence.

Research ethics board approval

According to the report, the researcher obtained a written authorization for carrying out the research from the scientific ethics committee of the University.

Interpretive Dimensions

Discussion section

Findings interpretations

All the major results are interpreted and argued within the background of the conceptual framework. The findings of the study indicated that providing the student nurses with SSE education led to positive changes in their understanding of skin cancer risks. Significant changes were also noted in the level of knowledge of body parts in the pretest and posttest that should be assessed in SSE, and the knowledge of the need to employ a hand mirror and complete mirror in SSE. It is noted that the results show that nursing students were educated about the prevention and risk factors of skin cancer using intervention (Woo, 2019). According to the conceptual framework, nurses play an important part in the early discovery of skin cancer in campaigning for secondary and primary prevention measures. Nurses should thus have knowledge of the early symptoms and danger factors of skin cancer to offer patients the finest care. The findings of the study were also interpreted and discussed within the context of previous studies (Polit & Beck, 2020). The report indicates that the apparent skin cancer future risk and knowledge of the early signs of the illness have been linked to the literature with the readiness to conduct SSE. The report points out that this study demonstrated that over 50% of the subjects showed low-to-moderate apparent skin cancer possibility, which suggested that they had knowledge of skin cancer risks and skin types (Erkin & Aygün, 2020). Besides, nurses should know the need of conducting a comprehensive patient’s history to recognize those at risk of having the illness. The pretest evaluation of the research demonstrated that using solarium was the most popular risk of skin cancer for most of the students, while birthmarks shown to be the least risks. In the pretest evaluation, the scholars indicated more awareness of skin cancer risks and they could recognize more risks (Erkin & Aygün, 2020). That is compare to previous study that reported a positive significant association between existence of four or more skin cancer danger aspects and SSE (Erkin & Aygün, 2020). The interpretations of the study are consistent with the findings and the study limitations. The interpretations of the study do not include literature that is beyond what was tested in the research questions. It is thus limited to the findings of the study.

Conclusion section

The report addresses the issue of generalizability of the findings. In its conclusion, the study report states that SSE training for early discovery of skin cancer had an optimistic impact on the practices and knowledge of SSE among nurses (Erkin & Aygün, 2020). Further, training intervention improved awareness or knowledge of the early detection and prevention, as well as ABCDE rule of skin cancer and act as its role model (Erkin & Aygün, 2020). Nurses should thus raise their knowledge related to skin cancer and should focus in ongoing training and dermatology practice.

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Strengths and limitations of the study

The study used health care providers as participants, which might have eased the used intervention to increase awareness on SSE and skin cancer. Moreover, promoting active learning through brochures and posters may have positively impacted conducting of SSE. When health experts are aware of self-examinations and use it on themselves, then they are likely to be better prepared for the promotion of helpful health behaviors.

The study exhibited a number of limitations. The study was performed in one institution, excluding the generalization of the results. Besides, the sample and design selection are also a limitation. Matching participants was necessary to compare the results of pretest and posttest. The data collected from the subjects involved in either of the tests were not integrated in the analysis. The other drawback is that the research findings were according to personal self-reporting. However, it is held that the questionnaire used in the evaluation of SSE education was helpful in the perspective of detection of skin cancer. Finally, the SSE education intervention used was limited to images and posters education resources.

Implications section

The implication of the study is that it contributes significant evidence in nursing practice in that nurses should be equipped with knowledge of risk features of skin cancer and warning signs, as well as SSE. That would help in the recognition of skin cancer and implementation of public teaching promotion on skin cancer.


Erkin, Ö. & Aygün, Ö. (2020). Effects of an education intervention on nursing students’ knowledge and attitudes regarding skin self-examination and skin cancer risks. The Journal of Nursing Research, 28(1), e62.

Polit, D. F., & Beck, C. T. (2004). Nursing research: Principles and methods, (7th Ed.)  Philadelphia: Lippincott Williams & Wilkins.

Polit, D. F., & Beck, C. T. (2020). Nursing research: Generating and assessing evidence for nursing practice, (11th Ed.) Philadelphia, PA: Wolters Kluwer

Woo, K. (2019). Canadian essentials of nursing research, (4th Ed.) Philadelphia: Wolters Kluwer