Nursing Research Essay Sample
The purpose of this assignment is to critically evaluate two journal articles from a selection of six. One is a quantitative piece; the other is a qualitative piece. A framework devised by Benton and Cormack (2000) has been used to help the process of critiquing in this assignment. This particular framework had been chosen, as it is a comprehensive framework covering most points needed in the critiquing process. This framework can be applied to both qualitative and quantitative research. However the framework will not be used as a definitive checklist. In this assignment the first article that will be discussed is a qualitative piece of research by Simons J., Franck L. &Roberson E (2001). Titled : Parent involvement in children’s pain care: views of parents and nurses. Journal of Advanced Nursing, 36(4), 591-599.
This study looks at the views of parents and nurses about the involvement of parents in the management of their child’s pain during the first 48 hours after surgery. The second piece of research is a quantitative piece by Dekyser F.G., Cohen B.B. & Wagner N. (2001). Titled: knowledge levels and attitudes of staff nurses in Israel towards complementary and alternative medicine. Journal of Advanced Nursing. 36(1), 41-48. The purpose of this study was to determine the knowledge level and attitudes of Israeli nurses towards complementary and alternative medicine and what factors are related to these variables. Finally a short conclusion will be drawn up on completion of both critiques.
In the first article, which is a qualitative study the participants were clearly identified as 20 parents and 20 nurses all the parents and nurses approached agreed to participate in the study. The sample of parents were mothers only, as the father although considered for interview were not available. The sample for the study was recruited from parents of children who had surgery at a large urban children’s hospital in England and the nurses who provided the most care for the children during the first 48 hours postoperatively. With the sample size being so small it may be debated that the results may be flawed. Polit and Hungler (1993) postulate that the larger the sample size, the smaller the sampling error will be. The phenomenological approach is used in this piece of qualitative research and as Bernstein et al. (1991), looks at the way each person perceives and interprets the world differently which makes up personality and guides behaviour.
The title is concise and informative about what the research article is going to be about and clearly shows the approach that is used to conduct the research. In the title it states that it will be discussing the ‘views of parents and nurses’, about parent involvement in children’s pain care. This clearly shows from the title that the article is more than likely going to be a qualitative piece of research as it is talking about people’s opinions, beliefs and views not fact (Ogier 1998). The title visibly states what the article is going to be about and when looking at the title it is clear that it will be about the involvement of parents in there children’s pain care and the views of parents and nurses on this topic.
The author’s qualifications are clearly stated on the front page of this article. It states that all three are Registered general nurse trained and all work within the child field. Linda Franck with PhD and Elaine Roberson with a BSc and two with job titles within the research area, although only one out of the three having a PhD it is made clear that Joan Simons is a senior Nursing research fellow, for the institute of Child health. Elaine Robinson does not have a PhD or a job title in research so it could be argued that she might not have any research qualifications at all, therefore does not know the research process. This could impair the results. This is supported by Bond (2000) who states that a good knowledge of research, subject and educational background will make the research more valid than it would without these. In order to credit an author and to give his/her research credibility and reliability the author must have appropriate clinical and research expertise (Lewis and Barnes 1997), which apart from Elaine Roberson seems to be the with this article.
The abstract of a piece of research is supposed to be a short comprehensive summary of the study (LoBiondo-Wood and Haber 1994). The abstract included in this research article is very unambiguous and is presented in a way that sums up the article. It clearly outlines the aim of the study and the reasoning behind it. It states the methodology that will be used during the piece of research but it doesn’t clearly say how the participants were selected and what sampling techniques were used, it appears after reading on that it is a purposive sample but nowhere in the text does it state this. The abstract states the findings and how they would be interpreted and analysed. It also plainly translates the findings of the piece of research and the differences between the subject groups and their differing views. This abstract also clearly outlines how the article concludes.
The main function of the introduction is to provide the background to the study, clearly indicating why the research was carried out (Crombie 1998). Holloway and Wheeler (1996) agree with this and say that the introduction should define the aim of the study and justify why they are carrying out the research. This is made apparent in the introduction of this article.
Morse and field (1996) state that the literature review should be written in a way that will convince readers that the study is worthwhile. While looking at the literature review in this piece of research it is clear that much research has already been carried out and a lot of it being in the London area which is where this research took place. There is a wide range of literature being reviewed and it appears to be very specific to the topic being researched in this article. The literature goes back as far as 1959 with the Department of Health (DOH) right up to the late 90’s. This is a 40-year span and 63% of the references are within five years of publication of this article. Wilson and Butterworth (1998) suggest that articles that are used over five years old can point to the author not being very thorough in their literature review or maybe leaving out some literature that opposes what they are hoping to find in there research.
Much of the literature being reviewed has been published articles of research printed in reputable journals. It becomes clear when reading the literature review that the authors are trying to add to knowledge to the topic already researched. Wilson and Butterworth (1999) say that this should be the case if the researcher had set their topic around the context of existing data or ideas. However Streubert and Carpenter (1999) state that in qualitative research the literature should be done at the end of the study, after the data has been analysed. Pinch (1993) points out that you learn more about a phenomena when you are a ‘stranger’ to the background of a study and that a literature review should not establish the grounds for the study, neither should it suggest theoretical or conceptual framework. It can be seen from looking at this article’s reference list that the authors have used a range of sources for the literature review, from books and journals to health and welfare sources. This also indicates that a thorough literature search has been conducted. Parahoo (1997) suggests that when only one source has been used, such as books, it shows that the researcher has either not looked wide enough to take into account all the recently published material or has deliberately missed out vital literature that conflicts there desired outcomes for there research. The reference list also shows that no references have been used more than once also suggesting that the literature search is a thorough one.
The authors have clearly identified the study limitations in this article. Dempsy and Dempsey (1996) say that the limitations of a study should be clearly identified in order for the readers of the study to judge the effects of the study for themselves. They also point out that the limitations in a qualitative study are restrictions, which are out of the researchers control. The authors talk about the limitations of this study being the small sample size and how direct observations of the involvement of parents and parent/nurse interactions would have provided additional information on the nature of parental involvement. Children were not interviews the authors mention this as a possible limitation as this could have provided a third perspective. They have said that the timing of the interviews being just before there child’s discharge, might have been a limitation influencing the parents and nurses to reply with positive answers towards the other party, due to feeling under pressure to do so. However this was not the case and both parents and nurses expressed negative views anyway.
Holloway and Wheeler (1996) say that in qualitative research there isn’t an initial Hypothesis, but the researcher will have an idea on the development of the study. This was true to this study and it does not have a Hypothesis.
It is clear that the method used for the study was a qualitative approach. Niewswaidomy (1998) postulates that each qualitative method is unique. It should be dependent on the hypothesis or desired outcome of the research. As there is no hypothesis the desired outcomes are looked at instead to see the views of parents and nurses about the involvement of parents in the management of the child’s pain during the first 48 hours after surgery. It is highlighted that the method used within the qualitative piece will be phenomenology. Phenomenology is usually used in qualitative studies as they relate to people’s experiences and lives. Burns and Grove (1999) support this. Phenomenological approaches to research usually gain high levels of data that in return needs to be analysed. This is why when phenomenology is usually used the researchers might keep the sample size down to a minimum. This could have been the reason for the sample in this study being a small one. The authors point out that this approach is ideal for exploring the views of parents and nurses regarding parental involvement in their children’s pain care.
In order to meet aims of exploring parents’ and nurses’ perceptions of parental involvement in their child’s pain care, each interview had an open-ended structure involving four questions designed to elicit the parent’s and nurse’s individual perceptions of involvement in each child’s pain care. Open-ended questions allow the respondent to compose their own answers rather than choosing between a number of given answers. Haralambos and Holborn (1995) say this may be more likely to provide valid data since respondents can say what they mean in their own words. However, they go on to say this kind of response might be difficult to classify and quantify. Answers must be interpreted carefully before the researcher is able to say what the views of parents or nurses are on the subject. According to Clamp and Gough (1999) questionnaires are probably the single most common research tool that is used in the social sciences.
This is due to the simplicity, versatility and low cost of this particular method of data collection. Interviews were taped to gather the information required for the research. Bernstein et al, state that interviews are a very good tool for collecting information that is sensitive and cannot be predicted in advance. However interviews can provoke powerful emotions relating to past events, which can be both traumatising and emotional for the interviewee. This can place considerable responsibility on the interviewer and can have great ethical implications. (king 1996)
This study clearly outlines the ethical implications of this research study. The local Research Ethics Committee of the hospital at which the study was taking place granted ethical approval. All the participants gave written consent for their participation in the study. It was acknowledged that some parents would find talking about their child’s pain might be stressful to them or they may wish to talk about some other aspect of their care. For this reason interviews were conducted where the parents felt most comfortable and there was no time limit for the interviews. Lewis and Barnes (1997) say that when dealing with integrity variables such as the consistency and the interpretation of a research article, confidentiality must be maintained at all times. Polit and Hungler (1991) state that in situations when anonymity is impossible, appropriate confidentiality procedures need to be implemented. In this study interviews were transcribed by the researcher using Microsoft word for windows, version 7.0. Chunking and coding programs have been specially developed for researchers to meet the needs of qualitative studies and are particularly useful for analysing fieldnotes and transcripts. (Benton 2000) The 20 parent and 20 nurse interviews were coded to maintain anonymity of the participants.
The results of this research article were set into tree major categories that had emerged from the analysis of the interview transcripts, these were made very clear and easy to understand as three bullet points, with a brief description of each, ‘shared perceptions,’ ‘differing views’ and ‘communication difficulties’. These categories were derived from the qualitative data analysis undertaken. Further on in the findings section these points are expanded on and explained.
In order that the conclusions drawn from this study reflect the views of the parents and nurses, data analysis occurred through a form of recursive comparative analysis this design is appropriate if the researcher is going to examine and describe the variables in two or more groups. (Carter 2000) This is clearly the most appropriate data analysis for this piece of research as the two groups, being the parents and nurses, the variable, being the Phenomenon of interest, and then comparison of these variables. The unfolding description in constantly tested and refined then the themes were checked by two expert nurses for further validation, and they were in agreement with the themes found. According to Depoy and Gitlin (1994) rigorous data analysis allows the researcher to uncover multiple meaning and perspectives of the phenomena being researched.
In the discussion undertaken in this study the research findings state that perceptions of parents and nurses regarding parental involvement in the management of their child’s pain, that they had some shared and some differing views on key aspects of involvement. They talk about nurses not inviting parents to get actively involved or discussing way they could be involved and how parents were not willing to challenge the nurses or even in some cases voice concerns. They give a possible explanation for this being difference in power, in nurse/patient relationships. They back up these comments with reference to other people’s research that had previously been undertaken as well as their own finding.
These findings were consistent with other research suggesting the lack of involvement by parents in children’s pain care. However with all that has been stated within the discussion section it all tended to lean toward the researchers original research question and supported there finding, but no-where in this section did they present an argument against there findings. They have however noted that there must be a lack of communication between parents and nurses to have such differing views and that nurses need to discuss with the parents the involvement they could have in relation to pain management.
The second article that is going to be critiqued is a quantitative piece with a systematic random sample of 369 staff nurses working at a major academic medical centre in Jerusalem Israel were invited to take part in the study, of which a total of 279 nurses actually participated. This could suggest that a certain type of person (one that answers to questionnairs) will be in the main part of this sample. (O’Donnell 1997) Systematic random sampling involves selecting names at regular intervals, depending on how big the sample is to be. According to O’Donnell (1997) systematic sampling leads to greater precision than totally random sampling as it produces a more even sample spread over the population list. This appears to be an appropriate way to sample as the numbers are large enough to have selected a group representative of this target population.
The participants were from a hospital in Israel but the authors point out that the population of about six million is made up of immigrants from vastly differing cultures. They also say that with differing cultures comes different health care beliefs. This could have been one of the limitations as culture would be of major importance to the participants when thinking about and answering questions about CAM. The authors have mention these points but have not really discussed much about them or that they could have influenced any of the results.
When looking at the title it is clear to see what the authors are trying to find out which are knowledge levels of staff nurses in Israel towards complimentary and alternative medicine. There is no obvious hypothesis as there usually is with most quantitative research. There is however several questions the authors want answered in the study section of the research. Because they want so many questions answered maybe this is why they did not stick with only one hypothesis and used a selection of questions instead. These questions will and can be tested using questionnaires.
At first it appears that the research piece is not set out the way an article is usually constructed with an introduction section to start. This leaves the article somewhat different to start reading. The main function of the introduction is to provide the background to the study indicating why it was carried out. (Cromby 1996) Although the authors have not called it an introduction they have produced the same thing but under the heading ‘background’ Cormack (2000) points out the general introduction to the subject of the research will include a discussion of the importance, and of the need for it to be researched. The authors in this piece have done this in their background section of the article.
According to Crombie (1998) an immediate guide to whether a piece of research is worth reading or not comes from the title and the abstract of a piece. This goes in line with what Ryan-Wegner (1995) states in her published book. She states that the abstract of a research article should answer accurately the following questions. They should clearly state the research problem, the sample, what major variables are included, the research question and hypothesis, the method and the results of a piece. When looking at these points indicated by Ryan-Wegner it could be said that the abstract of article 2 looks to be quite a good one with all the indicated points included except for the hypothesis which the article does not have anyway.
The literature review appears to be a thorough extremely up to date (mainly research in the late 1990’s) piece of the research with a very wide range of studies from many different countries. They found that previous studies showed that participants felt good about CAM and enjoyed time and attention from their CAM practitioner. The authors also mention the three studies, which found no association between patient satisfaction and referral to CAM so showing that important references are not omitted just because they don’t agree with the other finding. They also point out that these discrepancies could be due to varying definitions and methods of measuring patient satisfaction. (Corner 1991) This shows that the literature review does present a balanced evaluation of material both supporting and challenging the position being proposed. Other studies showed that some variables such as education, income, age, perceived health status and satisfaction with medical therapy are associated with use of CAM. As indicated by Notter and Holt (1994) the purpose of a literature review is to familiarise yourself with the literature in the field under study. Upon reading the literature review it becomes clear that an ample review was conducted.
As the researchers have studied human experiences, it could be considered to be a qualitative study and the fact that there is no apparent hypothesis. However, the methodology employed, particularly in the data analysis would indicate a quantitative approach even though this was already known at the beginning it would have been a bit more difficult to work out if this information was not available.
There was no pilot study and the research doesn’t seem to be experimental, as there is no hypothesis to test under a controlled situation. Cormack (1996) suggests that a pilot study might have given the researchers an idea to help to determine a variety of practical questions and make sure the participants understand what is being asked of them. This study is a descriptive survey of patients and nurses, but only the part about the nurses is described in this research. The research design is one that seeks to accurately describe what is and to analyse the facts obtained in relation to the problem under study, this appears to be an accurate design for the research in this article.
Four self-administered, pencil and paper questionnaires were distributed to each of the participants. Questionnaires according to Grey (1994) are of great advantage when conducting research; they are cheap, easy to complete and can assure anonymity to the participants. The first questionnaire it was designed to determine the level of knowledge and attitudes towards CAM. A four point Likert scale was used, Edelmann (200) points out that although the 1 to 5 format is widely used, a wide range of other formats have also been employed. In the article the authors do not discuss the rationale behind conducting their research by using this particular data collection method. Nonetheless it does seem from an outside reader to be the more appropriate tool to have used given the clinical setting and data needed to collaborate. It was beneficial too, to actually see the questions on the Likert scale and the choice of responses available. This helps the reader to understand the results and analysis a lot more efficiently. When looking at the Likert scale in this piece of research the four point scales are, ‘not at all’, ‘a small amount’, ‘a moderate amount’ and ‘very much’. It could have used the five point Likert scale and maybe it would have benefited from having the extra one, as there is no option for, ‘don’t know’ or ‘not sure’.
The second questionnaire was to measure a subject’s satisfaction with the patient-physician relationships. This one asked the nurses their levels of satisfaction with care they received from their physician this was also on a four point Likert scale and the questionnaire was divided into two halves. The first half is questions on their actual experience with physicians and the second half being the nurse’s perceptions of an ideal physician-patient relationship. The difference between the two is thought to represent the level of satisfaction with the physician. The third questionnaire was developed by Wallston et al. This was designed to test the health locus of control and used a six point Likert scale. The fourth questionnaire included questions about gender, age, and country of origin, type of nurse qualifications, general health status and clinical area; these too were measured on a Likert scale.
Edelmann (2000) states:
‘A Likert scale can thus indicate the relative ordering of different people’s attitudes but does not indicate precisely how close or far apart these attitudes are’. p. 281.
Conversely the authors of article 2 never mentioned ethical practice, only that informed consent was obtained. It was never stated if the participant’s anonymity would be respected. Furthermore there was never any mention of this research being brought before an ethics committee, which is both ethically and morally challenging.
One of the data analysis tools used were that of the Statistical Package for the Social Sciences (SPSS) that was derived for the usage in conjunction with windows in 1997. SPSS is a computer programme that can perform a data analysis and provide the results of the analysis in the form of a computer printout. Burns and Grove (1999) state that in order to get the correct information out however, the correct information must be put in. The t-test is a very common parametric test that is used to assess whether there is significant change between two or more phases. Robson (2000) supports this statement. According to DePoy and Gitlin (1994) the test for reliability should be administered twice, of which two mean scores should be obtained, from these then should be calculated the mean score of each group. The t-test has been carried out twice in this piece of research and is clearly mentioned in the data analysis section.
The data analysis tools used in article 2 were, Chi-squared to determine association between nominal level variables of which the difference can never really be measured. (Cormack 1996) Spearman P, to measure relationships between ordinal levels which is more informative. Pearson product moment correlation to look at correlation’s between interval and ratio level variables. Cormack (1996) points out that this is usually used only in quantitative data analysis as it has here.
As Smart (1997) discussed all data collection and analysis gives you a large amount of raw data that is burdensome and gives you very little information to both the authors and the potential readers therefore it is imperative that the data is summarised and portrayed in the correct manor.
Unless a person is well used to reading statistical results it would be very difficult to understand these findings by reading the results section, even though the statistical analysis appears to have been correctly performed. The four questionnaire results are clearly separated and identified by use of sub headings. There is sufficient analysis to determine ‘significant differences’ in the data that was being compared.
When reading the discussion and conclusion of the article no study limitations have been mentioned. Although the study was carried out at one hospital implications can be seen from its results. This has been identified in the discussion. All the questions the authors had put forward for this piece of quantitative research have been answered and clearly an overall satisfactory result was obtained. There are no recommendations identified and no weaknesses in its design have been recognised for further researchers reading this article.
In conclusion to both the articles that have been critiqued it is fair to say that they are both very informative to their topics. The qualitative piece was an extremely easy read and very clear and precise. The quantitative piece did seem to be difficult to read and understand but this might be due to the fact that the person reading it was unfamiliar with statistics and quantitative research and some research terminology. The framework used to critique both articles was that of Benton and Cormack (2000) and it was a very useful tool. This enabled a detailed critique of the articles and would be used in the future for any research critique to be carried out.
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