Day Surgery Patients - Book Report/Review Example

Critical Appraisal of Published Papers Essay Qualitative study: Gilmartin, J., & Wright, K. (2008). Day surgery: patients felt abandoned during the preoperative wait. Journal of Clinical Nursing, 17(18), 2418-2425. Introduction Day surgery is a new term for an old concept. In the past, hospitals were used mainly for the poor and were by and large voluntary units that were charitable in nature. These became widely used with the introduction of medical insurance and the beginning of the National Health Services (NHS). With complications arising in elective operations like taking more time, and with the replacement of Lister spray with anesthesia, more and more operations were undertaken at hospitals (Penn & Davenport, 1996). It has also been recognized over the history of time that many patients before and after surgical procedures need prolonged expert nursing care. This is where the examination of nursing routines and the importance of outlining the duties of the nurse in a day surgical setting assume importance. The following essay is in essence a discussion on one such research entitled, ‘Day surgery: patients felt abandoned during the preoperative wait’, published in the Journal of Clinical Nursing, and written by Gilmartin and Wright in 2008. Thesis statement: Do day surgery patients feel abandoned during the preoperative period? Executive summary of the research The article focuses on the fact that the increases in the volumes and the complications of surgery have meant an increase in the role of the nurse in the entire process. There is a big part to be played by the nurse-led pre-assessment in the ultimate diagnosis of the patient and in the management of provisions, such as information, pain management and postoperative intervention. The literature of the issue is scattered, disorganized and full of weaknesses. The problem with most studies is the lack of attention to the patient perspective from admission to discharge, the anxieties evoked, and the potential needs of patients are not well articulated. The study attempted to describe and interpret patients’ experiences of recent day surgery using an approach based in scientific research, justifying cognition based on evidence presented in a clear and concise manner. This, according to Cohen, Kahn and Steeves (2000), is in keeping with the principles of hermeneutic phenomenology. According to Makela and Witt (2005), the practice of evidence-based medicine and healthcare is a five-step process, which includes: 1. Clinical question formation for getting answers 2. Looking for an answer that is available in the best possible way 3. Analysing evidence for importance and validity 4. Application of evidence in practice; and 5. Evaluating evidence on a practitioner’s level It is on two different levels that the clinical problems occur; one at the level of handling the patient and another on deciding on the course of action required.. (Makela and Witt (2005)) This can be taken care of by going through the previous results taken from randomized trials, apart from diagnostic tests done with results from new tests taken into consideration. Statement of purpose Rosenbaum and Smith (1998) outlined the first major aim of a research paper set in a clinical context as being the statement of purpose, which would be the objective that the researcher is trying to achieve through the process of scientific investigation. In the context of this paper, the stated aim of the study was to make a description and come up with an interpretation of the patients’ experiences of contemporary day surgery. The stated purpose of the study is comprehensive, but could have been streamlined a little more in the context of the particular aspects of the patient care that the research wished to study. In the literature review, it is essential that the researcher carries out a thorough investigation of the previous researches in the field. (Cooper, H. M. (1988)). A literature review is conducted in terms of the three basic elements of academic reading: 1. Browsing in which one flicks though books and journals looking for things of interest; 2. Reading for specific information; and 3. Reading for research. The problem with the application of the first two methods in scientific research is that most ideas are random and other valuable articles might be missed. Therefore, according to Greenhalg (2006), there is the need for indexing and using databases so that the scattered nature of the information can be categorized and brought together in terms of the specification of subjects. In the context of the paper at hand, this categorization is missing in the introduction where the literature review comes across as being haphazard and random. The basis on which past research has been excluded or included in the study has not been specified, nor has any timeline been kept track of in terms of the publication of the research. Research Methodology Qualitative research methodology has been defined by Strauss and Corbin (1990) as “a way to gain insights through discovering meanings by improving our comprehension of the whole.” Qualitative research, broadly defined, means “any kind of research that produces findings not arrived at by means of statistical procedures or other means of quantification. (Bogdan, R. F., & Biklen, S. (1992)).”. Interpretative Phenomenological Analysis (IPA) is a relatively recent qualitative approach developed specifically within psychology. A research based on IPA method would be ideal in dealing with the identified problem, because it would take into account the nuances of the human mind and the responses in similar kinds of aggrieved situations. Given the fact that much of the data collected in this research focuses on the subjective perception of the patient in terms of satisfaction, the qualitative data would be the better methodological approach for this research. The method is scientific, yet philosophical. Sampling took place with patients in the three departments of gynecology, urology and general surgery, which would seem to be a comprehensive list. The sample size of 20 patients is small, which could be argued as being non-representative. Just like other studies of this form, this study also has its limitations. The most notable limitation in the study is the existence of method bias.  A big problem with the sample was the race bias, given the fact that the population comprised mostly of white patients, thereby eliminating the race and cultural aspects of the sample. Data collection method: Walliman and Appleton (2009) are of the opinion that an appraisal of the article necessitates an analysis of the method of data collection and analysis to be read in detail, so as to reach the crux of the data in hand.. Unstructured interviews were used to collect data. One important question was asking participants a direct question on their own experiences pertaining to the day of surgery. Questions were then asked to clarify and understand the patients’ statements. They were encouraged to disclose only what they felt comfortable with. Probing, non-verbal cues, and active listening were used to get proper responses. The interviews were carried out in the participant’s homes. The problem with this method is that it is subjective and open to the interpretation of the interviewer. As opposed to this single answer questionnaires with multiple choices like ‘yes, no, or can’t say’ would have been a more objective manner of collecting information. Better still an online survey would have fetched more data or even a comprehensive manual survey.. The time space variable has not been kept in mind inasmuch as no range of circumstances were measured or varieties in them considered. Data collection was also limited to a single method and the research does not mention whether the methods employed are reliable and independently verifiable, such as audiotape, videotape, and field notes. Data analysis: the research made use of the following three essential approaches to the identification of thematic aspects of the phenomena: 1. Holistic approach was employed on the whole readable text and the unique question was the one that expressed the essence of the fundamental meaning of the whole. 2. A selected meaning approach was employed; the text was reread, posing the question regarding which statements appeared vital or revealing about the phenomenon being described. 3. Finally, to examine every sentence or cluster of sentences a comprehensive questioning tool was used. This led to the description of the experiences. One finds no mention of participant observation as a stated method of data analysis, which would have given the research a nuanced understanding of context that could have come from personal experience. The research seems to have glossed over the differences of interpretation inasmuch as there is an underlying assumption that all interviewers and the facts that they outlined were similar, and there was no conflict of opinion. Negative or discrepant results were not addressed in the data analysis. Patton (2002) outlines three methods of data evaluation: the formative, the developmental and the summative, which one can understand in the context of program development and the priority of information needs. The where, how and when questions have therefore not been correctly addressed. Results There was no quantitative measurement of the methods on which the generalizations of the results have been drawn in the research. In all fairness, the research identifies four basic emergent themes from the work done. These include: 1. The feeling of abandonment in the preoperative waiting area; 2. The feeling of empowerment during preparation; 3. The apprehensions encountered; and 4. The dynamics of recovery. The study has made its contribution in bringing out the human aspect of the surgical process, which most medical professionals in their urge towards efficiency tend to either overlook or completely ignore. The aim of the research has been to outline the issues of depression, emotional trauma and helplessness faced by pre-op and post-op patients. The research attempts to do this by outlining the important aspects of interviews by quoting them verbatim, bringing out the problems of the patients in their entirety. For example, women focused more on the potential threats associated with having a general anesthetic and undergoing surgical procedures. The basic outcome has been an inordinate focus on the psychological factors to define the patients in such a scenario. The problem here is that there is no balance and no consideration for resource constraints, along with no solutions being offered to solve the problem. Finally, the problem statement is complete; however, the research shows no ingenuity in asserting even remote solutions. Conclusion To sum up, it may be stated that this particular research, if taken to be a study on the humane side of operations in day surgery, would provide one with bountiful insights into the psyche of the patient and the problems that plague these patients in question. On the other hand, as a work of academic research which seeks to have an impact on future research in medical management backed by empirical proof, the article falls far short of average expectations. All in all, this is a piece to be read more in terms of a discussion and less as a piece of research. References Abeyasekera, S., & Lawson-McDowall, J. (2000). Computerising and Analysing Qualitative Information from a Case Study Concerning Activity Diaries, pub, Case study produced as part of DFID research project R7033. Bogdan, R. F., & Biklen, S. (1992). Eight common questions about qualitative research. In Qualitative research for education: An Introduction to theory and methods (pp. 39-48). Boston: Allyn & Bacon. Cooper, H. M. (1988), "The structure of knowledge synthesis", Knowledge in Society, Vol. 1, pp. 104-126 Cohen, M. Z., Kahn, D. L., & Steeves, R. H. (2000). Hermeneutic phenomenological research: a practical guide for nurse. Sage Publications, CA Denzin, K. N. & Lincoln, S. Y. (2000). Handbook of Qualitative research (2nd ed.). Thousand Oaks, CA: Sage Publications Gilmartin, J., & Wright, K. (2008). Day surgery: patients felt abandoned during the preoperative wait. Journal of Clinical Nursing, 17(18), 2418-2425. Greenhalg, T. (2006). How to read a paper: the basics of evidence-based medicine. Wiley books, New York City 15-17. Makela, M., & Witt, K., (2005). How to read a paper: critical appraisal of studies for application in healthcare. Singapore Med J, 46(3), 108-114. Penn, S., & Davenport, H. T. (1996). Principles of day surgery nursing. Wiley Books. New York City, 2-5. Patton, M. V. (2002). Qualitative research and evaluation methods. Sage Publications. CA, Rosenbaum, D., & Smith, F., (1998). Clinical research monitor handbook: GCP tools and techniques. Informal HealthCare. 6-8. Walliman, N., & Appleton, J. (2009). Your Undergraduate Dissertation in Health and Social Care. Sage Publications. CA, 149-150. Western, A., Chambers, R., & Boath, E. (2001). Clinical effectiveness and clinical governance for midwives. A1 Books, Oxford, 63. Read More