Qualitative Article Critique - Essay Example

?Journal Article Critique Bibliography Elliott, N ‘Mutual intacting a grounded theory study of clinical judgement practice issues. Journal ofAdvanced Nursing, vol. 66, no. 12, pp. 2711–2721. doi: 10.1111/j.1365-2648.2010.05412.x. 1. Statement of the Problem a. Research Topic The topic of the research is the importance of decision making ability in nurses in their advanced clinical practice regarding chronic and acute care outpatient contexts. According to the author, “‘mutual intacting’ highlights subtle yet important strategies that practitioners used during the process of clinical judgement” (p. 2718). b. Research Problem As the topic of the journal article clearly suggests, it is very important for nurses to acquire excellent skills regarding the understanding of the patients’ problems and devising solutions to counter those problems. Many researchers (e.g. Hardy & Smith 2008; Pardue 1987; Mattingly 1991) have studied the importance of clinical judgments and have found that clinical decision making is becoming a significant part of today’s health care. Thompson et al. (2004), in their research, also affirm that the nurses’ “decisions have important implications for patient outcomes”. How clinicians process patients’ and their diseases’ information while giving serious consideration to psychosocial issues is the research problem the author has brought forward. According to him, the “current theoretical explanations of clinical judgement” are “incomplete” (p. 2711) because these do not talk about the psychosocial issues that should be involved in clinical treatment. Since, past research has only focused on decision making for acute care hospital settings; hence, there was much need for a research that talked about clinical judgments from outpatient perspective where clinicians and patients both participate in the decision making process. The author has come up with a grounded theory study that suggests mutual intacting which involves such strategies that the health practitioners used in decision making while enabling the patients to actively engage in the process. This also helped improve the relationship between the practitioners and their patients. The problem statement very well goes with the title the author has suggested and has good scholastic importance. The problem can be well understood by an average reader and the research is not limited to the author’s own aptitudes and ideas. The abstract provides a brief but compact summary of the research and gives a good overview of the research’s aim, background, method, findings and conclusion. c. Research Questions/Hypotheses This research sought to test the hypothesis about how much important is the decision making ability or clinical judgment for nurses who are working at advanced clinical level in chronic and acute care outpatient contexts. The hypothesis was testable and explained the problem surely well by simultaneously giving significance to physician-patient relationship which the author referred to as psychosocial issues often ignored in the past literature. The author’s main research question was- what practice strategies are being and should be used by the practitioners to assist eliciting patient information and deciding on treatment interventions? What were the clinicians’ main concerns when making clinical judgements for the patient? and how did they resolve those concerns? 2. Review of the Literature The author has given an extensive review of literature citing other researchers’ works and explaining them in order to support the need to conduct this specific research. He has cited many researches which discuss the importance of clinical judgment in acute care hospitals or for critical care. The research works in this manner studied by the author came from Lajoie et al. (1998), Cioffi (2001), McCaughan et al. (2002), Bucknall (2003), Hoffman et al. (2004), Hancock & Easen (2006). The author has mentioned the work by Lauri & Salantara (1998) who conducted an empirical research and found that the context of critical care was of significant importance in clinical judgment. The author shows major criticism in words like “…the majority of studies are carried out in acute care hospitals”, and “…few researchers have considered clinical judgement in outpatient settings, representing the opposite end of the continuum in relation to care context and level of patient dependency”. While explaining the cited literature’s discrepancies, the author states that the researchers should focus more on outpatient clinical settings where patients are allowed to be more involved in their health issues. Some researchers like Polkinghorne (2004) and Tanner (2006) have devised strategies and models to facilitate outpatient care. The author asserts that despite all past research, this study is going to fill the gap in the existing literature by giving even greater consideration toward devising strategies to support outpatient clinical judgment. The author has studied literature between the period of 1984-2007 hence we can say that the literature studied is not very current as most of it belongs before the last decade. 3. Research Design and Methodology The author has used an empirical approach. The design is qualitative or naturalistic as it talks about a human phenomenon of latent behavior that enables him to devise strategies to interact with other human beings. The author, with the help of past research works, has worked upon a grounded theory that explains this latent behavioral patterns within human mind. The methodology used to gather statistics and information to carry out the research has been fairly explained by the author. The data collection means have been described in substantial detail which will be discussed in the coming section no. 6. The author has not clearly mentioned why he wanted to use the naturalistic approach but we can assume that he wanted to find out the impact of human latent behavior on decision making. Hence, his choice was appropriate. 4. Population and Sample The author clearly mentioned the population and sample. The target population was all nurses working at advanced clinical level in chronic and acute care outpatient settings. The purposive sample consisted of twenty-one nurses working in “six healthcare organizations in the Republic of Ireland”. The sample size was small as compared to the author’s requirement of getting accurate results and keeping in view the variation existing in the population. However, the researcher spent good deal of time in selecting the sample elements by making certain criteria of which experience was the most important. The sampling strategy used was non-probability sampling. 15 nurses were recruited through tracing in mental healthcare institutions as this was known for nurses working in outpatient contexts. 27 interviews were conducted which suggested that mutual intacting in healthcare described the therapy plus therapeutic relationships. Six participants were recruited from a general accident and emergency unit to give variation to sampling, with which six more interviews were conducted. The response rate was fast enough. 5. Ethical Issues According to the author, “Approval was obtained from the participating healthcare organizations and from a research ethics committee”, which means that he gave special consideration to ethical issues that might arise during the research process. 6. Data Collection As stated earlier, the data was collected through unstructured interviews with participants, which was time consuming. In author’s words, the “interviews were audio-recorded and transcribed verbatim” and were conducted with a participant right after he had treated a patient in his private office. The only data collection tool the author created, not required to be tested in a pilot study, was the questions in the unstructured interviews. 7. Data Analysis The author used the grounded theory’s inductive analytic approach to study the latent behavioral patterns arising within a human mind with the help of which a practitioner utilizes techniques to maintain healthy therapeutic relationship with his patients. The author came up with various codes that described the practitioner’s clinical judgment. This coding was made to go through selection process until it was delimited to the emerging conceptual framework and a core category was identified. While going into the detail of the grounded theory, the author confesses that his findings should be reanalyzed and re-experimented because these did not completely complied with all the processes involved in the grounded theory. 8. Results/ Findings The core category that was identified was the mutual intacting which described the strategies practitioners used to deal with outpatient care settings. This concept described how practitioners improved their treatments and how much consideration they gave toward building healthy relationships with the patients. It was found that mutual intacting comprised of three main concepts: intacting therapeutic relationship, situated patterning, and intacting therapy. The participants worked on all these concepts thus validating the effectiveness of mutual intacting. The sampling procedures defend the results and the conclusions were logically based on the findings of the research. 9. Discussion Issues / Overall Critique It was an immensely detailed, well written and well systematized research project. The author has described some limitations in words like “…inductive–deductive analysis was grounded in the practitioners’ accounts and was limited to their perspectives.” He admits that the sample he used was small and that the recruiting criteria were limited because at the time of research, ANP databases were not formed which hardened the sampling selection. Comparing the study with past research works, the author states that this study focused more on person-to-person interaction which past researchers ignored. The author recommends that there is need for further research that should also focus on the patients’ perspectives in this context. The findings are transferable as the author also recommends that this research should be used to understand and implement the pursuance of education regarding psychosocial issues in health care. Overall, it was a good addition to the research base related to patient involvement in decision making regarding their heath. References Hardy, D, & Smith, B 2008, ‘Decision making in clinical practice’, British Journal of Anaesthetic and Recovery Nursing, vol. 9, pp. 19-21. DOI: 10.1017/S1742645608000028. Mattingly, C 1991, ‘What is clinical reasoning?’, The American Journal of Occupational Therapy, vol. 45, no. 11, pp. 979-986. Pardue, S 1987, ‘Decision-making skills and critical thinking ability among associate degree, diploma, baccalaureate, and master's-prepared nurses’, Journal of Nursing Education, vol. 26, no. 9, pp. 354-361. Thompson, C, Cullum, N, McCaughan, D, Sheldon, T, & Raynor, P 2004, ‘Nurses, information use, and clinical decision making—the real world potential for evidence-based decisions in nursing’, Evid Based Nurs, vol. 7, pp. 68-72. doi:10.1136/ebn.7.3.68. Read More