Research Methods in Healthcare - Essay Example

 Research Methods in Healthcare Purpose/Research Problem Seeking to critically appraise a published research paper form the Journal of Clinical Nursing, this project aims to provide a holistic analysis of a contemporary article entitled ‘Coronary heart disease patients’ perception of their symptoms and sense of control are associated with their quality of life three years following hospital discharge’ by Lau-Walker et al (2008). The framework chosen to critical appraise the article is from Coughlan, Cronin and Ryan’s (2007) analysis of quantitative research. This framework will be used as it matches the approach of critiquing a quantitative research paper and can be found in the attached appendix. Critical appraisal is an essential step in the process of putting research into practice. The Nursing and Midwifery Council (NMC 2008) requires registered nurses to be able to provide a good standard of care, as such is essential that nurses are able to properly synthesize and critique quantitative data. Asking questions about an article’s research methodology, scrutinizing its data collection and analysis methods, and evaluating how its findings are presented should help to determine whether a certain article’s conclusions should influence practical decision-making. This enables nurses to maintain both professional knowledge and competency to the highest standard by delivering care based on up-to date and relevant evidence. Critical appraisal can achieve this through the understanding of the research process by demonstrating the ability to retrieve the information and critically assess research findings. Logical Consistency Does the report follow the research steps in a clear and logical manner? Yes, prior to the introduction of this research paper, the authors are highlighted on the front of the article and all their qualifications are produced along side this. This is a useful indictor to highlight the authors’ qualifications for the research paper (Coughlan et al, 2007). Thus, the fact that each of the authors is a senior scholar in the UK lends credence to the assertions put forth in the paper. Having the qualifications at the outset establishes the credentials of the authors undertaking the study and demonstrates the scholarly nature of their analysis of coronary heart patient’s perceptions of their symptoms. Having this before hand experience can be beneficial to the researchers, in helping them to determine and develop the type of questions which they are trying to generate. Depending on the knowledge the authors are trying to gain, different types of research questions will generate different types of knowledge, making it important for the researchers to express questions in ways to produce the relevant outcome (Crookes and Davies, 2006). The title of this journal article at first seems informative but Coughlan et al (2007) suggest that the title of a report should be between 10 and 15 words long and the title of this research paper is much longer at 24 words long. This is perhaps is due to the context of the subject, allowing the reader to have enough information about the article prior to reading it, but it nonetheless remains a rather large title for a scholarly article such as this. Also absent in the title was the initial point of identifying that the study is a longitudinal study, thus resulting in the reader having to read more than the title to know the purpose and type of study it was. Therefore it is paramount for the title to be clear and concise for the purpose of the general reader. According to Gerrish and Lacey (2006) an abstract should enlighten the reader to the whole study; it should include information such as the research problem, sample size, methodology, findings and recommendations (Coughlan et al, 2007). In a research article the abstract enables the reader to decide whether or not that particular study will meet their needs or primary interests (Fain, 1999). The abstract in this article consists of a clear overview of the study which provides the reader with a short insight of the method, results and conclusion enabling the reader to assess if the article is useful. The abstract here is clear and concise as it has headings which relate to the aims of the study, the background, methods, results and conclusion. Thus it is very clear. The logical consistency throughout the review is consistent, and follows an expected order. There are subheadings in the article which allow the steps throughout the review to flow and allowing the reader to break up the review and follow it at his or her own pace. This allows the reader time to understand and consider the key aspects of this important study on people’s perceptions of the symptoms of coronary heart disease (Coughlan et al, 2007). Literature Review The main purpose of a literature review is to define and develop the purpose of the research study and to be able to identify an appropriate method of data collection (Gerrish and Lacey, 2006). This article includes a thorough literature review, which allows the reader to gain a reasonable understanding of the issues surrounding coronary heart disease and the applicability of the study being carried out. It clearly gives a detailed account about the issue been researched, mainly people’s perceptions of symptoms with heart disease and their effects. In this article the literature review is perhaps little long which causes the reader to loose interest and thus disengage with topic. Theoretical Framework The framework for this article can be analyzed by positive ideas drawn from the literature review and concluded into a viable hypothesis that would provide a good framework for this study. Having said this it is clear to the reader that the theoretical framework lacks detail however certain aspects of the framework can be considered concise. The relationship between the measures used to identify a patients quality of life have also been approved in the past by Garrett et al (1993); Ware et al (2000) and Garrett et al (2002), and have all been cited in this study. Aims The purpose and the problem of the research study should be established in the introduction (Bassett and Basett, 2003 cited in Coughlan et al, 2007). Allowing the reader to recognize what the purpose of the study is as well as what’s researched. The research paper under analysis explores the issues which arise with patients with coronary heart disease. The introduction was concise and very informative. It allowed the reader to grasp and engage in the concept under analysis. (Hamer, 2005). In any sort of report of this kind it is important that it is written well, concise, is grammatically correct and avoids the use of jargon. The layout is also paramount to the initial overview of the report; it should look well organised and tidy, as writing styles used in such research papers attend to attract readers (Polit and Beck, 2006 cited in Coughlan et al, 2007). In this research article the writing style was simple to follow and easy to understand, which meant it did not throw the reader off track and was it was easy to remain focused on the research topic that was being discussed. The article did not use jargon, and all the points discussed within the paper were relevant and concise to the research topic. The use of jargon in any article, can highlight difficulty for the reader, as the terminology is not always familiar to the reader and is not always easy to understand, therefore this paper was easy to read. A hypothesis needs to be clearly identified in order to declare and state to the reader the link between the initial purpose of the study and how the study will be undertaken. Resulting in the importance of a hypothesis in a research paper (Bowling, 2002). In this article the hypothesis is clear and concise which enabled the reader to identify what the study is designed to measure, namely to explore the association between coronary heart disease patients’ illness beliefs and their quality of life years after discharge. Sample In a research article the sample size reflects the population that’s drawn from and is identified as been a representative sample, this in term determines the adequacy of a study (Polit and Beck, 2006 cited in Coughlan et al, 2007). In this sample, 130 patiends above the age of 18 were utilized for the purpose of analysis. Using small samples in a quantitative study can be seen as a contingency, as they can overly represent small subgroups within the target population. In this paper noticeable to the reader, that there is a good sample size used, it clearly identified who the target population was and what criteria was used to include and exclude participants. Thus allowing the reader to understand why the target population was targeted and for what reason individuals were excluded. The researchers also used a statiscian; and this showed a good level of statistical background that was gained. The article discusses the response rates from the participants; and the participants whom did not complete the questionnaires the researcher gives reasons for this. The paper also mentions participants who were excluded from the study after the first questionnaire, this was because they no longer met the requirement, as they did not confirm a cardiac diagnosis, and therefore a decision was made to exclude them from the analysis. Ethical Considerations Critiquing the research with respect to ethical considerations, it is apparent that there were some ethical concerns when carrying out a study which involved other people’s safety. Due to having ethical principles governing the research individuals involved in the study are not harmed as a consequence of contributing in the research and should give their informed consent to participate (Bowling, 2002). In this article ethical issues were discussed briefly; the paper stated that all three questionnaires were approved by the local research ethical committee. For an order to take place of a certain study it requires an application from the NHS Research ethics committee (REC) which categorically states the primary research question and other secondary research questions (Gerrish and Lacey, 2006). As well as this the committees also require clear justification that establishes why the current research study is worth doing and what are the benefits from undertaking the study. Operational definitions Looking at the terms in this article, the reader was able to clearly understand the different theories and concepts involved throughout the paper. Terms should be made understandable to the reader throughout the research study, due to the fact of any terms, theories or concepts which are not clearly defined can be misleading and may cause the reader some confusion. This article flowed well with its theories and concepts. Clarity was important and the written components of this article were clear and concise. Methodology The methodology throughout the article is one of a longitudinal prospective survey and this was illustrated at the start of the paper. Longitudinal studies are observational and this research paper can best be described as a cohort study. The study is a quasi- experimental design, as defined by Robson (2000) (cited in Coughlan, Cronin and Ryan, 2007). The type of study corresponds to the hypotheses posed which illustrates a good point. This cohort study enables the reader to gather up the relevant information using the data produced throughout the paper. However the researcher used two samples from one set group of patients into two different hospitals as well as using three questionnaires with each patient. This method shows that there was not any random allocation of samples due to the fact of only two hospitals being selected in the United Kingdom generating less room for random sampling error. The questionnaires used in had not been specifically designed for this study; in term generic questionnaires that were already approved in the past were used. These were the pre-validated questionnaires; IPQ and SF36v2. The paper does highlight the effectiveness of these questionnaires to the reader with the use of their generic questions. In not designing their own questionnaires the researcher is right, it saved gaining necessary approval that would be required. Plus these questions are appropriate for the research being undertaken and the fact that there is already an approved set of questionnaires available. Validity in an article refers to the assessment of whether an instrument measures what it aims to measure (Bowling, 2002). In this article from the data collected the validity of the paper shows it has measured the aim of the study. The questionnaires used in the article were validated previously. (Garrett et al 1993; Ware et al 2000; Garrett et al 2002; Weinman et al 1996, all cited in Coughlin, Cronin and Ryan, 2007). Validation can be seen as an important part for the research instrument. It provides extra credibility for using that instrument rather than a newly designed one which may not have been looked at by other peers resulting in it being approved. Looking at this paper from a reader prospective there was no evidence of a pilot study so if needed the main study could be altered accordingly. In term this could affect the reliability of the research undertaken in this study. The reliability refers to the reproducibility and consistency of an instrument (Bowling, 2002) used in the article paper, and there are number of ways reliability can be established. However due to timescales; a pilot study may not have been viable under the circumstances. Data Analysis The data section of this article is presented in tables and there are no graphs or visual aids to illustrate the findings. This acts as a down point for this section because it makes it harder for the reader to understand and make sense of the data produced. The data stands out at being raw whilst using some statistical analyses but that can come across as challenging to the reader who may has a weakness in statistics. This would enable the reader to analyze the data which could lead to putting the whole point of this research exercise into jeopardy. The use of a specialist medical statistician has developed the depth of the study but has not done the reader any favors. Accordingly, the regression analysis for the Illness Perception Questionnaire (IPQ) remains confusing to the reader and difficult to decipher. The different tests came across to the reader as clear and descriptive, however the reader would have research more into them to gain a deeper understanding to enable them to see what is going on. In the research paper it is evident that some of the statistics would be confusing even to the qualified reader unless they are explained thoroughly in the text itself as it being a quantitative exercise. Thus, an important drawback is that the data used by the authors remains unclear and not fully explained. Discussion Following on from the literature review in the introduction, the discussion gives a brief overview of previous research. Accordingly, the authors conclude that a person’s perception of his or her symptoms has a very important relationship to quality of life following discharge. Accordingly, “patients, who perceived a lower frequency of symptoms and have a higher sense of control of their illness, have a better physical and mental quality of life three years after hospital discharge.” The authors acknowledge the limitations of this study and use description to describe their conclusions. Due to the fact of having any limitations, there is a possibility that these results may have varied significantly. The results have been presented with caution due to some limitations being out of the authors control and some are perceived as being economically unviable. References References are paramount in research articles, as they allow us to acknowledge other peoples work, giving the reader opportunity to access the primary source of information cited or used in the paper (Bowling, 2002). This research paper offers a full section of references at the end of the article these are adequately cited from the original source. Final Appraisal Overall this study is informative and the conclusions are relevant, however a major drawback to this analysis would be the complexity through which the raw data is utilized. The quantitative component of this research paper is a major hindrance although overall the authors conclude with some relevant information for healthcare practitioners as it relates to the individual perception of symptoms and the resulting health ramifications on individuals. This study is particularly relevant for healthcare practitioners because it provides ample evidence that a patient’s positive attitude can be good for their health. Despite a few hindrances, the overall quality of this article was quite good. Word count: 2,999 References: BOWLING, A. 2002. Research Methods in healthcare: Investigating Health and Health services. Buckingham: O U Press COUGHLAN. M. CRONIN. P. RYAN. F. 2007. Step-by-step guide to critiquing research. Part 1: quantitative research. British Journal of Nursing 16, 658–663. GERRISH K and A LACEY. 2006. The Research Process in Nursing (5th Edition), Oxford, Blackwell Publishing GREENHALGH T 2001 How to Read a Paper: the Basics (2nd Edition) London, BMJ Books * HAMER S and G COLLINSON. 2005 Achieving Evidence-based Practice: A Handbook for Practitioners. Edinburgh, Baillière Tindall in association with the RCN HOLLOWAY I and S WHEELER. 2002. Qualitative Research in Nursing (2nd Edition), Oxford, Blackwell Science LAU-WALKER, O. M. COWIE, R. M. ROUGHTON, M. 2008. Coronary heart disease patients’ perception of their symptoms and sense of control are associated with their quality of life three years following hospital discharge. Journal of Clinical Nursing. 18 pp 63-71. Blackwell Publishing Ltd NURSING AND MIDWIFERY COUNCIL. The code in full. [Online]. [Accessed 21st April 2009]. Available from World Wide Web: http://www.nmc-uk.org/aArticle.aspx?ArticleID=3056 PARAHOO, K. 2006. Nursing Research. Principles, Process and issues. New York: Palgrave Macmillan PARAHOO K. 2004. Nursing Research: Principles, Process and Issues (2nd Edition) Basingstoke, Macmillan Press Ltd POLIT D F and BECK C T. 2006. Essentials of Nursing Research: Methods, Appraisal and Utilization (6th Edition), Philadelphia, Lippincott Williams & Wilkins OLIVER P. 2003. The Student’s Guide to Research Ethics, Maidenhead, Open University Press Appendix 1. Research questions - guidelines for critiquing a quantitative research study framework by Coughlan, Cronin and Ryan, 2007. Read More