Fatigue and Sleep Disturbance in HIV-Positive Women - Essay Example

Fatigue and sleep disturbance in HIV-positive women: a qualitative and biomedical approach Wei-Ti Chen, Shih-Yu Lee, Cheng-Shi Shiu, Jane M Simoni, Chengen Pan, Meijuan Bao and Hongzhou Lu Name Institution Date Critical evaluation of the title of the paper, its abstract and credibility of the author/s The title indicates the use of a mixed approach of both qualitative and quantitative methods. Yet the methodology indicates use of one form of evidence, qualitative method. This creates confusion on the aims and objectives of the study. Research shows that there has been growing limitations to the use of one form of evidence either qualitative or quantitative. This has lead to requirements for more inclusive forms of reviews, so as to efficiently use primary source data (Pearson 2004). Mixed methods have become the preferred method as the offer both objective and subjective evidence of the life situation. The title of the study does not imply critical intelligence of educative authentication as listed by Guba and Lincoln as a criterion for worthy topics (2005). In terms of the Authors, the credentials and academic achievements as well as their positions in the work place, the writing of the authors would thus be categorized as credible. According to Warnick (2004), the academic credentials are an important measure of credibility. The Abstract does not describe how the biomedical approach will be applied using the actigraphy including a lack of hypothesis to determine if the objectives were met or not; it factors more the behavioral effect of sleep collected through the in-depth interviews. The use of qualitative methodology is essential to this study and as (Kuper, Reeves and Levinson 2008) indicate ,the qualitative methodology comprises of many methods that have different theoretical bearings and hence used to provide varied evidence depending on the research problem, thus in depth interviews are appropriate for this research question. Critical evaluation of the introduction of the paper and the rationale presented for the research The introduction section does not seem to indicate why the use of the mixed methods of behavioral and biomedical approaches is important to sleep research. Hence, the paper lacks a clear rationale for using such a combination. It does not also justify why the sleep research is important in the nursing field and does not give a good introduction into the HIV/AIDs disease which is a contributing factor in the research Evaluation of literature review leading to problem statement and a case for the research with clear defined objectives The literature outlines the causes of fatigue and its relationship with depression; it refers to fatigue as a symptom of HIV infection. According to Barrosso (1999), fatigue results from other HIV complications like Anemia and is said to be more psychosocial rather than physiological, hence it can be said to be a secondary symptom of HIV/AIDs and not a debilitating symptom as it is referred to in the research. The literature gives no information or previous research done on the relationship or association between fatigue and sleep disturbances on the HIV/AIDs disease. The problem statement would thus be how the impact of sleep disturbance and fatigue affects the sleep and energy levels of the patients and how it can inform much on the progress of patients diagnosed with HIV/AIDs. The objectives would then be investigation of the sleep patterns of the HIV positive women using the actigraphy and the determination of the presence and level of fatigue in the sampled women. Critical evaluation of methodology and its appropriateness, and presentation of results The research aimed to use snow balling sampling procedure which is an appropriate method of sampling for the hard to reach people as well as for sensitive cases normally known as the hidden population (Eland-Goossensen.et.al 1997) ) this enables the participants to avoid cases of stigmatization (Hack, Kalichman and Somali 1995). The disadvantage to this sampling is that the results cannot be generalized due to the non-random selection applied in sampling. In analyzing the in depth interview, thematic content analysis was used, this analysis enables the integration of both qualitative and quantitative data (Dixon-wood.et.al 2005). According to these researchers, the use of themes in the analysis brings confusion on whether to use the frequency of the themes in analysis of the more prominent themes with high explanatory level; hence though it provides the basic data analysis for qualitative research, thematic analysis offers little theoretical structure. The methodology lacked thick description of the processes involved in data collection as well as the analysis and interpretation of the data. The use of in-depth interview was appropriate for this study as it has advantages of getting in depth and more accurate information from the participants. It guarantees confidentiality as it is done one on one unlike the focus group interviews (Gielen.et.al 1997). The research methods employed create good rigor in terms of the time allocated for the interviews, which the study puts at 2 hours of interviewing process in a private location. This enabled the researcher to get adequate information that would be significant to the study. The quality of the data as well as the transparency was enhanced by the use of different investigators who analyzed the data separately and coded it then discussed amongst themselves to remove any disagreements and inconsistency in the codes (Tracy 2010). Though the transparency was not well documented in the data analysis due to less detail on the transcription process. There was transparency in the acknowledgement of the work done by the various authors, the grants and financing groups and other technical groups that assisted in the project as well as the study participants. The presentation of the results is confusing as there is too much additional information that should have been incorporated in the literature review and in the discussion. Use of the technologies like actigraphy enabled the research data to be reliable and the use of the interviews enabled the data to be valid referred to by quantitative researchers as internal validity in qualitative methods. Critical evaluation of the conclusion drawn The study seems to focus on Nursing as eluded in the introduction and also the conclusion yet the body of the research does not seem to indicate any role of the nursing field in the sleep research or the HIV support management. It is indeed true that research is evolving technologically and hence all manner of research studies should embrace the new technologies. There is indication that the aim of the study was accomplished as many of the women confirmed on being fatigued due to sleeplessness resulting from psychosocial stress and depression and sleep disturbance due to nightmares and worry of disclosure. The conclusion does not indicate any limitations to the study which is normally the case when applying different data collection methods, in this case the in depth interviews and the use of the actigraphy. The limitations arise as a result of varied answers from participants who are included in both methodologies. (Tracy 2010). Impact of the research findings on Nursing Practice The study indicates that there is importance in the data collected as it indicates that HIV infected women suffer from sleep disturbances and fatigue which may have compound effect on the HIV infection progress (Christian 1992). It is thus paramount for there to be a routine check on the HIV patient’s sleep pattern by the nurses during the clinic checkups. This will enable the nurses to determine if a patient needs to see a psychologist or go through relaxation techniques like acupuncture.(Philips and Skelton 2001). The effect of sleep deprivation and fatigue in HIV infected women has been shown to be due to depression, worry of disclosure, use of recreational drugs as well as side effects of the antiretroviral drugs. Nurses can be able to find out if the patient is depressed hence refer to psychologist or prescribe antidepressants, if it is because of the anti retroviral drugs then the nurses can be able to prescribe another favorable drug. If the fatigue is brought about by use of recreational drugs, then the nurses can be able to recommend the patient attend counselling or focus groups formed for the intention of changing the behavioral use of these drugs. If the fatigue or sleep disturbance is due to the worry of disclosure (Prizzi 1992), the nurses can recommend counselling for the family or partner of the patient and thus help in disclosure. A patient suffering from Anaemia can also be discovered by the investigation of the sleep pattern and onset of fatigue. Hence, this study goes to show that there is importance in nurses embracing the sleep question regimen for their patients infected with HIV as it goes a long way in helping the patient cope with the any adverse effects of the disease. Word Count: 1444 References Barroso J (1999) A Review of Fatigue in People With HIV Infection. Journal of The Association Of Nurses In Aids Care,10 (5), 42-49 Christian, J. (1992). Fatigue, sleep disturbance, disability, and indices of progression of HIV infection. Am J Psychiatry, 1, 49. Dixon-Woods M., et.al (2005) Synthesizing qualitative and quantitative evidence: a review of possible methods J Health Serv Res Policy.10: 45 Gielen CD., O'Campo P., Faden RR., & Eke A (1997) Women's Disclosure of HIV Status: Experiences of Mistreatment and Violence in an Urban Setting, Women & Health, 25:3, 19-31, DOI: 10.1300/J013v25n03_02 Guba, E. G., & Lincoln, Y. S. (2005). Paradigmatic controversies, contradictions, and emerging confluences. In N. K. Denzin & Y. S. Lincoln (Eds.), The Sage handbook of qualitative research (3rd ed., pp. 191-216). Thousand Oaks, CA: Sage. Hack K., Kalichman S., &Somali, A (1995) Women with HIV/AIDS: The Dual Challenges of Patient and Primary Caregiver. Presented to the HIV Infection in Women Conference, Washington, DC. Kuper A, Scott Reeves S.,& Levinson W (2008) An introduction to reading and appraising qualitative research BMJ ;337:a288 Pearson A. Balancing the evidence: incorporating the synthesis of qualitative data into systematic reviews. JBI Reports 2004; 2: 45–64 Phillips, K. D., & Skelton, W. D. (2001). Effects of individualized acupuncture on sleep quality in HIV disease. Journal of the Association of Nurses in AIDS Care, 12(1), 27-39. Prizzi M (1992) Women, HIV Infection, and AIDS: Tapestries of Life, Death, and Empowerment The American Journal of Occupational nempy; 46(11): 1021-1027 Tracy SJ (2010) Qualitative Quality: Eight ''Big-Tent'' Criteria for Excellent Qualitative Research Qualitative Inquiry 2010 16: 837 Warnick, B. (2004). Online Ethos Source Credibility in an “Authorless” Environment. American Behavioral Scientist, 48(2), 256-265. Read More