Violent Incidents in a Medium Secure Unit - Essay Example

Critical Appraisal of the Article: Hinsby, K. & Baker,M. (2004). Patient and Nurse Accounts of Violent Incidents in a Medium Secure Unit. Journal ofPsychiatric and Mental Health Nursing, 11, 341–347. Before conducting a detailed critical appraisal of the paper, some of the points which are worth mentioning as we look at the paper are: 1. The study is a qualitative study involving a very small sample size. 2. The flow of information across the paper is clear and easy language is used to explain the research. 3. Since the study is a qualitative research, there is no outcome measure which has been studied. Title The title of the study is "Patient and nurse accounts of violent incidents in a Medium Secure Unit." The title is clear and concise. It is informative and does reflect the content of the study. It is clear from the title that they study is only accounts of the patient and nurse about violent incidents in Medium Secure Unit. Authors Both the authors are clinical psychologists, the first author works at Leeds Mental Health and Teaching NHS Trust and the second author at the University of East London, UK. They have researched and presented papers in similar topics before. They have appropriate professional qualifications and clinical experience to conduct a study of this type and magnitude and deliver this paper. Abstract There is an abstract included in the paper. It is structured, short and to the point, summarizing the study and the main findings. The abstract gives crisp information about the study undertaken, Ethics Committee permissions, the methodology of study and analyses. However, there is no mention of the outcome of the study. Infact, there is no proper conclusion in the abstract. Introduction The introduction clearly presents the background of the study. The authors have clearly elaborated the importance of studying violent incidents in a forensic setting. The purpose of the study is relevant and clearly stated. The latest articles discussing these issues, prior to the commencement of the study were studied and compared with. There is no research question asked in this study. This study is only an account of the violent incidents in a forensic setting. Literature Review The literature review is up-to-date. It does identify the underlying theoretical frameworks. Literature review supports the objective of the study. It presents a balanced evaluation material supporting the proposal in the study. Objectives and hypothesis The objective of the study is to understand the nurses and patients perspective of violent incidents in the medium secure unit. The research questions asked in this study are: 1. "In what ways do patients and nurses describe violent incidents?" 2. What categories of analysis may be observed in their accounts? Operational definitions The study is about ‘violence’ and this term is not properly defined in the study. Infact, the participant was asked to choose whatever he felt was violence. Methodology The methodology section clearly states the research approach to be used. The study design is that of qualitative research. This type of study was chosen to understand the subjective realities and to describe, interpret and understand the subjectively meaningful worlds. Qualitative research methods are being used increasingly because these approaches give scope to explore human experience (Baker, Stern & Wuest, 1992). They are invaluable for the exploration of subjective experiences of patients and nurses (Carr, 1994). "Qualitative research means that research that produces findings not arrived by statistical procedures or other means of quantification." (Strauss & Corbin, 1990). In this method, data collection, analysis and eventual theory stand in close relationship to one another. Also, the researcher does not begin a project with a preconceived theory in mind; rather, he begins with an area of study and allows the theory to emerge from data. Subjects The subjects are clearly identified in the study. The participants were nurses and patients with definite inclusion and exclusion criteria. Sample selection The sample size was small but appropriate. As Annandale (1993) mentioned, "the importance of choosing an appropriate sample in non-experimental research studies is undisputed, but it is an area which causes problems for researchers from many fields, including nursing." The participants of the study were four male nurses and four male patients. These participants were selected from a 49-bed outer London MSU. The sampling was purposive and convenient. Inclusion criteria were that the participants needed to have 2 years of either experience in working within a forensic setting (this is for the nurses) or were residents for atleast 2 years in a similar setting (for the patients). Exclusion criteria included primary diagnosis of personality disorder or with a perceived risk of immediate violence. Data collection Data was collected through a semi- structured interview. Each of the participants was asked to identify an actual violent behaviour he was involved with and then asked to describe the event in a comfortable recounting. There was no clear definition for violent incident or the degree of violence. Infact, the participant was asked to choose whatever he felt was violence. Abusive shouting, intimidation, sexually inappropriate behaviour and physical fight between 2 patients- all were considered violence. Once the participant identified the incident he wanted to narrate, the researchers put forth further questions to allow expansion of details to the incident and also to explore interpretations and views of the incident. "Qualitative methods smooth out those contradictions and are themselves a mysterious combination of strategies for collecting images of reality" (Morse, 1994). Ethical considerations The study involves human subjects and has been approved by the ethical committee. Informed consent of the participants was sought. Confidentiality was assured. We do not know whether anonymity was guaranteed. Results The results are presented clearly and consistent internally. Since the study is a qualitative research, no graphical presentation was used. However, sufficient detail was given to enable the reader to judge how much confidence can be placed in the findings. Data analysis The data obtained through the interview was analyzed using grounded theory methods and discursive approach method. The second method was used to address possible weaknesses in using the former theory alone. Discursive resources drawn upon by participants were given crucial importance. This is because, the topic under investigation attracted great media publicity. "A grounded theorist has the ability to step back and critically analyze situations, can recognize the tendency toward bias, can think abstractly, can be flexible and open to helpful criticism, can be sensitive to words and actions of respondents and has a sense of absorption and devotion to the work process" (Strauss & Corbin, 1990). Through the study it could be seen that nurses and patients had different accounts of the violences. Validity is a measure of the integrity of the drawn conclusions and is the actual truth-value of a study (Bryman, 2004). Construct validity may be defined as the extent to which a scale measures a certain construct (Parahoo, 2006) in which the link between conceptual definitions and operational definitions is examined. The term ‘violence’ was not defined properly and all the 8 participants used their own perspective of the term. Though this study does not have an outcome, it has many important implications. The most important implication prompted by this study is that "forensic nursing education might respectfully include more user-involvement when teaching on the topic of violence." Discussion The discussion of the study is not balanced and goes in favour of the patients description and narration of violence. This is probably because, nurses are expected to maintain professional competence and safety of the patients (Burnard & Chapman, 2004) and hence the burden lies on them not to complain on patients. The discussion is not drawn from previous research. The limitations of the study have been acknowledged to some extent. Appropriate clinical implications have been well discussed. "Since grounded theories are drawn from data, they are likely to offer insight, enhance understanding, and provide a meaningful guide to action" (Strauss & Corbin, 1990). Making decisions on the findings by looking at their relevance and applicability is an important aspect of critical review (Cutcliffe, 2003). Potential source of bias Bias may be defined as delivery of opinions, values and views as if they were universal without looking at other points of view. "A qualitative researchers challenge is to demonstrate that his personal interest will not bias the study" (Marshall & Rossman, 1989). In this study, bias could either be introduced by the researchers’ strong allegiance to their own professionals or could be introduced by their own perspectives. Profound preoccupation with the subject could be a potential source of bias. The personal evaluations and values of the researchers can be reflected in the choice of methodology, interpretation of findings and the choice of a research topic and the researchers may select fragments of data which only support his argument. The researchers own perspective and historical context are horizons that may influence interpretation (Kahn 2000). Limitations The main limitation of this study is that it was done on a small scale. The other important limitation is that the study is more an exploratory type. Also, not many readers are aware of grounded theory methods and discursive approach. Conclusion The study concluded with suggestions for further research and probable clinical implications that can be instituted in future. The conclusion was supported by the results obtained. Recommendations The recommendations do suggest further areas of research. References Annandale, E., 1993. Sampling in Non-experimental Research. Nurs Stand., 7(28), pp.34-6. Bryman, A., 2004. Social Research Methods. 2nd Edition. Oxford: Oxford University Press. Baker, C., Stern, P.N., and Wuest, J., 1992. Method Slurring: the grounded theory/phenomenology example. Journal of Advanced Nursing, 17, pp.1355- 60. Carr, L.T., 1994. The strengths and weaknesses of quantitative and qualitative research: what method for nursing? Journal of Advanced Nursing, 20(4), pp.716- 721. Cutcliffe, J.R. and Ward, M., 2003. Critiquing Nursing Research. Dinton: Quay Books. Marshall, C. & Rossman, G.B., 1989. Designing Qualitative Research. London: SAGE Publications. Parahoo, L., 2006. Nursing research: Principles, Process, and Issues. London: Macmillan. Strauss, A. & Corbin, J. (1990). Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. Second edition. London: SAGE Publications. Read More