Experiences of Patients in Their Recovery Form Stroke - Essay Example

Assessment of Research Word Count 2,162 CITATION: Burton, C.R. (2000). Living with stroke: a phenomenological study. Journal of Advanced Nursing, 32:2 301-309. STUDY PURPOSE The purpose of this study was to understand how stroke patients perceived their recovery once they returned home. Burton wanted to also understand any issues or themes that may come from the study. LITERATURE REVIEW The literature review focused on the experiences of patients in their recovery form stroke. The literature identified a variety of studies that focused on the way that people were recovering from stroke once they returned home. The researcher used a compilation of other literature reviews on the subject that included mostly studies that were important to showing how stroke patients were recuperating after their hospital stays. One ethnography study was used. Burton chose to use other full reviews rather than using single articles. According to Jones (2003) the literature review must identify, analyze, assess and interpret (Jones 2003:43) the body of knowledge that relates to a specific topic. The purpose is also to create a baseline or basis for the study that the researcher will conduct. Another purpose of the literature review is to justify the proposal and show any gaps that happen to be in the literature. A final reason for the literature review is to show how a certain topic has been approached by other academic scholars (Jones 2003). With these thoughts in mind, a better look at the literature reviews by Burton (2000) is in order. Burtons purpose for the study was to identify the experiences of stroke patients form their perspective. Within the review, Burton identified information from studies that showed specific ideas that was presented by others. The general issues that showed several perceptions that patients had. There were no clear distinctions of how there were gaps in the literature. AT the beginning of the review, Burton suggested that stroke recover received only limited description; (Burton 200:302) in nursing studies. There was more information found about the experience of the disease rather than the experience of the perception that the patients had. However, the literature reviews she found did have information about what she found. Burton did not indicate whether the studies that were found were form nursing or form medicine in general. Jones (2007) states that a successful literature review not only states what other scholars have said but also offers an assessment of the quality and scope of existing studies … (p. 45). Burton did not give an assessment of the quality of the studies but only told what other researchers stated on the topic. Burton used the literature review to show the literature may support her study. APPROACH AND METHODOLOGY Burton chose a phenomenology framework to gain a meaning of life with stroke. The study used grounded theory to gain an understanding form interview transcripts. Interviews were used as a way of gathering information when the patients first were admitted to the hospital. These initial interviews were informal and unstructured because Burton wanted to allow the patients to speak freely. Burton gathered monthly data for at least a year after the patients went home, and follow-up interviews were done for the first year. Burton also kept a log journal for the full duration of the study. Barnes (2001) states that a key element in using a questionnaire is that each respondent must be asked the same questions in the same way. Although Burton used interview techniques it would seem that there would be specific questions that needed to be asked in at least the first interviews. Burton did unstructured interviews which was not explained. It would seem that demographic information was collected the same but that may be the only information that was gathered exactly the same. The quality of the questioning would also be important. Burton seemed to be more laid back about what was being asked than making sure it was a scientifically based study. Barnes (2001) suggests that a series of questions should be asked that assess attitudes, behaviors and attributes. Each type of question would have a specific purpose and they should take no more than 20 minutes to complete. Burtons average interview was 35 minutes which did seem lengthy considering that 73 interviews were conducted over time. Burton did not give a sample of questions asked so there is no way of knowing whether her design was appropriate for her study question. However, in looking at the relationship between the purpose of the study, it does not seem that a series of interviews would yield valuable information that could be used throughout the field. Another challenge for Burton is that the information gathered would be more subjective than scientific. The information may depend on how the patient felt on the particular day that they were interviewed rather than on specific data. Also it did not seem that this particular design would actually yield a good understanding of what patients go through. They would each have a different experience so it is doubtful that there would be specific patterns that would emerge. Bazeley (2002) states that qualitative research can be structured or unstructured, exploratory and interpretive. Burton has already met the criteria for qualitative research because she is using unstructured interviews. The researcher was able to create an approach that at least worked for her, but it is not clear that it would add anything to the field. One point that Burton brought out that is relevant to this essay is the fact that there are three issues that had to be met in a study for it to be "trustworthy." These three issues are credibility, transferability and dependability (Burton 2000: 304). She feels that her study metes these three issues because of its design and the log journal. The journal received peer review and debate with a nurse that had experience with qualitative research methods. In light of their information, the study seems to meet the criteria for credibility but her idea of how it is transferable and dependable seems weak. A bias that may exist is the fact that they only talked to patients in one hospital. This could indicate that the study only looked at one race or ethnicity of people. This would indicate that a wider sample may have been better to use. For this particular study, I do not think it would influence the results. SAMPLE There were eight people who were approached for the study and only six gave their consent to participate. All participants had been admitted to rehabilitation unit in a district general hospital. All had been diagnosed as having first stroke. Six females and two males between the ages of 52 and 81 participated; two were widowed, two were married, one was single and one was divorced. The study population was kept small so the researcher could do a more in-depth and long-term study. The sampling process was to go into the general hospitals stroke unit and ask people to participate. The researcher received consent form the participants for audio-taping the interviews and for their participation. The sampling was small and random in nature . Ethical approval was gained form the local research ethics committee. Consent forms were received form the participants before the start of the study and another consent form was used for the audio-tape. To receive ethical approval the participants had to be free of dysphasia, none could have clinical depression before the stroke, not cognitive impairments were allowed and no medical history that might impede their recovery. DATA COLLECTION Individual interviews were done when the patients first came into the hospital, and more data was collected for at least on year. Follow-up interviews were done to explore any new issues that may have come up in the first interviews. There were 73 interviews with 8 from one participant and 15 from another. Most interviews were 35 minutes although they varied; Burton did not state the incremental of interviews. A lo9g journal was kept through the time of the study so the researcher could reflect on the data generation process and so they would have access to the contextual features. There was no statistical data taken since it was not a quantitative study. This was not necessary because it was such a small sample. The researcher was able to gain very intimate detail, I would imagine, because of the time spent in the interviews. There was no data about how each interview varied; this information would have given the reader a stronger sense of the data collection method. There seemed to be informant left out of the data collection as well. As an example, I wondered about the questions that were used and whether they were asked in a questionnaire or survey format. A few sample questions would have given a better idea of what the data would have provided. Barnes (2001) suggested that the way in which questions are asked can determine what a respondent says to the interviewer. The interviews could be distorted if the questions are asked in ways that could show bias (Barnes 2001). RESULTS The results of the study gave informant about how people dealt with recovery form stroke which matched the purpose of the study. Some of the results were what was expected, but the researcher suggested that there was a stronger emotional aspect to stroke than was seen from previous research. They were able to identify themes which was consistent with one of the purposes of the study. The clinical importance of this study is that it gave a thorough understanding of the various emotions that these stroke patients experienced. They were able to express emotions like anger, frustration and loss of control as well as hope. They were also able to talk about social recovery issues like having to give up employment, finding changing roles and isolation. These emotions need to be understood for health practitioners to be able to work more effectively with stroke patients. No participants dropped out of the study after it began and there was only one group. RELIABILITY AND VALIDITY Mays and Pope (2000) suggest seven factors that are important to test the validity of qualitative research. Those that are relevant to this essay are 1. Triangulation - -this means that more than one type of results are compared. In Burtons study, interviews, transcripts from the interviews and journals were compared. 2. Clear exposition of methods of data collection and analysis. A clear idea of the process of the data collection and analysis. Burtons study was clear about how they collected the data. 3. Attention to negative cases -- the individual must examine and discuss any contradictory data. The study did not explain any deviations or challenges with the data. 4. Fair dealing -- the research should be seen from a variety of perspectives. The sample size of Burtons study was very small and did not allow for it to be observed by several perspectives. 5. Relevant -- it is relevant when it adds to knowledge in the area studied or increased the confidence where the current knowledge is shown. From the point of view of the researcher, the study is relevant because it shows a stronger sense of the emotions for stroke patients (Mays and Pope 2000:51-52). Golafshani (2003) suggests that triangulation is an important way of testing validity in qualitative research because it controls bias in the research. He also suggests that to test reliability is to test its trustworthiness. Burton states that the study has been tested for trustworthiness because it meets the criteria of credibility, transferability and dependability. The credibility and transferability is seen through the studys design and the log journal. From all of this information it would seem that this study was valid and reliable. CONCLUSION AND CLINICAL IMPLICATONS Burton states that the key limitations of the study were that only one hospital was used, there was a small number of informants, and the small size limited the generalizabilty of the study findings. The conclusion was that the study gave an understanding of stroke over the long-term by tracking them for at least a year. The clinical implication was that it gave an understanding of the personal significance of the experience was different at home after the rehabilitation experience in the institutional setting. Another significant issue was that the work of rehabilitation after a stroke really is so personal and it involves the restructuring and rebuilding of the individuals world. This means that although there was a very small sample it did yield information that could be used for a larger study by a different researcher. The implications for this study showed that most studies have shown that the delivery of stroke services in the past had more to do with professional interpretations of what they think is needed for rehabilitation, but it does not focus on the individual. There needs to be a provision of ways to help the individual and families adapt to life after the stroke. This information is important to the research as many people suffer from stroke and they will need to have a more personal assistance. References Barnes, S. (2000). Questionnaire design and construction. [Online]. Available from: http://www.cros.ac.uk/question_design.pdf [Accessed 18 August 2010] Bazeley, P. (2002). Issues in mixing qualitative and quantitative approaches to research. [Online]. Available from: http://www.dedoose.com/_Assets/PDF/Publications/ %20in%20Market%20Research.pdf [Accessed 18 August 2010] Golafshani, N. (2003). Understanding reliability and validity in qualitative research. The Qualitative Report 8 (4),pp. 597-607. [Online]. Available from http://peoplelearn.homestead.com/MEdHOME/QUALITATIVE/Reliab.VALIDIT Y.pdf [Accessed 19 August 2010] Jones, K. (2003). Doing a literature review. [Online]. Available from http://www.sagepubl.com/upm-data/13615_03_Saks_ch03.pdf [Accessed 18 August 2010] Mays, N. and Pope, C. (2000). Assessing quality in quantitative research. [Online]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC1117321/pdf/50.pdf [Accessed 18 August 2010] Read More