Rural Nurses' Perspective of Self to Manage to Work in the Community - Research Paper Example

Qualitative Research Report Appraisal and Critique Introduction This is report is an appraisal and critique paper on a research published in an academic journal. The paper is a qualitative research on rural nurses and their multiple perspectives of self. Model for critique In the appraisal and critique of the qualitative research paper, a modified fashion of the consolidated criteria for reporting qualitative studies (COREQ) is used with a 32-item checklist. Health providers and researchers need to refer and evaluate the works of others in the development of protocols, practice guidelines, reviews and proposals among others. In order to know the quality, rigor and weight of evidence presented in a research paper, tools such as (COREQ) are used depending on the research design used (Agustin 7). (COREQ) is used in assessing qualitative studies. Other tools used to assess qualitative studies are MOOSE for Meta analysis of observational studies in epidemiology while the TREND is used for Quasi-experimental or non-randomized assessments (Finlay and Gough 22). Journal The study is reported in the Journal of Advanced Nursing, which is a leading international journal that is peer reviewed and is highly rated on Impact factor of 1.54. The target audience for the journal is health care professionals in pursuit of advanced practice and professional development. It provides knowledge and evidence. The journal is published by Blackwell Publishing Ltd, which has offices in many locations in the world, one of them being in Melbourne, Australia. The journal provide a wealth of knowledge and information that addresses issues of international interests and concern and present them as research findings, research-based reviews, discussion papers and other articles from practitioners, administrators, researchers, educators among others in the field of nursing, midwifery and health sciences, and therefore, I would apply this information into practice. Authors The study conception and design was done by Jane Mills who is a research fellow in the School of nursing and midwifery at the Monash University, Victoria, Karen Francis a professor in rural nursing at the School of nursing and Midwifery of Monash University and Ann Bonner who is a senior lecturer and the School of nursing, Midwifery and Nutrition at James Cook University, Victoria, Australia. Mills drafted the manuscript and performed data collection and data analysis while Francis and Bonner made the vital revisions to the paper and supervised the whole study. The authors are researchers and educators in nursing with Francis being a professional researcher in rural nursing, and therefore, they bring a wealth of knowledge into rural nursing and specifically mentorship, and therefore, would apply this information into practice. Title The title of this research is ‘Live My Work: Rural Nurses and their Multiple Perspectives of Self.’ A good research title is described by Simera, Moher, Hoey, Schulz and Altman 37) to be explicit. It clearly states the general idea of the research without leaving any doubts, questions or room for clarifications while remaining exact and to the point. It is also intriguing enough to make readers want to continue reading the paper. This title achieves all this in that it is short, clear and to the point and gives, the general idea of what the study is all about, mentorship in rural nursing practice. Background and explanation of rationale Mentoring has been cited internationally as a solution to the problem of retaining rural nursing workforce. Rural nursing has been described well by the RRMAS Index of remoteness in terms of distance to the service centres and distance from other people. Research has also helped in outlining the characteristics that distinguish rural and urban nursing practice. From these characteristics, the implications of living and working in the same community for the rural nurses worldwide have been identified as the most significant. In Australia, recruiting and retaining rural nursing staff has been a great challenge. In order to address this, mentoring strategy has been implemented through various programs. There is a need, therefore, to examine the experiences of the rural nurses in mentoring. The specific objectives and aims of the research The specific objectives of the study were to find out how rural nurses created the concept of self and the interactions they had during the working days. The reasons why they were attracted to working in rural and remote areas, how they managed multiple perspectives of self, and their perspectives on mentoring in rural nursing were also the objectives of the study. Literature review The literature review of the paper defines and describes briefly, what the practice of rural nursing is and when this perspective was introduced. The authors also state that one of the challenges rural nurses faces separating their lives from work, which is not possible in rural nursing, and therefore, mentoring was recognised internationally as a strategy for helping nurses cope. However, the authors do not provide any details on the other challenges that face rural nurses and which urban nurses are not faced with and what mentoring means in this case. They do not mention other interventions apart from mentoring and their application in other places or the success of the strategy. The authors do not provide a solid base for the research. Reflexivity Reflexivity is the influence of a researcher’s values, beliefs, interests and acquaintances on their work (Nicholas and Pope 51). It is necessary that researchers do not demonstrate reflexivity in their role. Relationship between the researcher/s and the researched There was prior relationship between the researcher (s) and the researched prior to study commencement since the nine rural nurses had all attended mentor development workshops the researchers had facilitated. The participants knew the interests and goals of researchers in developing mentoring relationships in rural nursing. The participant who had not had formal training in mentorship knew about the researchers’ promotion of mentoring in rural nursing. Characteristics reported about the interviewer/facilitator The researchers’ had interests in testing Krueger’s theoretical definition of mentoring in nursing as a process of teaching and learning that is acquired through personal experiences in one-on-one basis between two individuals with diverse characteristics such as age, experience and professional status. The researchers were also out to test the frames of reference rural nurses constructed in their work and life within the community they serve. They also think that this could also apply to other health professionals practicing in rural areas. This is important to know in that we are able to put the research and its findings into perspective. Methodological orientation used The researcher used grounded theory, which is applied to the methods of collecting and analyzing data. Participant selection The participants were selected purposively through advertising through advertising nationally for the qualified people then selecting those who had participated in the mentorship workshops facilitated by the researchers. Snowballing was also done. This method was appropriate in that it targeted people who had experience and knowledge of mentoring. The participants were first approached through the advertisement where they showed interests in participating in the study. From there, the researchers contacted them through telephone and planned face-to-face meetings. Three interviews were conducted through the telephone while the rest were face-to-face, and one of them engaged in an email dialogue for a second interview. This was appropriate since the sample size was small and the data collection tools were detailed and needed clarification here and there. The sample size was nine rural nurses. Setting of data collection The researchers have not mentioned where the interviews were conducted and whether there were other non-participants present. The participants were female Australian rural nurses who had practiced between 3 years to 33 years with the average experience being 19 years. They also had taken part in a mentor development program or an informal one and defined themselves as rural nurses. Data collection The methods of data collection were clearly described and used a semi-structured aide memoir administered during a telephone or face-to-face interview, situational analysis maps and frame analysis. The interviews were all recorded digitally and transcribed verbatim. The tools were not pilot-tested but were improved as data generation went on as participants suggested. Two repeat interviews were carried out. The interviews were recorded digitally and recorded verbatim. The study was conducted between 2004 and 2005. There is no mention of transcripts being returned to the participants for comment or correction. Ethics The research received ethical approval from the University Ethics Committee. The researchers also obtained signed consent forms from the participants who were free to withdraw any time if they were not comfortable with the issues outlined. They have also used pseudonyms in reporting the findings. The research was funded by Queensland Nursing Council, which is acknowledged in the report. Analysis and ?ndings Description of analysis Data collection and analysis was concurrent as is required by the grounded theory methods. Theoretical sampling was done on the basis of ongoing analysis and tools such as interview aide memoirs were amended to put in consideration the current construction and questions that were unanswered. In the same light, interviews were transcribed and coded. This process is well described. Managing data Axial coding of the data was done first line-by-line to give categories then categories coded in the same manner. This data was then coded using Text Analysis Markup System software then transferred to file maker Developer 7 database software to sort further. Mapping and diagramming were done with the help of Inspiration 7 software. Data saturation is not discussed Reporting The authors demonstrated consistency between data presented and findings by using different tools to collect data on different perspectives. The data recorded was analyzed into categories, which are discussed in the findings and in the use of grounded theory, which is used in the analysis. The analysis has provided meaningful and insightful picture of the phenomena being investigated by testing and presenting the theoretical definition of mentoring and the frames of reference rural nurses constructed in their work and life within the community they serve. Enough evidence is given from the data to illustrate the findings in that they have given lengthy quotations from interviews with different participants and their pseudonyms are mentioned. Discussion The major findings of the research are that rural nurses have many perspective of self in order to manage living and working in the same community. Then mentoring novice rural nurses is done on three frames of culture, politics and clinical practice. Finally, the expected outcomes of mentoring strategies by experienced rural nurses are orientation to the local culture and increase in confidence, in neophyte nurses. Limitations of research The limitation was in the design of research advertised initially. The participants had also participated in mentor development workshops offered by the researchers, which led them to think of mentoring as supportive relationships. One participant also came from a group, which saw a possibility of mentoring training, which influenced how they thought of their eligibility. Transferability The findings can be used in other healthcare professions, in medicine and allied health practicing in rural areas. References The references are recent and have been adopted from journals such as Rural and Remote Health, The New Rural health, International Journal of Nursing Practice, Online journal of Rural Nursing and healthcare, Journal of Community Health Nursing and Australian Journal of Rural of Health. All these are focused on evidence based research on rural nursing and healthcare. They, however, do not present comprehensive literature review other interventions apart from mentoring. Conclusion The study is high quality since the researchers have used adequate references and have presented evidence in a way that the data collection and analysis can be replicated by others and have presented a good description of the context and the information that exists about the topic (Litman 2). The conclusion made was that rural nurses have many perspective of self in order to manage living and working in the same community. Then mentoring novice rural nurses is done on three frames of culture, politics and clinical practice. Finally, the expected outcomes of mentoring strategies by experienced rural nurses are orientation to the local culture and increase in confidence in neophyte nurses. The findings of this study are useful in that they can inform local action of retaining neophyte rural nurses in the workforce. Mentoring can also be used on a broad range of issues and give higher value than currently being realized. Quantitative Study Report Appraisal and Critique Introduction The second study is quantitative research done by paediatrics researchers under the title, “Rapid versus standard intravenous rehydration in paediatric gastroenteritis: pragmatic blinded randomized clinical trial. Model of critique In the appraisal and critique of the quantitative research, the CONSORT criteria are used. The CONSORT (Consolidated Standards of Reporting Trials) is comprehensive guidelines for reporting randomized controlled trials. The CONSORT has a checklist and a flow diagram. This is important in outlining evidence since clinicians need sound evidence in their practice (Newcombe 70). Other reporting models are STRICTA which reports controlled trials of acupunture, hehavioral medicine RCTs, ehealth interventions, TREND and RedHot for homeopathic treatments (Ryan, Coughlan and Cronin 742). Journal The BMJ originally named British Medical Journal is an international peer reviewed medical journal which is publlished online first before it goes to print with an open access and no limit to usage. The journal is ranked by impact factor which is 13.471 by the ISI Web of Science, 2011. The journal is published by BMJ Publishing Group Limited in London (BMJ). With such an open access, the journal is widely reviewed by researchers, doctors, researchers and health professionals which means it provides cutting edge evidence based research which I can confidently apply into practice. Authors The research was conducted and authored by Stephen Freedman an associate professor of paediatrics, Patricia Parkin, a professor of Paediatrics, Andrew Willan a senior scientist and Susan Schuh a professor of paediatrics. These are experts in the field of paediatrics since they are lecturers and practicing medical doctors in various institutions except for Willan who is a scientist in a child health research institute and lecturer school of public health at the University of Toronto. The research was conducted at the emergency department of The Hospital for Sick Children Toronto, Canada. The authors are experienced researchers, teachers as well as practicing medical doctors, and therefore, I would use their findings in practice. Title The design of the research, which is in a single centre but with two parallel, randomized pragmatic controlled trial. The participants and caregiver, assessors, investigators and others involved were not aware of the treatment assignment. Abstract This is a structured abstract since it has distinct sections that are clearly labeled such as design, setting, participants, and outcomes etc, which make it easy to comprehend what is being discussed in the report. (U.S. National Library of Medicine). The conclusion of the study is that there are no significant clinical advantages of administering rapid instead of the standard intravenous rehydration to haemodynamically stable children that are thought to require intravenous rehydration. Background, rationale and objectives Gastroenteritis is a big public health concern. Prolonged intravenous rehydration brings overcrowding in emergency rooms. Rapid rehydration regimen is advocated for in treatment of dehydration due to the benefits of reducing agitation and clinical signs of dehydration and restoring appetite and alertness. If these are achieved within a shorter time period length of stay and costs will be reduced for patients and overcrowding will be reduced. There exists risks, however, on the use of rapid intravenous rehydration in possible hyponatracemia or hypernatraemia. Standard rehydration in haemodynamically stable children has established safety. Lack of evidence in the benefits and complications of widespread, rapid intravenous rehydration has necessiated the need for rigorous evaluation. Hypothesis The specific objective involving the study was to establish if a rapid intravenous regimen for children who require intravenous rehydration resulted into clinically importanmt increase in the numbe of children achieving rehydration as compared to the standard intravenours rehydration considered as slow. Methods The trial design involved defining dehydration as the clinical dehydration scale of >3. The design also excluded children weighing 33 kgs. The design included recruitment of children brought to the emergency department of the children’s hospital between December 2006 and April 2010. First children were screened for participation, and those who met the criteria were enrolled either for rehydration using the rapid intravenous rehydration or the standard one on a ration of 1:1. The randomization sequence was computer generated and stratified by the severity of dehydration. Inclusion and exclusion Eligibility was based on children aged over 90 days and weighed between 5 and 33 kgs who have been diagnosed with dehydration secondary to gastroenteritis and had not responded to oral rehydration, and intravenous rehydration has been recommended. This excluded children that required fluid restriction, a suspected surgical condition, and history of chronic disease, abdominal surgery, hypotension, bilious or bloody vomit, hypoglycaemia or hyperglycaemia. Further exclusion was done on children whose parents/guardians exhibited overwhelming language barrier and those without telephone contact since it was needed for follow-up. Interventions First all potentially eligible children were given an oral rehydration of 5 ml of a flavored oral rehydration through a syringe after every 5 minutes. Those that showed no response to oral rehydration were then recruited from 8 am to midnight. The intravenous catheter and performance baseline biochemical tests were done and the bedside nurse set the intravenous rate according to the randomization assignment. The children on standard intravenous received 20 mL/kg while those in the rapid intravenous received 60mL/kg 0.9% saline infusion for 60 minutes then 5% dextrose in 0.9% saline for maintenance rate. Caregivers then were to continue oral dehydration during the study period. The research nurse was to record clinical outcomes every 30 minutes, and if any adverse effects were reported the attending physician was to determine their presence and relevance. Outcomes Primary outcomes were outlined as rehydration after two hours of treatment, which was to be based on scores of clinical dehydration scale. The secondary outcomes were based on prolonged treatment measured by specific measures. These include admission within 72 hours of randomization, score on clinical dehydration scale, consumption of at least 5 mL/kg of liquid per two-hour period and chart review among others. Sample The sample size included 226 children among the 278 who met the criteria in order to provide an 80% power to identify a 20% point difference in the ratio of children rehydrated 2 hours after the start of the treatment. This would result to a two-sided type 1 error probability of 0.05 and a 40% chance of success in the standard group. A 5% adjustment allowance was given to account for the losses to follow-up, missing data and withdrawals. Randomization A permuted block randomization was generated by a computer and a sequence generated based on the severity of dehydration. This was concealed from research nurses by putting the sequence in sequentially numbered and sealed opaque envelops that were created by an independent coordinator. These were only given when consent was granted and were then opened sequentially once participant information was written on the appropriate envelops. Randomization codes were kept secure until enrollment and data entry were finished. The participants, research nurses, attending physicians were all blinded to the treatment allocation except for the bedside nurse who was instructed not to say anything. Statistical methods Statistical methods used followed intention to treat principle. Analysis was done with the version 9.1 of the SAS software. In both primary and secondary outcomes, Fisher’s exact test was used, and additionally Fisher’s exact test for proportions or the t test was used. Participant flow chart Flow diagram shows the progression of the participants through the stages of the trial (Williams, 21). This has been used in this research and is shown in the figure above and all the information on each group and number of participants and the treatment they received. The participants were recruited between December 2006 and April 2010 and follow-up was done after the child was discharged from the hospital. The trial ended when the researchers determined that continued investigation would not bring any new data. Ethics The study was stamped by The Hospital for Sick children’s research ethics board. Clinical Trials registries are certified platforms and catalogues for registering clinical trials with an aim of increasing transparency and access to such trials by the public (World Health Organisation). The full protocol of the trial can be accessed from the hospital’s research centers website. Written informed consent was from caregivers was obtained, and where appropriate participant assent was acquired. Sources of funding were from a grant from The Physicians’ Services Incorporated Foundation and The hospital for Sick Children Foundation. Results There are several tables that have been used to present findings. The first table is on baseline characteristics in the sample children shown in the two methods of intravenous rehydration. The second one is the table on secondary outcomes over time according to different methods of rehydration. Clinical and biochemical characteristics over time presented on the two methods of treatment and follow-up data table presented in the two methods of rehydration in the sample. There is no reported harm or unintended effects in each group. Discussion The major findings of this research are that no clinical advantage are acquired from the rapid intravenous rehydration in children with mild to moderate dehydration secondary to gastroenteritis compared to the standard treatment. There is no enough evidence in support of rapid intravenous rehydration and given the potential side effects that could occur it is best to avoid it in children with gastroenteritis. Comparison with prior studies There is scarcity of high quality trials in rapid intravenous rehydration. One such study done on 45 children as described by Freedman (53) did not give conclusive findings since the outcome measures were not clearly defined and had only 60% power for identifying clinically relevant difference between two groups. The role of the nurse Nurses are very instrumental in enrolling patients for such as trial and in the administration of the treatment and recording of the outcomes and other monitoring signs. Emergency department nurses also play a big role in recruiting participants. Limitations Imprecision in available clinical characteristics for assessing dehydration is one of the limitations of the study. Secondly, limitations in ethical and logistical issues excluded the study of children with compromised cardiovascular stability, and therefore, results cannot be generalized to such cases and finally unblinding attending physicians in the repeat electrolyte results, which could have affected the results. Generalization The findings cannot be generalized to children with compromised cardiovascular stability, and other characteristics, which made them excluded from the study. Interpretation The primary and secondary outcomes of the study consistently show negligible significance in both groups of children, and therefore, the interpretation is consist with results considering the possible risks of the use of rapid intravenous rehydration. References The references used are quite recent with the oldest three being published in 1990s. The journals range from the Pediatric Emergency Care, Journal of Pediatric Gastroenterol Nutrition, Academic Emergency Medicine, Journal of Pediatrics, Clinical Pediatrics and Am J Emerg Med among others. These journals and the textbooks used give a comprehensive literature review. Conclusion The major conclusion is that routine rapid intravenous rehydration should be reconsidered given the risks involved and the lack of significant benefit over the standard treatment. This is high quality research since the researchers have used adequate references, and have presented evidence in a way that the data collection and analysis can be replicated by others. In addition, they have presented a good description of the context and the information that exists about the topic (Ryan, Coughlan and Cronin 739). The results of the research do not favor treatment through rapid intravenous rehydration since the effectiveness is the same with the standard treatment and should be discouraged because of the shown trend of possible worse outcomes. Works Cited Agustin, Cherry. "How can Reporting Guidelines Help you Write Your Research Findings?" The Radiographer, 10.3(2009: 5-14 BMJ. About BMJ. Retrieved on 12 April 2012 . Finlay, Linda and Brendan Gough. Reflexivity: A Practical guide for Researchers in Health and Social Sciences. USA: Wiley-Blackwell, 2003. Freedman, Antony. Pediatric Hydration Therapy: Historical Review and a New Approach. USA: Kidney Institute, 2005. Litman, Todd. Evaluating research quality: Guidelines for Scholarship. Australia: Victoria Transport Policy Institute , 2012. Newcombe, Robert. "Reporting Clinical Trials in the JO-the CONSORT Guidelines." Journal of Orthodontics, 6.3(2000): 69-70. Nicholas, May and Catherine Pope. "Assessing Quality in Qualitative Research." BMJ 14.8 (2000): 50-52. Ryan, Frances, Michael Coughlan and Patricia Cronin. "Step-by-step Guide to Critiquing Research. Part 1: Quantitative Research." British Journal of Nursing 23.7(2007): 738- 745. Simera, I, et al. "A Catalogue of Reporting Guidelines for Health Research." European Journal of Clinical Investigation 4.9(2010): 35-53. U.S. National Library of Medicine. "Structured Abstracts." 20 September 2011. U.S. National Library of Medicine. Retrieved on12 April 2012 from. Williams, Hywel. Cars, CONSORT 2010, and Clinical Practice. UK: BioMed Central Ltd, 2010. World Health Organisation. "International Clinical Trials Registry Platform (ICTRP)." n.d n.d 2012. World Health Organisation. Retrieved on 12 April 2012 from . Read More