Quantitative Nursing and Qualitative Critique - Essay Example

?MN504 Qualitative Critique Please use the below Qualitative Critique Completion Form to complete your critique of quantitative research. Type in your responses under EACH section. If your opinion is that the research article does not address or infer an answer to a particular section, then you must so state and JUSTIFY your statement. IMPORTANT: Do not leave any section blank! Do not provide a “yes" or “no” answer without an explanation. You must justify all your responses. ALL responses must be written in YOUR OWN WORDS. Do NOT use quotes. You must submit the full article in PDF form. Critiques submitted without the PDF will not be accepted. Save your file as YourName_QualitativeCritique.doc and upload to the unit Dropbox. NAME Full and Complete Reference for the Article Note: You must submit the full article in PDF form. Critiques submitted without the PDF will not be accepted. Problem It has been identified in many researches that diabetes self-management education is important in maintaining health care but the problem in this regard is lack of knowledge about this program, lack of adherence and lack of implementation of DSME among persons with type 2 diabetes mellitus (DM). As the result statistics represent that only 50% of the adults who have type 2 DM use diabetes self-management education activities while among those 50% of the participants only 16% of the participants can perform diabetes self-management activities properly which indicates the severity of the problem that are lack of knowledge, lack of adherence and lack of implementation too. Though there has been consistent improvement in the knowledge of persons regarding DSM activities but practically the results have failed to demonstrate self-care of persons. So, it can be stated that there is some problem either in addressing issue of proper adherence or knowledge because spreading DSME is not fulfilling the needs of better health care. In this regard there imply a moral and professional duty upon nursing staff to understand and participate actively for spreading DSME knowledge and teach persons with type 2 DM to perform self-care treatment properly (Gucciardi, E., 2006). Study Purpose The study analyses of Funnell in his research have identified the problems of DSME. In the light of those evidences the actual purpose of this study is to construct the diabetes self-management education program which uses co-created learning procedures considering the needs of persons with type 2 diabetes mellitus (DM) (Funnell & Rogers, 2011). The program should be adaptive in fulfilling the gaps that have been observed in adhering diabetes self-management activates properly. The study purpose has been set to evaluate the DSME program performance at the end through qualitative research methodology. Research Questions The study inquires about the gaps in the diabetes self-management education, it examines, what are gaps in this program which have not yielded proper health care even after achieving knowledge about the program and how these gaps will help in organizing such activities that can make self-management an effective tool for health care. It examines, what are the needs and requirements of persons with type 2 DM. What are the effects and outcomes of this co-created program which have been examined through the qualitative factors of adaptation, program satisfaction and through the self-management activities? The qualitative methods such as focus group discussion and intervention, demographic analysis, knowledge about the program and self-care are sufficient enough to evaluate this co-created learning program. Gap analysis is an effective way of modifying and designing a new program which is not performing to its optimum potential because gap analysis help looking into the drawbacks and faults of prevailing methods and techniques. After analysis it enables the reader to redesign and reconstruct his own opinion and model. The worth mentioning aspect of this qualitative study is that the DSME program has used the co-created learning process which ensures the participation and involvement of focused group member in understanding the program more conveniently. Study Design The qualitative methodology used for this study is quasi experimental, in this experimental study at first the focus group of person with type 2 DM was designed, in this focused group the DSME program was designed with involvement of participants (Shadish & Cooke, 2011). In the next step the participants were given knowledge about self-care, they were trained about the self-management activities and adaptation too. In this quasi experimental model after intervention, the participants were required to be tested for post intervention analysis. At the end the results of DSME intervention group were compared with the knowledge, awareness and with practical activities of those who were not introduced to such co-created program. In short this study was a three phase analysis in which at first groups and co-created intervention were designed, in the second step the participants were tested for their learning behavior with pre and post intervention analysis then at the end program satisfaction was tested and compared between both groups. The qualitative method used in this study is quasi experimental. The most important key factor of this research model is that it includes non-random participants which means that the group selected under study will be designed after certain considerations such in this article group of persons with type 2 DM was selected for study, not the random participants were selected. In this experimental model the assumption of internal validity is maintained. In quasi experimental designs any implementation or action for participants can be processed easily. It is evident from medical literature that quasi experimental method which is usually known as the pre-post intervention research model is often used by health care institutions and researchers, most of the clinical tests and data collection is also performed through quasi experimental methodology (Harris, et al., 2006). Philosophical/Theoretical Framework Basis for the Study (Determine from Literature – this does not refer to the methodology.) The theoretical framework used in this study is supported by many researches as Funnell and Anderson in their study examined the non-compliance behavior of person with diabetes. They tried to examined the gap that why patients do not comply with the intervention prescribed by the doctor. In this regard they provided professional training to the participants and prescribed them to do as the professionals suggest while the program designed for the other group was to empower the patient centered strategies. The results of their study stated that patient centered strategies yielded effective results in empowering and self-management of diabetes among the participants (Funnell & Anderson, 2004). This provides a platform and support for the study that using co-created learning procedure is an effective measure for research. Another study examined the demographic, sex and gender aspects of self-management diabetes habits among male and females which stated that male were more reluctant and non-observant in managing their glucose level than females while females were very active and sensitive in integrating self-management and care in their daily lives. Their findings further revealed that women were more eager to receive physician help and support for their healthcare and diabetes management while male usually rely on their self-defined and self-directed treatments. It provides a theoretical base for this study to keep in mind the gender and demographic aspects of persons with type 2 DM (Mathew, Gucciardi, Melo, & Barata, 2012). Review of the Related Literature The articles and researches examined for theoretical framework and for the study are consistent with the body of knowledge in this regard, it has been justified by almost all clinical researches that self-motivation, self-participation, self-commitment by the diabetic patient are necessary for avoiding and controlling diabetes. Medical research requires systematic analysis for which random samples for study waste precious time and resources so, conducting quasi research has always been supported by researchers in medical sciences. The references used for supporting study analysis are current as well as based on previous studies too. The sources used for the study within the last ten year time bar are around 15 while sources within the five year time bar are around 8. The current state of knowledge about research problem has further been divided from individual to what type of persons have failed in adapting self-management properly such from persons, the knowledge has been divided to gender differences, to demographics and to age groups. Subjects and Setting The subjects were selected from the same city of Forest city, Arkansas. The persons with type 2 DM over 40 years of age were selected and were divided into two groups with 20 members in each group. Before starting program pre intervention knowledge test data was collected and participants were given an introduction about the study and further scenarios for meeting were also decided then. Co-created learning program constructed as there should be four educational while one informational session consisting of about 90 minutes on every weekend. National standards for DSME curriculum were ensured and supervised by the experts but the activities were incorporate with the help of participants. It was a medical study for which systematic research was necessary and to maintain research objectives every possible recruitment tool was used such as snowballing, flyer publicity, newspaper ads, referrals and direct contact which are all appropriate in getting attention of those fitting the model and willing to participate. Medical researches are usually costly which require handsome resources, techniques and time. Considering such prospects around 30 participants is an ideal limit for sample size while this study uses 20 participants which is most appropriate figure for analysis. The settings, certified diabetes education centers and West Memphis are perfect to keep two comparison and intervention groups apart and analyze the performance of program. DSME program introduced its program structure in the introductory session which indicates that every aspect of participants’ rights has been respected (Pimple, 2008). Data Collection Procedure and Appropriateness of Data Analysis Methods The data was collected through the focus group method in the beginning of the program for pre intervention analysis, and later at the end post intervention analysis were also collected through focus group method, all opinions and recommendations were also collected in the process. The data collected by means of audio tape and by the transcriptionist. The data collection procedure focused on qualitative aspects consistent with the purpose of the study such as demographics, diabetes knowledge, diabetes empowerment scale, self-care activities, and management and evaluation tools. Specific Data Analysis Procedures Used First qualitative analysis was obtained through examining the knowledge about diabetes for which 14 item basket was used to analyze the level of knowledge of participants, second instrument of qualitative analysis was adaptation which consisted of two sub instruments. Adaptation analyzed psychological adaptation and sensitivity of diabetics to sense changes. Third instrument was diabetes self-care which include four further sub scales of exercise, glucose self-monitoring, diet and medication. The last qualitative scale was of program satisfaction consisting of 39 items based upon five point likert scale and was targeted to examine the reaction of the participants. Evidence of Auditability/Decision Trail/Member checks Decision trails are the actually the decision rules specified by the researcher to categorize the data by which the analytical analysis and exploration can easily take place. Researchers usually note down their analytical choices throughout the research process which help in increasing transparency and auditability of the research. Decision trails in this study were reported specifically before and after every session where all activities and possible decisions were noted down. Specific Results Obtained The study was based upon six sessions in which many issues and topic were covered such as eating patterns, dealing with complications, peripheral neuropathy, cardio vascular effects, sexual and psychological issues, diabetes knowledge, medication and exercise were discussed. The study results of pre and post intervention results stated no such significant difference among the comparison and experimental groups as the qualitative instrument diabetic knowledge pre intervention score was 9.36 and 10.47 for comparison and intervention group respectively while post intervention score was 10.43 and 10.53 for comparison and intervention group respectively; their p stats value at 0.773 stated no significance difference though the cronbach alpha value for reliability of this instrument was acceptable at 0.7. Similarly adaptation pre intervention score for first sub instrument was 52.07 and 52.53 for comparison and intervention group respectively while post intervention score was 52.21 and 48.32 for comparison and intervention group respectively; their p stats value at 0.336 stated no significance difference though the cronbach alpha value for reliability of this instrument was acceptable at 0.82; and for second sub instrument pre intervention score was 29.43 and 29.63 for comparison and intervention group respectively while post intervention score was 31.43 and 33.16 for comparison and intervention group respectively; their p stats value at 0.331 stated no significance difference though the cronbach alpha value for reliability of this instrument was acceptable at 0.84. Interestingly diabetes self-care activities total score showed some significant changes and improvement in intervention group for this instrument pre intervention score for comparison group was 59.50 and 47.59 for intervention group, their post intervention score was 62.19 and 64.27 for comparison and intervention respectively. ANCOVA test revealed statistical significance as p value was at 0.02. The results of last qualitative instrument are conflicting as the focus group results at the end provided positive results while the indicators score provided contrasting insignificant results. Strengths and Limitations The strength and credibility of the study can be examined through the reliability and validity analysis of qualitative model for which cronbach alpha values were significant and reliable at 0.7 for diabetes knowledge, 0.8 for adaptation, and 0.95 for self-management. Secondly the participants joined program by their own will which ensures self-motivation among participants. First limitation of the study is that the sample was based upon a selected region of high prevalence of type 2 DM which are selective in numbers too so, the results of this study cannot be generalized to the overall population at large scale. Secondly the study is based upon six sessions of 90 minutes in week which shows short term collection of data but long term results and no follow up was used to capture longitudinal impacts of the study. Implications/Recommendations The study used co-creation learning process for participants in their DSME program which yielded significant results in proper self-management among parsons with type 2 DM. so, it is recommended that clinicians or nursing staff or professionals who have interaction with DSME education should prefer self-participation and self-involvement of their patients in identifying activities, barriers and possible solutions according to their desires and requirements. In the medical care of diabetic patients, professional should not just provide prescriptions (“do as I say”) rather activities about foot care, glucose monitoring and medication should be demonstrated to them for effective self-treatment. Finally their social interaction should be prioritized so that they spit out their feelings. This research provide analysis of a specific geographic location in a short period with relative small sample size, it is recommended to conduct this study at large scale for longitudinal analysis so that results may be generalized. REFLECTION Qualitative research is a multi-dimensional study of factors which are determined by value judgments. The factor which were used in this research were simply analyzing the judgments of the participants as diabetes knowledge had its 14 indicators, now what participants think of those indicators personally is what matter in qualitative research not how much does that is none of any concern in qualitative study. This article of qualitative research has provided great deal of knowledge about the thinking patterns of humans as prescriptive methodologies have failed to teach the adherence of diabetes self-management education activities in practical but with the help of co-creation, such limitations have been transformed into strengths and yet the result of only self-managing activities are significant which states that the diabetes complications and problems can be resolved through self-motivation. This article provided extensive knowledge considering the nursing practice because clinical practitioners are usually unaware of this aspect of self-motivation and imply their prescribed opinions without considering the needs and desires of their patients. So, this analysis will help in future references of such events of non-compliance among patients. Qualitative research focuses on exploring issues, after identification it assumes understanding problem and then responding to the problem and finally the evaluation comes in line. This aspect of qualitative research will be useful in solving medical problems through qualitative measures in nursing practice. REFERENCES Funnell & Rogers, P. J. (2011). Purposeful program theory: Effective use of theories of change and logic models. San Francisco, CA: Jossey-Bass. Funnell, M. M., & Anderson, R. M. (2004). Empowerment and Self-Management of Diabetes. American Diabetes Association, 22(3), July. Gucciardi, E. (2006). Determinants of attrition from diabetes self-management education programs. Harris, A. D., McGregor, J. C., Perencevich, E. N., Furuno, J. P., Zhu, J., Peterson, D. E., & Finkelstein, J. (2006, Feb 13). The Use and Interpretation of Quasi-Experimental Studies in Medical Informatics. Journal of American Medical Informatics Association, 16-23. Mathew, R., Gucciardi, E., Melo, M. D., & Barata, P. (2012, Decemeber 19). Self-management experiences among men and women with type 2 diabetes mellitus: a qualitative analysis. Licensee BioMed Central Ltd. Pimple, K. D. (2008). Research ethics. Aldershot, England: Ashgate. Shadish, W. R., & Cooke, T. (2011). Experimental and quasi-experimental designs for field research. New York: Taylor & Francis. Read More