Nursing Research Appraisal - Essay Example

Nursing Research Appraisal This paper is a research appraisal of the article by Rycroft-Malone J, Harvey G, Seers K, Kitson A, M Mccormack B & Cormack Titchen A published in Journal of Clinical Nursing. The title of the article is "An exploration of the factors that influence the implementation of evidence into practice". The authors investigated the subject using focus groups and interviews. The results are represented with the help of grounded theory framework. The research has been designed as to provide for a basis for future studies and researches in this field, as the question of implementing evidence into practice is a relevant problem in the field of nursery. The Study The purpose of the study is to investigate the background of "getting evidence into practice". In order to provide for representation of the facts that revealed during the study, the authors used a framework, reflecting the elements influencing the process. The elements that are observed by the authors to be major influencing factors are the "nature of the evidence", the "context", and the "facilitation". The authors aimed at examining the components of the framework with the help of empirical enquiry approach. The authors set out to answer a set of questions: 1. What difficulties do the practitioners face during the process of implementing evidence into practice 2. What are mediating issues of the process 3. Are evidence, context and facilitation the key issues that shape the framework reflecting the process The subject is relevant for clinical experience, as it may provide the basis for further consideration and development of evidence implementation. The research was divided into two parts. At the first stage investigative focus groups were appointed to give a perspective of the factors that may influence the process of implementing the evidence into practice. At the second stage the experts collected the data of case studies. The designed used by the authors is effective to provide for relevant data within the research and represent them in accurate manner. Qualitative research involves narratives, in-depth interviews and focus groups (Lane, McKenna, Ryan & Flemming, cited in Schneider et al. 2003). Powell et al give the following notion of a focus group: "a group of individuals selected and assembled by researchers to discuss and comment on, from personal experience, the topic that is the subject of the research" (p. 499). Focus groups are similar to interviewing groups but they have definite distinctions. As Jones states, "Group interviewing involves interviewing a number of people at the same time, the emphasis being on questions and responses between the researcher and participants. Focus groups however rely on interaction within the group based on topics that are supplied by the researcher". (p. 379) As it is stated in Research Methods, "The rule for selecting people for focus groups tends to be commonality rather than diversity. Research has shown that people tend to disclose more to people who resemble them in various ways than to people who differ from them. The kind of homogeneity you need depends on the specific purpose of the research. It is likely that you will want to consider the relevance of factors such as age, educational background, sex, professional status and ethnic formation". All qualitative researches and this in particular are based upon analytical categorization to describe the phenomena. (Rice, P. L. & Ezzy, D, p.168) The data revealing in the research process provide for a ground to point out new categories. Thus, the authors of the study reconsidered pre-set theories and pointed out new categories to be highlighted within the research process (Gibbs). The grounded theory approach usually is "to read (and re-read) a textual database (such as a corpus of field notes) and "discover" or label variables (called categories, concepts and properties) and their interrelationships. The ability to perceive variables and relationships is termed "theoretical sensitivity" and is affected by a number of things including one's reading of the literature and one's use of techniques designed to enhance sensitivity". (Rice, 1999 , p. 79). The same scheme was represented in this study. Sampling The size of sampling material influences the content and quality of the research, and it should be carefully carried out. (Pope, p.1) If the size is smaller than it should be, the most detailed information and scrupulously carried out research wouldn't provide for relevant results of the study, missing necessary elements or estimating them improperly. (Introduction to research methods - qualitative and quantitative). In case the size is too large it would be more difficult to complete the study and it would cost much (Zodpey). Besides, this also may influence the quality of the findings, as it is hard to provide for quality research while dealing with a large amount of information. Locke et al. stated, that "optimum sample size is an essential component of any research." (p. 79) As far as the given study is concerned, the sampling size is relatively small, so the results of the study cannot be regarded as fully representative and reliable, but at the same time the size didn't overweigh the process and allowed careful observation of the results. The groups consisted of 10 nurses at the first stage and 7 at the second. Data Collection And Analysis According to McLafferty (2004) focus group interview is a popular method for collecting qualitative data in health care. In most cases of qualitative researches the process is divided into several stages. The process starts with the collecting of the information, then the authors proceed to the analysis and then the results and findings are defined. (Silverman, p. 26) The authors of Focus Groups article state that, "Consider the words of the participants Consider the context of each comment (is it based on a prompted example, etc.) Consider the internal consistency Consider the frequency or extensiveness of comments Consider the Intensity of the comments Consider the specificity of responses (give them more weight than vague, impersonal responses) Find the big issues". The analysis allows the researches come back and change questions, refine the process and, if necessary, add new items for the investigation. This also helps the authors of the research to find out negative issues, as the commentators describe it, "examples of talk or events that run counter to the emerging propositions or hypotheses and can be used to refine them" (Britten, qtd in Patton, p. 322). According to Schneider, Elliott, LoBiondo-wood and Haber (2003), qualitative research is carried out between researcher and research participants through direct relationship. A flexible approach used by the authors of the study is important for qualitative researches, as the process of collecting the information and analyzing it are carried out together. The first stage observed the data collected by two focus groups consisting of 10 nurses. "The focus group discussions were moderated by the research lead, lasted 60-90 minutes, were tape-recorded and later transcribed verbatim." The second stage collected the information from 7 nurses that were interviewed. "The interviews took approximately 1 hour, were audiorecorded and later transcribed verbatim." The results of the study can be regarded as relatively reliable and accurate, due to the flexible approach towards the data collection and interviewing. They could be more accurate if the sampling size was larger. Analysis was carried out within the info sets and then the findings were compared within the sets and sites to find out the similarities and distinctions. This allowed finding out matching themes. As stated in Schneider et al (2003, p.144) "It is very important for qualitative researchers to be aware of and sensitive to ethics and ethical issues". The authors of the research solved the problems with access to the site with the help of the gatekeepers that were aware of the experiment and its purposes: "Once verbal consent to proceed was given, ethical clearance was sought. Written applications were made to the local research ethics committees." Rigor The process was clearly divided into two sections, which were carried out separately, thus making a solid basis for data analysis and making conclusions. All the data collected are represented in the framework which makes the process clear for all the specialists or experts that were not involved into the process. The framework makes evident that these three factors are the nature of the evidence used by the practitioners, the context and its quality and the kind of facilitation that is necessary to make the process of implementation successful. The work is of high creditability, as the research was carried out carefully, and the data were analyzed with the help of appropriate approach. As far as the reliability for the research is concerned, the data collected within the research and the results cannot be referred to as fully reliable as the participants were the persons interested in the subject of the research and willing to implement evidence into practice, and this was confirmed by the authors. Thus, the present study should be completed with the research made with the help of independent participants. One of necessary aspects of the study is provision for further utilization of the results. (Williams, 2002). The literature on this subject pays much attention to the nurses' attitudes to the utilization of the research results. (Schneider et al.) The problem of further utilization is also observed in the study. The results of the investigation may be transferred to another field of medical experience, as the findings would be relevant for any other cases of getting evidence into practice. Findings And Limitations The results of the study demonstrate and prove that the major elements influencing the process of "getting evidence into practice" are "evidence nature", "context" and "facilitation". The findings of the research make evident that the content and the aims of the research framework demand more careful consideration to prove its appropriateness and accuracy. The study allows suggestions that those who intend to implement the evidence into practice are in need of solid evidence basis to provide for person centered care. This basis should include practical experience, research and patient's experience. It is important to provide for integrity and appropriateness of these key elements into the context of practice. In addition to the motivation of the specialist that implements evidence in practice, the support at organizational level is to be provided. Moreover, the heads of the institutions are to ensure the staff is trained enough to have motivation and experience to provide for successful implementation of evidence into practice. The authors of the research state that the approaches worked out by individuals to implement evidence are not effective. The most important issues that appeared within the research process due to theoretical investigations and practical experience are represented by the authors with the help of the framework. It was designed especially as to provide for accurate information to be used by the specialists not involved into the experiment for further consideration, as the findings of the study demand empirical enquiry. There are some limitations in the study that worth mentioning. These limitations are as follows: a small scale of the research and subjectivity of the data reported. These limitations determined relative reliability of the study. Those who took part in the research were the proponents of getting evidence into practice, and avoiding perspective expectations in their opinions was impossible. Another important issue is that the result of the research should be observed in relation to the fact that the statement about potentially successful outcome of implementation is based upon the disadvantages deriving from the absence of implementing evidence into practice. Conclusion The results of the study may be used for further investigation but a more profound study is needed. The sampling size is relatively small, and that doesn't make the results fully reliable, although the process of data collection and study was carried out accurately. It is evident that this subject demands more careful consideration and further researches as it is relevant for the nurses in their practice. References Gibbs A., Focus Groups, Social Research Update, viewed 15 Nov 2005, available at http://www.soc.surrey.ac.uk/sru/index.html Introduction to research methods - qualitative and quantitative. Available at http://www.ceu.hu/soc_ant/introductiontoresearchmethodsprint.htm Focus Group Research, viewed 2004 December, 27, available at http://legacywww.coventry.ac.uk/legacy/ched/research/fogrweb.htm Jones, J., 1999, Qualitative research: Consensus methods for medical and health services research, British Medical Journal, 5, p376-380 Locke, L. F., Silverman, S. J. & Spirduso, W. W., 1998, Reading and understanding research Thousand Oaks, CA: Sage McLafferty, I, 2004, 'Focus group interviews as a data collecting strategy', Journal of Advanced Nursing, vol. 48, no. 2, pp. 187-194, viewed 4 Jan 2005, available at Patton, M.Q., 2001, Qualitative Research & Evaluation Methods, Thousand Oaks, CA: Sage Pope, C., 2000, Analysing qualitative data, Qualitative research in health care, Education and debate. viewed 15 Nov, available at http://bmj.bmjjournals.com/ Powell R.A., Single H.M., Lloyd K.R., 1996, Focus groups in mental health research: enhancing the validity of user and provider questionnaires, International Journal of Social Psychology 42: 193-206. Rice, P. 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