Quality of Life Issues in a Group of Older People with Pressure Ulcers - Analysis - Research Paper Example

Introduction The research paper is a report of the findings of a phenomenological study that explored the experience of living with a pressure ulcer. The study was a pilot study to test the feasibility of undertaking a wider European study. It was undertaken in four centers in two European countries and was funded by the European Pressure Ulcer Advisory Panel (EPUAP). In this paper, we describe the findings of the pilot study, which explored quality of life (QoL) issues in a group of older people with pressure ulcers, and discuss the implications for nursing clinical practice. The implications to the practice of nursing includes further understanding about the impact of pressure ulcers on the lives of older people, revelation about the pain suffered by older people with pressure ulcers and how the use of pressure relieving devices may increase their pain and awareness of the coping mechanisms developed by older patients with pressure ulcers. Does the title reflect the content? The authors of the research came up with the title “Patient stories of living with a pressure ulcer”. The title is informative and it indicates the focus of the study. It allows the reader to easily interpret the content of the study. The following are the noted characteristics of the title of the research. 1. The title is the subject matter of the study. The locale of the study, the population involved, and the period when the data were gathered were all omitted on the title but were indicated on the description of participants on page 347 of the research. 2. It was broad enough to include all aspects of the subject matter studied or to be studied. Hence, the title indicated what the readers should expect to find inside the thesis report. 3. It was brief and concise as possible. 4. The authors avoided using the terms “An Analysis of,” “A Study of,” “An Investigation of,” and the like. This is important since all these things are understood to have been done or to be done when a research is conducted. Does the abstract summarize the key components? The abstract is found on the first page of the research. It has the findings which provide the summary of the key components of the research. The abstract provides a short summary of the study. It includes the aim of the study, outline of the methodology and the main findings. The purpose of the abstract is to allow the readers to decide if the study is of interest to them Are the authors credible? The researchers hold appropriate academic qualifications and are linked to a professional field (nursing) which is relevant to the research. The authors or researchers are Alison Hopkins MSc RN DNCert is a Clinical Nurse Specialist, East London Wound Healing Centre, Tower Hamlets PCT, London, UK. Carol Dealey BSc MA PhD RGN RCNT is Senior Research Fellow, Research Development Team, University Hospital Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK. Sue Bale BA PhD RN RHV NDNDip FRCN is a Professor, Associate Director of Nursing, Gwent Healthcare NHS Trust, Grange House, Llanfrechfa Grange, Cwmbran, UK. Tom Defloor PhD RN is a Professor, Head of Nursing Science Department, Nursing Science Department, Ghent University, Gent, Belgium. Fran Worboys BSc DN Cert. RGN is a Clinical Nurse Specialist, East London Wound Healing Centre, Tower Hamlets PCT, London, UK. The authors have established their credibility through experience and knowledge while practicing the nursing profession. Is the aim of the research clearly stated? The aim of the study is clearly stated and conveys what the researcher is setting out to achieve. The aim of the pilot study is to explore the lined experience of older patients with pressure ulcers. To describe, the aim is very purposive and is geared towards further understanding of the lives of patients experiencing pressure ulcers and how the current nursing practices affect these people. Is the rationale for undertaking the research clearly outlined? The researchers present a clear rationale for the research, setting it in context of any current issues and knowledge of the topic to date. Research literature found on the research is composed of discussions of facts and principles to which the present study is related. For instance, the present study deals with the quality of life the patients with pressure ulcers have, literature that was reviewed or surveyed was composed of materials that deal with the consequences of having pressure ulcers such as endless pain, restricted life and the need to cope with the clinical problem. The materials that were used were usually printed and found in books, encyclopedias, professional journals, magazines, newspapers, and other publications. Materials can be classified as 1. Local, if printed in Europe; and 2. Foreign, if printed in other lands The sources for the research literature are mixed since mostly were from British Journal while others were from internationally published books, journals and dissertations. Is the literature review comprehensive and up-to-date? The literature review should reflect the current state of knowledge relevant to the study and identify any gaps or conflicts. It should include key or classic studies on the topic as well as up to date literature. There should be a balance of primary and secondary sources Related studies, on the other hand, are studies, inquiries, or investigations already conducted to which the present proposed study is related or has some bearing or similarity. They are usually unpublished materials such as manuscripts, theses, and dissertations. They may be classified as 1. Local, if the inquiry was conducted in Europe; and 2. Foreign, if conducted in foreign lands A survey or review of related literature and studies is very important because such reviewed literature and studies serve as a foundation of the proposed study. This is because related literature and studies guide the researcher in pursuing his research venture. With the research conducted by A. Hopkins et al the following are the observed characteristics of their related literature and studies that make them of true value. 1. The surveyed materials were as recent as possible. This is important because of the rapid social, economic, scientific, and technological changes. Findings several years ago may be of little value today because of the fast changing life style of the people. 2. Materials reviewed were objective and unbiased. Some materials are extremely or subtly one-sided, either political, or religious, etc. Comparison of these materials cannot be made logically and validly. Distorted generalizations may result. 3. Materials surveyed were relevant to the study. Only materials that have some bearing or similarity to the research problem at hand should be reviewed. With this, they included research information regarding the current nursing practices in UK as well as the implications of these to patients with pressure ulcers. 4. Surveyed materials have been based upon genuinely original and true facts or data to make them valid and reliable. There are cases where fictitious data are supplied just to complete a research report (thesis or dissertation). Of course, this kind of deception is hard to detect and to prove. Thus, this is a real problem to honest researchers. But given the scholastic and clinical credentials of the writers, much benefit of the doubt is due to them. 5. Reviewed materials were not too few or too many. They were only sufficient enough to give insight into the research problem or to indicate the nature of the present investigation. The number was also dependent upon the availability of related materials. Sometimes, there is a paucity of such materials. Ordinarily, from ten to fifteen related materials are needed for a master’s thesis and from fifteen to twenty-five for a doctoral dissertation depending upon their availability, as well as their depth and length of discussions. For an undergraduate thesis, from five to ten may do. The numbers, however, are only suggestive and not imperative nor mandatory. These are only the average numbers observed from theses and dissertations surveyed by the author. Are all ethical issues identified and addressed? Ethical issues pertinent to the study are discussed. The researchers identified how the rights of informants have been protected and informed consent obtained. The patients who participated in the study were informed regarding the purpose of the research and approval was sought from them prior to the interviews. Health service research committees were responsible for getting the permission of these patients. The information regarding and confidentiality of the study were both communicated to them both in written and oral form. During the interview processes, the patients were regularly monitored for any signs of discomfort or anxiety that may affect their care. Is the selection of participants described and the sampling method identified? The researchers made clear which research strategy they are adopting, i.e. qualitative. A clear rationale for the choice was also provided, so that the readers can judge whether the chosen strategy is appropriate for the study. The research work involved a comprehensive and extensive examination of a particular individual (patients with pressure ulcers), group or situation over a period of time which is somewhat similar to a case study. (Mckee and Robertson, 1975). Young (1966) defines case study as a “comprehensive study of a social unit – be that unit a person, a social institution, a group, a district, or community.”(Cited by Sanchez, p. 43) Good and Scates define descriptive research such as this one as a method which takes account of all pertinent aspects of one thing or situation, employing as the unit for study an individual, an institution, a community, or any group considered as a unit. The research consists of the data relating to some phase of the life history of the unit or relating to the entire life process, whether the unit is an individual, a family, a social group, an institution, or a community. The complex situation and a combination of factors involved in the given behavior are examined to determine the existing status and to identity the causal factors operating. (Good and Scates, p. 726) Are the philosophical background and study design identified and the rationale for choice of design evident? The design of the study, phenomenology, was identified and the philosophical background and rationale was discussed. The design of the study is appropriate to meet the aims of the study. The Heidegerrian phenomenological approach was used. In Heidegerrian terms phenomenology asks the question of the being (meaning) of being. But ultimately one has to suspend being itself in order to radicalize this question. One has to ask the question: What is other than being? According to Levinas this is the ethical reduction. Even the assumptions of moral theories and ethics have to be suspended. Heidegger actually states that there is a residual object and self afterward an infinite knowing resulting from infinite knowing. Is the context of the study outlined? The researchers provide a description of the context of the study, how the study sites were determined and how the participants were selected. The context of the study was outlined in the methods part of the research. Is the selection of participants described and the sampling method identified? Informants are selected for their relevant knowledge or experience. Representativeness is not a criteria and purposive sampling is often used. Sample size may be determined through saturation. The selection of participants was described and the sampling method was also identified. They recruited eight patients during 2003-2004 as purposive sample. The patients were over 65 years of age, have pressure ulcer for more than a month and with severity grade of 3 or 4. Is the method of data collection auditable? Data collection methods are described, and appropriate to the aims of the study. The researchers describe how they have assured that the method is auditable. The method of data collection was auditable. The tabulation of the interview results was a good presentation of the data collected from the patients for easier analysis. The method of data analysis was somewhat credible and confirmable. This was due to the feeling of pain being relative and the magnitude may be varied from one patient to another. Is the method of data analysis credible and confirmable? The data analysis strategy was identified; the processes were used to identify patterns and themes. The researchers identified how credibility and confirmability have been addressed. Almost all data-gathering devices are used in collecting data for a research study. The interview is very important. The patients who fit the description for the requirements for the sample population were interviewed to be able to gather data since they might be able to shed light on the problem or pressure ulcers. Long probing interview may be conducted especially with the patient himself. Another important tool is observation. This involves observing the patient’s behavior of an adequate length of time and some other observable conditions that might have contributed something to the maladjustment of the patient. The authors who made research study may act as participant-observers which were more effective. The questionnaire is another instrument. This is given to the patient himself and to some people who may be able to contribute something to the discovery of important data about the case. Autobiographies, too, are rich sources of information about the patient and his problems. When the patient writes the story of his life he usually includes those incidents that have great impact or consequence upon his life and these may reveal at once the cause of the problem. Little incidents may also have some cumulative effect which may create a problem which cannot be ignored later on. Other devices employed are the checklists, score cards and rating scales. Letters and notes to and from the patient and his diaries may also help in diagnosing a case. Cumulative records in school and in guidance and counseling offices are valuable sources of information. Needless to say, all pieces of information are carefully and accurately recorded. Statistical procedures are then applied to analyze and organize or summarize the data in which case frequencies, types, trends, uniformities, or patterns of behavior are revealed. These serve as the basis for resolving the problem or conflict. This is interpreting the evidence available. Conclusion: The research includes the following characteristics as well: 1. Completeness of data. The potential range of information includes symptoms, examination results (psycho-physical, health, educational, and mental, and history (health, school, family, and social aspects). 2. Validity of data. For instance, a doubtful birth should be verified through the birth registry and employment records by reference to employers. 3. Confidential recording. Educational workers have something to learn from medicine with respect to the confidential nature of professional records; the difficulties of individual teachers or pupils in relation to discipline, failure, achievement, or mentality should be regarded as professional problems to be treated in confidential manner. 4. Synthesis. This is an interpretation of the evidence that is more than a mere enumeration of data secured; it embraces diagnosis in identifying causal factors, and prognosis in looking toward treatment or developmental procedures. REFERENCES: Caldwell, K., Henshaw, L. and Taylor, G. (2005) Developing a framework for critiquing health research. Journal of Health, Social and Environmental Issues. Vol.6 No.1 p45-54 Downie R.S., Tannahill C. & Tannahill A. (1996) Health promotion: Models and Values. Oxford University Press, Oxford. Esposito N. (2001) From meaning to meaning: the influence of translation techniques on non-English focus group research. Qualitative Health Research 11(4), 568–579. Hopkins A. (2004b) The use of qualitative methodology to explore the impact of leg ulceration. Journal of Tissue Viability 14(4), 142– 147. Jasper M. (1994) Issues in phenomenology for researchers of nursing. Journal of Advanced Nursing 19, 309–314. Kahn D. (2000) How to conduct research. In Hermeneutic Phenomenology Research: A Practical Guide for Nurse Researchers (Cohen M.Z., Kahn D.L. & Steeves R.H., eds). Sage Publications, London, pp. 57–70. Marks D., Murray M., Evans B. & Willig C. (2000) Health Psychology: Theory, Research and Practice. Sage, London. Price P. (1996) Defining and measuring quality of life. Journal of Wound Care 5(3), 139–140. Smith J. (1995) Semi-structured interviewing and qualitative Analysis. In Rethinking Methods in Health Psychology (Smith J.A., Harre R. & Van Langengrove L., eds). Sage, London, pp. 9–26. Smith J.A., Jarman M. & Osborn M. (1999) Doing interpretative phenomenological analysis. In Qualitative Health Psychology: Theories and Methods (Murray M. & Chamberlain K., eds). Sage, London, pp. 218–240. Twinn S. (1997) An exploratory study examining the influence of translation on the validity and reliability of qualitative data in nursing research. Journal of Advanced Nursing 26, 418–423. Read More