Diabetes in Primary Care - Essay Example

Diabetes in Primary Care Diabetes in Primary Care Introduction This paper will researched on one of these studies that deal with “diabetic patients views concerning their consultations with nurse prescribers and the effect on medications management” and below it will present a critique of the study. The article in question is “Consultations between Nurse Prescribers and Patients with Diabetes in Primary Care: A Qualitative Study of Patient Views” by Karen L. Stenner, Molly Courtenay and Nicola Carey. In order to achieve this, this critique essay will make use of the Caldwell 2005 Framework, which criticises every element of a study from its authors to its conclusion and also the references. It will identify the strengths and weaknesses of the study and its implication of nursing practice. Polit et al. (2001, p. 28) argue that a proper introduction should include the background of the topic as well as what is expected at the conclusion. Karen and her group started by describing the relevance of the topic as well as the conclusion they reached. Providing the readers what the relevance of the topic as well as the conclusion reached is influential in making the reader want to understand how they reached the conclusion (Polit et al. 2001, p. 28). Title, Authors and Abstract The title of Karen’s et al. (2011) article echoes its contents and is simple to understand. Caldwell et al. (2005) claim that the title of any study should be clear and make it easier for the reader to understand its contents. This is because an inaccurate or unclear title can perplex the reader. However, the title was rather too long, as Polit et al. (2001, p. 29), argues that reports of researches should start with a title, which concisely conveys (typically in 10 or fewer words) the study’s nature. Karen’s study was 17 words, which surpassed this Polit’s et al. (2001, p. 29) rule. The researchers (authors) of the article are overly qualified and show that they hold relevant academic knowledge and skills needed for this field of study. They all have the prior experience of working in a hospital setting and are all lecturers at the University of Surrey, Guildford, U.K., at the Division of Health and Social Care. Critics argue that the qualifications of the authors prove their expertise and knowledge. It will also help establish the reliability of the study. Thus, this article can be considered reliable because the researchers appear to be overly qualified to carry out such as study. The abstract provides a clear summary of the paper, the research problem is acknowledged and rationale is described in brief, findings, as well as future recommendations are stated. This permits the reader to comprehend what the article necessitates and if it is of any interest or relevance to them (Stenner, Courtenay & Carey 2011, p. 37). Critics argue that the abstract should include the research question/problem and also reveal to the readers how the study was conducted. According to Walker (2005, p. 572), the abstract is possibly the most significant part of an article because most readers will look at this section the first and then decide whether to continue reading or not. Rationale of the Study The rationale of the study was to assess nurse prescribing from the viewpoint of diabetic patients. They wanted to explore patients’ perception concerning their consultations with a nurse prescriber, as well as any effect of this on medications management. A proper research should briefly explain the rational of the research in order for them to understand the background of the research (Stenner et al. 2011, p. 37). A rationale of a study should be one to two sentences in order not to confuse the reader. The research paper in question had only two sentences explaining its rationale. Literature Review, Ethical and Aim of the Study The literature review included sources that were published in 1997 to 2008. Karen and her group were not biased as they referenced almost all the sources in the literature review. This goes a long way to clarify the critical thinking of the author and also the reliability of the information presented in the literature review. Judging on the fact that the article was published in 2011, sources from 2003 to 2005 can be considered as current sources. Current sources mostly fall from the current year the article was published to 4-5 years ago (Burns & Grove 2010, p. 54). The aim of the research was clearly described just after its introduction (Karen et al. 2011, p. 39). It was to investigate nurse prescribing from the viewpoint of diabetic patients. The aim of any research (long or short) should be as brief as possible in order for the research to quickly grasp what they are going to read (Benton & Cormack 2000, p. 58). The aim section of this article had only three sentences, which made it easier for the reader to understand what they were going to find in the article. The Karen et al. (2011, p. 39) did not state all the ethical considerations applicable to the research and how they were achieved, but they confirmed that they obtained their ethical approval from both NHS and University ethics committees. The research and development approval was also obtained in each Primary Care Trust (The Karen et al. 2011, p. 39). It is vital understand to state all the ethical considerations applicable to the research and how they were achieved in order for critics not to question the ethical angle of the study (Bowling 2006, p. 34). Methodology Karen’s group conducted a qualitative methodology to come up with their findings. Their aim was collect a comprehensive understanding of patient behaviour towards nurse prescribers, as well as the reasons, which govern their behaviour. Caldwell et al. (2005, p. 48) argue that the type of methodology assumed by a study will be instrumental to validate its findings. Such as study as Karen’s et al. (2011, p. 37) study required theoretical understanding rather numerical understandings and that is why a quantitative methodology was adapted (Gomm & Davies 2000, p. 99). Philosophical Background, Context and Participants A phenomenological approach (interviews) was utilised as the qualitative research strategy. This strategy advocates for freedom from prejudice or influence so that the research is a true reflection of the patients experience (Green & Thorogood 2004, p. 56). Karen and her group used semi-structured interviews to study the views of diabetic patients under the care of a nurse prescriber. Collecting data from these patients can be categorised as a descriptive research since it helps in gaining knowledge of the patients and their feelings to acknowledge that their views might be different from what people think (Kuzel & Engel 2001, p. 78). In addition, purposive sampling also referred to as judgemental sampling was use through the study. This is where the researchers choose participants rooted in their personal judgement concerning who will be most informative agent (Mays & Pope 2000, p. 51). Karen et al. (2011, p. 39) recruited nurses through a system of diabetes nurse prescribers. Every nurse had expert knowledge in diabetes. All of them were qualified and working as Nurse Independent Prescribers in the general practice or community clinics. The 40 participants used in the study were not enough because the findings of the study can be used to affect many people therefore a larger population would be preferable (Mays & Pope 2000, p. 52). Using a small number of participants represents just a small population instead of using many participants, which can easily generalise the information. They could have used more than 1000 participants in order to represent a larger population. Major Concepts The major concepts identified by Karen and her group include consultation between nurses prescribers and diabetic patients and how the patients comprehended it. This was referred to as “openness to nurses,” a concept which can only be articulated by the patient(s) talking to the nurses. The study advocates for diabetic patients to be open to nurses. Critics argue that a research should build on its concept in order for its findings to be reliable (Mays & Pope 2000, p. 53). Karen and her group maintained this concept throughout their paper, which ensured its reliability. Also, this concept should have a relationship with the empirical findings. Data Collection The method used for collection of data was through semi-structured interviews that assessed patients’ view of their consultation with diabetes nurse prescribers. A semi-structured interview is an oral self-report wherein a researcher asks the participation questions while having a pre-set plan concerning the flow of information or content to be gathered (Richardson 2000, p. 400). This method presumed that there was a strong connection between experiences of being diabetic and being cared for by a nurse prescriber. Data Analysis The analysis of the data was conducted centrally and interpretative phenomenological examination was employed in evaluating the rich data gathered. They also used thematic methods to analyse their data. This examination further established the relevance and implications of the data for nursing understanding and knowledge. However, Karen and her group did not clearly state how they had made sure that the data analysis method was auditable (Tomita & Kitamura 2002, p. 96). The data presentation was very clear as subheadings are used to explain the participants’ findings and details. The findings were split into categories of themes and subthemes that are simple to comprehend. The article offers a section that describes how the participants felt and how they related which the nurse prescribers. However, the data presentation seems to summarise all the results and can easily be misunderstood in discussing the findings. In such an article, it is easy to argue that the themes were explaining the experiences of the participants in precisely the same manner even if some participants might not have faced these feelings (Valente 2003, p. 130). The findings of the research were clearly discussed and a proper comparison was made with the other earlier research conducted. Each finding was discussed specifically (nurse consultation style, non-hurried consultation, care and rapport, clear and understandable information, approachability, continuity, specialist diabetes knowledge and experience, broad consultation) and these are contrasted to earlier research on the subject matter. A proper discussion should show that the survey went a step further to study the issues that connect to the subject matter (Polgar & Thomas 2000, p. 104). It should indicate that the issues that were stumbled upon and not anticipated. Furthermore, the results can be utilised in other groups or settings and; thus, transferability is clear. Discussion This is a significant first research that explores the perception of diabetic patients with on their relationships with a nurse prescriber. The manner in which patients described these interactions shows that nurse prescribers do and can assume principles of patient-centred care plus this was advantageous to patients. The benefits signify greater concordance over treatment choices that theoretically must improve treatment adherence and eventually health outcomes in reference to guidance on services for diabetic patients (Karen et al. 2011, p. 41). Implications for Nursing Practice The wide and unrushed consultation method and friendly, caring approach assisted patients to make them feel at ease while expressing themselves; therefore, allowing the nurse to get a proper comprehension of the patients’ lifestyle and condition (Karen et al. 2011, p. 41). Continuity of patient–nurse relationships can improve this further. Patients can be more able to ask the nurse queries that they consider as insignificant and open up concerning their lifestyle (McCormack & McCance 2006, p. 473). This can have a direct effect on the manner patients manage their condition as they can more probably to raise issues and find solutions to them (Luker 2008, p. 54). The accessibility and approachability of the nurse, enhanced by telephone contact, can make it easier for patients to reach out to a nurse for non-routine appointments or advice, therefore enhancing access to treatment and advice (Jones 2007, p. 488 and Ford 2003, p. 589). The work of nurses is normally to practice, know about and monitor illnesses. Enhancements to self-management can happen through a relationship between the patients and nurse wherein the two work mutually to discover solutions to issues as that arise (Hiscock 2001, p. 80). Strengths and Weaknesses of the Study Strengths The findings of this study add to peoples’ understanding of what diabetic patients value and benefit from relating to care provision. During prescription, nurses exercised standards of care delivery suggested in global guidance for diabetes. Given the rising demand on efficient services, higher recognition must be provided globally to the role of nurse prescribing to enhance diabetes care (Entwistle et al. 2008, p. 327). Findings establish that nurses’ capacity to offer patient-focused care is not presently jeopardised by their practice (prescribing) (Carey & Courtenay 2007, p. 397). Nevertheless, a number of issues were recognised as essential prerequisites, including: flexibility over consultation period, continuity, specialist diabetes knowledge and interpersonal skills. It is significant that these traits are protected and promoted (Ball 2009, p. 45). Enhancements can be made to the steadiness of information provision on side-effects treatment and sensitivity can be revealed to patients’ need for involvement in healthcare choices at diverse points of care. Weaknesses As a qualitative research, the findings might not embody the viewpoints of every patient. They only presented points offered by 31 participants. This is because the authors reached their conclusion on a majority of basis. Critics claim that researchers should also present the results of the minority participants in order for the study to not appear as if it is biased (Ball 2009, p. 46). A specific weakness being that the nurses who concurred to be included might have done so since they were assured of their competence and skill in conducting consultations (Karen et al. 2011, p. 45). Even though, nurses chosen do echo the vital settings wherein nurses normally prescribe to diabetic patients in primary care, the transferability of the results to other environments has yet to be established. Also, another weakness is that the data lack transferability because it uses a small number of participants. This can affect the study in the sense that its findings cannot be widely applies (Ball 2009, p. 47). Conclusion In the conclusion, even though this faced had experienced some limitations, its strengths surpassed all these weaknesses. Karen and her group also show that the information gotten can be utilised to improve the need of every diabetic patient. The research uncovers problems and experiences that were not expected during the design of the research. A recommendation of the research is that these results should be dealt with in current management and assumptions in coping with diabetes. The research is comprehensive and focused and offers any reader a clear overview of the experiences of diabetic patients. The research findings are shown rationally even though more information would have made the article much clearer. In finalising the article, the researchers maintained their findings and expressed them very well. References Ball, J 2009, Implementing nurse prescribing: an updated review of current practice internationally, Geneva, International Council of Nurses. Benton, D C & Cormack, D F S 2000, Reviewing and evaluating the literature, In D. F. S. 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