Quality of Nursing Care: the Journal of Advanced Nursing Published Data - Essay Example

Research article critique: Quality of Nursing Care in the Words of Nurses by Linda Maas Burhans and Martha Raile Alligood s Submittedby Names: Tutor: Date Adapted from: © Letts, L., Wilkins, S., Law, M., Stewart, D., Bosch, J., & Westmorland, M., 2007 McMaster University Critical Review Form - Qualitative-Studies Burhans, L. and Alligood, M. 2010, Quality nursing care in the words of nurses, Journal of Advanced Nursing, 66(8), pp.1689-1697. Introduction The report on Quality of nursing care in the words of nurses entails published data in the Journal of Advanced Nursing and based on a study in the United States, the paper is a report of a study concerning the meaning of quality nursing care as far as practising nurses are concerned. The report also continues to acknowledge that healthcare remains an aspect that is at the centre of intense criticism as well as debate. Even though the quality of nursing is important to the outcome of patients, significant advances have been distressingly slow and an assessment of literature concerning quality care demonstrates that nurses do not often get involved in the development or definition of improvement initiatives intended for quality of care. Purpose of the study The main aim of the study was to report the meaning of quality nursing care for practicing nurses since quality of healthcare increasingly remains to be at the centre of criticism and argument. Regardless of the fact that quality healthcare is important to the outcome of patients as well as their safety, significant improvements have not been seen. According to the abstract for this study, an assessment of literature concerned with quality of care reveals that practicing nurses get involved in the development or definition of improvement initiatives meant for quality of healthcare. Based on this the study was developed with the main grounds being that quality of nursing must be significant to nurses and that revealing the nurses’ meaning of quality nursing care may lead to more efficient improvement approaches. These justifications for caring out the study at hand were made clear and were compelling enough to go on with the study. Study design The study was based on the hermeneutic phenomenological approach to research involving human sciences by van Manen (1990), and was designed to reveal the actual meaning of pragmatic experiences. Hermeneutic phenomenology is a qualitative approach to research that was developed from phenomenological philosophy, which is a branch of continental philosophy (Friesen, Henriksson and Saevi, 2012, p. 169). The fundamental principle of hermeneutic phenomenology is that the most simple and basic experiences of man concerning the world are already laden with meaning (Frost, 2011, p. 46). This means that man in involved in his world and immediately experiences the world as being meaningful since the world, along with other people, culture and events, precedes any intentions on the part of an individual to appreciate and develop an explanation. The main purpose of research carried using the hermeneutic phenomenological approach is to reveal and reflect the meanings of fundamental experiences. Researchers try to create descriptions of phenomena in the manner in which they are seen in everyday life prior to theories, interpretations, explanations and abstracts being developed, while maintaining the awareness that the attempts to do this are uncertain, conditional and never complete (Van Manen, 1990, p. 100). The main objective of phenomenological studies such as this one is to develop a full understanding of the essence of some phenomenon, which in this case is the quality of nursing care (Gerrish and Lacey, 2010, p. 117). This can be achieved through long comprehensive interviews with the individual nurses chosen for the study. The key objective for this form of interviews is usually to develop a description and interpretation of the experiences of the nurses in order to appreciate the essence of the experiences as viewed by the nurses themselves. This is founded on the fact that there are numerous ways of interpreting an experience and that the meanings of the experience to every nurse are what reality entails. A phenomenological research problem puts emphasis on the important aspects concerning the meaning of an event, occurrence or interaction while maintaining its focus on understanding the voice of the people who participate in the research. The problem may be stated directly or less directly with a central question in the research along with a number of sub questions that are employed in order to orient the researcher in the collection of data and framing of the results. The respondents are chosen since they have gone through the experiences that are being investigated and wish to share what they think about these experiences as they have an ability to articulate their conscious experiences. In most cases, the respondents come from a single site but there are instances when they come from multiple sites with between five and twenty-five people being interviewed. In this study, data was obtained using personal comprehensive interviews, which were semi-structured. Since phenomenological research is more focused on meanings and consciousness, the researcher was supposed to take a lot of care in dealing with codes and theories that develop the basis for descriptions and meanings (Hoffmann, Bennett and Del Mar, 2009, p. 209). The analysis began with a description of the experiences the researcher has concerning the quality of nursing care. Statements that demonstrate the manner in which the respondents experience quality of nursing care were identified and meaningful units constructed from the statements through verbatim language from the respondents as illustrations. Method(s) used The method that was used to collect data for the research was focused interviews that were tape-recorded and lasted approximately forty minutes for each respondent. The interviews took place privately and in a confidential manner and were all conducted by the same interviewer through telephone or one-on-one. All the interviews were conducted personally by the researcher and also accomplished the phenomenological inquiry procedure that entailed empirical and reflective methods with the intention of revealing the lived meanings of the quality of nursing care for the nurses who took part in the research. The respondents were supposed to respond to a number of questions in their own words including their thoughts about quality of nursing care and their experiences in the delivery of quality of nursing care. The questions that were used were appropriate in the collection of information of the phenomenological nature that was required for this study. Further, the interviewer used probing questions in order to refocus the respondents back to the research topic or to get more information after a specific question. Unstructured interviews are preferable in the cases where the researcher has adequate understanding of experiences as well as the topic of interest in order to have clear agendas for the discussions with the respondents while still remaining open to having his understanding of the area of inquiry to be revised by the respondents (Whitehead and McNiff, 2006). Since the interviews for the research were semi-structured, and since the level of understanding of the researcher is still increasing, it was important to anticipate the need to make sure the responds provide comprehensive responses to the questions. The unstructured interviews are very beneficial in the development of an understanding of an experience that is not yet fully understood such as quality of nursing care (Tappen, 2011, p. 237). This is because they make it possible for the researcher to emphasis on the responses of the respondents on a specific topic of interest while enabling the researcher to assess his or her initial understanding. The semi-structured interviews may act as a crucial preliminary phase when developing more structured interview guidelines and surveys. Sampling In research, sampling involves the selection of the people who will become part of the study where qualitative studies prefer to use purposeful sampling that is based on a certain criteria or characteristic that relate to the research questions (Flick, 2008, p. 32). The best example for this is the study that is concerned with understanding quality of care from the nurses point of view where if a random sample of ten people is considered, there is likelihood of not having any respondent who will be a nurse. Continuing to sample people randomly until the adequate number of nurses is achieved may take too much time and thus delay the research. Therefore, it is important in this case to purposefully target the population that is relevant to the study in order to save time and achieve success in the research (Holloway and Wheeler, 2013, p. 137). In the case of the research seeking to understand the experiences and perceptions of nurses on quality of care, the participant selection criteria preferred Registered Nurses who were employed in hospitals and possessing baccalaureate degrees. Additionally, the nurses needed to have worked for a minimum of one year in the hospital environment and with experience in clinical patient care in various sections of the hospital including acute care among others. The nurses who met these criteria were enrolled to the study, interviews arranged, and this created a purposive sample of practicing nurse respondents who were chosen based on convenience. Data Collection: Descriptive Clarity The data was collected through focused interviews that were tape-recorded and lasted forty minutes, and this can be considered as adequate time to conduct an interview in a conducive environment. The interviews took place privately and in confidence with all of them being done by the same interviewer. The interviews being done by the same interviewer ensured that there was some form of consistency in the manner in which they were conducted and the data recorded. Some of the interviews were conducted on a one-on-one basis while others were conducted through the telephone. Additionally, probing questions were used in order to motivate the respondents to expound on some of the issues they responded to and this provided more information for the study in terms of understanding the quality of healthcare (Stommel and Wills, 2004, p. 282). Procedural Rigour Methodological rigor is concerned with transparency in the description of the manner in which the research took place and it entails providing details of aspects such as accessibility to objects, building of rapport and trust, data collection, recording, coding and analysis approaches as well as accounts of the way errors are addressed (Hesse-Biber and Leavy, 2010, p. 210). Therefore, in critiquing research and examining qualitative methods in the research seeking to understand the quality of care, issues like access to the nurses, who was the interviewer and how long the interviews took have to be addressed. In the study, all this issues are documented including the criteria that were used to arrive at the final sample population. The data collection method was also flexible as it catered for the respondents who could not be accessed on a one-on-one basis through conducting telephone interviews, which were also recorded. Tape-recording the responses of the interview, auditing transcripts as well as field notes were used for validation and this made ensure the accuracy of data while contributing to the credibility of the materials employed for the research (Bassett, 2004, p. 166). The research also employed verbatim quotes as low inference descriptors to enable anyone reading to view the perspective of the respondents. Dependability of the quotes was reinforced through directly verifying the accuracy of the transcripts through comparing with the audiotapes and notes from the field. Data analyses: Analytical Rigour The data that had been gathered through interviews was subjected to analysis and interpretation as well as synthesis using a qualitative hermeneutic phenomenological research approach developed by van Manen (Sim and Wright, 2000, p. 279). The research involved an investigation of experiences in the manner in which they are lived and not the way they are conceptualized while at the same time developing a reflection of the essential themes that create the phenomenon. In the process of data analysis, the developing themes that come from the interviews were identified based on the audio tapes along with the interviewer’s transcripts (Maltby et al., 2014, p. 140). Further, the process of coding involved empirical and reflective approaches when analysing the transcripts with the identified words being put into categories in subsequent coding phases. The research context was also balanced through considering the parts together with the whole as the study concerned with the lived meaning of quality of care from a nurse’s perspective needed mindfulness as well as some form of balance in regard to part and whole in its entire conduct. Auditability Qualitative research develops the assumption that every researcher comes with a unique perspective to the study and the results that come out of the study have to be confirmed or collaborated with others from different studies (Boeije, 2009, 172). Various approaches can be employed to enhance this aspect as the researcher may decide to document the processes he follows for checking and rechecking his data in the entire study. A different researcher may decide to play devil’s advocate as far as the results are concerned and the process may be documented. Additionally, the researcher may decide to search for develop a description of the negative occurrences that go against previous observations where after the study, a data audit can be conducted to assess how data was collected while analysing the procedures and judging the potential for bias or distortion. In the research seeking to understand the lived meaning of quality of care from the nurse’s perspective, the reader can establish auditability as the steps of the research can be followed with ease from development of the research question all the way to collecting data and the findings (Polgar, 2013, p. 187). The reader can follow the thinking of the researcher through interpretation and synthesis that has been done by the researcher as well as the data examples that are provided. Theoretical Connections Theories are essential in research while remaining a valuable tool for the researcher where the simplest theories are considered the best and most appropriate (Garner, Wagner and Kawulich, 2009, p. 37). A good theory should not be highly complex or redundant and should have a minimum number of elements (Basford and Slevin, 2003, p. 329). Creating and testing theory can be approached from two directions that include abstract thinking where a logical connection of ideas is developed between theory and concrete evidence and then the ideas are tested against the collected evidence. On the other hand, they can start with particular observation of empirical evidence and based on this evidence, an increasingly abstract idea can be generalized and built. Since the main aim of a theory is to explain, researchers mainly put emphasis theoretical explanations, which are the logical arguments that explain the reasons why some things take place. The research on quality of care developed orientations into the manner in which the perspectives of the nurses could be perceived through a providing a set of assumptions, theories and various explanations. Ethical considerations Applying a qualitative approach to research in social sciences involves particular duties to the profession as well as the people taking part in the research so that they can be protected (Walsh and Wigens, 2003, p. 106). A willingness to take part in a study that enhances an understanding of different phenomenon exposes the participants to various states of vulnerability and thus a set of guidelines must be developed in order to protect them (Albon, 2007, p. 140). The study seeking to understand quality of care accorded ethical considerations a high priority with various bodies approving the study before it was conducted. The participants were also promised and assured of discretion, while at the same time being made aware that they had the freedom to withdraw from the study at any point if they became uncomfortable. Conclusion The article concluded by stating that nursing knowledge regarding the meaning of quality nursing care has a capacity to create enhancements in the discipline while at the same time leading to practice changes and improvement in quality care. From the findings of the study, future research should be directed at issues like the lived meaning of quality of nursing care for the nursing who are in practice in various acute settings and other general and intermediate level units and the lived meanings of nurses working in environments that are not acute like community health and other care delivery environments. Bibliography Albon, A. 2007, Introducing psychology through research, McGraw-Hill, Maidenhead. 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Hoffmann, T., Bennett, S. and Del Mar, C. 2009, Evidence-based practice across the health professions, Elsevier Australia, Chatswood, N.S.W. Holloway, I. and Wheeler, S. 2013, Qualitative Research in Nursing and Healthcare, Wiley, Chicester. Maltby, J., Williams, G., McGarry, J. and Day, L. 2014, Research Methods for Nursing and Healthcare, Taylor and Francis, Hoboken. Polgar, S. 2013, Introduction to research in the health sciences, Churchill Livingstone, Edinburgh. Sim, J. and Wright, C. 2000, Research in health care, Stanley Thornes (Publishers) Ltd, Cheltenham. Stommel, M. and Wills, C. 2004, Clinical research, Lippincott Williams & Wilkins, Philadelphia. Tappen, R. 2011, Advanced nursing research, Jones & Bartlett Learning, Sudbury, MA. Van Manen, M. 1990, Researching lived experience, State University of New York Press, [Albany, N.Y.]. Walsh, M. and Wigens, L. 2003, Introduction to research, Nelson Thornes, Cheltenham. Whitehead, J. and McNiff, J. 2006, Action research, SAGE Publications, London. Read More