Nurses Narratives of Unforgettable Patient Care Events - Research Paper Example

Running head: CRITIQUE ON A QUALITATIVE RESEARCH Critique on a Qualitative Research: “Nurses’ Narratives of Unforgettable Patient Care Events” ______________________ Regis College Abstract The Gunther and Thomas (2006) study utilized qualitative research to look into how nurses describe their experience. The purpose of the study is to determine through the nurses’ narratives their experience so society can understand the situation of nurses better. The study employed purposive and network sampling and gathered data through unstructured interviews. The significance of the study lies in its graphic description of the concerns and experience of registered nurses. The description can help society understand better the situation of registered and, hopefully, act on the concerns confronting them at work. In general, the qualitative method used for the study is appropriate although some aspects of the study can be improved. Critique on a Qualitative Research: “Nurses’ Narratives of Unforgettable Patient Care Events” This critique assesses the research of Gunther and Thomas (2006) with regard to the research problem, purpose, method, sampling, protection of human subjects, data collection, data analysis, findings, and conclusion. The exercise is undertaken to have a better understanding of qualitative research. Statement of the problem. The research problem of the Günter and Thomas (2006) study can be best described this way: What are the key themes of the nurses’ narrative of their experience? What do their narratives indicate of their concerns and perspectives? What concerns are important to them? What do the narratives tell of their situation? Purpose. The authors stated explicitly that the purpose of their research is to “explore the experience of registered nurse (RNs) caring for patients in contemporary hospital”. Implicitly, the authors defended the significance of their study this way: although there have been studies on how society value the work of nurse, there have been few studies on how nurses value their own work (Gunther & Thomas, 2006, p. 370-371). Understanding how nurses value their own work through their own narratives will be important towards society’s better understanding on the value of their work. A study on the value of nurses’ work is important especially as the work of registered nurses remains largely “invisible and undervalued by society, physicians, and administrators (Gunther & Thomas, 2006, p. 370, citing works of several authors). The purpose of the study is highly significant to nursing because putting a proper value to nursing would be crucial to enhance the proper supply of nursing to attend to society’s needs. Gunther and Thomas (2006, p. 370) noted that although “abundant quantitative research has been conducted on variables such as job satisfaction and perceived stress”, only few studies have been done on areas of concern from the perspectives of registered nurses. On the last point, the authors cited works of several other authors that supposedly provide confirmation that only a few studies were done on the subject. Method. As per the description of their research by the authors themselves, the study of Gunther and Thomas (2004) employed purposive sampling recruited through network sampling. From the sample, data were collected through unstructured interviews and analyzed by an interpretative group in which theme were identified. The authors described their research methodology one that employed descriptive phenomenology based on the philosophical perspective of Husserl and Merleau-Ponty. The method of descriptive phenomenology is highly appropriate because if we want to place a proper value to nursing, then the perspectives of nurses, registered nurses in this case, is very important. Qualitative research is appropriate for the subject area addressed by Gunther & Thomas because qualitative research can address research pertaining to “lived experiences, behavior, emotions, and feelings s well as about organizational functioning, social movements, cultural phenomena, and interactions between nations” (Strauss and Corbin, 1998, p. 11). In the opinion of this writer, the method used by the Gunther and Thomas (2004) are adequate for the concern of their study. The fundamental premise of the study is that only a few studies were done from the perspective of the registered nurses themselves. Although the study cannot competently say the findings would be applicable for all nurses as a whole, it is useful nevertheless for understanding how the registered nurses in southeastern Tennessee view the concern. In general, qualitative methods can reveal a number of details about a phenomenon or situation that can be difficult or learn from conventional research method (Strauss and Corbin, 1998, p. 11). From the quantitative research, research strategies can be developed for application to other settings like among the registered nurses outside of southern Tennessee, the whole of the United States, or nurses in other parts of the world. Sampling. As mentioned earlier, the sampling method used by Gunther and Thomas (2004) was purposive sampling. As defined by Polit and Beck (2004, p. 294), “purposive sampling or judgmental sampling is based on the belief that researchers’ knowledge about the population can be use to hand-pick sample members”. According to Polit and Beck (2004, p. 294), “researchers might decide purposely to select subjects who are judged to be typical of the population or particularly knowledgeable about the issues under the study.” In the qualitative research being analyzed, members of the purposive sample were recruited through network sampling (Gunther & Thomas, 2006, p. 370). Network sampling is also called snowball sampling or chain sampling (Polit & Beck, 2004, p. 292). Network sampling is a variant of convenience sampling (Polit & Beck, 2004, p. 292). In network sampling, the first members of the sample are requested to identify and refer other people who may be meeting the criterion or criteria arrived at based on the purpose or judgment of the researcher (Polit & Beck, 2004, p. 292). Snowballing starts with the initial members and then proceeds based on referrals produced from the initial sample until a target sample has been reached (Polit & Beck, 2004, p. 292). According to Polit & Beck (2004, p. 292). Polit and Beck (2004, p. 292) has described convenience sampling as the weakest form of sampling. At the same time, Polit & Beck (2004, p. 292) recognize that it is the most common form of sampling in a great number of disciplines. Protection of human subjects. This writer believes that human subjects were adequately protected. Firstly, nobody among the subjects was identified by name. Secondly, no hospital or health unit was identified by the researchers thereby making the identity of the subjects completely and fully anonymous other than the identification that the subjects as registered nurses. In other words, we can be confident that the principle of beneficence was upheld in the research process. According to Polit and Beck (2004, p. 143), one of the fundamental ethical principles in research is beneficence that “encompass the maxim: above all, do no harm”. Ethical principle 2 of the ANA guidelines covers beneficence. ANA refers to the American Nursing Association. According to Polit and Beck (2004, p. 143), study participants can be harmed in several ways: physical harm like injury or fatigue, psychological harm like stress or fear, social harm like loss of friends, and economic harm like loss of wages. The research write-up of Gunther and Thomas has no indication that any of the subjects was subjected to any type of the harm mentioned. Consistent with rule 1 of the ANA prescribed by Silva (1995), a written informed consent was obtained from the study participants (Gunther & Thomas, 2006, p. 371). However, there is no indication whether rule 3 of the ethical guidelines for nursing research recommended by Silva (1995) was followed during the research process. According to Polit and Beck (2004, p. 143), rule 3 of the Silva (1995) guidelines for ethical research holds that a researcher must respect the personhood of “research participants, their families, and significant others, valuing their diversity”. Nevertheless, there is also no indication that the ethical guideline was not followed and the researcher can invoke innocence unless proven guilty. There is also no indication that the rest of the ethical rules or the seven other ethical were not followed (Polit & Beck, 2004, p. 144, citing the work of Silva, 1995). Rule 1 of the ethical rules pertains to the researcher’s respect for a research participants’ autonomy. Rule 4 refers to the equitable sharing of the benefits and burden of research. Rule 5 refers to maximum privacy. Rule 6 refers to ethical integrity through the observance of check and balance throughout the research. Rule 7 pertains to the obligation to report misconduct. Rule 8 refers to the obligation to maintain competency. Finally, rule 9 prescribes zero or least possible harm or suffering to animals. Earlier, we covered rules 1 to 3. There is no indicating or refuting the view that rule 4 was violated. It appears that rule 5 was upheld: there was maximum privacy in the implementation of he research. It is both difficult and inappropriate to assess whether rules 6 to 9 were upheld. However, based on the presumption of innocence unless there is adequate proof to contrary, it seems reasonable to assume that the rules have been followed and, therefore, there was no harm committed on research participants and, thus, human subjects were adequately protected. Nevertheless, we can anticipate that some quarters can criticize or complain that rule 4 was not upheld. Critics can say that glory for the conduct of the research went only to Gunther and Thomas and no adequate credit was given to the graduate assistants that actually conducted the interviews among the registered nurses. The graduate assistants who conducted the interview were not given adequate credit in the research. For example, the names of the graduate assistants were not provided in the journal write-up. However, it is also possible that the graduate assistants were not given adequate credit because of the editorial policies of the journal. Data collection. The main primary data were collected through unstructured interviews. Indeed, data collection was focused on human experience as interpreted by the interviewees themselves on their life, work, or human experience. The data collection strategy implemented is as follows: graduate research assistants conducted 46 interviews during an 18-month period (Gunther & Thomas, 2006, p. 371). Using network sampling, registered nurses were approached by the graduate students and were invited to participate in the study (Gunther & Thomas, 2006, p. 371). A set of criteria were used to select members of the sample through network sampling: 1) licensed registered nurse; 2) employed in a hospital for at least 3 years; and 3) willing to talk to the researcher for at least an hour (Gunther &Thomas, 2006, p. 371). The data collection strategy also employed an “individual, in-depth, nondirective interviews”. Each interviewer asked a participant to tell him/her about a time that the research participant or member of the sample provided nursing care to a patient (Gunther & Thomas, 2006, p. 371). Further, during the narration, the interviewer “spoke only to seek clarification or elaboration” (Gunther & Thomas, 2006, p. 371). The authors stressed that “consistent with the tenets of phenomenological methodology, no prespecified agenda or list of questions was used (Gunther & Thomas, 2006, p. 371). This description indicates also the data collection procedures. However, to put the data collection strategy in a few words, we can use the following description: combination of purposive and network sampling and utilization of unstructured interviews. There is no indication whether the authors employed saturation of data. As indicated earlier, the interviewer “spoke only to seek clarification or elaboration” (Gunther & Thomas, 2006, p. 371). Only one key question was used. Thus, control for saturation was provided de facto by the time limit imposed for interviews. The time limit for the interviews was 90 minutes for each of the study participants (Gunther & Thomas, 2006, p. 371). Polit and Beck (2004, p. 57) narrated that many qualitative researchers use the principle of data saturation in managing their research. According to the Polit and Beck (2004, p. 57), data saturation “occurs when themes and categories in the data become repetitive and redundant, such that no new information can be gleaned by further data collection”. Data analysis. The method used by Gunther and Thomas is fundamentally thematic analysis. This means that from the data captured by the unstructured interviews and recorded in audio and transcription (Gunther & Thomas, 2004, p. 372), the authors sought to identify contexts and themes in the narratives of the registered nurses (Gunther & Thomas, 2004, p. 372). In the words of the two authors, “analysis of data included the identification of both the contextual ground and the figural (predominant) themes which stood out in participants’ perceptions” (Gunther & Thomas, 2004, p. 372). It is not explicit how the authors ensured that the research would be able to determine contexts. However, the choice of graduates students of nursing as interviews and their own experience as nurses or professors/instructors of nursing fundamentally ensured that they would be able to understand the contexts behind the narratives recorded in the audio and transcriptions of the data obtained from the unstructured interviews. It goes without saying that the researcher appear to have adequately recorded the research process. It is difficult to find out whether the Gunther and Thomas have remained true to the data of their research but the existence of transcriptions and audiotapes on the research can promote researcher fidelity to data. Moreover, we cannot be sure if the participants to the research would recognize the experience as their own. There is no indication in the work of Gunther and Thomas (2004) that validation sessions were held among the participants to confirm or validate the findings of their qualitative research. Perhaps, the Gunther and Thomas (2004) should have designed the research such that there is a validation meeting among the participants to verify, confirm, or validate the findings of the research or for the registered to recognize their inputs in the Gunther and Thomas research as their own. Some of the findings of the Günter and Thomas (2006) research would probably apply to many nurses but it is difficult to be certain of this because the purposive/network sampling was only implemented in southeastern Tennessee. Moreover, the research results would probably be meaningful to policy makers not involved in the research process because the research findings add to knowledge on situation and perspective of nurses. For instance, the research highlights heroic efforts among nurses and the impact negative impact that the death of a patient brings to nurses (see in Gunther & Thomas, 2006, p. 372). The method used for the analysis is very compatible with the purpose of the study. The purpose was about the experience of nurses. Experience involves details and qualitative methodology is fitted for this as we pointed out earlier through Strauss and Corbin (1998, p. 11). With regard to findings, Gunther and Thomas managed to put this in a context. The findings are useful for society’s proper valuation of nurses: nurses confront unwholesome and traumatic situations, patient deaths mean much to them, they are interested to improve the outcomes of their work, nurses feel alone in their work, they are concerned with their patients, and their effectiveness in work can be affected by contexts. In general, these themes can be easily understood by a reader of Gunther and Thomas (2006). Conclusion, implication, and recommendations. The Gunther and Thomas research (2006) does not have a set of recommendations but only a set of conclusions. The conclusions are actually in the details of the research findings and the conclusion section only provides a summary. As Gunther and Thomas summarized/concluded their research: “moral distress appears to be inherent in the work life of registered nurses” (Gunther and Thomas, 2006, p. 375). In the opinion of this writer, the findings are actually larger than the conclusions of the Gunther and Thomas (2006) study. Thus, this writer suggests that the findings will have to be elaborated a little bit in the conclusion section of the study. The relevance of the study is explicit but not in the conclusion section of the study. Relevance of the study is discussed in the first sections of the Gunther and Thomas (2006) research write-ups. References Creswell, J. (2007). Qualitative inquiry & research Design: Choosing among five approaches. 2nd Ed. Thousand Oaks: Sage Publications. Gunther, M. & Thomas, S. (2006). Nurses’ narratives of unforgettable patient care events. Journal of Nursing Scholarship, 38 (4), 370-376. Marshall, C. & Rossman, G. (1995). Designing qualitative reearch. Thousand Oaks: Sage Publications. Polit, D. & Beck, C. (2004). Nursing research: Principles and methods. 7th ed. Philadelphia: Lippincott, Williams, & Wilkins. Straus, A. and Corbin, J. (1998). Basics of qualitative research. Thousand Oaks: Sage Publications. Read More