The Meaning of Mental Health Nurses Experience - Essay Example

Critical Appraisal of a Phenomenological study Critical Appraisal of a Phenomenological study Introduction This study aims at critically appraising a qualitative article using the CASP tools as a guideline to check on the relevance and validity of the results and conclusions. The study will critically appraise, “The meaning of mental health nurses experience of providing one-to-one observations: a phenomenological study” authored by Rooney Ba and published in the Journal of Psychiatric and Mental Health Nursing. Critical appraisal entails the process of careful and systematic examination of a research aimed at judging trustworthiness, value, and relevance in a given context (Burls February 2009). Qualitative CASP study tool will be used in the critical appraisal of the research study because of the nature of the study. Using qualitative CASP provides a clear guideline on the critical appraisal of qualitative research and is comprehensive in the question covering all the areas of qualitative research. Qualitative data entails information on qualities that cannot be measured while quantitative data entails information that can be represented in form of numbers (Russell 2011). Qualitative research methodology is appropriate because the study under appraisal aimed at investigating subjective experiences of the participants (CASP, May 31 2013). Critical appraisal is required for health professionals to allow for the understanding on the quality of a research for use in decision-making and provides for the introduction of evidenced-based research in public health practice (Ciliska et al. 2008). The other reasons for health professionals to conduct critical appraisal include the need for use of research that relies on scientific reasoning for effective health delivery, which can only be evaluated through clinical appraisal (Sturmey & Hersen 2012). A critical appraisal allows nurses to seek and gain most appropriate and important knowledge globally (Gambrill 2012) for the validation and improvement of nursing care (Ingham-Broomfield 2014). Understanding the limitations of a study and deciding on the value of the research for use in decision-making are other importance of critical appraisal of research in nursing. According to Woods et al. (2012) critical appraisal of research allows nurses to support their care provision with evidence from research allowing patients to receive quality care and result in better outcomes. Screening questions The goal of the research by Rooney Ba was investigating the perspective of mental health nurses who work in intensive care situations. The main areas of exploration by the study included understanding the experiences of nurses tasked with constant patient observations, impact of the intensive care requirement on the nurses, processes involved, and gaining insight on measures to aid in meeting the development needs of the nurses (Rooney 2009). The research made use of the phenomenological approach on conducting the research to ensure the issues are explored in-depth using a sample of nurses from the local National Health Service Trust’s acute units (Rooney 2009). The author considered the subject of finding the experiences and providing development and support platforms for nurses working in intensive care units important because of the uniqueness of the task and because it is the highest level of observation (Brooker et al. 2011). Other reasons for the importance of the subject include the emotional demand on the nurse requiring high communication skills and support (Rooney 2009 and Brooker et al. 2011). The issue dealt with in the research is relevant because of the high importance of constant observation of self-harm patients including mentally ill patients (NICE 2014). The need to understand the experience of nurses providing constant observation is relevant to the nursing profession and extension of available literature (Page 2013). Was there a clear statement of the aims of the research? Yes the author was clear about the aim of the study, which was stated as exploring the “experiences of mental health nurses in providing one-to-one observations” (Rooney, 2009, 78), and use of phenomenological research in exploring the meanings. The aim of the research was clearly evident in the abstract of the research where the author states why the research was conducted allowing the reader to have upfront information on the aim of the research (Rooney 2009). According to Conrad (2008: 20), a phenomenology study’s aim is to understand a given “social and psychological phenomena from the perspective of the people involved”. Phenomenology research is aimed at providing a description of a phenomenon as accurately as possible remaining true to the facts and not making use of pre-determined frameworks (Madden 2008). Is qualitative methodology appropriate? Yes the qualitative methodology is appropriate for use in the research for several reasons. The author discusses the choice of qualitative phenomenological research approach in conducting the research including that it is most appropriate for understanding live-in experiences by the nurses (De Chesnay 2014). Other reasons given for choosing phenomenological research include allowing for setting aside of personal beliefs and previous knowledge, allows for knowledge build-up in the development process, and allow mental health nurses to provide meaning to their experiences (Rooney 2009 and Madden 2008). The writer believes that qualitative phenomenology was an appropriate research approach for the study. Quantitative research entails the collection of numerical data and use of mathematical-based methods in data analysis and presentation of results (Muijs 2010). It is not appropriate for the research because of the opinions and lived-in experience of mental health nurses aimed to collect by the researcher (Wagner et al. 2012). However, the data collection method and sample used in the study were not adequate to allow for the collection of a large amount of data to form comprehensive conclusions. The sample could have been increased from six nurses to allow for access to views by a large number of nurses. Further, focus groups, observation, and questionnaires would have been added to increase the depth and breadth of the data collection for a more comprehensive study (Creswell & Clark, 2012). Interaction with the participants in the study could result in a personal bias of the researcher providing another demerit of using qualitative research (Taylor 2005). Is the research design appropriate? The qualitative phenomenology research approach was appropriate for conducting the research because of the need to have in-depth understanding and exploration of the lived-in experiences of nurses involved in the constant observation of mental health patients (Tarozzi 2010). However, the study could have made use of mixed designs considering the benefits accrued by researchers using both qualitative and quantitative designs. The need to access the experiences of nurses through collecting quantitative research design to complement data from the quantitative research is evident in the research requiring the use of mixed research design (Williams-Smith 2008 and Isaias 2012). The use of qualitative research resulted in subjectivity that could have been reduced using mixed methodologies to allow for objectivity and open the way for the use of numbers, as opposed to words in data analysis (Information Resources Management Association 2015). The other benefit of mixed methodology would be the ability to generalize the results of the research, which cannot be done in the research (National Institute for Health Research n.d.). Mixed research would also have allowed the researcher to use both inductive and deductive reasoning to answer the research question completely, which may not have adequately been done using qualitative design only (Sreejecsh & Mohapatra 2013) Was the recruitment strategy appropriate to meet the research aims? No, the recruitment strategy used in the study was not appropriate for meeting the research aims. The involvement of the nurse manager in the selection of the participants could have resulted in bias in the study, which could have been more appropriate using random sampling (Cooper & Endacott 2007). The author makes use of purposive sampling in the research to select six nurses consisting of male and female nurses who were either registered or unregistered with at least 2 years’ experience in mental health and providing one to one observation (Rooney 2009). Willingness to participate in a recorded interview was the other criteria for inclusion in the research. The writer’s view is that the researcher would have considered the use of random sampling in the research to ensure the sample chosen for participation in the study is representative (Cooper & Endacott 2007). The research provides that the participants were willing to participate in the study, but no discussion is provided on the reasons for non-participation in the study. The study should have given the reasons why other mental health nurses chose not to participate in the study despite measures taken to protect their confidentiality and privacy (Rubin & Babbie 2009). The research also states that the six participants in the research consisted of male and female mental health nurses but does not list the number of male or female participants for the reader to know if a balance between male and female respondents was achieved (Rubin & Babbie 2009). The Nursing and Midwifery Council does not provide guidelines for nurses to have proficiency in undertaking constant observations in practice highlighting the reasons for lack of formal teaching on conducting observation reported by the study (Nursing and Midwifery Council 2015). Was the data collected in a way that addressed the research issue? Yes, the data collection allowed the researcher to address the issue of nursing observations in the research. The setting for the data collection was provided to be the assessment room in the acute unit chosen to allow for convenience, save time, and limit disturbance on the working time of the nurses (Rooney 2009). Demerits of the data collection include that it occurred during working hours and snatched time from nurses’ shifts, reduce the appropriateness of the setting because of the pressure to complete the interview to get back to work, and reduce the possibility of getting in-depth information because of the limited time (Houser 2011). Conducting the interviews during working hours also resulted in biasness in the study owing to the time and attention dedicated between work and the interview affecting the ability of the nurses to provide their true feelings (Houser 2011). Narrative interviews were used in the research in data collection, and it would be more appropriate to add surveys, questionnaires, and observation methods (Information Resources Management Association 2015). The researcher does not provide reasons behind the decision to use unstructured interviews for data collection. The researcher provides a question to make the interview explicit to the reader on how the data collection was conducted. The form of data is clear as taped recording of the interviews that were later transcribed and copied by the researcher but we are not informed of data saturation or any alteration in data collection method in the course of the study (Munhall 2012). However, the researcher believed he had collected enough information for the research after six interviews of the mental nurses to which the writer believes is too limited consideration the importance of the issue and the need to collect comprehensive data for the study (Macnee & McCabe 2008). The reliability and validity of the research is affected by the small sample of six nurses. Has the relationship between the researcher and the participants been adequately considered? Yes the researcher considers the relationship between the researcher and the participants in the study. The author considered his role and the possibility of bias emanating in the case of conducting the study and used a journal to record personal beliefs and attitudes on the topic (Rooney 2009). According to the researcher the personal beliefs and attitudes developed from personal experience, management of staff in similar situation and reading were recorded to avoid their influence on interpretations (Rooney 2009). However, the ability to influence the validity and reliability of the study owing to reflexivity on the part of the researcher could not be fully solved with bracketing depicting the critic of the research (Willig, 2013). In data collection, formulation of research questions, choice of location, and sample recruitment; the researcher did not consider the influence potential bias in the study (Munhall, 2012). The researcher gave the best to give into events during the study to ensure the success of the project for example conducting interviews in the assessment room and completing the interviews within the limited time provided (Rooney 2009). The researcher did not however consider changing the research design to allow for more information to be collected for example with the limited interview time, the researcher should have prepared and sent questionnaires to the sample respondents to be filled at their free time (De Chesnay 2014). This would have ensured pertinent information not elicited in the interview would be accessed and allow a rapport to be built between the respondents and the author. They would also augment the reliability of the results and conclusions made by generating more data for analysis by the researcher (De Chesnay 2014). According to Gerrish & Lathlean (2015), questionnaires allow for the collection of primary data from patients and healthcare professionals, which would have been appropriate for the research by Rooney. It provides access to valid, unbiased, and reliable data from a representative sample that would allow the research to access more credibility and provide more tangible and representative evidence to reach comprehensive conclusions. Have ethical issues been taken to consideration? Yes, ethical issues were taken into consideration by the author to ensure ethical guidelines were followed in completing the study. The author provides several measures undertaken to ensure the research was undertaken ethically including informed written consent for participation, assurance of anonymity and confidentiality (Rooney 2009). Other ethical considerations undertaken include offering participants information on Trust debriefing service for support after the interview in case strong feelings emerge. However, a collection of personal information is not mentioned in the research limiting the ability of the reader to understand if the privacy of the respondents was assured (Waltz et al. 2010). The benefits, risks, and duration of participation in the study are the other important ethical considerations that the study ought to have revealed to the participants but are not detailed in the research (Lo 2012). Secure keeping of the recording is required for seven years, but the researcher does not adhere to this requirement when he states that the tapes were destroyed after transcribing. The research was approved by the Local Research and Ethics Committee for Northamptonshire in 2004 (Rooney 2009). Was the data analysis sufficiently rigorous? Yes, the data analysis was conducted sufficiently in the research on the experiences of nurses conducting constant observations. The study made use of Giorgi’s (2000) framework of analysis in the analysis of the six transcripts. The study provides the mechanisms in which the analysis of the data was done, which entailed the reading and rereading of the transcripts containing the responses of the six mental nurses in the study. The other analysis procedure evident from the article is the typing of the transcripts to ensure a focus on the themes, content, differences, and similarities (Rooney 2009). The use of a reflective journal is stated to note the attitudes and beliefs on the topic to ensure personal experience, reading, and experience does not affect the success of the project (Rooney 2009). The article makes use of thematic analysis of the transcripts resulting in several themes on the experiences of the nurses on mental constant observation (King & Horrocks 2010). The article clearly explains how the themes were derived from the data resulting in preparation for undertaking observations, nursing skills, risk management and decision making, the impact of observations, and support and coping mechanisms (Rooney 2009). Reading and rereading of the data are the main avenues used by the researcher to get the main themes from the sample. The data represents a sample of the views of the mental nurses to support the conclusions made in the article (Rooney 2009). However, the ability to generalize the conclusions to a wider population is not possible because of using a small sample and the lack of triangulation of data collection (Gambrill 2012). The researcher does not provide contradictory evidence in the research with all the themes presented providing similar results. I believe the lack of contradictory data is to some extent a fault of the researcher because of conducting the research in the same setting consisting of nurses of one acute hospital who are faced with the same difficulties and challenges. Conducting the research on different setting and consisting of a larger sample would have resulted in the presence of contradictory data and augment the comprehensiveness of the study (Abbot et al. 2013). The researcher does a good job in considering his role in resulting in potential bias in the study through keeping a reflective journal to guard against personal experience, reading, and experience of managing staff in similar situations from affecting the data collection, analysis, and results of the study (Rooney 2009). Is there a clear statement of findings? Yes, the article presents explicit findings from the analysis of the main factors that explain the experiences of the mental health nurses in undertaking constant observations. The main themes evident from the research include experience, being with, different roles, coping, and nursing skills (Rooney 2009). Discussion on the credibility of the research including triangulation, validation of the respondents and having more than one analyst to review the data to allow for high credibility is not provided in the article (Abbott et al. 2013). For example after six interviews, the author reports having reviewed the data in relation to analysis methods and decided it to be sufficient and decided not to conduct more interviews. Having another researcher/ analysis to review the results would have resulted in a different decision of may be conducting more interviews to allow for high sample respondents for use in the research (Gerrish & Lathlean 2015). The researcher ought to have considered having some parts of the article to discuss triangulation of methods in the study to explain the decision to go with only six interviews as the only data collection method for the study and found it enough for the study (Madder, 2008). The study should have also given a reason for the need to have the respondents validated for participation in the study. The research discusses the results in relation to the research question resulting in the revelatory themes that comprise a large part of the discussion and results meeting the needs of the study in the conclusions (Rooney 2009). The article discusses the results in relation to themes evidence from the data aimed at answering the research question. How valuable is the research? Yes, the research is valuable through adding to the current literature and the recommendations to policy, management, and healthcare staff. The author discusses the benefit of the research to literature on positive experience of patient’s and nurses on constant observations with one of the aim of the research being the contribution of the research on experiences of nurses in providing constant observation (Rooney 2009). The research discusses recommendations for policy, healthcare staff, and managers with several observations provided. These observations include incorporation of measures of supporting patients and managing risk, planning care provision to meet staff and patient expectations, and development of policies that empower nurses in decision-making on constant observations (Rooney 2009). The other policies and practice discussions in the article relate to preparation and support and skills training of nurses involved in the provision of constant observations. The article also comes up with new ideas including the understanding of teamwork and collaboration. The author states the benefits of teamwork including improving staff morale, sharing of new ideas, and opinions to facilitate efficiency and success in nursing practice. Despite the practice and policy issues discussed by the researcher in the article, the author does not provide a discussion of new areas of research that could be undertaken relating to the experience of nurses conducting constant observations. Further, a discussion on the ability of the findings to be transferred to other populations or considered in a different manner is not present (Yin 2011). The reason for the lack of discussion on extrapolation of the findings is the use of a limited sample of six nurses and that the study was conducted in the same location (Yin 2011). Limitations The study makes use participants/respondents from the same acute hospital. The nurses are faced by similar circumstances and have the same experiences in meeting constant observation needs of clients reducing the ability to generalize the results to other health care centres. The use of a smaller sample of six mental health nurses and that the research used on qualitative research design are the other limitation of the study making the generalization of the results impossible (Sreejecsh & Mohapatra 2013). The use of only taped interviews as the data collection method is the other limitation of the research on other methods of data collection including observation and questionnaires were also appropriate for use in the research (Gambrill 2012). Conclusion The study is valuable and has positive implication to clinical practice including acting as a guideline for the provision of psychosocial support, training, and provision of practice sessions for nurses. The need to have experiences nurses and nurses with highest skills undertaking observations is also the other impact of practice from the article. The study adds to the literature by providing an understanding on the experience of nurses conducting constant observations and the measures that can be put in place to ensure success. These measures include training nurses, conducting practice sessions, and 10 year experience required for better patient experience. The research article does not identify new areas for research but the need to undertake research on the experience of patients being cared for by the nurses is evident. The use of a small sample and lack of collection method triangulation make the research conclusions applicable to a small population. The research will benefit my future as a nurse in terms of gaining an insight on the requirements for conducting constant observations in terms of skills and knowledge and will also be helpful in writing and conducting research. My research writing skills and knowledge on practice are the other benefits of that the research helps, which are beneficial for me as an future nurse. References Bottom of Form Top of Form Bottom of Form Abbott P, Mc Sherry R, & Simmons M, (2013) Evidence-informed nursing: A guide for clinical nurses. London: Routledge. Brooker C, Nicol M, & Alexander M (2011) Alexander’s Nursing Practice: Hospital and Home-The Adult. Elsevier Health Sciences. 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