Quality Nursing Care in the Words of Nurses by Burhans and Alligood - Article Example

Critical Appraisal of Qualitative Research Article Name Institution Professor Course Date (Word Count: 1980) Burhans, L., &Alligood, M. (2010). Quality nursing care in the words of nurses. Journal of Advanced Nursing, 66(8), 1689-1697. Introduction Scores of people consider quality nursing care as the overarching sunshade through which the safety of patients resides. Quality nursing care is essential to patient’s safety and outcomes. Given that nurses are an essential portion of every patient’s care, they should be involved in establishing and defining improvement programs for quality care. Quality nursing care, therefore, must be relevant and meaningful to nurses to promote more productive improvement approaches. This paper reviews ‘Quality nursing care in the words of the nurses’ to ascertain the meaning of quality. Drawing from an extensive literature review, the paper assesses the article based on the applicability of the research process to ascertain its strengths and weaknesses The recommendations will also be assessed to determine their applicability in evidence-based clinical practice. Title, Authors and Abstract The title is clear and appropriate. Apparently, the article holds credible information because plausible authors in the field of nursing author it. Burhans is a PhD holder and associate executive director of education and practice in East Carolina University College of Nursing while Alligood is a PhD holder and a professor and director of PhD program in East Carolina University College of Nursing. The fact that the authors hold the highest level of education in nursing and are active in nursing education makes the information presented in the article reliable and useful in nursing education and practice. The abstract is clear, brief and straight to the point. It summarises the aims, literature review, methodology and findings of the article in a concise and clear manner besides highlighting the concluding remarks of the authors. Background Information The introductory and background section of the article is enlightening and gives an overview of the research. These sections draw the attention of the reader. Statistics are used in these sections to appeal to the logic of the readers. The authors drew pertinent data from distinguished institutions such as the Institute of Medicine an aspect that makes the information provided in the article credible. For instance, the authors cited 98, 000 hospitals deaths every year as provided by the IOM.. Based on these reports, healthcare professionals are challenged to be accountable and responsible for the quality of their practice and dynamically enhance the safety and quality of healthcare. The authors cited several reports to give the reader a glimpse understanding of the importance of quality care. Over 2.5 million nurses in the US deliver patient care devoid of a shared comprehension of what quality care entails. This is because nurses are not involved in the development of quality measures. There lack evidence of the nurses’ input in the development of quality measures. According to Joel (2013), involvement of nurses in the development and testing of models aimed at promoting access to quality care is paramount. This assertion corresponds to the intent of the article. According to the authors, it is important to measure quality care based on the understanding and articulation of quality by practising nurses as opposed to only basing quality care on patient satisfaction and outcome. The information provided in the article is rich and edifying because it is based on extensive literature review. Burhans and Alligood (2010) consulted a wide body of literature to identify major gaps in literature and formulate the research question. According to the authors, the need to tackle healthcare quality improvement has intensified with the past ten years. Bisgaard (2009) who asserts that healthcare is heading for a serious worldwide crisis supports this affirmation. Improving and reforming healthcare is one of the most troublesome problems facing the world. The article claims that high quality care is equal to competence in the cognitive psychomotor and affective domains among nurses. Similarly, high quality care among British nurses is affected mainly by values and the major aspect to improvement in nursing practice may be enhancement of motivational and emotional tendencies. Venneti (2002) who confirms that the key improvements in practice may be the improvement of motivational and emotional tendencies reflects this assertion. Based on the extensive literature review, the authors managed to identify the gaps in literature. They drew from major findings from previous studies on quality nursing care. The article confirms that the presence of professional setting in the US compared with high quality nursing care. However, in Australia, the perception of quality care by nurses entail themes of patients’ needs satisfaction and therapeutic effectiveness. More so, interpersonal link with patients and affective leadership are viewed as powerful quality indicators. In Thailand, quality-nursing care is linked to the degree to which patient’s psychosocial and physical care needs are attained. It is evident that the authors considered the perceptions of care by nurses in different regions of the world. This step gives them a strong foundation for their research and a prospect to formulate productive research question besides determining the best research approach. The authors brought views of diverse global researchers in attempt to get their views regarding definition of quality nursing care. The article indicates that nurses evaluate quality based on planning, assessment, effectiveness and knowledge with which medications and treatments are delivered. On the contrary, patients view quality care through assessing the communication, responsiveness and kindness of the nurses. Nursing managers evaluate quality care based on cost-effectiveness and efficiency. These discrepancies mirror the understanding and values of different participants in healthcare. By bringing different views regarding quality care, the authors demonstrate the importance and need of understanding the meaning of quality care by practising nurses. It is through analysis of diverse literature that the authors realised that research linked to perception, meaning and definition of quality nursing care is limited. The article affirms that the meaning of quality nursing care need to identified to allow for the development of nurse-valued measures. Given that the lived meaning of quality nursing care for nurses had not been identified, Burhans and Alligood (2010 developed an investigative qualitative study using van Manen’s (1990) approach to hermeneutic phenomenology. Methodology The article aimed to uncover the comprehension of the meaning of quality for practising nurses. In this respect, the researchers formulated a research question to guide them in their study. The research question is feasible and well articulated. In fact, the research question is suitable for qualitative research. According to Pope et al. (2005), qualitative research is suitable in identifying what matters to caregivers in healthcare quality. Qualitative research helps in understanding experiences and meanings of occurrences. Clifford and Gough (2012) assert that qualitative research focuses on finding out what is happening in a given situation instead of attempting to explain relationships. Similarly, Boswell and Cannon (2007) confirm that qualitative research brings offers of augmented knowledge to the evidence-based practice of nursing and yield and reliable results. The qualitative research with hermeneutic phenomenological approach is suitable for the research. The research approach considers the patient as the text and as such interpreted to gain information for decision making in clinical practice (Acton, 2012). In this regard, the methodology applied in the article is in line with the research question. According to Gerrish and Lathlean (2015), the findings of phenomenological study can resonate at a feeling level and richly describe human experiences. Given that hermeneutic phenomenology discloses pragmatic meaning blueprints, it was appropriate in assessing lived meaning of quality nursing care for nurses. Study Sample The authors’ selection of participants is feasible. The criterion used in the sample selection is appropriate where the authors selected hospital-employed RNs with a baccalauratee degree. The participants had a one-year experience in providing direct, bedside, hands-on and clinical patient care on surgical and medical units for adults. The sample involved 12 nurses who were selected based on data saturation. Twelve was a good number and appropriate for qualitative research. According to Boswell and Cannon (2012), the sample size in qualitative research is usually small. Although the sample size is suitable for the qualitative research, it might be unrepresentative of the general population. This is a major weakness of the article. Cohen, Manion and Morrison (2013) assert that small sample size in qualitative research can be a serious limitation of a given study. Houser (2013) also confirms that a small sample is vulnerable to bias from observations that do not represent the whole population. Data Collection and Ethical Considerations Burhans and Alligood (2010) employed feasible data collection methods that were in line with the research design. Data was collect via single, tape-recorded, focused interviews. The fact that the interviews were conducted confidentially and privately through telephone or face-to-face helped in yielding reliable results. The researchers got the chance to seek for clarity of the collected data from the participants. According to Hughes (2008), confidentiality is a critical ethical consideration in qualitative research. Prior to data collection, the researchers sought approval from IRB and from the hospitals involved. Ethical considerations promote collection of reliable data. Data Analysis The data analysis approach employed by the researchers was appropriate to the research. The researchers used qualitative hermeneutic phenomenological approach to analyse, interpret and synthesise data. This approach helps in searching out the relationships and meanings that context and knowledge holds ( Speziale, Streubert and Carpenter, 2011). Therefore, the data analysis applied by the researchers is practical and yields credible results. The fact that the researchers used triangulation of multiple procedures during the data analysis procedure helped in yield valid data. According to Bamberger (2000), triangulation is the principle of increasing the validity of data. Findings The findings of the research indicated six major themes of quality nursing care. These themes include advocacy, caring, empathy, intentionality, responsibility and respect. The lived meaning of quality care for practising nurses was interpreted and understood to be meeting of human needs through the mentioned themes. These themes were the essence of quality nursing care. Houser (2011) who asserts that quality care entails meeting human needs through responsible, empathetic interactions, caring, intentional advocacy for patients and accountability for attaining quality outcomes supports the findings. The article recommends that nurses employ the major themes in their practice to ensure quality nursing care. It indicates that the meaning of quality care is anchored in the art of nursing. The findings can be useful in informing practice and evaluating the quality of nursing care. Nurse managers can develop strategies aimed at supporting better identification of care based on the six themes of quality care. Nurse educators can use the findings to identify the shifts in nursing education curricula. They can teach students the intrinsic qualities of quality nursing care. However, given the small sample size and use of self-selected sample, the results cannot be generalized. More so, the findings from the research methodology used are subjective to different interpretations. Conclusion Burhans and Alligood (2010) assess the meaning of quality care for practising nurses. According to the authors, healthcare quality is a subject of intense debate and criticism. The article indicates that even though quality-nursing care is essential to safety and outcome of patients, momentous developments of quality care has been slow. The authors stress the importance of involving practising nurses in development of improvements programs to make quality care pertinent and meaningful to nurses. Based on van Manen’s hermeneutic phenomenology, the researchers disclosed the meaning of quality care through analysing interview. The methodology and sample used was appropriate. Surfacing themes were revealed via reflective and empirical analysis of transcripts and audiotapes. The findings indicated that practicing nurses viewed quality nursing care as attaining human requirements through respective, empathetic and caring interactions within which intentionality, support and responsibility form a crucial foundation. The authors concluded that nurse managers should establish strategies that promote nurses in determining and delivering quality care that mirrors advocacy, respect, empathy, caring, intentionality and responsibility. The article recommends that nurse educators adjust education curricula to teach student nurses the intrinsic qualities categorized within the productive meaning of quality care. References Acton, A.(2012). Issues in nursing research, training, and practice: 2011 edition. USA: Scholarly Editions. Bamberger, M .(2000). Integrating Quantitative and Qualitative Research in Development Projects. UK: World Bank Publications. Bisgaard, S.(2009). Solutions to the healthcare quality crisis: Cases and examples of lean six sigma in healthcare. ASQ Quality Press. Boswell, C., & Cannon, S.(2007). Introduction to nursing research: Incorporating evidence- based practice. UK: Jones & Bartlett Learning. Burhans, L., &Alligood, M. (2010). Quality nursing care in the words of nurses. Journal of Advanced Nursing, 66(8), 1689-1697. Clifford, C., & Gough, S.(2014). Nursing and health care research. UK: Routledge. Cohen, L, Manion, L., & Morrison, K.(2013). Research methods in education. UK: Routledge. Gerrish, K., & Lathlean, J.(2015). The research process in nursing. UK: John Wiley & Sons. Houser, J.(2011). Nursing research. UK: Jones & Bartlett Publishers. Houser, J.(2013). Nursing research: Reading, using and creating evidence. UK: Jones & Bartlett Publishers Hughes, C.(2008). A narrative inquiry: Nurses’ perception of pain in the elderly in a nursing home. UK: ProQuest. Joel, L. (2013). Advanced practice nursing: Essentials of role development.UK: F.A Davis Pope C., van Royen P. & Baker R. (2005). Qualitative methods in research on healthcare quality. Quality and Safety in Healthcare, 11, 148–152. Speziale, H, Streubert, H., & Carpenter, D.(2011). Qualitative research in nursing: Advancing the humanistic imperative. USA: Lippincott Williams & Wilkins. Venneti, N.(2002). Nursing: A bibliography with indexes. USA: Nova Publishers. Read More