Day Surgery by J Gilmartin and K Wright - Article Example

Critical Analysis of a Qualitative Research Article by Gilmartin, J. and Wright, K. (2008) Name of the Student Name of the University Critical Analysis of a Qualitative Research Article by Gilmartin, J. and Wright, K. (2008) The main aim of this paper is to critique a Qualitative Research article called ‘Day Surgery: Patients’ Felt Abandoned During The Preoperative Wait’ by Gilmartin, J and Wright, K (2008). The qualitative research analyzes the experiences of patients who undergo Day Surgery. Day Surgery is the admission of selected patients to hospital for a planned surgical procedure after which they return home the same day (Gandhimani, P and Jackson, I, 2006). This article is purely from a patient’s perspective exploring in detail their experiences either before or after a day surgery procedure. A critique is a balanced assessment, which arises from a process of critical appraisal of the positive and negative aspects of the report (Taylor, B., Kermode, S., & Roberts, K., 2006). A good critique provides constructive criticism. The main reason why a critique is done is to promote student learning. Another reason for critiquing reports is to help clinicians analyze the reports and ascertain whether the report offers a foundation for a change in existing clinical practices. Literature Review Literature in essence means the total body of writing or text that is available on a particular research topic. It is a combination of theoretical and research papers along with any other available relevant material. Literature may be in the form of books, journals, articles in periodicals, conference reports, unpublished papers and any kind of communication from other researchers. Literature review means to ready, analyze and the sort the available literature and arranging it in order. It is the portion of a thesis or dissertation, which provides an amalgamated assessment of previous research and theory on the given topic (Taylor, B., Kermode, S., & Roberts, K., 2006). The main purpose of reviewing the available literature is to acquire a comprehensive understanding of the topic at hand and ascertain what questions have already been answered and what other questions need answering. This will ensure that the research goes in the right direction. Reviewing the literature can also narrow down the topic for study. The purpose of a review is to critically analyze a published body of knowledge through a summary and comparison of previous research studies and theoretical articles made on the same subject (University of Wisconsin, 2009). There are some basic characteristics for a good literature review. It must first and foremost sum up the existing body of knowledge that deals with the topic of research. It must identify and adequately define the key or most important concepts and convince the reader that the study has to be undertaken. It must identify the questions that have been answered in the previous researches and must provide clear information on the gap in the knowledge that is prevalent. It must lay a foundation for further study. The main purpose of the study must be easily identifiable. The given literature review clearly summarizes the existing body of knowledge related to day surgery and patients’ experiences so far with day surgery. It discusses the issues raised by day surgical patients about their experiences in preparation for surgery, the day of surgery and postoperative care. However the review has few key concepts, which have not been adequately defined. The literature review convinces the reader that the study needs to be undertaken. It suggests that for an improvement of nursing services in the ever-expanding area of day surgery, patients’ views are of prime importance. This study focuses on patient perspectives and hence has to be undertaken. It explains that the gap in the previous researches is the significant lack of patient perspectives on the issue at hand and it will aim to fill this gap and lay the foundation for improvement in services. The literature review makes the purpose of the study easily identifiable and has a clear significance as far as nursing is concerned. The review also contains a good match between the research problem, the paradigm and the methods it proposes to use. The research problem is that the pre-operative care for day surgery is lacking. Current trends from existing literature shows that most patients feel that sufficient information before surgery is not provided to them to ease their anxiety and while waiting for the surgery many of them feel abandoned and not cared for. The method proposed for this study is a qualitative study using the Hermeneutic Phenomenological approach. This approach deals with the small or trivial aspects of human experience, which may be overlooked, in other circumstances. This approach matches with the research question and the paradigm. Theoretical Framework The research contains a theoretical framework. A theoretical framework is a set of statements made up of concepts connected in some way to develop an overall view of a phenomenon (Fitzpatrick, J. and Wallace, M, 2006). Theoretical frameworks occur when a researcher uses existing literature that has related essential concepts with valid research. Since this study explores existing literature that relates concepts using valid research it contains a theoretical framework. There are two types of explanations provided by theoretical frameworks, namely, descriptive and perspective. Descriptive explanations provide an understanding of the interaction between variables. Perspective explanations anticipate a specific set of outcomes. This study aims to provide a descriptive explanation of the issue at hand by detailing the interaction between variables. Viewing a problem from several perspectives is very challenging. The main purpose of a theoretical framework is to obtain a clear perspective through which the researcher can view the problem. It sharpens focus and provides additional clarity to the problem (Astate Education, Online). A theoretical framework assists the reader in making logical sense of the relationship between variables and other factors that are relevant to the issue concerned. It provides a basic definition of the relationship between all the variables and factors. Theoretical frameworks guides the research and helps determine which things need to be measured and assists in comprehending which statistical relationships one must look out for (Analytitech, Online). Methodology and Method Research Question, Hypotheses, Purpose of the Study and Research Design The research question and the aim of the research have been explicitly stated in the beginning of the study in a clear and concise manner. Day surgery is a growing trend in hospitals today. This has led to a shift in surgical nursing intervention. There are a number of deficits in pre and postoperative care for day surgery patients. The main aim of this study is to describe and interpret patient experiences of current day surgery practices. The literature review provides a significant amount of research results that conclude that most patients are unhappy with pre operative care in day surgery and the conceptual framework aims to understand the relationship between day surgery and poor pre-operative care. This however is not consistent with the aim of the paper, which states that it will describe and interpret patient experiences. Qualitative Research method is used in this paper. The qualitative study in this paper uses a Hermeneutic Phenomenological approach. This approach is concerned with the life world or human experiences as it is lived. The main focus of this study is to throw light on the minute details and the trivial aspects within experiences, which are usually overlooked or taken for granted (Laverty, S. M. 2003). It investigates human experiences as it is expresses through spontaneous productions of writing, speech or art (Ronald S. Valle, 1998). Since the main aim of this study is to describe and interpret patient experiences regarding Day Surgery care this research design an appropriate approach. Sample and Setting Qualitative Research is primarily used when analyzing human experiences. Hence the qualitative sample must be large enough to ensure that the researcher obtains all the important perceptions, but at the same time must be small enough to prevent failure to discover the perception that is required. While a small sample size can narrow the array of perceptions that may be obtained, a large sample size may result in failure to get a specific perception (Paulo, P, 2000). Hence there needs to be a balance. A good sample must connect with the main objectives of the research, be achievable and practical, be cost effective and provide data of population parameters that are true and unbiased representations. This study does not match the above criteria as it has too small a sample size, which has also been stated as a limitation. Though the study provides basic information on the setting and sample, it lacks sufficient details on the same. The approach utilized to gain access to the site and recruit participants was appropriate. The sampling was done across an array of patients who underwent different kinds of Day Surgeries and hence suited the study. Ethical Considerations Appropriate measures were taken by the study to safeguard the rights of participants of the study. The report was first submitted to the local NHS Trust and approval gained. The participants were furnished with detailed information on the study and informed of the risks and commitment involved. The participants were ensured that they could withdraw from the study at any point and to preserve confidentiality and anonymity each participant was given a pseudonym, which was the only form of identification used throughout the study. They were further assured that the audiotapes used for interviews would be erased after the completion of the study. Data Collection and Analysis The data were gathered by means of unstructured interviews, with one main question, encouraging the participants to give an account of their experiences and hence was appropriate for this specific study design. The researcher further asked the appropriate questions to clarify and comprehend the patient statements. The interviews were audio taped as per norms and transcribed verbatim. This form of unstructured interviewing results in the collection of rich and in-depth data. The procedure used for data collection and recording is sufficiently described and appears appropriate to the study. Data collection was done in an unbiased manner. The paper clearly details the data analysis methods and describes it sufficiently. The research has employed 3 approaches for data analysis and it explains each approach in detail and what each approach seeks to do. The analysis yielded four main themes relating to patient experience of day surgery and explains each theme in detail with examples. Enhancement of Rigor Rigor can be defines as the degree to which research methods are reliably and accurately carried out in order to identify important influences occurring in a given experiment (Colorado State University, Online). There are many criteria that are used to judge the rigor of a qualitative study. In qualitative study the rigor has to be open, has to scrupulously abide by a philosophical perspective, have thoroughness in data collection and must consider all the data in a subjective theory development phase. Furthermore there has to be logic in the emerging theory and clarity with which it throws light on the subject of the study (Burns, N and Grove, S K, 2004). The study met with all of the above criteria. Member checking and peer review were used to enhance the trustworthiness of the data and these methods were adequately described. Independent review was utilized to improve credibility of the data collected and was sufficient. Finally the research procedures and decision processes were well documented which resulted in auditable and confirmable findings. Results The results were summarised under four major themes relating to patient experience after day surgery. Although each theme has been dealt with by the use of excerpts, which have been transcribed and presented verbatim, a more thorough explanation of each theme, is lacking in the study. And despite presenting a fairly meaningful analysis of the current issue, the study lacks a provocative and insightful picture into the same. The themes that yielded from the results however are logically connected to each other and are convincing as they detail patient experiences both before and after the surgery. But the themes fail to form an integrated whole, which results in an inconsistent presentation of the current trends. More detail on the themes and integration of the themes will give an insightful picture of the issue at hand. Discussion, Limitations, Implication for Practice and Research All major findings are clearly interpreted and discussed within the context of prior studies. The researcher has cited various other studies and compared and contrasted those results and findings to his own study of the issue of patient experiences of day surgery and the interpretations are consistent and steady with the limitations of the study. The study is of a small size within one location and the results have been interpreted in accordance with the limitations. Findings regarding patient experiences during pre-operative wait are very useful to nursing. Lack of information about the procedure and delays, lack of emotional support and psychological disengagement are the reasons stated for patient anxiety during the pre-operative wait. These could be avoided by improving nursing services. Nursing can help provide the right kind of information, offer psychological support and relieve a considerable amount of stress and anxiety thereby making day surgery an easier procedure on patients. The findings presented in the study are convincing and are relevant to clinical practice as well as further inquiry. As stated above nursing can play a major role in addressing the pre-operative anxieties of patients and these findings can help enormously in improving the nursing services that are rendered to patients during day surgery. The study has stated one important distinction it has form prior studies. Previous studies have failed to deal with pre-operative waiting experiences of patients, which have to be addressed in order to reduce patient anxiety. Hence the implications of the study are also reasonable. The study has stated the small sample size and the single location as limitations that may hinder an accurate generalised conclusion. Another limitation was that sampling was limited to patients undergoing only gynaecology, urology and general surgery and did not consider other types of surgery. Hence the experiences obtained form patients was of a limited nature. Overall the study findings and results were discussed adequately and can be useful in clinical and nursing practices. Conclusion The study has been carried out in a reasonably accurate manner. It clearly highlights prior research done on the same subject in the literature review and explains the questions that have been answered and those that need answering. The methodology used is accurate and matches with the issue at hand, despite a small sample size and a single location. The results have been summarised with excerpts, although additional details are required for the same. The discussion has been made in a clear and concise manner, by interpreting the findings within the context of prior research on the subject. The discussion section of the paper also explicitly states the issue that has not been addressed by prior studies with references and has provided an insight into the same. Overall the very convincing and provides a meaningful insight into the varied experiences of patients who have undergone certain types of day surgery and can be applied to improve nursing practices. References Analytitech. Elements of Research. Analytitech Website. Retrieved 15 April 2009. http://www.analytictech.com/mb313/elements.htm Astate Education. Logica Structure, Theoretical Framework. Retrieved 15 April 2009. http://education.astate.edu/dcline/Guide/Framework.html Burns, N and Grove, S K (2004). The Practice of Nursing Research: Conduct, Critique, and Utilization. Elsevier Health Sciences, 2004. P 55 Colorado State University. Writing at CSU :Glossary of Key Terms. Retrieved 15 April 2009. http://writing.colostate.edu/guides/research/glossary/ Fitzpatrick, J and Wallace, M (2006). Encyclopedia of Nursing Research. Springer Publishing Company, 2006. P 594, 595 Gandhimani, P and Jackson, I (2006). UK Guidelines for Day Surgery. Elsevier Ltd. 2006 Laverty, S. M. (2003). Hermeneutic Phenomenology and Phenomenology: A Comparison of Historical and Methodological Considerations. International Journal of Qualitative Methods, 2(3). Article 3. Retrieved 15 April 2009. http://www.ualberta.ca/iiqm/backissues/2_3final/pdf/laverty.pdf Paulo, P, 2000. Sample Size For Qualitative Research. Quirk’s Marketing Research Review. Retrieved 15 April 2009. http://www.quirks.com/articles/a2000/20001202.aspx?searchID=215035&sort=5&pg=1 Taylor, B., Kermode, S., & Roberts, K. (2006). Research in Nursing and Health Care: Evidence for Practice.(3rd ed.). South Melbourne, VIC: Thomson. University of Wisconsin (2009). Review of Literature. The Writing Center. Retrieved 15 April 2009. http://writing.wisc.edu/Handbook/ReviewofLiterature.html Valle, R S (1998). Phenomenological Inquiry in Psychology: Existential and Transpersonal Dimensions. Springer, 1998. P 49 Read More