Making Sense of It All - Essay Example

CRITIQUE OF RESEARCH ARTICLES A Research Paper Presented to (Name of professor) (Name of Institution) In Partial Fulfilment Of the Requirement for the Degree Bachelor of Science (Nursing) By (Your name) 23rd, November, 2008 Study Number 1 ‘Making sense of it all’ is a qualitative study conducted by Mancini, Lawson and Hardiman. (2005) The purpose of the study was stated clearly i.e. to define and explore from a service users perspective their recovery, and what were the key factors that facilitated or hindered their recovery. The research design utilized a qualitative approach using grounded theory methodology within a symbolic framework was utilized within this study. The use of qualitative methodology is appropriate within this study as the aim of the research question was to discover experiences from mental health service user’s perspectives, finding answers that revolve around social experiences and how they give meaning to human life within recovery. According to Crookes and Davies, (2004, p 236) qualitative research is a ‘systematic, interactive subjective approach used to describe life experiences and give them meaning’. The value of qualitative research is that it produces knowledge in the intra and interpersonal realms i.e. what health and illness feels like for the patient .Where interpretations of illness and recovery experiences come from, how experiences change under a variety of interpersonal, historical, cultural and other conditions: and how subtleties or human influence including professional influence can derail illness, adjustment and recovery. A brief explanation of grounded theory methodology within a symbolic interactionism framework is provided for the reader. According to Glaser (1999) grounded theory is a methodological package that provides a series of systematic and exact methods, which transform data into concepts, and concepts into core categories that can be used to formulate scientifically valid and theoretically plausible research results (Glaser, 1999). The authors acknowledge also that they utilize a modified grounded theory approach – classical version (Glaser and Strauss, 1967) within Charmaz constructivist inquiry position (Charmaz, 2000) Grounded theory methodology is appropriate within this study as it explains social processes and can increase our understanding of human behavior one of the major strengths of grounded theory is that it generates hypotheses and theories and once these hypotheses have emerged they can be tested deductively. Sampling The authors utilized purposive sampling throughout the study. However, within grounded theory Glaser and Strauss (1967) developed their own sampling technique. This is referred to as theoretical sampling. Within theoretical sampling the researcher jointly collects, codes, and analyzes the data and decides what data to collect next and where, in order to develop the theory as it emerges. This process of data collection is controlled by the emerging theory (Glaser & Strauss, 1967). Indeed, only when some theoretical ideas have emerged is the researcher able to determine what further data should be collected in order to explore and elaborate the ideas. Sampling in grounded theory must be theoretically informed (Dey, 1999).However, this process was not followed; therefore key informants may have been excluded from the study. Consequently, this may lead readers of this paper to question the findings. The sample size was appropriate i.e. 15, however it is unclear from the paper if sampling was stopped when saturation was reached. Data collection Data was collected via semi structured interviews’ with a focus group of 15 people. All interviews’ were audio taped According to Glaser and Strauss (1967) the use of focus groups is an appropriate method for data collection. All data is a fundamental property of GT which means that everything that gets in the researcher’s way when studying a certain area is data. Not only interviews or observations, but also anything that helps the researcher to generate concepts for the emerging theory. Field notes can come from informal interviews, lectures, seminars, expert group meetings, newspaper articles. To strengthen the findings of this study other data collection methods such as field observations could have been incorporated within the study. Data Analysis The strategies of grounded theory include: (a) simultaneous collection and analysis of data; (b) a two-step data coding process; (c) comparative methods; (d) memo writing aimed at the construction of conceptual analyses; (e) sampling to refine the researcher’s emerging theoretical ideas; (f) integration of the theoretical framework (Charmaz, 2000). Simultaneous collection and analysis of data. The authors acknowledge clearly within their study that this process was modified. Interviews were conducted close together and data was analyzed subsequent to completion of all interviews. This may have impacted on the findings as the emergence of categories identified in early interviews may not have been further explored and conceptualized. . The authors clearly demonstrate within this paper that they utilized the two step data coding process ‘common codes were collapsed into broader categories’ This follows the principles of Glaser and Strauss version of grounded theory (Glaser and Strauss, 1967). They also utilized the constant comparative method The constant comparative method is a method for analyzing data in order to develop a grounded theory and is the heart of the process .At first the researcher compare interviews (or other data ) to interviews (or other data) . From this process theories emerge quickly. When theory begins to emerge the researcher begins to compare data to theory until saturation has been reached. . Findings The findings are clearly stated in the first paragraph of this study and a diagram is presented to illustrate the core category and its relationship to categories related to it. However, in critiquing this paper, a substantial section within the findings related primarily to the factors that facilitated and /or impeded recovery. The first part of the question in defining and exploring service user’s perspective on recovery is not addressed adequately. The authors clearly acknowledged the limitations of their study and throughout the paper clearly identified the aspects of grounded theory that they had modified. The authors make suggestions for further research within this area i.e. future recovery research must use research designs and theories that are able to effectively account for this process’ Study Number 2 A qualitative analysis of turning points in the recovery process by Manicini M.A (2007) this is a qualitative study utilizing grounded theory methodology. The purpose of this study is clearly stated in the abstract and the main body of the paper. It sets out to identify critical turning points instrumental in the recovery of 16 people with an identified mental illness. The research design chosen for this study is appropriate as it seeks to understand and explain phenomena from a personal, and subjective, emic (insider) viewpoint. (Benoliel, 1984, Denzin and Lincoln, 1994, Streubert and Carpenter, 1999) rather than an objective etic (outsider) viewpoint (Denzin and Lincoln, 1994) In addition, research using this design is useful when few studies have been conducted within the chosen area. (Strauss and Corbin, 1998) The goal of the Grounded Theory approach is to generate theories that explain how some aspect of the social world 'works.' (Strauss and Corbin, 1990) The aim is to develop a theory that emerges from and is therefore connected to the reality the theory is developed to explain and this fits in which the research question. Sample Within grounded theory a large sample size is not an indication of good theory. What is paramount is that theory proposed has reached saturation point According to Strauss and Corbin (1998) saturation is reached when your interviews add nothing to what you already know about a category, its properties, and its relationship to the core category. Mancini (2007) did not state clearly if saturation had been reached. Theoretical sampling was not utilized within this study; instead purposive and snowballing was adopted. The essential feature of theoretical sampling, according to Parahoo (2006) is that the researcher is unaware in advance who to interview. As the data is analyzed categories emerge and guide the researcher in choosing who to interview/ collect data from. Ultimately by not using one of the key characteristics of grounded theory the strength of the emerging theory is brought into question. (Strauss and Corbin, 1998) Data Collection Two methods of data collection was utilized which fits well with grounded theory methodology i.e. semi structured interviews and field notes to supplement the data emerging from interviews approach According to Strauss and Corbin (1998) REFERNCE The author clearly indicates that all interviews were tape recorded and transcribed. Data Analysis The data analysis section is well structured and easy to follow. The reader is provided with an in depth description of the analysis process. In relation to grounded theory methodology Mancini (2007) states clearly that the key characteristics of grounded theory were utilized in this study i.e. coding process referenced is the modified version of Glaser and Strauss, (1967) and Charmaz (2000) and that the constant comparative method was employed throughout the analysis of this study. However, interviews were conducted close to each other which limited the ability of the author to use themes emerging from each interview to inform subsequent interviews. Mancini (2007) gives a clear description as to the reasons for this and that to overcome this limitations extensive field notes were kept which were analyzed and used to inform subsequent interviews. . This strengthens the finding of the study. The author attempted to overcome potential bias by using a neutral outside reviewer to verify emergent categories. Findings Within this study the findings are made explicit within the discussion section. Mancini (2007) illustrates that the findings are a ‘complex interplay of environment, personal agency and identity involved in the recovery processes’. In support of his finding he references research studies by eminent researchers that support his findings for example e.g. Strauss, Hafez, Lieberman and Harding. (1985) and Cohen (2005). The findings are discussed in relation to the original research question. Finally, the author acknowledges four limitations of the study. This increases the credibility of the study. From an evidenced based perspective Mancini (2007) suggests how the findings of this study can be utilized in clinical practice; this will facilitate a reduction in the variation and provision of services and in patient outcomes by developing institutional environments that are empowering. On a personal level, Mancini (2007) study recommends that practitioners re-examine the role they play in supporting clients. The two previous studies explore the process of recovery. In the first study the factors that facilitate and impede recovery is the focus of the research. In the second study the critical turning points that put people on the road to recover is addressed. However, within the findings both research studies have similar commonalities. Both studies highlight the role other professional and families play in the role of recovery. For recovery to be facilitated, supportive relationships from professionals, families and friends is essential. They support the stance that empowering of the individual on a micro (personal) and macro level is paramount in the process of recovery. Study number 3. Introduction Evidence based practice (EBP) integrates clinical expertise and patient values with the best available research evidence. It essentially implies that evidence based nursing is very important in making informed decisions about the health care of a patient and also for identifying knowledge gaps for further research . EBP assumes that nurses are capable of appraisal of whether or not a research study is scientifically rigorous. It is but one step in the very challenging process of clinical decision making. Therefore nurses should effectively be able to criticize a research report as it broadens understanding, improves practice and provides background for conducting a study. An intellectual critique of research entails the careful examination of all aspects of a study to judge the merits, limitations, meaning and significance. This essay will critique Marit Borg, and Kristjana Kristiansen’s article on recovery oriented professionals: Helping relationships in mental health service. Mental problem has been a problem that for a long term been treated as a disease which requires the therapeutic treatment by professional in health care provision. However minimal studies have been carried out about the care receivers in this sector to establish their perception on the effectiveness of treatment in mental health problem and the relationship with the care providers, the psychiatrists. Sometimes severe mental problem is perceived by care providers as chronic and resistant to any therapeutic treatment thus little can be done about it. Amazingly there are survivors of such tragedies who recovered from this situation. In the research by Marit and Kristjana, the role of helping relationships in mental health service for recovery of patients has been examined. Title The title of the article clearly shows the focus of the research study and allows the reader to be able to contemplate what the research is all about. This gives this research some strength as a research article. Aim of the study The aim of the study has been clearly stated at the beginning of the research report which is meaningful and gives the reader the focus of the research study. Hypothesis A hypothesis is a tentative statement that puts forward a possible explanation to a given phenomenon or event (Parahoo, 1997). A valuable hypothesis should be a testable statement which may include a prediction. In the research by Marit and Kristjana, there is no stated hypothesis. However a hypothesis is based on previous studies by other researchers which were not available in for the researchers. According to Parahoo (1997), a hypothesis should not be confused with a theory as a theory is based on facts. Literature Review The research article has very little information about previous works in this research problem. However the researcher notes that there are very few research and literature concerning the receiver’s of care in mental health first person experience with recovery process. The few that exist as the researcher notes agrees that the treatment relationship plays a major role in recovery process of patients with mental health problem. Therefore the underpinnings available conform to the research finding of this research. A good research article should have an enriched literature about the research problem and should be supported by relevant, valid sources to strengthen the research. Primary and secondary sources should be used appropriately in order to give validity to the research (Polit, & Hungler, 1997). Conceptual framework A conceptual framework is the sequence of flow of events in a research. The research article by Marit and Kristjana lacks a conceptual framework. The article is generally disorganized. A conceptual frame work is important as it gives the research article some strength and also gives strength to the result findings. Research question The research used an open question “What was helpful in your process of recovery” This type of a question in an interview is very effective in research as it allows the respondent to be able to give a personal experience without limitations. Methodology of research In studying recovery, the researchers used phenomenological approach to knowledge which aimed at deepening the researchers understanding of personal experiences in recovering from severe mental illness and the type of helpful relationship with professionals. This phenomenological approach is useful in this research and useful to a psychiatrist in the nursing profession as he or she can be able to understand this relationship to recovery process. Research design The research design employed in this research is descriptive and uses the experiences given by the informants to draw out conclusions. Hence it was established that recovery relied on relationships of the service giver with the recipient. The research design helped the researcher to come up with the following conclusions; discovering fellow humanity, available everyday helper, experiencing what is therapeutic and finally breaking the rules. However, the design was appropriate as there was a well drawn criterion for determining the research group (Parahoo, 1997). According to Burns, & Grove (2005), an appropriate research design is important as it ensures that the results are not jeopardized. The research methodology of any research determines the results and includes analysis, sampling as well as interpretation. Sample The research group was appropriate, 15 was a good sample size and with diverse characteristics such as age which varied from 29-63, sex was well balanced with the researcher taking seven women and eight men, marital status was also observed with married, divorcees and singles. This sample was appropriate and hence the result findings are not biased with regard to socio-demographic data (Burns, & Grove, 2005). The researcher did not however tell as whether his samples had reached a saturation point. A saturation point as described by Polit & Hungler (1997) is a point at which the researcher gets nothing new from what he already knows from his respondents. This would have been important as it would have suggested to other researchers to use a different sample for future research. Thus it makes the research at this point to be unreliable to other psychiatrist in the profession. This study design strengthens the research and makes it valid to other psychiatrist in the health care professional. There was inclusion and exclusion in sample selection of the sample. The study was limited to: Those who considered themselves as having fully recovered or in the process of recovering from a serious mental problem, Those who were coping with their lives, Those who had improved their lives with help from the mental health service Those who had not received inpatient psychiatric care for the past two years. At the time of the interview, three informants reported that they were not use mental health services while the other twelve confirmed that they at least continued to receive some form of support. Eleven of the 12 participants used some kind of psychotropic medication. Lack of inclusion and exclusion can lead to the use of an ineffective sample in result findings. Method of Data Collection The research applied a single method in data collection. Interview was used to collect information from the informants and the information was recorded in audio tapes. This is a useful method in qualitative research which is descriptive. The participants are able to describe their experiences in their own words which are meaningful to qualitative research (Parahoo, 1997). In addition, the research report made use of demographic interview such as age, sex, marital status, income, and other aspects which is strength in any research report. Data needed was collected successfully and a relationship between the subject of interest as conceptualized and approach of data collection was established. To strengthen the findings of this study other data collection methods such as field observations could have been incorporated within the study (Polit & Hungler, 1997). However the method of data collection was appropriate for the results to be trusted. Data Analysis After the interview was complete, each tape recorded interview was transcribed. The tapes were taken later to the informant for their review and approval of the information in the tape. The research team then read through the transcribed, tapes noting recurrent themes related to recovery of the patient. Summaries were drawn and used to in identifying specific aspects of recovery and included, active role of a person, events, support and influence of others, environmental factors and the understanding the meanings underlying experience of mental problem and recovery. The analysis was not sufficient as it was only carried out by the researches themselves without incorporating the views of other practitioners in analysis of the data which is a limitation in this research. (Burns, & Grove, 2007). The paper focused on exploring of the topics which were concerned with experiences and perspectives on helpful relationships with mental health care professionals. Since the research is purely qualitative, result analysis was descriptive. The use of qualitative research is flexible, people centered and holistic. Some of the most common methods of qualitative research are phenomenology, grounded theory, ethnography and historical method (Crookes, & Davies, 2004). In the research article by Marit and Kristjana however lacks to define a methodology of qualitative research used which is a major limitation. Since there has been no prior research in this area, the researchers should have used the grounded theory which is appropriate for such studies where little or no prior research or literature is available. The use of methods of analysis was not defined; most common method of analysis of qualitative research is the Giorgi’s methodology that helps in interpreting the result findings. Giorgi's method is a sequence of steps in analyzing the personal accounts given by informants of their experience of a particular phenomenon (Burns, & Grove, 2005). This method would have been appropriate in this research and would have increased its importance to the nursing profession. Research findings and theoretical integration The research findings corresponded to the shallow literature that the researchers have appreciated in their research. From the interviews conducted on 15 informants, it was clear that the helping relationships were useful in recovery in mental health problem. Recommendations The research did not have any recommendation thus it does not open door for other researchers with interest in the same research problem. A good research recommends for various research methods (longitudinal studies) in order to come up with more valid findings about the research problem (Burns, & Grove, 2005). Ethical Consideration Ethical principles are principles of respect for person, beneficence and justice which are relevant to the conduct of research. Beneficence involves protection of participants from physical and psychological harm. Ethical studies therefore are the considerations which outweigh risks (Barbour, 2003). In this research, the researchers did not observe ethical issues as the article does not illustrate whether this issues were considered during the research. The names of the participants were used. The researcher would have used anonymity in their research article, whereby identities are not disclosed. The tapes that were recorded for the interviews were not destroyed right after the research was through. This is necessary in any research that observes ethical issues (Polit, & Hungler, 1997). Validity and reliability The research findings were not valid nor reliable as they did not use quantitative research study at even a single point. It is important for a researcher to incorporate some statistics which allow qualitative analysis hence making the research replicable. In nursing practice, the use of both qualitative and quantitative data analysis is useful as it makes the results verifiable for other researchers to be able to extend longitudinal research on the same issue (Burns, & Grove, 2007). The researcher does not identify any limitations in their work. It is essential for any researcher to point out a few limitations that might have influenced his or her study for other researchers to be able to carry out research and noting this limitation to validate their findings (Polit, & Hungler, 1997). In general this research article does not have a flow. It does not lay down procedures for a research study thus it is not appropriate for the practitioners to put trust in it. The research article fails to provide a literature and hence the researchers point out that there is little research pertaining to this area in the nursing profession. Conclusion In looking at the three articles however, all the researchers come up with the similar themes regarding recovery and health care provision by psychiatrists. In using the three articles one could possibly agree that the recovery of mentally ill depend not on the professional therapies carried out by the psychiatrists, but on the relationships that the psychiatrists establish with their patients. The patients seemed to appreciate very little things that were done by their psychiatrists. The studies in this area show clearly that recovery in mental health care is highly determined by the psychiatrist. The professionals have a great duty in helping their clients to recover from mental problem in all the possible ways even if it involves violating of professional ethics (Crookes, & Davies, 2004). For example in the research by Marit and Kristjana, it was established that the psychiatrists went an extra step to assist their clients at personal levels. The researchers identified this as “breaking the rules” At some instances a nurse could lend his client with cash, visit them during off work hours. Even though the research is not standard as a research report, it is in one way or the other influential in the psychiatric profession and can assist practitioners in developing their career. After role one feels contented when the results of his or her work turn out positive. Nurses are there to help people. References Barbour, M. (2003), Evaluating and Synthesizing qualitative research: The need to develop distinctive approach’ Journal of Evaluation in Clinical Practice, Vol 9 no 2, pp. 179-186. Burns, N. & Grove, K. (2007), Understanding nursing research: Building an evidence-based practice. (4th ed.), (Philadelphia, WB Saunders) Burns, N. & Grove, K. (2007), Study Guide for understanding nursing research - building an evidenced-based practice. (4th ed.). (Philadelphia, WB Saunders) Burns, N. & Grove, S. (2005), The practice of nursing research, conduct, critique and utilization, (London, Oxford University press) Crookes, P. & Davies, S. (2004), Research into practice: Essential skills for reading and applying research in nursing and health care, (Sydney, Balliere Tindall) DePoy, E. & Gitlin, L. (1994), Introduction to research: Multiple strategies for health and human services, (Sydney, Mosby) Giorgi, A. (1985), Phenomenology and psychological research. 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