NURS472 Evidence Based Practice And Nursing Research, University Of Tennessee, USA
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Question 1: Participation
A. What are the criteria for inclusion or exclusion?
Answer: The considered article(Salzmann-Erikson, 2018) discuss about a psychiatric hospital in Sweden, the hospital name and location is kept anonymous. However, the hospital appears to be a big one as it serves patients from a city population of 300000 people and has multiple emergency wards. The Nurses under consideration were either a bachelor degree (3 years license course) or specialized master's degree course or nurse aide (1 year training after post-secondary education).
B. Is the number of participants stated?
Answer: Monthly meetings were organized on regular basis, which included 4-6 nurses for each meeting. In total 12 nurses were considered for the study(Salzmann-Erikson, 2018).
C. Is the number appropriate to the research approach?
Answer: Because of the variation in duty hours some nurses attended the meeting multiple times, whereas few never attended. In total 12 nurses attended the meeting sessions which lasted for around 90 minutes each time(Salzmann-Erikson, 2018).
D. Is the number of interviews with each participant stated?
Answer: The number of interview is not explicitly mentioned in the study. One can say that, there were multiple meeting sessions with group of 4-6 nurses each time(Salzmann-Erikson, 2018).
E. Are these elements appropriately explained?
Answer: Elements are explained adequately in this article. But it is difficult to draw conclusive remarks on the entire nursing staff across the Sweden, as the number of nurses interviewed are only 12(Salzmann-Erikson, 2018).
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Question 2: Methods
A. Is the methodology (i.e., the philosophical basis of the approach) adequately explained?
Answer: The methodology is explained in a five point manner adapted from Ward et al. (2013)(Ward, Furber, Tierney, & Swallow, 2013).
1. Familiarization through immersion in data
2. Identification of theme and development of theoretical framework
3. Preparing plots, charts and indexing
4. Summarize data in an analytical framework
5. Synthesize data by mapping and interpreting
B. Is it appropriate to the question?
Answer: According to the raised research question the methodology used are appropriate. Still the study could have been extensive and could have extended conclusion, if the sample number would have been more. However, the 5 step research analysis gives a robust framework, which can act a template for larger scale studies.
C. What methods were used to collect the data?
Answer: On a monthly basis the staff in the target unit attended the Ethical Reflection meeting. The meeting was meant for discussion of the work ethics in the hospital setup and the concern of the staff. According to the author, the meeting was led by two external consultants and the author attended 6 of the meetings. Each meetings were recorded and later transcribed, which resulted in 94 pages of data material.
D. Are the methods appropriate to the methodology?
Answer: The methods used in the study are concise and fitting to the raised research question. The study utilized a descriptive study design. The data were collected from the observation of the participant. The collected data were analyzed by framework analysis, which is a pragmatic approach and is well recognized for nursing research.
E. Are they the most appropriate methods that could have been selected?
Answer: Some other study method could have been implemented as many of the nurses of the same hospital were not able to attend the meeting. In my opinion it would have been better to go for the interview with a set of questioner and one to one meeting to find the individual point of view of the each nursing staff of the hospital. Moreover, in this way the study could have been extended to other psychiatric hospitals in the nearby cities. One of the drawback of the study is that, the study doesn't provide any demographic data which is protected under the guidelines set by Swedish Data Protection Authority, hence the author has analyzed and concluded the data at a group level.
F. Are the data collection steps explained?
Answer: Yes, the data collection steps are explained appropriately. Which was collected through a monthly 90 minute meeting named ‘Ethical reflection'. Firstly, the meetings were audio recoded followed by transcript preparation.
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Question 3: Data Analysis
A. Was the data analysis in accord with the methodology? If not, were the differences adequately explained?
Answer: The data analysis was primarily based on methods described by Ward et al. (2013). It is a framework analysis method which is an established method in nursing studies. The author could have mentioned the methods and criteria undertaken for transforming the participant comments to synthesize data for plotting, charting and indexing.
B. Were the assumptions of the methodology explicitly taken into account when analyzing the data?
Answer: In the first step of analysis, entire transcript was studied repeatedly by the author and the author recalled the mode of presentation and body language of the participants. Then the author prepared abstract themes and put it in excel file. In the third stage the author refined the abstract theme. In subsequent step the author reduced the raw data to summaries. In the final or the fifth stage the author got principal perspectives of the study gained from raw data, themes and abstract. The approach in analysis creates ambiguity as many things are dependent on the author's assumptions. Which creates room for the readers to draw their own conclusion.
C. Does the discussion reflect the appropriate methodological assumptions and understanding?
Answer: The study concludes that the nursing staff were aware of the ethical and caring values in patient care. But high expectations and high workload is taking them away from following the ethical values. The author highlights the requirement of coercive intervention in psychiatric nursing practice.
D. Are the findings consistent with the intent of the methodology?
Answer: The intent of the methods used in this study, was to find the ethical and moral concern of the nursing staff in psychiatric health care setup. The finding of the study as described by the author is in correlation with the intent of the methodology.
Question 4: Rigor
A. Is the study credible-that is, faithful to the human experiences of the phenomenon?
Answer: It is difficult to draw a holistic conclusion from a study conducted in a single hospital in certain location. Hence more research with different methodologies and on different demographics are required to understand the nursing practice ethical issues in a psychiatric healthcare setup. However, it can be said that, for the considered hospital the conclusion drawn are credible, as the same nurse may experience different challenges if she joins another hospital or even change of the administrative staff of the same hospital.
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Question 5: Fittingness, Auditability, and Conformability
A. Do the findings fit into situations outside of the study context?
Answer: It is difficult to predict whether the findings of the study can be translated to other healthcare units. Because the scenario may be different in other hospital and other healthcare set up. It can be explained by the example that, the psychiatric patients their conditions (mood, emotion, behavior etc.) are not similar throughout the day.
However, I feel the over expectations and tremendous work load may lead to the loss of the ethical concerns of the healthcare staff and make them unprofessional(Salzmann-Erikson, 2018).
B. Can you follow the decision trail of the researcher-that is, is the study auditable? Was any attempt made to confirm the findings with the participants?
Answer: The decisions trails at the first step of analysis, that is the interpretation of the raw data by remembering the gesture and body language of the respondents at the time of meeting can't audited as it was from the memory of the author and would be difficult to replicate by others.
The author has not mentioned regarding the further discussion with the respondents after the conclusion of the analysis, which would have been better to confirm the authors interpretation of the meeting transcript and body language analysis done by the author(Salzmann-Erikson, 2018).
Summary: In a psychiatric healthcare set up, it is obvious that the patient would demonstrate challenging behavior towards the caregiver and healthcare professionals. Hence, it is expected that the nursing staff would also face the challenges for administer the planned care to the patient. This can lead to loss of ethical concern of the nursing staff. The present study has identified the salient points which are determinant for loss of ethical concern in nursing staff at psychiatric healthcare hospital. Those are,
1. Staff concerned about proper care delivery to the patient
2. Nursing staff were concerned about the safe working environment
3. The respondents were critical about the high expectations and high workload, which make them insensitive towards the ethical guidelines of the nursing profession.
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