Research For Nursing And Midwifery: Critical Appraisal And Implications For Practice

Overview of Research Design

Discuss about the Research for Nursing and Midwifery.

Critical appraisal of journal articles related to nursing and healthcare is a notable process of accurately and systematically analyzing research for judging the trustworthiness, its significance and relevance to the practice domain. Appraising articles in light of literature is crucial for evidence based practice. The present paper is a critical appraisal of the research paper titled “Patients’ experience of identifying and managing exacerbations in COPD: a qualitative study” written by Williams, Hardinge, Ryan and Farmer (2014). The complete reference is as follows-

1. The health issue that is the focus of the present study by Williams, Hardinge, Ryan and Farmer (2014) is chronic obstructive pulmonary disease (COPD). The researchers found that one in three patients suffering from this disease in the UK have readmissions within 28 days of a hospital admission for suffering from exacerbation. A research gap was identified by the researchers pertaining to the definition of exacerbation as understood and recognized by patients. It is noted that ability of the patients to feel confident in undertaking treatment of exacerbation at home denotes self-care abilities.
2. Previous studies have revealed that patients have considerable awareness of imminent exacerbation. However, the studies did not have proper methodologies. Though there exists some amount of research on the clinical assessment of exacerbations, restricted knowledge is there regarding how patients manage exacerbation of COPD.
3. The present study has the significance that it aimed at identifying the manner in which COPD patients recognize and manage exacerbations at their respective homes.

1. The aim of the research was to carry out an exploration of the present experience and understanding of patients about identification and management of COPD exacerbations at homes.
2. The study considered qualitative research design for addressing the research question.
3. According to Lewis (2015) qualitative research is an exploratory research form that helps in gaining an in-depth understanding of the underlying opinions, reasons and motivations. Such form of research is beneficial for uncovering trends in perceptions and opinions of individuals.
4. In the present research, undertaking a qualitative research design was justified as such an approach helped in looking deep into the experiences and viewpoints of the participants in relation to management of COPD at home. Qualitative research design encouraged individuals to provide expansive responses on the research question. A detailed picture could be built regarding how patients with COPD act in a particular manner and what their feelings are. A naturalistic inquiry could be undertaken that sought in-depth understanding of the chosen phenomena (Kotrotsiou et al., 2015).

Sampling

1. Recruitment of participants was done as a part of the clinical trial from hospital admission records, pulmonary rehabilitation programs and general practice by a respiratory research nurse.
2. Individuals were recruited on the basis of a set inclusion/exclusion criteria of diagnosis of COPD; smoking history of more than 10 pack years, a forced expiratory volume in 1 s (FEV1) post-bronchodilator <80% and predicted ratio of FEV1 to forced vital capacity (FVC) <0.70; MRC dyspnoea scale>2; registration with a general practice and with an exacerbation of COPD needing home treatment; absence of other lung disease; absence of chronic heart failure; life expectancy of more than 3 months; ability to give informed consent; ability to read and write in English (Williams, Hardinge, Ryan & Farmer, 2014).
3. As opined by Parahoo (2014) inclusion and exclusion criteria are important as they ensure safety of the patient during the study and justify data collection. Further, these criteria are essential for minimizing withdrawal from study and ensuring that all primary end points of the research are reached.
4. Purposeful sampling method was used in the study which is a judgmental and selective sampling method. The goal of such a sampling method is to create a sample population with the idea of making generalizations from the sample to the population of interest (LoBiondo-Wood & Haber, 2017).
5. In the present case such a sampling was justified as the idea was not to carry out random recruitment of participants.

1. The present research considered data collection with the help of in-depth interviews.
2. These interviews were undertaken out as per the convenience of the individuals at the homes of the patients. The first author of the research paper was responsible for carrying out the interview. The rationale was that the author had previous training in carrying out qualitative research studies. The study considered utilization of a semi-structured topic guide. The questions that were decided upon by focusing on the experiences of the participants; the manner in which they identified exacerbation; how these were managed at home. The interviews were carried out for almost 20 to 55 minutes. The researcher considered recording filed notes immediately after the interview was completed for providing context of the interview and data analysis. It is to be noted that six participants had their family member or spouse present at the time of the interview (Williams, Hardinge, Ryan & Farmer, 2014).
3. The qualitative research interview had the aim of describing the experiences of patients supposed to manage COPD at home. A qualitative interview seeks to unearth the factual and meaning level of the concerned topic (LoBiondo-Wood & Haber, 2017). Face-to face interviews are useful in uncovering the story behind lived experiences. An informal and conversational approach can be upheld for extracting optimal information from participants.
4. This method of data collection has some advantages and disadvantages which can be understood from the work of Parahoo (2014) and Moule, Aveyard and Goodman (2016). In a face-to-interview, any mistakes and misunderstandings can be easily rectified since there is the physical presence of the researcher. Relationship between the two parties can be fostered that is essential for optimal data extraction. Adequate data is easy to be collected when an interview is carried out. The same is a time saving process apart from being a flexible and less costly one. An interview further increases the level of knowledge of both an interview and interviewer through exchange of information. In addition, planned interviews ensure in depth analysis. Nevertheless, in case of an interview, there is scope for confusion occurring in the future that cannot be resolved then. Suitable skills are required for making the process accurate. In case the interviewee is not attentive, real information is not possible to be collected.
5. An alternative method of data collection that the researchers could have chosen is survey. Survey research can be done with the help of a questionnaire that the participants care to fill up within a stipulated time frame. Such as questionnaire can be self-administered and is appropriate for reflecting on diverse aspects of the research question consequently. It is advisable to send the questionnaires to the participants who can respond accordingly as per their convenience. It is a practical method of data collection (LoBiondo-Wood & Haber, 2017).

1. Audio recording of the interviews were done and verbatim transcription followed. Subsequently, import of anonymised transcripts was done to NVIVO 10, which is a qualitative software data programme that is useful for data storage and data analysis. A grounded theory approach was taken for data analysis. Identification of theoretical links and key concepts was done with the help of constant comparative method, open, axial and selective coding and memo-writing.
2. As opined by Moule, Aveyard and Goodman (2016) it is it important to select applicable methods of data analysis in qualitative research since the basis of data analysis of development of ideas and hypothesis for research. Since data analysis widely depends on interpretation of data, the presence of an accurate analysis method is crucial.
3. For ensuring rigor of the coding process, coding of two interviews was done by a qualitative researcher who had prior experience in this field but was not a part of the project. Further, the researcher as well as the other members of the research team had regular meetings for reviewing and discussing the process of analysis and consequent implementation. This ensured transparency and credibility of findings (Williams, Hardinge, Ryan & Farmer (2014).
4. The study demonstrated that patients are able to identify exacerbations through assessment of visible symptoms that are based on clinical parameters, and invisible symptoms that are based on experiential knowledge. Individuals experiencing exacerbations previously reported to ‘just know’ the time of exacerbation. The self-management techniques they demonstrated were breathing and pacing techniques, self-administered antibiotics and steroids. Patients further reported that they engaged in monitoring their conditions in course of the exacerbation and accessing care professionals when improvements were not achieved. Delay was however done under certain circumstances when crisis points were reached.
5. The results of the study findings can be applied to healthcare settings where nurses are responsible for outlining care plans for COPD patients (Zakrisson et al., 2017). Since the role of nurses in managing and monitoring COPD patients is crucial, the findings of studies such as the present one can be used as the foundation for bringing changes in nursing practice.

Conclusion

The present critical appraisal was helpful in analyzing the value of the chosen research paper. The implications for practice as highlighted from the paper can be implemented in professional practice in future. The key knowledge gained from the paper was related to management of patients suffering from COPD. Nurses are to engage in extensive evidence based practice for ensuring professional development. Enhancement in current level of knowledge is required for enabling better outcomes for patients suffering from this condition.

References

Holloway, I., & Galvin, K. (2016). Qualitative research in nursing and healthcare. John Wiley & Sons. Retrieved from https://books.google.co.in/books?hl=en&lr=&id=EKu-DAAAQBAJ&oi=fnd&pg=PR11&dq=nursing+research+book&ots=1a9J5HL29g&sig=m7Sh6fB7Dlwo4U3qwWTxpmOp6_c&redir_esc=y#v=onepage&q=nursing%20research%20book&f=false

Kotrotsiou, E., Tzounis, E., Daniil, Z., Hatzoglou, C., Skenteris, N., & Gourgoulianis, K. (2017). Anxiety, stress and depression on COPD patients. A qualitative research. European Psychiatry, 41, S243. DOI:  https://doi.org/10.1016/j.eurpsy.2017.02.017

Lewis, S. (2015). Qualitative inquiry and research design: Choosing among five approaches. Health promotion practice, 16(4), 473-475. DOI: https://doi.org/10.1177/1524839915580941

LoBiondo-Wood, G., & Haber, J. (2017). Nursing Research-E-Book: Methods and Critical Appraisal for Evidence-Based Practice. Elsevier Health Sciences. Retrieved from https://books.google.co.in/books?hl=en&lr=&id=vGclDwAAQBAJ&oi=fnd&pg=PP1&dq=nursing+research+book&ots=9IUAPxBZd0&sig=7qNgjHTDNMvA1oovs7KpwlHmL04&redir_esc=y#v=onepage&q=nursing%20research%20book&f=false

Moule, P., Aveyard, H., & Goodman, M. (2016). Nursing research: An introduction. Sage. Retrieved from https://books.google.co.in/books?hl=en&lr=&id=Yi0jDQAAQBAJ&oi=fnd&pg=PP1&dq=nursing+research+book&ots=xwoaDJuLLX&sig=iXhIFaJSd9-Oat8eWFn0Lbn2OkM&redir_esc=y#v=onepage&q=nursing%20research%20book&f=false

Parahoo, K. (2014). Nursing research: principles, process and issues. Palgrave Macmillan. Retrieved from https://books.google.co.in/books?hl=en&lr=&id=5ti3AwAAQBAJ&oi=fnd&pg=PP1&dq=nursing+research+book&ots=RBvFYuGozX&sig=RYzcilr_1NW2yErgt-Y1OvQwt5U&redir_esc=y#v=onepage&q=nursing%20research%20book&f=false

Williams, V., Hardinge, M., Ryan, S., & Farmer, A. (2014). Patients’ experience of identifying and managing exacerbations in COPD: a qualitative study. NPJ primary care respiratory medicine, 24, 14062. DOI:10.1038/npjpcrm.2014.62

Zakrisson, A. B., Arne, M., Hasselgren, M., Lisspers, K., Lundh, L., Sandelowsky, H., … & Theander, K. (2017). A description of requests for self-management support among patients with COPD in primary health care. European Respiratory Journal, 50.  DOI: 10.1183/1393003