Critical Appraisal of a Qualitative Journal Article

Research is a significant element in all professions, but perhaps more so in healthcare. It forms the basis of development and adaptation in the healthcare world, and allows professions to merely ‘observe change’ (Griffiths, 2009). This essay critically appraises a research article, Using CASP (critical appraisal skills programme, 2006) and individual sections of Bellini & Rumrill: guidelines for critiquing research articles (Bellini &Rumrill, 1999). The title of this article is; ‘Clinical handover in the trauma setting: A qualitative study of paramedics and trauma team members.’ (Evans, Murray, Patrick, Fitzgerald, Smith, Cameron, 2010). Many research articles are appraised due to the sheer degree of information obtainable in health care settings. Critically appraising articles allows one to filter out the low quality studies and distinguish misleading information (Cormack, Gerrish & Lacey, 2010).

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The article title clearly explains the research, without being too extensive, using extraneous words or explaining the results found. It is able to inform the reader of the research aim without becoming uninteresting. The basic concept of a title should provide a summary of the content. A good title should be straight forward; a poorly written title will defer readers (Centre for research writing resources, 2012). Key words serve as key elements in the article, including handover, trauma and paramedics. Again allowing the reader to know precisely what the article consists of.
The abstract of this article elucidates the purpose of the research, its results and reasoning’s. It also briefly articulates the method, highlighting key factors necessary. Everything declared in the article is present in the central text; all statistics and findings are indistinguishable. The abstract enables the reader to decipher if the article is of interest.
This article clearly identifies the aims of the research in the abstract and main text. By using aims, the results and discussion are simply interpreted and flow effortlessly. Aims should be written plainly, in non-technical language and state the concepts the research is addressing (Stommel & Wills, 2004). By using comprehensible and concise aims, the reader can simply understand what the researcher is setting out to obtain, giving the research a focus. In the background of the article, the researcher clearly identifies the relevance of the research aims and why the research is required, including medical mishaps and misinterpretation of trauma handovers. This allows one to understand the concepts behind the research, give the aims credibility and support incorporation into the results. Background information suggests that the topic has been thoroughly researched and aids construction of research methods and aims (Blaxter, Hughes & Tight, 2006).
This research uses qualitative methods, which deem appropriate for this type of research, as the researcher is trying to highlight the attitudes, experiences and emotions of participants concerning handovers. The research does not use statistics, rather participant’s responses and their subjective experiences around the topic. Qualitative research looks at the essence of social phenomena, giving people the opportunity to understand what people do and why (Williams, 2010).
In the abstract, the researcher articulates using grounded theory and thematic analysis. Grounded theory is used to develop theories that can be used in practice (Oktay, 2012), suggesting this is a desired method for this research. The article is well set out, permitting the research design to be effortlessly recognisable and easily read. Although the researcher states that grounded theory was used, one may say that it was used incorrectly. Grounded theory is used to create theories that can be applied in real life situations (Oktay, 2012) and although this study does create a theory, (effective and ineffective handovers) it is building on an already established theory (MIST Mechanism-Injuries-Signs-treatment). The use of grounded theory is very ambiguous in this research; it could be argued that is has been applied correctly, due to using current research to guide the study. Whether it was applied accurately or not, the researcher has not explained how they used grounded theory or integrated the theories into the research. The researcher does not disclose how they determined the exact method used. This would be beneficial as the research question, method of data collection and data analysis all depend on each other, and therefore these paramount decisions need to be made continually throughout the research process (Willig, 2008).
The participants were selected through purposive convenience sampling, with no incentives. Although this is convenient for the researchers, it may mean the respondents are not the most appropriate to the task itself (Burnard & Newell, 2011). In this case, all the participants were Paramedics or part of a trauma team and all had understanding with trauma cases. As the researcher states in the limitations, the conclusion may be different for less experienced participants or those who were trained differently. There is no explanation as to why the participants chose to take part in the study, nor why others chose to decline the opportunity. This would be valuable information as there may be a specific group of people that decide to volunteer for research studies, therefore the research may not be applicable for all paramedics and trauma staff. One may find it difficult to consider how all of the volunteers happened to be experienced, this may lead to the suggestion that the researchers filtered through the respondents and chose the most suitable, still using convenience sampling. The article is also unclear about how the volunteers came to know about the research and what they were told before the research commenced. Convenience sampling is most commonly used in larger- scale studies (Sim & Wright, 2000) and therefore seems an outlandish method to use, as only 27 participants were used in this study.
In this article, the researcher does not disclose the setting in which data was collected. This may well have an impact on the results, as it could influence the participant’s emotions, how comfortable they feel and how much information they are willing to provide (Shi, 2008). Also, they do not specify which researcher conducted the interviews. By the interviewer being a Paramedic, part of a trauma team or neither may have an ‘interviewer affect’ (Alder & Clark, 2011). This in turn may change the results of the study, make it bias or unreliable. There is an obvious section in the article relating to how the data was collected. All participants were interviewed face to face, but the researcher does not specify if these were in groups or individual. By interviewing as a group some people may conform to others responses. Using a semi-structured face to face interview allows the interviewer to observe non-verbal communication techniques, as well as how the participants give their responses (Flick, 2009). The interview consisted of pre-determined questions, using a topic guide. It is not discussed who wrote the topic guide, this again could have an effect on the results or the way in which certain questions are worded. The paramedics were given a somewhat different question format to those of the trauma team, allowing the researchers to gain full potential of questions given. The topic guide was integrated into the article, so readers are fully aware of questions asked. The participants were given a copy of MIST and asked to comment on how it could be enhanced. This was modified and presented at the specialties’ clinical meetings and opinions were given to the researchers by email or telephone. The researcher does not specify who was present at the clinical meetings, and whether the Paramedics were given the opportunity to see the modified version. It also does not disclose how long participants were given to respond and if they were given a chance to confer with any other people. If the participants were able to discuss the modified MIST before replying, the results may be inaccurate; some responses may be influenced by other professions with different experiences. The article is very vague about who was interviewed on the minimum dataset for handovers, as only the speciality groups were declared. This could cause a bias result, if only one profession was interviewed on specific aim. The researcher has not commented on their rationale for using any of these methods; supplying a rationale can help ensure validity in the research process and results (Piekkari & Welch, 2004).There is no mention of any changes made throughout the study, therefore one can assume the original plan was followed through the majority of the study. The researcher has not mentioned how the data was recorded; this could have a detrimental effect on the results, because if they are noted from the researcher’s memory, mistakes could be made. Grounded theory usually records data using audio and video tapes, allowing the researcher to carefully examine responses given (Schreiber & Stern, 2001).
At no stage in the article does the researcher comment on their own role and any bias they may cause in the study. Researchers are said to be bias when they do not take an objective approach to research (Powers & Knapp, 2006). From the article itself one can see that the research team consists of 1 Ambulance service employee, 1 trauma team member and 4 people from the research centre of excellence, suggesting there is minimal bias from researchers, but this is not documented. One may say bias was reduced as the participants were not given MIST until after they had been asked some of the questions; therefore it had no influence on previous responses. There is no research question used in this study, but there are four clear aims that were derived from the extensive background and initial research.
Ethical issues have been considered by the research team as the study was approved by an ethics committee, but there is no justification of ethical issues taken into consideration concerning the participants. Although there are no ethical issues relating to the welfare of the participants, the researchers do not explain confidentiality and informed consent. One can presume that informed consent was gained from each respondent as they volunteered for the research. Informed consent requires the participants to have adequate information regarding the research (Surrena,2011).
During this study, the data was sufficiently analysed, using thematic analysis. Thematic analysis uses coding to identify the recurrent or main themes in research results. It is most often used in qualitative research as it emphasises recurrent ideas and feelings (Mays, Popay & Pope, 2007). By using a coding programme to categorise responses from participants, the researchers were able to find recurrent themes and were capable of placing responses into three nodes that were directed by the initial aims. This was independently checked for consistency and in some cases a third researcher was used to decipher any discrepancies, again reducing bias. In the main text, the researcher does not mention the use of thematic analysis, only the coding process, although it is mentioned in the abstract; one can assume this method was used throughout. It is not explained why the responses shown in the article were chosen to be published, but there is a descriptive table shown that entails several responses. It is exceedingly supportive to the results given, as it concurs with the results and highlights how the paramedics and trauma team share equivalent experiences with trauma handovers. The data analysis materialized no contradictory responses; there was a general consensus between all participants, emphasizing the need for further research and handover training and frameworks.
There is a clear consensus that countless handovers are ineffective and several participants agreed on reasons for this. This was evidently stated by the researcher, along with the need for paramedics to obtain training in effective, concise handovers. There is no evidence for argument as all participants agreed that handovers needed to be enhanced in order to improve patient outcome and quick treatment. The researchers were not trying to settle argument, merely emphasise the experiences of professionals in the emergency setting. The researcher considers triangulation, but declares it should be used with caution in other hospitals, not mentioning the study’s use in other ambulance services. Triangulation refers to approaching data from various perspectives (Flick, Kardorff & Steinke, 2004).The discussion is flawlessly set out as the aims the researcher set out to justify. This makes it easier to alternate between the method, results and discussion with ease.
The researcher discusses how the study can be the basis to further development with trauma handovers and illuminates the need for further research and application. It does mention the need for further paramedic training, but as a lone piece of research, it is unable to act upon this. The research has not highlighted any new areas that need investigation or further research, but has merely emphasised the awareness of poor trauma handovers. There is also no mention of transferability in this study, other than using it cautiously in other hospitals. Transferability refers to the probability that the study has meaning or use in other situations (Surrena, H 2011). In addition, there is a short time period between the article being written and it being published; meaning the information in this study is relevant and up to date.
In conclusion, this research study is well designed with meaningful and useful results. The aims and background information are impeccable, giving the researcher ample reasons to conduct the study. The results are well analysed and supported by the discussion. The only downfall to this article is the minimal justification of choices made throughout the study. There are various limitations, that the researchers have identified themselves, allowing further researchers to replicate the study, modifying the limitations noted in this article. Due to the researcher identifying the need for further research, the reader may not consider changing their current practice based on this article alone. However it would be exceptionally useful in further research.