Question:
Discuss about the Countertransference in Qualitative Research.
The aim of the assignment is to appraise the quality of the research article to assess the quality of the clinical evidence. For this purpose, a qualitative research study is selected named- “Mental health nurses’ experiences of managing work-related emotions through supervision” by MacLaren et al. (2016). The purpose of the critical appraisal is to apply the research findings into practice as a sheer degree of information obtainable in the health care setting. Critical appraisal is the effective method to filter out misleading information by identifying the low quality studies. The critique framework chosen for this assignment is the CASP tool for qualitative studies.
The qualitative study must provide a clear statement of the aims of the research. The goal of the research must be presented along with the relevance and its importance (wixstatic.com, 2017). The aim of the article is evident from the title itself, and in the abstract, the aim and objective are clearly elucidated. MacLaren et al. (2016) stated the aim is to explore the nurse’s experience of managing the work-related emotions through supervision and identify how it functions as an emotionally safe space promoting the critical reflection. The aims and goals are well explained in simple and nontechnical language. The concept that the research is trying to address is well explained through the relevant background. The author explained that the aim of the research is important because the previous studies showed that there is a positive impact of supervision on the nurse’s emotional well being. The researcher highlighted that there is a literature gap in regards to the process involved in motivation through supervision and if it all positively influences the emotion management by nurses (MacLaren et al. (2016). Thus, the research is important as it will explain how the “styles of emotion interaction” are established in supervision. The research aim is concise and comprehensive and is relevant as per the given background, which also indicates that the researcher has thoroughly reviewed the literature. The thorough literature reviews have helped in the construction of the research methods and aims.
According to the CASP tool, the qualitative methodology must seek to illuminate the subjective experiences of the research participants. The qualitative methodology should be appropriate in addressing research goal (wixstatic.com, 2017).
The qualitative method for the exploratory research is appropriate as the researcher aims to illustrate the attitudes, experiences, and responses of the nurses while managing the work-related emotions. These are subjective experiences, thus the qualitative approach is deem, appropriate for the study. According to Bennett et al. (2017), the qualitative research finds the essence of the social event that gives the people to understand the reason underlying the people’s action. Thus, the quality paradigm is the right approach for addressing the research goal.
According to the CASP tool, the research design should be appropriate to address the aims of the research (wixstatic.com, 2017). MacLaren et al. (2016) had used a narrative approach to understand the experiences of supervision via the semi-structured interview process. The author had justified use of narrative review that it is the conceptualised method of making sense of social phenomenon. It helps to find experiences with socially constructed and institutionalised meanings. It aligns with the views of Buus et al. (2013). Thus, the research design is justified as the author adopted it from previous studies that may have established the validity of the research process. However, it would have been more convenient if the author had explained how it was decided which method to be used. This can be considered the weakness of the study.
The CASP tool evaluates the sampling method by identifying the appropriateness of the sampling method. The tools consider if the sampling method is explained and justified the participants recruited for the study. It further scrutinises if the inclusion and the exclusion criteria were mentioned (wixstatic.com, 2017).
The author has included only 8 community mental health nurses and is not justified. There was a small number of participants chosen for the study which may limit the themes on experiences analyses. It can be considered the weakness of the study. Out of these nurses, 7 were female, and 1 was male (MacLaren et al., 2016). The study gives no details on the mode of sample selection, which can be considered the major drawback (LoBiondo-Wood & Haber, 2017). The inclusion criteria were mentioned by the author. In the study, the sample was recruited from a single geographical region of the UK and was working since 10 years. The research excluded the newly qualified nurses. The exclusion criteria were justified as the new nurses cannot give an account of their experiences. There was no justification on the inclusion criteria. There was no discussion on any participants if chose to opt out of the research. However, it can be concluded that the sample selected were appropriate to give access to the type of knowledge sought by the study.
As given in the CASP checklist, the data collected must address the research issue. The qualitative article must justify the setting for the data collection, an instrument used, and explicit details of the instrument given. Further, the qualitative study should give an insight to the readers on any modification of the research design with the justification. Further, there must be clear evidence in the form of data that is being collected, for instance, tape recordings and video materials (wixstatic.com, 2017).
MacLaren et al. (2016) had stated that the setting for the data collection that is workplace or the university building. However, the paper had not provided any justification on the rationale for the setting. Moreover, the drawback of the study comes from the precise location of the study being concealed that may hamper the data collection making the results unreliable. The instrument used for data collection is the semi-structured interview of one to one basis. Each interview lasted for 60-90 minute and involved the use of the loosely structured topic guide. It can be interpreted that the data collected will address the research issue, as interviews will produce rich and detailed narratives on the experiences of supervision of the participants (Holmes, 2014). However, the data collection process was not made explicit by the author, which adds to the weakness of the study.
MacLaren et al. (2016) gave no insights into the modification of the research process. It appears that there was no modification required. The researchers had not clearly highlighted the type of data collected except it was mentioned that that data was arranged in the prosodic style that gives perspectives of the participants via tone of speech, rate and rhythm of speech. It is still not clear if tape recording or videos were used for data collection. The researcher has not discussed the saturation of data. This may hamper research reliability.
As per the requirements of the CASP tool, there must be sufficient details on the informed consent of the researcher during sample recruitment to know if the ethical standards were maintained. Details of the ethical approval and the ethical issues of confidentiality and privacy must be highlighted by the qualitative article. The researcher should provide details on how the harm caused to the participants were handled (wixstatic.com, 2017).
MacLaren et al. (2016) had clearly stated that the ethics approval was obtained from the authorised “institutional Research Ethics Committee”. It indicates the ethical issues were considered in the research process (Nadelson & Nadelson, 2014). There is no explanation given by the researcher on how the participants were informed about the study, which is the drawback of the study. The author has gained written informed consent from all the participants. It is slightly difficult to assess if the ethical standards were maintained. The author had stated that the research considered the voluntary participation of the subjects and maintained confidentiality in the team. The arrangement of private rooms is good to maintain confidentiality, yet it is challenging as due to narrative research, which relies on context-dependent details. The author of the study had provided no details if there was any negative impact on the participants after the study or how this was handled.
The data analysis must be rigorous with an in-depth description of the analysis process. There must be details on the themes or thematic analysis. There must be sufficient data to support the findings while explaining the potential bias (wixstatic.com, 2017).
The author had explicitly discussed the data analysis process in three stages using thematic analysis. However, thematic analysis was not mentioned anywhere. The first stage deals with the narrative section of discourse and its transcription from the interviews using the method already adopted by another researcher in previous studies. Presenting the further details on the instrument would have been considered the strength of the study as it determines the validity of the data (Andersson et al., 2016). It is the strength of the study to present the data in prosodic style. It closely reflects the speech. It helps draws the readers attention to perspectives of the participants via tone of speech, rate and rhythm of speech (MacLaren et al., 2016). In stage 2, the author elucidated how the topics were interview narratives were compared between the participants. The data interpreted was carried in a nuanced manner by collecting the long, unfragmented data extracts. It will help preserve the details of context and gives share discourses around supervision to emerge from the data (Barker & Linsley, 2016). Thus, the structured interpretations helped in illuminating the feeling rules present in the data. This constitutes the strength of the study.
In stage three, the data was analysed by categorising into the type of the feeling rules expressed during the data collection. Though not mentioned triangulation process was used (Barker & Linsley, 2016). It is the process of analysing the narrative data from different perspectives. This constitutes the strength of the study as it helped in the identification of discourses scripting these emotional processes. Overall, it helped in obtaining the co-constructed narratives of personal experience. The author had provided sufficient data that supports the findings of the research. There is no hint of considering contradictory data in the paper except that the author except the contrast between feelings rules in supervision and the organizational context. It indicates the need for further study. There is no hint in regards to bias towards gender in the sampling process. However, it is considered appropriate, as it was not possible for the study to analyse the influence of gender (Kallio et al., 2016).
MacLaren et al., (2016) did not critically examine the personal role and influence in selection of data for presentation or analysis. It appreciates to find in the “Author’s contribution” section that the all the authors agreed together on the final version of research design. It was mentioned that the authors ensured meeting one of the criteria from “ICMJE”. There was the substantial contribution made by all the authors of the qualitative study in designing, data acquisition, and analysis and defining of the article but there is no hint who conducted the interview.
The qualitative article must clearly present the findings with the clear statement. For this section, the critique tool considers the explicit nature of the findings and the arguments presented by the author regarding validity and reliability. The qualitative article as per the CASP tool needs to relate the findings with the research question (wixstatic.com, 2017).
The abstract of the qualitative article clearly elucidated the research findings with reasoning. MacLaren et al. (2016) presented the clear statement of the findings. The author stated that three feelings rules were identified with which effective supervision was associated. It includes “safety and reflexivity; staying professional; managing feelings”. The author has made the findings explicit. For this study, the author had used the interpretive validity, and the data was understood from both socio-linguistic and topic-centred perspectives.
There is a discussion of the evidence for the researcher’s arguments. There is no evidence against the researcher’s arguments that may be a drawback. However, the findings were related to the research aim or question with the flawless discussion. It was clearly stated that through supervision, a positive influence on the management of emotions by nurses is possible. It will help in reducing burnout. According to wixstatic.com, (2017), the qualitative research must identify the new areas o research, which was not given in the paper. There were no highlights on how the results can be transferred to other populations.
Conclusion
In conclusion, there is a positive implication of findings for nursing practice due to meaningful results. Overall, the research is valuable as it adds more knowledge to the existing literature. With the help of the feeling rules, it is easy to connect individual emotional experiences in the real nursing practice. The study finding supports how supervision helps. Hence, in real practice, the educators can help nurses develop emotion culture of their supervision practice. It will thus promote the well-being of the practitioners. Future studies can replicate by modifying the limitations mentioned by the author.
References
Andersson, E., Salickiene, Z., & Rosengren, K. (2016). To be involved—A qualitative study of nurses’ experiences of caring for dying patients. Nurse education today, 38, 144-149.
Barker, J., & Linsley, P. (2016). Critical Appraisal and Qualitative Research. Evidence-based Practice for Nurses and Healthcare Professionals, 110.
Bennett, S., Abell, B., Bennett, J., Bogossian, F., Ee, C., Jennings, P., … & Williams, C. (2017). Understanding Evidence from Qualitative Research: Examples of Assessment of Quality (Critical Appraisal) from Different Health Professions. In Evidence-Based Practice Across the Health Professions, 3rd Edition (pp. 248-291). Elsevier Australia.
Buus, N., Cassedy, P., & Gonge, H. (2013). Developing a manual for strengthening mental health nurses’ clinical supervision. Issues in mental health nursing, 34(5), 344-349.
Holmes, J. (2014). Countertransference in qualitative research: a critical appraisal. Qualitative Research, 14(2), 166-183.
Kallio, H., Pietilä, A. M., Johnson, M., & Kangasniemi, M. (2016). Systematic methodological review: developing a framework for a qualitative semi?structured interview guide. Journal of advanced nursing, 72(12), 2954-2965.
LoBiondo-Wood, G., & Haber, J. (2017). Nursing Research-E-Book: Methods and Critical Appraisal for Evidence-Based Practice. Elsevier Health Sciences.
MacLaren, J., Stenhouse, R., & Ritchie, D. (2016). Mental health nurses’ experiences of managing work?related emotions through supervision. Journal of advanced nursing, 72(10), 2423-2434.
Nadelson, S., & Nadelson, L. S. (2014). Evidence?Based Practice Article Reviews Using CASP Tools: A Method for Teaching EBP. Worldviews on Evidence?Based Nursing, 11(5), 344-346.
Schneider, Z., & Whitehead, D. (2013). Nursing and midwifery research: methods and appraisal for evidence-based practice. Elsevier Australia.
wixstatic.com. (2017). Critical appraisal skills program (CASP). https://docs.wixstatic.com. Retrieved 8 October 2017, from https://docs.wixstatic.com/ugd/dded87_25658615020e427da194a325e7773d42.pdf
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