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Nursing is a science besieged by increasing challenges and complexity. As a career that deals with human beings, it requires utmost care and consideration of details, as lives may be at stake. Nurses need to be critical in their decision-making skills.
This essay critically reviews two studies -one qualitative and one quantitative study. A critical review analyzes each part of the study objectively, highlighting both its strengths and weaknesses, to see if the study has integrity. Such exercise in critical thinking significantly benefits not only the readers but the one doing the critique himself because it pays attention to the details which may have been carefully or carelessly dealt with by the researchers of the study. It sharpens analytical and decision-making skills. Not because it has been published and is a peer-reviewed article does it already mean it is worth following in practical life.
The qualitative study to be reviewed is “Informal carers’ experience of caring for stroke survivors” which discusses the change in lifestyle of carers of stroke survivors, and the quantitative study to be reviewed is “Effects of acupressure on dysmenorrhea and skin temperature changes in college students: A non-randomized controlled trial”, which tests out the effectivity of alternative therapy for relieving painful effects of menstruation in women. These two studies will be analyzed part by part from their title to their conclusion. It will be scanned for the integrity of its data and how faithful it stays with appropriate research methodology to gain its seal of approval.
The essay will have the headings of each part of the study to be critically reviewed namely its title, authors and the journal it was published by, its abstract, its introductionliterature reviewbackground, the research design/methodology/methods used, the study’s rigor and validity and reliability, the ethical issues involved, its findings, its discussions, conclusions, implications, limitations and recommendations, and finally an overall conclusion based on findings from the critical review and a discussion of implications in evidence-based practice.
Qualitative Study: By Lorraine N. Smith, Maggie Lawrence, Susan M. Kerr, Peter Langhorne, Kennedy R. Lees 2004 Journal of Advanced Nursing 46 (3) 235-244
It is usual in nursing studies to have patients or the intervention as the object of investigation. However, one strong factor in facilitating the healing of illness is the carer of the patient before being admitted and after being discharged from the hospital. In this particular study, the experiences of carers of stroke survivors are showcased, and how their informal nursing tasks affect their own lives.
Title, Authors, and the Journal
The title of the article gives the readers outright what it is all about. It used simple, understandable words that help prepare the readers for what is to be discussed. However, the use of the word “informal” may be open to interpretation. Throughout the paper, it was referred to as someone who does not have nursing training, and all of a sudden was thrust to a nursing role for the patient. A more apt word may be ‘layman’ or ‘civilian’, or some other generic word to depict the true nature of the carer.
The authors’ names and major credentials were effective in gaining respect from the readers because of their impressive line-up. To have a team of master and doctoral researchers specializing in the nursing field is enough to lend credence to the article.
Coming from a well-respected journal, this peer-reviewed article impresses readers as having high scholastic merits, hence, it needs to come up too high expectations of being thoroughly researched with rigor.
Abstract
The abstract has headings for background, aims, study design, findings, and conclusion which offer the actual summary of the long article. This is not usually the case with abstracts, as most give a very short summary, with all of the above components narrated without its headings, so readers may get lost as to which of those said meant the background or the findings, etc.?
The abstract was worded in such a way that it provides enough information to give readers an overview, but likewise kept a lot of details that the readers need to unearth as they read the full article.
Introduction/literature review/background
The background introduction gave a general picture of stroke and its effect not only on the patient but also the carer. It sets the tone and solid foundation for the whole article. The sub-topics are detailed although succinct. It provided all the information necessary as if anticipating any possible question that may be raised by the reader. No stone was left unturned, and while laying all the cards on the table, it did not overload the reader with useless information. The inserts (e.g. the carer interview prompt questions) were appropriately placed just enough for the reader to have a clear picture of the study while it was being narrated.
Unlike most researches, this qualitative study did not have many reviews of literature, as it was admitted from the beginning that not much is available pointing out to the carer’s perspective. Most of the research came from the data gathered itself and presented in such a way that depicted how the true situation of the interviews went, as well as the realities shared by the carer-patient pairs.
Research design/methodology/methods
The qualitative research design has been successfully detailed from the criteria set for the needed participants of the study, the data collection methods, the data analysis, and the thorough presentation of findings. The study was very well-organized.
Bowen(2005), did an in-depth investigation in a small number of communities. Like in the current article, he used purposive sampling in the selection of his participants instead of random sampling used in most experimental studies. His selected participants underwent in-depth, open-ended interviews. Padgett (1998) advocates that since the emphasis in qualitative studies is on quality rather than quantity, the objective of sampling was not to maximize numbers but to become “saturated” with information on the topic.
The taped interviews of carers set one year after the stroke of the patient was an attempt to achieve objectivity. It was assumed that being distanced from the stressful event of the stroke by one year, the patient has achieved some sort of progress from the time of the stroke while the carer has gained more nursing skills and that both have settled into a more stable arrangement. The factor of high stress in both the patient and the carer during the time the stroke happened unto the first few months under close supervisory care may have been settled into a more accepted and comfortable level.
Putting together the data gathered and sorting them into categories was a tedious task. However, the researchers were able to find a way to make sense of all the responses gathered from the participants, in coming up with summaries of themes. Bowen’s (2005) analysis of interview transcripts identified patterns in the data using thematic codes. Patton (1980) explains “Inductive analysis means that the patterns, themes, and categories of analysis come from the data; they emerge out of the data rather than being imposed on them before data collection and analysis” (p. 306). Bowen’s analysis of data entailed studying the patterns that emerge, making logical associations with the interview questions, and reference to the review of the literature.
Study Rigour
Study rigor was ensured by having the interviews transcribed verbatim and checked for accuracy then entered into a QSR NUD*IST (Non-numerical Unstructured Data Indexing Searching and Theorizing). Data were coded compared and categorized for analysis. The article did not mention who would do this.
In this study, the patient-carer pairs may have their case study, because each pair may tell a different case story. Critics argue that with the nature of case studies, the small numbers are unable to establish reliability and generalizability of findings. This is compromised by the researcher’s intense exposure to the cases at hand (LIS 39 ID.1, 1997). This study used the same interviewer to conduct all interviews using a prompt schedule which has been developed and tested in a previous study.
This prompt schedule was also used to standardize all the interviews. However, the same interviewer for all the interviews stands to suffer from fatigue and response overload. It may be suggested that effective training of interviewers be done as well as people who will serve as judges who may also be trained to determine themes in the interview answers, so these themes may be compared and analyzed objectively. This will add to the rigor of the research as well as maintain objectivity.
Ethical issues
The study was ethically sound, obtaining the necessary approval from the Local Research Ethics Committee. All the participants were briefed well with information sheets and provided written informed consent. For their convenience, the interviews were held in the participants’ homes and audiotaped with their permission. They were ensured anonymity and confidentiality. Since the interviews were conducted in the presence of the patients, carers could corroborate with them on certain issues for validation. However, interviews may have yielded more personal data if there were separate individual interviews aside from the paired ones, to truly get to the core of issues harbored by the carers. They may be holding back some issues to avoid causing conflict with the patients.
Findings
The study’s findings were presented according to the themes derived from the data, in chronological order from the time of the stroke to the present, one year later. Winter (2000) argues that with qualitative research, there may be no hypothesis or standardized or accepted tests involved. In this case, it is to investigate carers’ experiences with their stroke patients. Butt (1992) defines qualitative validity simply as the congruence of research claims to reality.
“In the case of the human sciences, it is the congruence of our text of understanding with the lived reality of persons (Eisner & Peshkin, 1990 pp. 97-98). It is quite helpful to have included actual words of the participants quoted in the text. The validity of the findings depended on how well perceptions are represented – the feelings, thinking, the experience of persons, the breadth, depth, and interrelations of issues, concerns, and themes (Butt, 1992). All these seem to be in place in the presentation of findings for this particular study.
Discussions, conclusions, implications, limitations, and recommendations
The discussion of the article pertained to salient issues raised from the in-depth interviews and focused on the voice of carers. The tone in the first part of the discussion showed sympathy towards them. However, as it went on, it widened the readers’ horizons by opening doors to future possibilities. Implications to nursing practice as well as practical conclusions to enable carers in the future to smoothly flow. This is where the article took the findings into reality.
Conclusion based on findings from a critical review and discuss implications in evidence-based practice
This article may be voted as an ideal qualitative study in terms of its compliance to high-quality standards for good research. Straus and Corbin (1990) claim that qualitative methods can be used to better understand any phenomenon about which little is yet known. These methods can also be used to see things in a new light even if much is already known about them or to gain more in-depth information which may be challenging to communicate quantitatively.
Glesne (1999) states that qualitative researchers seek out a variety of perspectives; they do not reduce the multiple interpretations to a norm. She adds that in qualitative research, face-to-face interactions are the predominant distinctive feature and also the basis for its most common problem. Such problems she states include researchers’ involvement with the people they study and the accompanying challenges and opportunities that such closeness brings. Considering the possibly stressful issues raised in the interviews, and the high emotional content of such issues, it is but appropriate that good training be provided to the interviewers to unearth useful information. As an apt recommendation for both the carers and the patients, effective and nurturing care training before the patients are discharged is in order.
Quantitative Study: Effects of acupressure on dysmenorrhea and skin temperature changes in college students: A non-randomized controlled trial By: Eun-Mi Jun,_Soonbok Chang, Duck-Hee Kang, Sue Kim 2007 International Journal of Nursing Studies 44 973–981
Title, authors, and the journal
The title captures the readers right away because it makes use of catchwords that truly depict the study. It is assumed that the interested readership will be mostly women because it is about a topic they can relate to.
The authors’ names are Korean, and their qualifications are briefly stated, giving credibility to the paper.
The journal, being of high repute lends its good reputation to endorse this article as a peer-reviewed, scholarly work.
Abstract
The abstract provided all the necessary information about the study in outline form. Details of the study components were presented so readers need not ask any more questions, but rather, jump in and read the body of the research study.
Introduction, literature review, background
This part is abundant with information gleaned from research. It reported statistics and mentioned previously done studies on the topic. Concisely written, it did not spare details about the topic.
Research design/methodology/methods
The study took on a classic experimental design in which subjects were not aware of which treatment group they belonged to (the SP-6 treatment group or the control group provided with only a light touch). The study is meticulous in providing details on steps taken in the research design. Recruitment of subjects was a challenge to the researchers since they could not estimate the menstrual cycles of each woman at the university, so they had to be patient and lengthened the data-gathering stage. They also came up with a system to make it easier to group the subjects where the ones who volunteered on certain dates went to the treatment group and the rest of the volunteers belonged to the control group.
To avoid inter-rater error, there was only one researcher who conducted all the treatments. This researcher has thoroughly trained in the SP-6 acupressure method. Since each SP6 session lasted 20 minutes, there is a risk of researcher fatigue which may compound results.
Upon arriving at the lab, the subjects filled up a survey questionnaire. This instrument was adapted from another questionnaire and translated by one of the authors into Korean. Although that may be another risk in terms of subject understanding, the translation had high internal consistency.
Remarkably, all the variables needed in the study were made quantitatively measurable. The questionnaire was 5-pt. scale and even the severity of dysmenorrhea were provided a way to be quantified.
The tables which presented the quantitative results may look overwhelming to someone who is not adept at statistics, however, it is easy to see trends there that can be analyzed.
Validity and reliability
The independent variables in this study were the SP-6 and the Light touch placebo treatment and the dependent variables were the severity of dysmenorrhea and skin temperature changes affected by the treatment. Heiman (2002) claimed that a variable should be a measurable aspect of behavior that may change, and it is this that produces the scores and data of a study. In this study, the many steps undertaken by the subjects may have produced some confounding variables. However, the researchers took all effort to ensure that the validity and reliability of the study is maintained.
Ethical issues
The complication of the topic may affect the sensibilities of the subject. They had to agree to some highly personal conditions such as refraining from the use of intrauterine devices and oral contraceptives for the duration of the study as well as the use of nonsteroidal anti-inflammatory drugs (NSAIDs) or other analgesics with prostaglandin synthetase-inhibiting activity the week before the expected onset of each menstrual period. The researchers did not in any way force them to participate, as seen in the turnout of the final number of participants. Of the 312 probable subjects invited to participate, a mere 58 complied with the inclusion criteria and agreed to participate. For these women, they would not have stuck to the study had they not been treated with the utmost respect.
Findings
Results of the study were carefully presented in tables and explained per variable. Its objectivity and integrity of findings were laid out, detailing the statistical procedures used. It showed evidence that SP6 works to relieve some pain from dysmenorrhea at least after two hours of treatment.
Discussions, conclusions, implications, limitations, and recommendations
This part was very reflective of the whole study process. It analyzed all points – its strengths and limitations and reported them as is. It was like wrapping up with the reader a journey they both took, and was evaluating the whole trip. The recommendations for further studies on the issue would be worth taking if evidence for the effectiveness of SP6 as an alternative pain alleviation treatment is to be promoted.
Conclusion
The conclusion, although short, completely embodied the integrity of the study. It needed no more numbers to interpret the simple conclusion of a complicated study. It only emphasized the significance of the study and the effectiveness of the treatment proposed.
Conclusion based on findings from a critical review and implications in evidence-based practice
This is another study that was tightly designed for validity and reliability. The details of each step make it possible for other researchers to replicate with their homework halfway done. The thoroughness of the researchers was exhibited in covering a vast ground of work and just leaving a few loopholes to be filled by future research.
In terms of content, it provides convincing evidence of the effectiveness of a welcome alternative therapy for pain, much needed by a growing population of women suffering from their monthly monsters.
References
Bowen, G.A. (2005) “Preparing a Qualitative Research-Based Dissertation: Lessons Learned”, The Qualitative Report Volume 10 Number. Web.
Butt, R. (1992) On Being Personal About the Collective. A paper presented at A.E.R.A., San Francisco.
Eisner, E.W. & Peshkin (Eds.) (1990) Qualitative Inquiry in Education. New York, N.Y.: Teachers College Press.
Glesne, C. (1999) Becoming Qualitative Researcher: An Introduction 2nd Ed. Longman, An imprint of Addison Wesley Longman, Inc.
Heiman, G.W. (2002), Research Methods in Psychology, Third Edition, Houghton Mifflin Co.
Jun, E., Chang, S., Kang, D. & Kim, S. (2007) Effects of acupressure on dysmenorrhea and skin temperature changes in college students: A non-randomized controlled trial. International Journal of Nursing Studies 44 973–981.
Padgett, D. K. (Ed.). (2004). The qualitative research experience. Belmont, CA: Wadsworth/Thomson Learning.
Patton, M. Q. (1980). Qualitative evaluation methods. Beverly Hills, CA: Sage.
Smith, L.N., Lawrence, M., Kerr, S.M., Langhorne, P., Lees, K. R. (2004) Informal carers’ experience of caring for stroke survivors. Journal of Advanced Nursing 46 (3) 235-244.
Strauss, A. & Corbin, J. (1990). Basics of qualitative research: Grounded theory procedures and techniques. London: Sage.
Winter, G. (2000) “A Comparative Discussion of the Notion of ‘Validity’ in Qualitative and Quantitative Research”, The Qualitative Report, Volume 4, Numbers 3 & 4. Web.
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