This paper aims to provide a critical appraisal on the research article entitled “Quality nursing care in the words of nurses” authored by Linda Maas Burhans and Martha Raile Alligood. A critical appraisal is the manner in which a research study is carefully explored and examined in order to assess its validity, evaluate its level of reliability, and understand its relevance based on a particular research objective and context (Burls, 2009). It is important for evidence based research to be subjected to a systematic critical appraisal process in order to identify possible research partiality on the part of the authors which can significantly influence the overall objectivity and effectiveness of the research. This will assess the overall implementation and results of the research journal in order to identify if the study is able to prove that its results is reliable and there is significant reason to believe that these results make sense in applying to improving clinical health situations (Burls, 2009).
The article written by Burhans & Alligood (2009) highlights the primary research objective of exploring the meaning of quality nursing care among practicing nurses. The researchers leveraged Manen’s hermeneutic phenomenology as its primary research design on which twelve nurses where interviewed and asked the question “What is the lived meaning of quality nursing care for practicing nurses?” Results of the transcribed interviews were analyzed and searched for emerging themes relating to the overall responses of the participants. The results highlight that participants view the meaning of quality nursing with concepts that are synonym to the concept of care. This paper will carefully explore and examine of the results of the research study, including its validity and reliability, in order to understand its relevance towards improving the process of professional development among clinical nurses.
Brief Article Critique
Introduction
The study introduction highlights the rationale of the study where it identifies the gap among American nurses where there is limited understanding on what quality nursing really means. This gap identifies that current research are limited to measuring nursing quality based on patient responses and satisfaction. This study aims to reveal and explore the meaning of nursing quality based with focus on how this concept is viewed from the eyes from nursing professionals. The research article aims to address this gap in order to understand how nursing quality s viewed and understood from the point of view of nursing professionals. The articles argue that if this gap is not addressed, then it will impact the development practice among nursing professionals. If the analysis on the literature on the gap is accurate, then this research study will contribute towards adding more knowledge in understanding how nurses view quality care which can be significant in aligning with current nursing practice.
Background
The background of the study explores various literatures to identify common themes relating to the concept of the lived meaning of quality nursing care. The background mentioned several articles written by Coulon et al. (1996), Kunaviktikul et al. 2001, and Gunther and Alligood (2002) which highlights the characteristics and values that relates to care as the predominant meaning congruent to the meaning of quality care nursing. However, the background also highlights that these literatures support the knowledge gap where there is a limited understanding in the meaning of quality nursing care from the perspective of professional nurses. The review of the various literatures enabled the researchers to present the idea that the meaning of quality nursing care is derived from patient centric researches and as such creates a knowledge or literature gap on how the meaning of quality nursing care is perceived based on the perspective of actual nurses.
In this aspect, the background and review of literatures enabled the researchers to have strong justification to explore the concept in order to address the existing research gap and to further expand knowledge on the meaning of quality nursing care across various stakeholders which can be used to improve nursing practice development and patient care. Together with the aims of the study section, the research states and emphasizes the primary research question which is “What is the lived meaning of quality nursing care for practicing nurses in the USA?” (Burhans & Alligood, 2010). This connects how the research methodology is designed to answer the primary research question.
Methodology
The research methodology made use of a hermeneutic phenomenological approach which is used to explore and gather experiential narrative that can be used to analyze a specific social or human phenomenon. This type of research can be used to explore a specific research topic based on using an interview process to have deeper understanding (Kafle, 2011). The research article did not specify the limitations in using a hermeneutic phenomenological approach research design which can be compared to the limits of implementing a qualitative research approach. In this aspect, having to implement a qualitative based research highlights the limitation of too much focus on a significant small number of clinical participants and the lack of verifiable result which limits the ability of academicians and scholars to support the research findings to represent a specific research population (Choy, 2014). The research design can provide quality insights on the nature of the topic through participant experience but it cannot be representative of a specific nursing population because of the limitations of a qualitative based research approach. Furthermore, the limitation of hermeneutic phenomenological approach highlights its focus on exploring a topic based on subjective knowledge that is rooted on specific participant experiences (Kafle, 2011). This limits the ability of the research to have an objective assessment of clinical participants which can open up results to a variety of interpretation.
Participants
The research made use of hospital employed registered nurses with having a specific year of experience in providing hands-on and bedside clinical patient care in the south-eastern USA. Final sample size was pegged at twelve participants. This highlights that the small sample size cannot be used to generalize the results of the research study (Vance et al, 2013; Mayring, 2007). All participants were female with only 1 African-American and the rest were all white nurses. This is a specific weakness of the research study as failure to diversify participant population impedes the development of racial based variation and ideas relevant to the growth of clinical care practice (Tilley et al 2012). In this aspect, the minimal diversity of participants impacts the ability of the research to deeply explore the topic based on various racial based responses that can affect diversity of the results.
Data collection, data analysis, and ethical considerations
Data collection implemented an interview process conducted through a 40 minute tape recorded session per participant. The interview asked open ended questions on the participants with the central idea on how they perceive quality care nursing. Confidentiality rules were observed with participants given informed consents prior to their participation. In the area of data analysis, interview data were processed through using van Manen’s qualitative hermeneutic phenomenological research approach. On a high level this identifies the common and emerging concepts or themes based on the interview transcripts. The analysis also tried to explore commonalities to derive holistic elements that are present across participant responses on the interviews. Through identifying these shared and common themes on participant responses, the researchers were able to identify the significant concepts that were used to derive the meaning of lived meaning of quality nursing care among participants. In this aspect, the strengths of the data analysis focuses on identifying common themes imbedded on participant responses.
Trustworthiness of research responses was also maintained through the use of referenceable audio recordings to ensure data accuracy (Burhans & Alligood, 2010). This provides a significant process that organizes interview results that is relevant towards highlighting common responses that can be used to answer the interview questions. In a way, this describes the common responses of a particular group to summarize their communal understanding and experience on the specified topic. The weaknesses on this type of analysis highlight the lack of objectivity in interpreting the meaning of these common themes or concepts identified through participant responses. In addition, the research was not able to discuss their ability to facilitate the interview process which is a specialized process in which researchers need to ensure their facilitation skills are able to support the interview process. Similar to a qualitative research approach there is a skill requirement for interviewers (Choy, 2014). This can impact the quality of data collected from the participants if not properly addressed.
Findings, Discussion, and Study limitation
Findings resulted to discovering six essential themes which highlight commonality on concepts connected with advocacy, caring, empathy, and respect. Meanings were interpreted based on the audio transcript context in which the participants referred to the concept. Participant responses reflect their experiences related to the manner of care delivery and also show limited association with concepts relating to skills needed in nursing delivery. The results of the study highlight a start-up knowledge that provides an insight on the meaning of quality nursing care by practicing nurses. This signify that common meaning among participants reflects that the six essential themes of responsibility, caring, intentionality, empathy, respect, and advocacy reflect the quality of nursing care as experienced by the participants (Burhans & Alligood, 2010).
In addition, the study also stated that similar to qualitative research designs, the results and findings of the study are limited to the experiences of the participants that were interviewed. These highlight the weaknesses of the study to relate the results to a specific clinical population. These also limit the use of the study as a start-up knowledge in exploring the topic of how nurses perceive the meaning of quality nursing care. The limitation also extends to the lack of diversity among selected participants as it does not include a male nurse contributor in the interviews conducted. This yields a significant weakness of the study in terms of its reliability and generalizability.
Conclusion
Analyzing the research study written by Burnhans & Alligood (2010) highlights that the study can only be used as a start-up knowledge to explore how nurse practitioners perceive the meaning of quality nursing care. Limitations on the use of hermeneutic phenomenological approach reflect the same partiality of using a qualitative research design. In this aspect, the findings of the study only reflect the experiences of the selected participants and cannot be used to connect its findings to a specific clinical population.
References:
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