Most research problems will be well developed if the researcher searched and read what has already been published about the problem (Thomas, Nelson and Silverman, 2010). This is because much research might have already been done which might be beneficial and of interest. Browsing in the library or electronically will confirm the existing information that can be used as source and referencing (Thomas, Nelson and Silverman, (2010). Literature reviews stimulate inductive reasoning and assist the researcher to locate and synthesize all relevant information on a chosen topic to develop a more general explanation or theory to explain certain phenomena. It is essential, therefore to balance materials that have both current and old obscure documents and be related to the topic area (Kirby, Greaves and Reid, 2006). However, the writer carried out a comprehensive review that addresses the topic, stating the recommended times and rationale as to why practice continued and criticism by other writers as to what times fasting pre-operatively should be carried out. With regard to the references, some of them related to the topic in question, most of the literature reviewed was not up-to-date; some were far back more than ten years. This could be that there was a gap in the research of the search topic and it’s related. The references of the article were from a secondary source such as books, articles and journals but do not have enough information on the topic because some of the references are not relevant the topic.
There was no hypothesis but aims, the aim intended for the research was clearly stated; to explore nurses attitude, opinions and knowledge about evidence-based practice, to generate new theories on why patients fast for long pre-operatively and strategies to achieve the best practice was stated through questions. Lee (2006) stated that “The intended aim of the research should therefore be stated and the questions the research seeks to address should be identified”. The aim of the article is neither too long nor short. According to Munhall (2011), the aim of what the researcher wants to address should be stated and explained as precisely as possible, not too long or too short.
Ethical issues were identified and addressed by sending a letter of consent informing the nurses about details of agreement to participate, how the interviews would be carried out, the goals of the study, information sheets giving details of the study, their help that was required, how it would be proceeded, how the information will be handled and ultimately reported. The researcher requested for ethical consent from the research committee at the hospital explaining how the research will be conducted and recorded with results reported confidentially. Ethical issues are not only to attain ethical consent for a study but must ensure that participants’ rights, anonymity and confidentiality are not breached but protected at every stage of research process (Lee, 2006). The research committee sent approval of ethical consent.
According to Kothari (2008) research methodology is the techniques and systematic way of conducting research scientifically and solves research problems, using various steps in the study to understand the assumption underlying the various techniques and to know the criteria by which certain techniques and procedures will be applicable to certain problems.
With research, the researcher has to specify clearly and precisely what methodology is selected, the reason for selection, so that it can be evaluated by him or herself or by others. It should state how the problem was defined, in what ways and why the hypothesis was formulated, what data was collected and what particular method was adopted, why particular technique of analysing data was used and a host of similar other questions are usually answered (Polit, Beck, 2006).
Methodology for the research was identified as qualitative research design using a grounded theory with the rationale to draw out and explore nurses’ attitudes surrounding the topic under review. It was justified that qualitative research methodology was used with the reason that concrete directions on how to develop an empirical –based theory could be obtained through interviews, analysing, observations, categorising findings and testing out theories in a systematic way, before finally arriving at the story (Holland and Ress 2010). According to LoBiondo-Wood and Haber (2006), grounded theory has to be used to attain the understanding of the experience gained by the person involved in the situation. Therefore, asking nurses about their experience of pre-operative fasting clearly shows the use of qualitative paradigm, as thoughts and feelings are being considered. Qualitative data can be collected so as to explore in-depth driving and restraining forces (Newell, and Burnard, 2006).
Data was collected through the use of semi-structured interviews that were conducted in main conference room in the surgical unit, all interviews were tape-recorded subsequent to each session, which allowed a spontaneous exchange of information using focused questions and notes were kept on the progression of the study (Jackson 2010). Furthermore, the interviews were transcribed and read several times for the familiarity of the contents under-study. The data collected were coded into main themes and sub-themes throughout the interview period. Similarities and differences between emerging categories were identified enabling the author to build up and break down categories into smaller units of meaning (Crowther and Lancaster 2008). It was transparent, because it was considered by interviewees as suitable and quiet environment to perform interviews; questions were clearly stated and were recorded so that if one wants to check, then the recording can be referred to.
Alternatively, the selection of participants was not described. Their age, gender, life style or status, but the sampling method was identified as stratified sampling, targeting staff nurses currently employed in five surgical units at the local hospital and purposeful sampling to select information sources, to explore meanings from the identification of appropriate participants who would best inform the study and to maximise representation of a range of perspectives on an issue with the aim of challenging the researcher's own views.
Major concepts were identified as follows: that a conceptual framework derived from the developing themes and their interaction was generated. The themes generated were incorporated to create an overall account of the experiences of the participants. The results presented were appropriate with the three primary categories coded as knowledge, practice and system encompassed a number of sub-categories. It stated the participants (nurses) knowledge about pre-operative fasting, the timings, hospital policies and procedures which have no clear consistency in the practice. It clearly stated that those nurses have poor knowledge about the awareness of current research findings on pre-operative fasting and the understanding of research articles language as most of their training consisted of practical assignments and competency at work.
In practice, the article stated clearly how power and authority is creating conflict about orders given that should not be questioned as well as rigid routines and rituals of nil by mouth from mid-night before surgery; systems as to theatre schedules with delayed or late admissions, stand by cases, disorganisation of operating rooms list, lack of communication and patient self-fasting (Timmins and McCabe, 2005)
The discussion was comprehensive as it reflected on nurses’ perception and attitudes toward pre-operative fasting times, the use of grounded theory to generate the three categories that described and explained nurses’ feelings and perceptions of their current practice. It highlighted ways that nurses can keep themselves updated with the latest evidence of pre-operative fasting times and barriers to attain the best practice in clinical settings (Parahoo, 2006). Having issues that are transferable, through grounded theory, identification and explanation of substance that forms the theories have been studied. However, care must be taken as the themes discussed cannot always be applied to the context of individual patients and nurses (Newell & Burnard, 2006).
Conclusion
In conclusion, pre-operative fasting times are said to be different in clinical settings and patients are given the same time to fast regardless of the time of the procedure. Having identified the perceptions and attitudes of nurses, positive findings and their expression about the ritualistic traditions of nil by mouth from mid-night, suggested that improvement should be made on the aspects of care with regards to changing practice and respect to autonomy in terms of decision making. Significant barriers within the organisation such as communication difficulties, lack of knowledge and skills, lack of education about the effects of long pre-operation fasting, all hospital policies needed to be addressed and updated for effective collaboration among healthcare professionals.
REFERENCES
Cargill, M. O’Connor, P (2011), Writing Scientific Research Articles: Strategy and Steps 2nd Ed, Wiley Blackwell, Oxford.
Crowther D. , Lancaster G. (2008), Research Methods, A Concise Introduction To Research in Management and Business Consultancy. 2nd Ed, Oxford, Elsevier.
Garrard, J. (2010), Health Science Literature Review Made Easy 3rd Ed Jones & Bartlett, London.
Glasman-Deal, H (2010) Science Research Writing for Non-Native Speakers of English Imperial College Press, London.
Jackson S.L (2010), Research Methods: A Modular Approach, 2nd Ed, Belmont, Wadworth/Cengage Learning.
Kirby, S.L, Greaves, L, Reid, C. (2006), Experience Research Social Change; Methods Beyond The Mainstream 2nd Ed, Broadview, Canada.
Kothari, C.R. (2008), Research Methodology, Methods and Techniques, 2nd Ed, Delhi, New Age International
Macnee, C. L., McCabe, S. (2008) Understanding Nursing Research; Using Research in Evidence-Based, Lippincott, Crawfordsville.
Newell, R. Burnard, P (2011) Research For Evidence-Based Practice in Healthcare 2nd Ed, Wiley-Blackwell, Oxford.
Thomas, J.R., Nelson, J.K, Silverman, S. (2010), Research Methods in Physical Activity , 6th Ed, Human Kinetics, Leeds.
Timmins F, McCabe C (2005) How to conduct an effective literature review.
Nursing Standard , 23rd November, Vol20 (11): 41–7
Polit D, Beck C (2006) Essentials of Nursing Research: Methods, Appraisal and
Utilization. 6th Ed. Lippincott Williams and Wilkins, Philadelphia
Parahoo K (2006) Nursing Research – principles, process and issues. 2nd Ed.
Palgrave, Houndsmill
Newell R, and Burnard, P. (2006) Research for Evidence-Based Practice. Blackwell
Publishing, Oxford
Hek G, Moule P (2006) Making Sense of Research: An Introduction for Health and
Social Care Practitioners. 3rd Ed Sage Publications, London
Coughlan M, Cronin P, Ryan F (2007) Step-by-step guide to critiquing
research. Part 1: quantitative research. Br J Nurs 16(11): 658–63
Ely C, Scott, I. (2007) Essential Study Skills for Nursing. Elsevier, Edinburgh
Beecroft C, Rees A, Booth A (2006) Finding the evidence. In: Gerrish K,
Lacey A, eds. The Research Process in Nursing. 5th Ed. Blackwell Publishing,
Philadephia
Burns N, Grove SK (2007) Understanding Nursing Research – Building an Evidence-
Based Practice. 4th Ed. Saunders Elsevier, St. Louis.
LoBiondo-Wood, G., & Haber, J. (2006). Nursing Research: Methods and Critical Appraisal for Evidence-Based Practice. St. Louis, Missouri: Mosby Elsevier.
Price B. (2009) Guidance on conducting a literature search and reviewing mixed literature. Nursing Standard. 23(24) p.43-49.
Lahlafi, A. (2007) Conducting a Literature Review: How to carry out bibliographic database search. British Journal of Cardiac Nursing. Vol 2 No 12.
White, L (2005) Foundations of Nursing 2nd Ed, Thomson Delmar Learning, USA.
Brooker, C. and Waugh, A. (2007) Foundations of Nursing Practice: Fundamentals of Holistic Care Mosby Elsevier, Philadelphia.
Alkemi R. (2012) Keyword Research for Search Engine Optimization.
Http//www.redalkemi.com/articles/keyword.research-article.php