A Critical Appraisal of a Published Piece of Research Related to Practice. Patient Dignity in an Acute Hospital Setting, by Dr. Lesley Baillie (2008)

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 A Critical Appraisal of a Published Piece of Research Related to Practice

For this assignment the author has been asked to critically appraise a published piece of research related to practice. For the purposes of this work, a case study entitled “Patient Dignity in an Acute Hospital Setting,” by Dr. Lesley Baillie (2008) has been used. In justifying Baillie’s credibility as an author and as an experienced researcher, the author established she is a reader in healthcare at the University of Bedfordshire for the Institute for Health Research and she has been a trained acute nurse for the past 32 years.  She is an author in her own right and has contributed to a number of other publications. Baillie completed her PhD on Patient Dignity in 2007.  Between 2007–2009 Dr.Baillie was a consultant to the Royal College of Nursing’s ‘Dignity at the Heart of Everything we do’ campaign (Johnson, 2011).

In order to maintain some structure to the essay, the author chose to use the “Critical Appraisal Skills Programme” (CASP). CASP is an assessment tool that has been developed for those unfamiliar with qualitative research (PHRU, 2006). The programme aims to develop skills and make sense of research evidence, which in turn enables us as professionals to put knowledge into practice. The aim of a critical appraisal is to extract the following information; is it of any interest? Why and how was it done? What has it found? What were the implications and what else was of interest? (Crombie,1996). Critical appraisal is the process of assessing and interpreting evidence by systematically considering validity, results and relevance (www.evidence-based-medicine.co.uk, 2010).

The author Baillie (2008) sets out in the abstract her objectives for the case study. There are very clear and precise aims to the study which all relate to patient dignity i.e. what dignity means to patient’s, the threats and how patient dignity can be promoted in an acute hospital environment. The relevance of this case study was to investigate how a patient’s dignity is affected by situations that they are not in complete control of, which can ultimately result in how the patient’s outcome is determined.

Following the (DoH, 2010)) Essence of Care report and the National Service Framework (NSF) for Older People report (DoH, 2001b) which emphasised that older people’s dignity should be respected, it became an important issue within the National Health Service (NHS) for the subject to be researched. It is only from research that we can obtain information and knowledge in order to provide an understanding of nursing practice, its affects on patients and their carers and the use of resources (Parahoo, 2006).

Dignity is a very subjective issue and for this reason qualitative research as opposed to quantitative research was the appropriate method of study for this case study. Qualitative research is a method used for the understanding and motivations of the research subjects and is often associated with the search for reasons rather than causes (Porter, as cited in Cormack, 2000).

Parahoo (2006) states that qualitative research is an umbrella that covers varied approaches, which subscribe to the notion that phenomena can realistically be understood by studying the meaning that people give to them and the context in which they happen.

With qualitative research there is no definitive answer to the subject being examined. Every person’s interpretation will be distinctive to that particular phenomenon, in this case dignity. Therefore every researchers interpretation of the answers will be unique. Unlike quantitative research it is difficult to establish validity and reliability. The absence of similar conditions and unstructured interviews in dynamic encounters between an active interpreting subject and an active interpreting researcher will always result in diverse outcomes (Carter, Porter as cited in Cormack 2000).

In respect of this study, Baillie’s (2008) choice of qualitative research was the appropriate method to embrace, as Creswell’s (1998) definition of qualitative research states

“Qualitative research is an inquiry process of understanding based on distinct methodological traditions of inquiry that explore a social or human problem. The researcher builds a complex holistic picture, analyses words, reports detailed views of informants and conducts the study in a natural setting.”

Baillie’s (2008) research design was a qualitative, triangulated single case study. This was an appropriate method of research as it incorporated interviews with patients and health care professionals and their personal interpretation of dignity both on the ward and in the home following discharge, Baillie (2008) also conducted participant observations with patients and nurses in the acute hospital setting. Parahoo (2006) points out that in qualitative studies researchers should actively seek diversity and ‘negative’ cases in order to present phenomena in all their different facets and from different perspectives. This in turn creates more questions, which can be further investigated because of the flexible nature of qualitative enquiry (Parahoo, 2006). There are a number of advantages and disadvantages to participant observations depending on whether these observations are covert or overt. In Baillie’s (2008) case study all observations were overt. The benefits of this method are that all participants are aware of the reason for the research and have given their consent to the research taking place. It also allows the researcher to ‘observe’ the participants in the natural setting. A problem with overt observation is the effect on behaviour of the participants due to the presence of the researcher; For example, they may give an answer that they feel the researcher wants to hear, rather than the answer they want to give (Britten, 2006).

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The recruitment strategy for this case study was appropriate to the aims of the research. All participants were volunteers, although purposely selected, as they were either an inpatient on the surgical ward aged between thirty-four and ninety-two, fifteen men and nine women all from diverse socio-economic backgrounds, or a healthcare professional working on the ward or within the hospital. By purposely selecting the participants, Baillie was able to gain the most wide-ranging actions and answers to her semi-structured questions. This enabled her at a later stage to analyse her research more objectively when producing her findings for the research.

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