A critical appraisal of LevettJones, T., Lathlean, J., Higgins, I. and MCMillan, M. (2009) Staff Student Relationships and their Impact on Nursing Students Belongingness and Learning.
Nursing is an evidence based profession and conducting research is vital as it gives up-to-date information which is fundamental for nursing (Polit and Beck, 2010), as research is crucial in supplying evidence on the strengths and limitations of clinical interventions. The Nursing and Midwifery Council (2008) state that as a professional practitioner you must deliver care based on the best available evidence. This enables the practice to be improved by research into various fields of nursing, which will guarantee that whatever duty is being embarked, it is in the best interests of the patient (Aveyard and Sharp, 2009).
This critical analysis has been influenced by work of Ryan et al (2007), which has facilitated a clear and structured understanding of the approach to critically appraising and evaluating the Levitt-Jones et al Journalistic article of 2009. The article is of particular relevance, as a student nurse the report title, Staff-student relationship and their impact on nursing students’ belongingness and learning is prevalent to the current professional position of the reader.
Qualitative research is essentially an assortment of various approaches that have commonalities (Parahoo, 2006). Qualitative research is of particular interest within nursing care concepts as issues that are directly relevant cannot adequately be addressed by quantitative research methods; qualitative methods provide an in-depth understanding of peoples thinking and behaviour as opposed to statistical data (Shields and Twycross, 2003).
The background of the Author’s must be considered as this will assist in identifying the level of knowledge and qualifications in the study area and indicates the credibility of the authors and findings. (Ryan et al, 2007). There was one primary author/researcher and three additional researchers. Three are educated to PhD level and the other MA level. The primary author has completed various research studies and had additional work published. However, it is significant to remember that a research study should be appraised on its own qualities and not be presumed to be valid and reliable purely based on the authors credentials (Ryan et al, 2007).
The article being evaluated was published in the Journal of Advanced Nursing. It has an impact factor of 1.527 and an ISI Journal Citation Reports Ranking of 14/101. This increases the credibility of the research as published articles are ‘double blind’ peer reviewed to prevent bias while improving the standard of published material. (Royal College of Nursing 2013). Furthermore, it should not be assumed that because a report is published in a credible journal it is reliable and valid (Ryan et al). For example, Dr Wakefield published unreliable information about the correlation with autism and the MMR injection. Dr Wakefield’s report was published in a world leading medical journal called lancet, which as a high impact factor of 38.28.
The title of the article is of an appropriate length and is clear in its description. It should contain between 10-15 words and of which avoids loss of meaning (Polit and Beck, 2010). The title indicates that this is a qualitative paper although this is only mentioned within the introduction on the second page. A title which presents as informative remains important when evaluating the quality of a piece of work, (Parahoo, 2006).
The abstract should give a brief summary of the study, highlighting the aim, background, methodology, findings and conclusions and should consist of between 100-200 words (Polit and Beck, 2010). The abstract outlines both the title and in addition the aim of the paper. The aim gives further insight as to the purpose of the study. The abstract further outlines the research issue/problem and how positive and negative experiences can impact as well as influence working practice, future choices and decisions. It is at this point the reader will make an informed decision whether to continue reading the entire article based on the relevance of the article to them, (Parahoo, 2006).
In order to assist a review it is important that the researcher both outlines, then justifies the research design approach that they have chosen in order to provide a basis for overall sense and coherence as well as the way it corresponds with the research question. The methodology is clearly detailed within the abstract and the sample/population outlined as 18 final year nursing students both male and female across an age range of 20-47 years in 2006. It goes on to further indicate the sample has been taken from two Australian and one United Kingdom University. The data collection is also outlined as in-depth semi-structured interviews with data being analysed thematically.
Findings are detailed within the abstract. These are a broad representation of findings which indicate a broad continuum of views and influences on students’ feelings and learning experiences. Similarities of these feelings and experiences were also noted regardless of geographical area and differing education systems. The abstract concludes with the notion that staff-student relationships are key to students feeling they belong and this is essential to an effective and positive clinical learning experience.
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Keywords used within the paper are also identified and this assists with the comprehension of the paper.
There are many elements that will influence the robust nature of the study, that is, the ability of the study to overcome intellectual challenges of adversity. This is necessary as the study presents as abstract in nature, as the experiences of those interviewed may be interpreted differently by another person or in fact by the same person in differing circumstances. Within qualitative research such abstract experiences are identified as phenomena (Polit and Beck, 2006).
Within the introduction there should be adequate information to set the scene, clearly identify the phenomenon of interest and highlight the need for research. The purpose of the study should be explained and the desired outcomes identified at this stage, why the study will be of significance and how it will add to the general body of information (Connell -Meehan, 1999). It is at this point the qualitative approach to the research should be justified (Connell- Meehan, 1999). This is the case within the introduction of this study and is supported with the use of academic referencing.
The report continues by giving background information, it is rare that a qualitative study uses a literature review to underpin the research or study (Ryan, et al, 2007) as this may mislead findings within the research. The purpose is explained by way of association to previous theory prior to linking to the actual purpose; the relevance of the need for belonging within the nursing environment is then explained. The report acknowledges that a need to belong provides a positive clinical experience but goes further to indicate that few researchers have addressed the deeper issue of the association between belonging and learning and the factors that affect the feeling of belonging during clinical placement. This is supported by Nolan’s (1998) theory that the need of a student to be accepted and fit in during their clinical placement was an introduction to their learning in placement as well as their active participation. Further research and theory assists in indicating that the identified issues highlight the need for research. Polit & Hungler (2008), outline that the use of relevant primary theory should be made in order that central themes within the research are highlighted. On the contrary, while quite recent theory has been identified to outline the purpose and need for the study, previous theory does not indicate the size of the samples that were used.
Many studies of a qualitative nature have been described as inductive or atheoretical, that is, it serves to produce, lead or influence theory as opposed to testing it (Ryan et al, 2007). This is known as grounded theory and the description in this section would indicate that this was the framework used within this research as it states that the researchers have reached data saturation, a term commonly used for grounded theory (Polit and Beck, 2010). Phenomenology is also classified as theory generating and indications within this report would suggest that this was also used, as phenomenology is about the lived experience in relation to what is being studied (Balls, 2009). It is vital that the researcher not only indicates but also justifies the choice of framework, this was not evident within the design section of the report but only suggested as it was detailed that a purposive sample of third year undergraduate nursing students was used and again in the data analysis section where the use of the grounded theory was outlined.
The aim of the research is then identified and the qualitative nature of the study is indicated. This is followed by an outline of the design/methodology of the research; the sampling method and the sampling size are clearly detailed as well as the rationale for choosing the same. It was identified that eighteen students through three educational establishments informed the study and it can be agreed that these participants were suitable to inform the study due to the fact they were third year nursing students whom at this stage would have participated in a series of clinical placements and gained the necessary experience to inform the research, it could be said that this is a small sample size but when considering sample size for qualitative research. Polit and Beck, (2010) have stated that qualitative research does not require to have a large sample size but one where data saturation is reached. When conducting a piece of qualitative research those chosen to participate are as a result of their experience or exposure to the phenomenon outlined. This type of sampling is known as purposive sampling and normally ensures richness in data or information gathered (Fossey et al, 2002). Qualitative samples tend to be small and this is evident within this research also.
Fossey et al, 2002 indicate that this is not normally problematic as it is not the purpose of the researcher to make generalisations with the findings. As in this case, there was previous research, however, this additional study had the purpose of building on the information outlined within the previous studies in order to offer more depth to the phenomenon by use of the accumulation of data. It must be noted that there is a possibility that no new material will emerge (Parahoo, 2006). This was not the case with this research as new emerging detail and what the paper adds to the existing knowledge on the subject is clearly outlined within the findings.
The means by which the data was collected was identified. The strategies were clearly described within this section as in-depth semi structured interviews. This area of the report indicated that these interviews were conducted by the primary researcher Tracey Levitt- Jones, this can only add to the credibility of the research due to the experience, knowledge and background of the researcher (Parahoo, 2006). The length of each individual interview was detailed as 50-60 minutes and each was recorded before being transcribed verbatim. The use of open ended questions facilitated the participants in describing their experience of clinical placement and prompts were used when necessary to clarify or explore more deeply the thoughts, feelings and perspectives of each participant. Semi-structured interviews allowed for a fixed set of questions but with no fixed responses (Burns and Grove, 2011). There was no rationale for using this method indicated within the paper and limited information regarding the process was detailed. As suggested by Holloway and Wheeler, (2010) evidence of how themes and questions were derived should be available, this was not the case. An example of the open ended questions was noted.
As with any research studies, interviews in qualitative research can lead to ethical dilemmas (Houghton et al, 2010). Throughout this research and study ethical considerations were addressed and the study was also approved by the ethics committee at each university. The issues of confidentiality between the two countries were treated in a similar way due to the cultural similarities that exist between the two. In any study those participating should always be afforded the right to give their informed consent regarding their participation (RCN, 2009). The participants were recruited on a voluntary basis via the medium of university websites and the voluntary nature was explained to the participants, therefore those taking part knew the purpose of the study and were conversant in the type of information the study wished to glean, how this information would be used and what the implications may be for them as contributors to the study. The participants were advised they could withdraw at any time, the process was anonymous and pseudonyms were used. Parahoo (2006) outlines that anyone completing a study or research must give assurance to those participating that their identity will not be compromised to the reader and also that any data collected will not be given to a third party. At times during interviews those participating may open up and discuss personal experiences of the phenomenon (Houghton et al, 2010). This may reveal emotions or revisit uncomfortable or distressing experiences, therefore, post interview counselling was provided but none of those participating within the study availed of this.
When conducting a qualitative study many strategies can be used to collect the necessary data. In this study in-depth, semi-structured interviews were conducted, as previously mentioned. Holloway and Wheeler, (2010) indicate that interviews are the most common method of collection. This process was completed at each of the participating universities. Within this section examples of the questions that were asked were indicated, the researcher did not however give any rationale for the chosen method of collection. These interviews were conducted face to face by the primary researcher as is most common practice.
When analysing the data collected for a qualitative research study we must be careful to consider the process by which this is done as this is crucial to determining how credible the study is. This is the process where raw data is analysed and becomes the final description or is divided into themes or categories (Thorne, 2009). In this study the data analysis began soon after the commencement of the data collection. The purpose was to facilitate the clarification of the issues arising and allow categories and themes to develop. The researcher allowed for concurrent data collection and analysis while at the same time organising and retrieving data. A constant comparison was used; a style that was similar to the grounded theory approach and this facilitated the findings from each interview in informing subsequent data collection and thus allowing a more in-depth exploration of the issues outlined (Holloway & Wheeler, 2010).
Rigour is also known as the trustworthiness of a research study, one where the results cannot be experimentally examined (Ryan et al, 2007). In this study the trustworthiness was determined by considering the credibility, dependability and transferability of the study. This was ensured by the historical authenticity of the researchers, maintenance of a journal which recorded reflections, any questions or perplexities and understandings of the participants. Credibility was also ensured by the use of member checking; each participant was given a copy of the transcript of their interview and the facility to review and revise it, although no participant chose to do so. Dependability and truthfulness of the data is a necessity in order to avoid researcher bias. In this study this was enhanced by the verification of emerging themes and categories by two independent researchers. In order to meet the transferability criteria the findings of a study must be relevant and fit contexts which are external to the current situation (Ryan et al, 2007). Transferability was addressed by providing descriptions of the contexts regarding the student participants at each site.
Findings and discussion
Within a qualitative study findings are presented as a narrative, that is, an account of the events and the experiences that were researched. The researcher should discuss the findings with reference to what is already known (Ingham-Broomfield, 2008). This study presented findings with clarity by using titles and sub-headings, these represented the different themes that emerged from the study and were appropriate to the title and purpose of the study throughout. This may make the article easier to read as it allows the reader to focus on a specific area (Burns and Groves, 2011). The author discussed each of the emerging themes thoroughly, however these findings were only supported with relevant literature within the discussion section albeit thoroughly. The researcher should always relate the findings of the study to the original purpose of the research and thus determine whether the question has been adequately addressed (Ryan et al, 2007). This study deals with this area in an excellent way. A bordered section which differentiates this area from the main body of the narrative also contains separate sub headings. These include; what is already known about this topic, what this paper adds and Implications for practice and/or policy. Polit and Hungler, (2008) state that based on the identification of themes and categories it is therefore relevant that the researcher outlines recommendations to improve future practice in this area. The findings within this study are presented in a consistent manner as of those of other studies. In addition the presentation of this study is very emotive; it uses names of the participants when detailing the findings. Regardless of the fact that the names used are pseudonyms this gave a very personal angle to the study and resulted in the reader being able to relate to the emerging themes and categories. Bluffs, (1997) outlines that the researcher should capture the emic experiences of the participants and ensure that the themes which are identified in addressing the title can be viewed as credible.
The report identifies that there were limitations the study faced and acknowledge it would have been more beneficial to include the opinions and thoughts of both clinical nursing staff and nurse educators as this would have provided a differing perspective on the question and afforded some answers to the reasons why the difficulties occur. The author also acknowledges that the sample size and opportunistic recruitment may limit the transferability of the findings.
Conclusions, Implications and Recommendations
The researcher should conclude their report by putting their findings in context while indicating how this new information is of interest and its implications for nursing (Russell and Gregory, 2003). The conclusion within this report is clear to outline that acceptance, inclusion and being valued are crucial to the development, progression, confidence and motivation of nurses and without this may have an impact on whether or not an individual remains in the profession. The conclusion outlines the implications the findings have on individuals who have an absolute interest in the clinical experiences of nursing students; those who support and teach students.
As required by any academic or peer reviewed written text and outlined by Polit and Beck (2010), an accurate list of all journals, books, reports and any other media that was referred to within the study was included in a reference list at the end of the journal article. This has provided a good additional source of further reading for those who are interested.
Critical analysis of qualitative studies are no different to that of quantitative studies in that it requires an in-depth review of how each step of the study has been undertaken. As a result of the subjective nature of this research it is acknowledged that it may be difficult to critique, especially if the subject is not of interest to the reader. This research is a credible and interesting piece of work, especially as the subject has relevance to the current course of study. While the author has indicated that there may be limitations in the transferability of the study, the report can still be considered as relevant additional information to the subject area.
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Victoria Bradley 40032172