The key words used within the abstract were - communication, critical care, Jordan, nursing, phenomenology. It is vital that researchers choose appropriate keywords for their papers because they aid literature searching through databases (Webb 2005). The inclusion of key words is a helpful indication of the paper’s content. The keywords used were all relevant to the research report.
Background/literature review
Literature review
Literature review is considered to be critical in preparing the ground for new research (Cormack 2000). Walsh and Wigens (2003) identify three main reasons for performing a literature review - To clarify the research problem, this helps to focus the research idea more clearly. To help in the decisions regarding development of the methodology, this can give the researcher a good idea of how the area can be investigated. To improve the understanding of the research topic, this gives the researchers knowledge and understanding of the theories and evidence that currently exists.
Both Smith (1997) and Hek (1996) express the opinion that a critical evaluation of the literature must be included and not merely a descriptive account. They claim that some discussion of the previous work is needed if the paper is not to appear trivial and lacking in depth. The literature search referring to communication with the critically ill needed to be more critically reviewed rather than just reported. More selective use of material would have strengthened the justification for the study as it is, the reason for exploring the importance of effective communication is lost in the general presentation and its relevance to practice is not made clear.
The literature review performed by the researchers used mainly journals. Although journals are frequently used by researchers, not all journals publish original research (Cormack 2000). Although journals can provide accurate and up to date knowledge, for the purpose of literature review a wider range of sources could be utilised.
Referencing
The references used were mainly of a primary source which Tarling et al (1998) suggests offer more credibility. Many of the items used within the literature review were also dated; a general timeline for most academic or evidenced-based practice is to go back in the literature at least 3 – 5 years, although some research projects warrant going back 10 years or more.
A search of Cumulative Index to Nursing and Allied Health Literature (CINAHL) database has revealed several research articles relevant to this particular topic which although support the findings of this research, offer more up to date knowledge on the subject. In view of this more recent data supporting the findings which did not identify any gaps or inconsistencies a question to ask is ‘was this research necessary?’
One of the questions LoBiondo-Wood and Haber (2006) suggest to ask when critiquing a research article is ‘Does the literature search seem adequate?’, in view of the dated literature used and the material being confined to journals, the reader may conclude that the background information appeared inadequate.
Study aim
The aim of the study was to illuminate the lived experience of a group of critical care nurses with regard to communication with their patients. This study aim was realistic and relates to the topic under study; however it may have been more appropriate to gain knowledge from a patient’s perspective.
Methodology.
Methods
Methodology focuses on questions about the mode in which we obtain knowledge about what exists. Qualitative researchers argue that
qualitative research gives you access to the nitty-gritty reality of everyday life viewed through a new analytic lens (Silverman 2005).
The choice of method depends on the question being asked (Streubert & Carpenter 1999). To fully understand the experiences of the nurses who participated in the study, the researcher would use a phenomenological approach.
Phenomenology is a qualitative research method which focuses on, and aims to describe and understand the ‘lived experience’ of the individual with regards to their emotions and perceptions (Young et al 2001). Phenomenology provides researchers with the framework for discovering what it is like to live the experience (Streubert & Carpenter 1999). Greenhalgh (1997) suggest that before changing your practice in the light of a published research paper, you should decide whether the methods used were valid.
Sampling
The research article did not state how the participants were chosen, just that ‘28 nurses from the three hospitals were interviewed’. The reader would have to conclude that a purposive sample was used to generate the research data.
In purposive sampling individuals are selected to participate in research based on their firsthand experience with a culture, social interaction, or phenomenon of interest (Streubert and Carpenter 1999). Unlike quantitative research, there is no need to randomly select individuals, because manipulation, control, and generalization of findings are not the intent of the inquiry. This type of sampling aims to commit to observing and interviewing people who have had experience with the culture or phenomena of interest (Streubert & Carpenter 1999). The concern of the researchers is to develop a rich or dense description of the culture or phenomenon, rather than using sampling techniques that support generalizability of the findings.
The results of research may be considered to be biased if the sample is not representative of the whole population. Bias can be introduced if the sample is unrepresentative (Stewart & Parmar 1996). Gaulter and Buchanan (2000) argue that most sampling methods are likely to produce biased samples.
Sample size should generally be determined before the study is conducted and the general rule of thumb is always to use the largest sample possible (LoBiondo-Wood & Haber 2006). These principles are however not applicable to qualitative research, for which the researchers focus is to obtain rich data highlighting the participants lived experience.
Although this form of sampling appeared appropriate for this piece of research, the researcher, and the reader should be aware of the limitations of this sampling strategy; for as with non-probability sample, the ability to generalize to a wider population is limited.
Data Collection
In-depth interviews
Interviews were carried out using a broad initial question; participants were then asked subsequent questions to clarify their answers. This unstructured interview method is used primarily in descriptive and qualitative studies (Burns & Grove 2001). The unstructured interview provides the opportunity for the participants to fully explain their experiences and provides a greater depth in the answers provided (Streubert & Carpenter 1999). The questions and means of recording the interviews appeared an appropriate method of data generation.
According to Turnstone (2005), in-depth interviews last for about an hour and are ideal for exploring detailed processes, individual cases, and confidential or sensitive topics. The length of the interviews is an important factor as it determines how much information can be obtained from participants. Unfortunately there is no mention in the article the length of time spent interviewing the participants; with this in mind it is difficult to evaluate this aspect of the data collection. Even if the sample size was adequate, a study must continue long enough to gain adequate results to be long enough to produce enough data for analysis.
Participant observations
Participant Observation is a method by which researchers systematically observe people while joining in their activities. Data was collected using ‘overt participant observation’; where the researcher identifies him/herself and their purpose to the people being studied.
Participant observation is a method of data collection used within qualitative research (Streubert and Carpenter 1999). Participant observation involves the researcher being on the inside, he or she joins in with the activities of those being studied and shares their experiences (McNeill & Chapman 2005). It is believed that the researchers own experience of the group will give them access to data that may not be drawn out by a questionnaire or interview (Walsh & Wigens 2003).
It is not clear from the research how much time was spent observing each nurse, and whether the time spent with each one was relatively equal, as a result this aspect of the data collection is also difficult to evaluate.
Triangulation
Using methods triangulation at the level of data collection, researchers use two different techniques of data collection, but each technique is within the same research tradition. The purpose of combining the data collection methods is to provide a more holistic and better understanding of the phenomenon under study. When combining methods at this level, researchers must first carefully consider the advantages and disadvantages of each method (Streubert & Carpenter 1999). They should then combine methods so that each overcomes the weaknesses in the other. For example, observation is an excellent technique for qualitative data generation. However using observation, researchers cannot determine the reasons behind actions observed. Interviews are an excellent method for determining reasons behind behaviour. However, researchers can never be sure that individual’s actions mirror what they say they would do in an interview. By combining the techniques, investigators can see behaviour in action and hear the participants describe the reasons behind the behaviour. (Streubert & Carpenter 1999).
Qualitative researchers may choose triangulation as a research strategy to assure completeness of findings or to confirm findings (Miles & Huberman 1994). Completeness provides breadth and depth to an investigation, offering researchers a more accurate picture of the phenomenon (Denzin & Lincoln 1994).
Saturation of data
Although not discussed within the report, when using qualitative methods, researchers should generate data until saturation occurs. Saturation refers to the repetition of discovered information and confirmation of previously collected data (Morse 1994). Rather than sampling a specific number of individuals to gain statistical significance, the qualitative researcher is looking for repetition and confirmation of previously collected data (Streubert & Carpenter 1999).
Ethical considerations
The study was approved by the relevant research committees. The article states that participants gave informed consent prior to interviews and observations, and that the interviews were transcribed and pseudonyms were used to protect their confidentiality. Although the confidentiality of participants was maintained in this way, the report gave no indication as to how the information was stored; Hek (1996) states that data should be stored safely and should only be available to the research team.
Observation studies have raised several ethical issues as a choice of research method (McNeill & Chapman 2005). Brewer (2000) notes that observational studies pry into peoples innermost secrets, witness their failures and participate in their lives, with this is mind it is important that researchers gain continuing consent – it is unclear if the researchers did this on an ongoing basis throughout the observations and interviews. Whilst consent is given for one stage, it should not be implied for future stages and should therefore be a continual, evolving process (Burns & Grove 2001).
The ethical considerations of the patients were not addressed at anytime within the research article. It is unclear whether the unconscious patient’s next of kin consented on behalf of their relative or friend, for the researcher to be present, and from the research article it has to be assumed that this was overlooked.
Findings
Data analysis
The reporting of the participants comments used the verbatim principle, which requires ethnographers to use the speaker’s exact words (Streubert & Carpenter 1999). To adhere to this principle, the researchers used audio taping, this also provides the researcher with material for intensive analysis, and this can provide valuable insights into the culture, insight into the language and native expressions. The interpretation of the data included the transcribed interviews and the observation and reflective notes. Draper’s analysis of data was used to analyse the findings and although a brief description of the main principles was provided this seemed inadequate for the novice reader, more information is needed to judge its appropriateness fully.
Results
The researchers outlined their results clearly and systematically. The results of the report were organised into three themes which all related to the study aim; by illuminating the nurses lived experience with regard to patient communication. Including quotes within the report allows the reader to determine the rigor of research as their use can make the findings richer (LoBiondo-Wood & Haber 2006).
Although the themes contained participant verbatim statements, it could be argued that some of these may have been misinterpreted. The research report includes six verbatim quotes, two for each identified theme; it seems an inadequate amount to represent the views of the 28 participants. In addition it was observed that not all participant quotes related to the theme identified by the researchers.
Rigor
The measure of rigor of qualitative research is its credibility, auditability and fittingness (LoBiondo-Wood & Haber 2006). In this study, the researchers report that the rigor was enhanced in several ways; the auditability of the research by maintaining a clear decision trail which documented the process of data collection and data analysis and by keeping close to the data. Although as previously discussed, the description of the data collection process could be perceived as inadequate which may have posed a threat to the auditability.
The reader could question the credibility of the research article. The credibility of research relates to the truth of the findings as judged by the participants. This involves ‘member checking’, where researcher returns to the participants to share the interpretation of the findings (LoBiondo-Wood & Haber 2006).
Although there is no evidence of member checking within the research, Cormack (2000) suggests this method of rigor is not without problems as participants may deny recognition of uncaring attitudes and actions. There is evidence within the findings that these nurses are communicating with their patients, although it may not be as easy as communicating with a fully conscious and relaxed patient.
Fittingness refers to the relevance of the data to nursing practice, it is widely recognised that effective communication is paramount to good nursing care whether the patient is conscious or unconscious/sedated. One of the commonest criticisms of qualitative research is that the findings of the study pertain only to the limited setting in which they were obtained (Greenhalgh & Taylor 1997). The reader can fully appreciate the relevance of good communication skills. There is an adequate amount of detail for the reader to evaluate the importance of incorporating the findings into their own practice.
Summary
The conclusion of the report summarised the main study findings and made explicit the significance the findings may have to nursing practice. The researchers suggest further research is needed to address nurse-patient communication and the outcomes this may have on patient outcomes, and suggests the need for more emphasis on communication skills in critical care programmes and nursing practice.
Conclusion
The article was clearly presented and included an informative abstract which enabled the reader to identify whether the article was relevant. The use of sub-headings contributed to the ease of which the research article could be followed. Accurate referencing was included throughout the report which enabled the reader to study further. Whilst this article was published in a credible journal certain weaknesses were identified which may reduce its transferability, although the findings may help with nurse education and enhance patient care. When critiquing journal articles it is important to consider that word constraints may have influenced what was included, the article should therefore be evaluated with this in mind.
Interpreting and understanding research is a fundamental part of the process involved in working towards evidence-based nursing. It is essential that nurses are able to make judgements about the value of research, before altering their practice. Critiquing allows the assessment and identification of valid research, highlighting both its strengths and weaknesses. It can tempting to take published statements at face value, however the reader should remember that authors may misrepresent what they actually did, and can overestimate its originality and potential importance.
As a future practicing nurse, I find the results alarming as they reflect badly on the nursing profession, as effective communication skills are one of the core elements of nursing practice. On reflection this critique has enabled me to evaluate not only the findings of a piece of research but also the methods used throughout the research process.
References
Brewer, J.D. 2000. Ethnography. Buckingham: Open University Press.
Brown, S.J 1999. Knowledge for healthcare practice: A guide to using research evidence. Philadelphia: W. B. Saunders.
Burns, N. & S.K. Grove 2001. The Practice OF Nursing Research. Conduct, Critique, & Utilization. 4th Ed. Philadelphia: W.B. Saunders Company.
Clifford, C. 1997. Nursing and Healthcare Research, a skills based introduction. 2nd Ed. Hertfordshire: Prentice Hall Europe
Cormack, D. 2000. The Research Process in Nursing. 4th ed. Oxford: Blackwell Science.
Denzin, N.K. & Y.S. Lincoln. 1994. Handbook of qualitative research. Thousand Oaks, CA: Sage.
Gaulter,B. & L. Buchanan. 2000. Modular Mathematics for GCSE
Oxford: University press.
Greenhalgh,T.(1997). How to read a paper: Assessing the methodological quality of published papers
BMJ 1997;315:305-308 (2 August).
Greenhalgh,T. & R. Taylor. 1997. How to read a paper: Papers that go beyond numbers (qualitative research). BMJ 1997: 315: 740-743 (20 September).
Hek, G., M. Judd & P. Moule.1996. Making Sense of Research. An Introduction for Nurses. London: Cassell.
Hek, G. 1996. Guidelines on conducting a critical research evaluation. Nursing Standard. Vol. 11 (6): 40-43.
LoBiondo-Wood, G and J. Haber. 2002. Nursing Research: Methods, Critical Appraisal and Utilization. 5th ed. St Louis: Mosby
LoBiondo-Wood, G and J. Haber. 2006. Nursing Research: Methods and Critical Appraisal for evidence-Based Practice. 6th ed. St Louis: Mosby.
Macleod Clark, J. & L.Hockey. 1989. Further Research for Nursing. London: Scutari Press.
McNeill, P. & S. Chapman. 2005. Research methods. 3rd ed. Oxon: Routledge.
Miles, M.B & A.M. Huberman 1994. Qualitative data analysis: A sourcebook of new methods (2nd ed.). Berverly Hills, CA: Sage
Morse, J.M. 1994. Designing funded qualitative research. In N.K. Denzin & Y.S. Lincoln (eds), Handbook of qualitative research (pp. 220-235) Thousand Oaks, CA: Sage.
Omery, A., & R.P. Williams 1999. An appraisal of research utilization across the United States. Journal of Nursing administration, 29(12), 50-56.
Parahoo, K. 1997. Nursing Research, Principles, Processes and Issues. Basingstoke: Macmillan Press Ltd.
Polit, F. and B.P, Hungler 2001. Essentials of Nursing Research Methods, Appraisal and Utilisation. 5th ed. Philadelphia: Lippincott.
Silverman, D 2005. Doing Qualitative Research (2nd ed). London: Sage.
Smith, P. 1997. Research Mindeness for Practice: An Interactive Approach for Nursing and Healthcare. New York: Churchill Livingstone.
Stewart LA, M.K.B Parmar.1996. Bias in the analysis and reporting of randomized controlled trials. Int. J Health Technology Assessment 1996;12:264-75.
Streubert, H. J., and D. R Carpenter 1999. Qualitative Research in Nursing. Advancing the Humanistic Imperative. (2nd ed). Philadelphia: Lippincott.
Tarling, M., & L. Crofts. 1998. The Essential Researchers Handbook for Nurses and Healthcare Professionals. London: Bailliere Tindall.
Traynor, M & A.M. Rafferty. 2000. Research revealed. Nursing Standard. Vol. 14 (45).
Turnstone 2005. In-depth Interviews. . date accessed 23/02/06.
Walsh, M., and L. Wigens 2003. Introduction to Research. Foundations in Nursing and Health Care. Cheltenham: Nelson Thornes.
Webb, C. 2005. Choosing keywords for JAN papers. Volume 51, Issue 3, Page 203, 2005. . Date accessed 26/02/06.
Young, A. S., G. Taylor, & K. McLaughlin-Renpenning. 2001. Connections Nursing Research, Theory and Practice. USA: Mosby.
