The article was intended for nurses, doctors or anyone in the healthcare field, however, I believe it would reach out to anyone reading it as the subject is one that has the potential to affect most people, that have stayed in, visited or due to stay in hospitals.
From my own research I have noted that the article was researched and published in 2006, therefore this is a current article with current research.
The title of the article is clear and concise and it gives no doubt as to what to expect in its content, it encapsulates the research and although not necessarily inspiring it tells you exactly what you are going to find without even reading the article. When searching for an article to research this one jumped out at me as previously mentioned this is a current hot topic which has been bought to my attention by the media, also being in the care industry I have a genuine interest.
They used a semi structured questionnaire to get their results and before this they tried a sample questionnaire which was given to patients to get their feelings on the types of questions asked and from here they made the suggested alterations and sent out the main questionnaire. I feel this was a good way of collecting the data and it gave the patient’s time to give a true refection of their feelings as they were in hospital themselves and had time to consider the questions in the relevant environment.
Literature Review
The principle rationale for reviewing literature is to gain a broad background and understanding of information that is available to support the study intention. (Burns and Grove 1999)
The research article gives a broad range of information, relating to the subject of MRSA and cleanliness in hospitals and information around involving and empowering individuals. All of the references included in the literature review are current, between 2001 and 2006, it gives reference to government documents such as winning ways written by the Department of Health in 2003 which reinforced the importance of hand hygiene and also The NHS Plan written in 2000, which encouraged the empowerment of patients. From checking the references I have found that It includes studies written by well known writers in the field of health such as Stephen Henderson who in 2003 published the study Power imbalance between nurses and patients: a potential inhibitor of partnership in care. The topics covered in the article relates to all hospitals within the NHS but can be related to any hospital or medical centre.
The literature presents a balanced evaluation which both supports and challenges the area being studied. Epidemiological sources are included which give the appraiser a more In depth generalisation of nursing staff and their attitudes towards honesty and cleanliness in the wards.
Throughout the literature review the authors give a descriptive report and analyse each reference critiquing and giving both sides of the argument, they do not agree nor disagree, they do point out where they had problems such as lack of literature on a particular subject ‘ there was a significant lack of studies in the literature to link the availability of patient information about MRSA and hand hygiene to their willingness to question healthcare professionals about hand hygiene practice’. They also compare one authors views to another giving an informative start to the article, there are no sweeping statements as the authors provides evidence to support their comments with authorative references throughout.
The article is informative and appropriately written with a good sound structure, it can be easily read and flows allowing you to follow the subject through and identify the subject area and identifies the problem. Finally all of the evidence is supported with a bibliography, in order for you to check references and for further reading. I feel the references are adequate and overall the review covers the articles intentions sufficiently.
Methodology
A pilot study was used in this particular research, where the researchers used 12 patients from a large mixed ward of a hospital, this was to test the adequacy of the questionnaire and to make the information more accurate and relevant.
The main questionnaire used illustrations and easy to identify symbols to ensure all levels of intelligence could answer the questions easily and honestly.
The researchers enlisted the help of the IC link workers in each ward to ensure the questionnaires were completed and returned to the researchers. I feel that by using hospital staff this removed anonymity and may have affected results of some of these patients as they may have a relationship with the link workers as they were involved in their care whilst in hospital and this may have affected results. To get a more accurate and non biased result I believe the patients should have been left to fill in the questionnaire on their own with an envelope to seal it in when completed, to enable them to feel as comfortable as possible about giving open honest answers.
Randomized convenience sampling was used for the main body of the research as the population targeted for the study had already been identified as 224 inpatients from an acute NHS Trust hospital, this generated a satisfied sample of MRSA and non MRSA patients.
An alternative to randomized sampling is purposive sampling.
Purposive sampling can be very useful for situations where you need to reach a targeted sample quickly and where sampling for proportionality is not the primary concern. With a purposive sample you are likely to get the opinions of your target population, but you are also likely to overweight sub groups in your population that are more readily available. ( Bowling, A 1998)
The use of questionnaires and phenomenological research gave the researchers an in depth analysis on the actual thoughts of the patients on the subject, therefore making the research undertaken ecologically valid.
A set of close ended and open ended questions were used to reduce the possibility of patients not answering some questions as is typical when people complete questionnaires. Robson (1993) suggests that patients who complete survey questions about sensitive issues, such as questioning healthcare professionals about washing their hands, would feel less threatened and more likely to respond to close ended questions in a questionnaire.
As mentioned the criteria for the study and parameters of the population used were hospital patients in an acute ward. I believe that sampling from a large number of the patient population, because of the exploratory nature of the investigation was an appropriate approach to answer the specific questions set at the onset of the study. It was also a good method as a large number of patients could be surveyed and the data collected easily and promptly. If I were to attempt this study myself I think I would sample from a number of NHS hospitals and wards as I believe each hospital is different with a different level of cleanliness and this would give an even clearer picture to answer the question, this obviously would be on a greater scale and more time consuming and was beyond the constraints of these particular researchers.
Ethical Considerations
When research involves human subjects it is imperative that ethical guidelines are followed. The report does not clearly state that any ethical guidelines were adhered to, however it does state that patients ‘were invited to participate’, consent was granted and some refused to take part. It does not state that confidentiality or anonymity was assured and as already highlighted I feel that patients should have been given a envelope to ensure confidentiality as opposed to an IC worker collecting the questionnaires from the patients as this may have affected the results.
Results
The researcher’s arrangements of results are written in a simple well organised comprehensible language. The problem statement is written in interrogative form, therefore asking the respondents to give their views and opinions to answer the question. The use of charts to illustrate statistics collected from the data again make the findings more clear in addition to this they give a full descriptive account of the findings. Using spearman’s rank Order Correlation they were able to identify a strong negative correlation between the two variables which could indicate the patients were more anxious about asking staff to wash their hands if they had fewer admissions. As previously mentioned they used a mixture of questions to ensure all patients completed the survey. However, not all of the questions were answered this leads me to believe that possibly the questionnaire was too long or not written as the researchers stated in a clear and concise manner. Without a copy of the questionnaire I can not prove this statement, there is also the possibility that as this was an acute ward of the hospital patients were just too ill to be concerned over answering the questions and merely felt obligated to fill it in as they were being treated there. It is only natural that the researchers be more interested in the subject than the respondents.
The results were correlated between those who had experiences with MRSA and those who had not, this I felt was very thorough as, the results found that those who had had MRSA in the past were more active in asking nurses to wash their hands, this although needed to be investigated was a more obvious result for me as those who had contracted MRSA in the past are familiar of the dangers of the disease and how easily it can be spread than those with no experiences so would be more vigilant on cleanliness.
Conclusion and Recommendations
Conclusions are supported by the results obtained, the main findings being that not enough information on MRSA was available on the site, statistical analysis demonstrated a strong link between the patient feeling anxious about asking healthcare professionals to wash their hands when there was less information about MRSA and hand hygiene. Implications of the study are briefly mentioned, suggesting longitudinal studies, looking at differing cultures and demographic settings may be more suitable when researching patient’s beliefs.
Further research could be focused on readmission rates of MRSA positive patients. It could be determined whether readmission to hospital has any impact on patient’s confidence to challenge health care professionals about hand hygiene practices, this potentially could be a good comparative study with a new set of results.
Bibliography
- Bowling, A ( 1998) Research Methods in Health, Investigating Health and Health Services: OU Press: Buckingham
- C A Berglund (2001) Health research: University Press: Oxford
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Burns N & Grove K.S (1999) Understanding Nursing Research (4th ed) W B Saunders Co: United States Of America:
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Cormack D ( 2000) The Research Process In Nursing (4th ed) Blackwell: Oxford
- Robson C (1993) Real World Research: Blackwell: Oxford
