INTRODUCTION
This essay is a critique based on a pilot study carried out on ‘patient stories of living with a pressure ulcer’ and I will be using Caldwell, K. et al. (2005) as a structured research framework to carryout the evaluation on this study. First and foremost a definition of what research, (nursing research in particular) and research critique entails will give a greater understanding of what this essay aims at addressing.
On one hand, Polit and Beck (2006, p4), defined research as a systematic inquiry that uses disciplined methods to answer questions or solve problems, while on the other hand they define nursing research as a systematic inquiry designed to develop knowledge about issues of importance to nurses, including nursing practice, nursing education and nursing administration. The importance of having research carried out in the nursing field can only be emphasised as it is the key element in generating and guaranteeing evidence to guide nursing practice and improvements to care and quality of life of both clients and service users as claimed by Polit and Beck (2006, p4).
However once the research is undertaken and published, great emphasis is placed in finding out or identifying the strengths and weaknesses through critique. Polgar and Thomas (2000), point out that critiquing research entails identifying the strengths and weaknesses of research publications to ensure that patients/clients receive assessments and treatment based on the best available evidence. This evaluation encompasses a responsibility of judging the validity and relevance of the published material. In addition Polit and Beck (2006, p437), argue that research critique is not just a summary of a study, but rather a careful appraisal of its merits and flaws and the heart of a research critique lies in the appraisal of the researchers methodologic decisions. Hence a good critique should be objective, i.e. look at both adequacy and inadequacy of the published material, it should reflect a thoughtful, balanced and consideration of the study’s validity and significance.
Therefore, in critiquing the pilot study on patient stories of living with a pressure ulcer, I aim at being thorough and comprehensive and great attention will be based on the major dimensions of the study( namely substantive and theoretical; methodologic; ethical; interpretive and presentational by using Caldwell, K.et al. (2005) structured framework for critiquing health research. I will examine both positive and negative aspects of the article and provide a personal evaluation using a systematic analysis of the research that follows a set criterion.
CRITIQUE
The title of the study ‘Patient stories of living with a pressure ulcer’ (Hopkins, A. et al. 2006) gives a clear indication that the participants of the study are living with pressure ulcers and it aims at exploring these experiences that these individuals go through due to their condition. This title clearly shows what the study is all about. However, on one hand the title could have pointed out that, all the participants were above 65 years of age, e.g. ‘Over 65 year old patient stories of living with a pressure ulcer’ to indicate the age group that was involved. On the other hand the researchers could also have pointed out that participants had either a 3rd or 4th grade pressure ulcer e.g. ‘Patient stories of living with a grade 3 and 4 pressure ulcer,’ this would give a clear indication that not all kinds of pressure ulcers are covered in the study.
With reference to qualifications, it is evident that all the individuals involved in carrying out the study hold the relevant levels of qualifications that show and indicate a high level of academia necessary to carry out a study of such magnitude and importance. To start with Alison Hopkins is a clinical nurse specialist who holds a Masters degree in science (Msc), Registered nurse (RN), and certificate (DNcert). Carol Dealey is a senior research fellow and holds Bachelor of Science degree (Bsc), masters’ degree (MA), a doctorate (PhD), registered general nurse (RGN) and (RCNT). Sue Bale is a professor, Associate director of nursing and holds Bachelor of Arts degree (BA), a PhD, RN, RHV, NDN diploma, and is a French registered clinical nurse (FRCN). Tom Defloor is a professor; head of nursing science department holds a PhD, and RN. While Fran Worboys is a clinical nurse specialist and holds a Bsc, DNcert, and RGN. All these qualifications are evidence enough to certify that the study was carried out by knowledgeable and competent individuals.
The abstract is a highlight and summary of the main features of the study. It includes the aim of the study and outlines the methodology and main findings as argued by Caldwell, et al. (2006), and the relevance of the article/study towards practice or development should always be highlighted in the abstract. In this instance the abstract mentions briefly the qualitative nature of the study and the aim of the study. It also outlines the details of the sample (participants), the data collection and data analysis methods and the duration of the study (2003-2004). In addition it outlines the findings and its conclusion is so precise that it leads the reader on.
Similarly, the rationale for this study is clearly stated as testing the feasibility of undertaking a wider study on experiences of living with a pressure ulcer (Hopkins et al, 2006). It is precise and to the point.
Furthermore, the literature review demonstrates the current knowledge relevant to the study. It looks at other studies that were carried out on pressure ulcers in different settings and on a number of people of varying ages. These other studies include figures and prevalence of pressure ulcers in five countries. The literature review also encompasses the definition of the concept used in the study highlighting the prevention, treatment of pressure ulcers and the effects on the quality of life showing the extensive literature search appropriate to their current pilot study of pressure ulcers.
In addition, the aim of the study is clearly stated as an exploration of lived experiences of older patients with pressure ulcers. It aims at exploring quality of life issues of these older people and the implications for clinical practice.
When addressing ethical dimensions of research, the aim is to find out if there is any evidence of moral values that is concerned with the degree to which research procedures adhere to professional, legal, and social obligations to the study participants as claimed by Gerrish and Lacey (2006). There is need to consider the possible impact of those problems on the scientific merit of the study and the subjects well-being. This study however shows that appropriate steps were taken to get participants consent through written and oral information about the study. In addition confidentiality and withdrawal where addressed in any situations or circumstances that arouse during the interviews were the researcher felt as necessary in order to prevent any discomfort towards the participants as pointed out by Hopkins et al (2006). Moreover approval for the study was obtained through the health service research ethics committee and funding of the study was by the European Pressure Ulcer Advisory Panel (EPUAP) which is a reputable committee. However one would argue that privacy and confidentiality can sometimes be compromised when interviews are conducted in participants homes and other family members are nearby as pointed out by Polit and Beck (2006, p443), therefore in instances where the researchers carried out their interviews in the participants home is questionable in relation to privacy and confidentiality.
Furthermore, the researchers used a qualitative method for this study because they wanted to understand what patients living with a pressure ulcer went through. Qualitative research is an ideal way to gain awareness and understanding of issues being investigated. This methodology is very appropriate as this study aims at collecting rich narrative materials from the patients and it is a flexible research design. Its investigative phenomena is a typical in-depth and holistic approach as pointed out by Polit and Beck (2005).
A phenomenological approach is used as a qualitative research strategy. This approach advocates for freedom from influence or prejudice so that the study is a true reflection of the individuals experience. Collecting data on the experiences of living with pressure ulcer would be classified as descriptive research as it revolves from gaining in-depth knowledge of the participants and their feelings to acknowledge that every participant’s views may be different as pointed out by Polar and Thomas (2000).
In addition, the researchers identify the major concepts in the study and define them appropriately, e.g. Quality of life and how the participants understood it; endless pain a concept that can only be explained by the person(s) experiencing it.
Moreover, purposive sampling also known as judgmental sampling method was employed during the research, where the researcher selected participants based on personal judgement about who will be most representative of informative as pointed out by Parahoo (2006). Participants were hand picked based on the researchers knowledge about the population. The criteria for selecting participants was that they were to be over 65 years old, had a grade 3 or 4 pressure ulcer for longer than 1 month and were able to give informed consent. In addition, the researchers used the EPUAP grading of pressure ulcer.
The method employed for data collection was through unstructured interview which aims to explore patients’ view of their world and experience carried out at the patients own pace. This is an oral self-report in which the researcher asked the participants questions without having a pre-determined plan regarding the content or flow of information to be gathered. However this method assumed that there was a link between experiences of living with pressure ulcers and their belief.
The data analysis was undertaken centrally and interpretative phenomenological analysis was used to analyse the rich data obtained. This analysis further established the implications and relevance of the data for nursing knowledge and understanding. Nevertheless the researchers do not clearly mention how they had assured that the method of data analysis was auditable (Caldwell, K. et al. 2005), and they do not mention how they determined exactly how the interviews were transcribed and encoded.
The presentation of the data is very clear as simple tables are used in illustrating the participants’ details and findings. The table for findings is divided into categories of themes and subthemes which are easy to understand. However the data does not give a presentation of which of the participants felt what, and who described what in relation to living with a pressure ulcer. The data presentation appears to generalise all the findings and can easily be misinterpreted in expressing the findings. It is easy to say that the themes were describing the experiences of the patients in exactly the same way even though some patients may not have experienced these feelings.
The results of the research (themes) are explicitly discussed and a good comparison is made with the other previous research carried out on pressure ulcers. Each theme is discussed namely; pain, restricted life and coping with pressure ulcers and these are compared to previous research on the topic. This discussion evidence that the research has gone a step further in investigating issues that relate to pressure ulcers and shows a balanced discussion as it points out that some issues that were discovered were not anticipated. In addition the findings can be used in other settings or groups and hence transferability is evident. CONCLUSION
In the conclusion , although this study had encountered some limitations such as age limitation, anxiety from participants, and a reduced pool of suitable participants due to the nature of the problem (pressure ulcers), i.e. effective prevention programmes, its aim at refining and exploring the method and methodology for a research on a larger study was a success. This conclusion is supported by the findings of the study. The researchers furthermore point out that the information obtained could be used for a study that will give a European perspective of patient stories of living with a pressure ulcer. The study also uncovers issues and experiences that were not anticipated during the design of the study such as endless pain and coping strategies. One of the recommendations of the study is that these findings need to be addressed in current management and assumptions in dealing with pressure ulcers, (Hopkins et al, 2006). The information and findings are of great value to the nursing profession as it adds great knowledge and awareness of issue in pressure ulcers and produces a wealth of data that demonstrates the impact that pressure ulcers has on patients, carers and the society that we live in.
The study is comprehensive and purposeful and gives any reader a suitable overview of the patients experiences of living with pressure ulcers. The research findings are presented logically though more information in its presentation style would have made things more clearer. In concluding the researchers maintain their findings explicitly and have expressed them well