The author of this assignment will critically appraise a qualitative research report in the Nursing Standard titled Care of older people with dementia in an acute hospital setting.(Fiona Cowell, 2009) (appendix 1). He will use the Polit and Beck (2010) and Roe (1998) framework to help him critique this article.
The article was chosen mainly on a personal reasons that as a third year student nurse the author has witnessed how healthcare professional act differently towards patients with dementia and how there is a need for education to improve Health Care professionals skills in dealing with dementia patients. Also according to the Alzheimer's society (2010) there are approximately 750,000 people with dementia in the UK.
The reason for nursing research is to generate knowledge about nursing education, nursing administration, health care services, characteristic of nurses and nursing roles, in which the finding from these studies indirectly affect nursing practice and thus add to nursing body of knowledge. (Understanding nursing research, by Nancy burns and susan.k.grove, 2006).
Introduction to the study
According to Gerrish and Lacey (2006) the introduction must convince the reader that the proposed study is important and it should identify how the study will add to previous work and build on theory. For the purpose of this research paper Cowell (2009) has decided to write the introduction separate from the main abstract.
Cowell clearly explains why the study needs to be investigated within the introduction and convinces the reader that the best way to investigate this research would be to use a qualitative approach, to address this gap in knowledge.
According to Parahoo (2006) titles that are too long or short can be confusing or misleading. The title should suggest the research problem/purpose of the study. The title in Cowell's (2009) study is unambiguous, concise, and highlights with clarity the content of the research study.
A Literature review is to give an objective account of what has been previously been written on a giving topic (Moule and Goodman, 2009).
In this research the literature review provided a list of data bases that where used to search for articles papers on dementia and keywords that where used within the search. She also included the period 1980-2004 that she used within her literature review.
The articles investigated a range of different subjects however there was limited evidence that these had achieved a demonstrable change in practice due to study limitations and the sample size.
The literature review does comment on only a few research articles out of forty seven she found. This may be due to study limitation and one in particular, which was relevant to Cowells study was that none of the patients where actually diagnosed with dementia.
Holloway and Wheeler (2010) state that normally in qualitative literature overview the discussion of literature tends to be more limited than in other types of research.
The articles that the researches choose to comment on helps to convince the reader that views of nurses on dementia care are limited and that care of dementia patient in acute hospital needed to be addressed.
Overall the literature review provides detailed references, keywords and information on how she went about her search, but the study fails to provide recent research material in conjunction with the study title. Moule and Goodman (2006) advise researchers to use up to date studies, that is, certainly not more than ten years old and preferable not more than five years old. The reason why Cowell hasn't used any up to date studies may be because she might not want readers to be influenced by any previous material and that dementia has become a focus of political agendas, which enables the researcher to identify gaps that can be addressed.
Cowell has used a qualitative approach to this study and has decided to use naturalistic paradigm. Naturalistic researchers tend to look in detail at a specific group of people or a particular situation (Walsh and Wigens, 2003). This approach tries to gain an awareness and appreciation of how particular individuals or groups of people view and experience the world (Moule and Goodmand, 2009).
Qualitative research is a form of social inquiry that focuses on the way people make sense of their experiences and the world in which they live (Holloway and wheeler, 2010). Where quantitative research seeks to test a hypothesis or answer research questions based on a framework (LoBlondo-Wood and Haber, 2006).
The researcher tells the reader in the abstract that she will use an ethnographic approach. Ethnography means a "portrait of people" and involves writing about people and culture (Moule and Goodman, 2009).
These approaches use observational and interview data collection methods, which is what the researcher has used within this research article.
The aim of ethnographers is to learn from (rather than to study) members of a culture group to understand their world view as they perceive and live it and social norms of a particular group, such as nurses (Polit and Beck, 2010).
Overall the researcher has used the best approach to find out the experiences of patients and nurses in relation to care delivered to, and received by, older with dementia.
Data was collected during 2005- 2006 from 3 special older people wards. The researcher mentions that ethnographic observations and interviews where used and that a total of 125 hours of observation were completed in two five-hour blocks between 7am-8pm. Field notes where transcribed and eighteen interviews were audio taped.
No rationale was given for how the decision about the type of interviews that were going to be used. According to Moule and Goodman, (2009) it should have been clearly presented and justified.
How the data was collected in relation to the methodology used was ok but limitations to the study for example small sample size, using patient that had server dementia who may have had cognitive impairment. Which overall might have had influences on the results. Gerrish and Lacey (2010) say that sample size is not an intrinsic feature of the analysis in qualitative research.
Data was transcribed and verbatim as soon as possible following the data collection. This method also has implications in that the researcher may have to transcribe the interview ("write out what is said") (Moule and Goodman, 2009).
Nurse researchers have a professional responsibility to design research that uphold sound ethical principles and protect human rights (Speziale and Carpenter, 2007). I.e. informed consent, gaining access, confidentiality, anonymity and avoid harm.
Cowell has appeared too adhered to the guidelines and adequately safeguarded the rights of the participants due to the incorporation of these 4 principles into her research design.
Ethical approval was also gained from the local NHS research ethics committee and the NHS Trust involved within the study. All participants gave verbal consent before each period.
The researcher used two subs headings within the findings/results she listed them as Patient experience of care and Nursing Staff experiences of care delivery.
Within the findings section the researcher used some direct quotes from both the patient and nursing staff, which the reader found they where biased and not very reliable. Only because a small sample number of patients where involved with-in the research and all had server dementia which could have been an influence. According to the Alzheimer's society (2010) Memory loss is likely to be very severe in the later stages of dementia. So why did the researcher not included patients who where newly diagnosed or only had mild dementia that where able to communicate more and probably expressed the feelings better.
The strengths of the results was that all the patients where diagnosed with dementia before they where admitted to the hospital and Mini-mental examination where carried out, which results ranged from 0-7 that indicated server dementia.
The researcher also never comments on any organisation or environmental factors that could of influenced the results or have an impact on the patient's feelings/experiences.
The discussion is clearly separate from the actual findings which make it much easier for the reader to read and understand her work. The findings are well discussed within this article and the researcher relates back to her literature review and back ground information.
The major findings within the article where interpreted, discussed and backed up by references. The researcher did discuss that little is known about acute hospital care from the perspective of people with dementia.
She never mentioned the different types of dementia the patient had been diagnosed with and if any cognitive skills were impaired.
Normans (2003) process was used within this article, which is a process that encourages the researcher to take account of his or her influence on the study. The researcher does state to the reader that this could have influenced the data results.
LoBlondo-Wood and Haber (2006) suggest that the research may influence the participants if the researcher observers the participants to collect data.
The researcher decided to use two different methods of collecting data. This is known as triangulation collection. Triangulation is thought to improve the validity of a study, by drawing on multiple reference points to address research questions (Moule and Goodman, 2009).
Researchers using triangulation in data collection are hoping to overcome potential biases of using a single data collection method.
Brewer and Hunter, 1989 says that no one method is perfect, though using a combination of methods can, it is argued, limit the potential deficits and biases of one-particular method.
So with the researcher using both the interviews and observations she has enhanced the reliability, validity and trustworthiness of this research study and its overall quality.
No recommendations of further research were discussed within this article.
The researcher does mention study limitations in a separate column in which she comments that the study was on a small scale and conducted in one acute hospital. Therefore the findings are not generalised, but may be transferable.
As the work has been interpreted by the researcher she does say openly that the article is biased.
The researcher also says she never returned to the other participants to check data, as she believed it would be a burden to them, and may have limited valve. (REF about going back to participants)
She failed to mention the Hawthorne effect could have affected the participant's behaviour or performance, which could have impacted subsequently on the dependant variable (Moule and Goodman, 2009).
Relevance of the study to practice
The issues that Cowell (2009) identifies have also been seen over the years on clinical placements that prove Health Care Professionals need further education on dementia care. This will help patients in the future receive more patient focused care/individual care and not personalised dementia care.
The author doesn't think it would be hard to change practice due to the evidence within this study that nursing staff have a lack of knowledge and education in delivering nursing care to dementia patients. With most staff wanting to gain a more understanding in dealing with dementia patients the only factor that may be challenging would be resources, cost and time management on the ward area for staff to do the training.
Also by having Nursing journals available in ward areas would help staff attitudes for further training and using evidenced base research in practice.
There are other factors like staffing issues on the wards that are affecting patient care, which with the right staffing would improve patient focused care but further research would be needed to prove this.
The comments within Cowdells (2009) article and experience on clinical placement have made the author realise he acts as an advocate for dementia patients and that in the future he will make sure everything is done in the patient's best interest, instead of the nursing staff convenience.
The use of evidence based studies is the best way to improve quality of care and improve patient experiences is essential (ref).
Cowell (2009) study has been subjected to critique using the Polit and Beck (2010) and Roe (1998) framework, which has helped to gain a more understanding of dementia care.
Her article is presented well and flows that makes it easy to read and understand.
Cowdell (2009) chose a good method and approach but there where flaws within her data sampling, which was addressed within report. This could have posed a threat to validity and reliability.
By critiquing this article it has helped the author to increase his knowledge on reading research articles, understanding the terminology and appraising nursing research. It has also made the author more aware of how dementia patients feel in acute hospital setting and how he can, as a future staff nurse can make a change on how care is delivered to dementia patients.