This assignment will critically appraise the study conducted by Fraser et al (2006) ‘Living with Chronic Obstructive Pulmonary Disease: insiders’ perspectives’. The study shows how very severe chronic obstructive pulmonary disease affects the person’s life. This appraisal will critique the research process conducted by the authors. This will include the sampling methods, ethics, the data collection methods and the analysis of the data. The limitations of the study will be discussed along with the application to nursing practice.
The qualification and credentials of the authors are cited within the article. According to Siviter (2008) the authors of this article are suitable as they are both experienced within clinical practice and academically. This reiterates the author’s credibility.
ABSTRACT AND LIT REVEIW
The title appears to give a clear indication of the research aim and objectives. The article provides an insiders’ perspective of dealing with COPD. The abstract according to Parahoo (2006) is a short summary of the study which allows the reader to decide if this article is of any reference to them. The abstract should contain a short background, the aim of the study, the method in which the study was undertaken and the findings which the researchers found. This is clearly shown in the Fraser et al (2006) article. The abstract in which Fraser et al (2006) used was informative, kept the reader held by the information presented and was able to allow the reader to choose the article from the abstract.
The literature reviewed by the author’s shows in depth research to have an understanding of the topic and the literature used shows a broad timeline of articles used. The author’s show how they used older studies but were backed up by more up to date studies.
In order to conduct the study Fraser et al (2006) had the research study approved by the sponsoring university and the hospital institutional review boards. Griffiths (2006) has shown that ethical committees are there to protect both the participant and the researcher. When the participants were contacted about taking part in the study consent was gained for interviews to take place by telephone. The article does not state whether written consent was obtained. Parahoo (2006) states that as much information must be given to participants to allow them to make the decision and within the article the researchers sates that information was given when the participants were first approached. Fraser et al (2006) state that anonymity was kept by using pseudonyms as interviews were transcribed verbatim ensured confidentiality was kept by the interview tapes and transcripts being anonymous and not having the participants name on them. By pseudonyms being used this kept in accordance to the confidentiality policies expressed by The Nursing Midwifery Council (2008). In accordance to ethical protocol all participants have the right to withdraw from the study at any time without having their treatment discontinued.
The research perspective in which the authors used was a qualitative study which allowed the authors to gain a personal view from the participants. By using a qualitative appraoach this allows personal experiences and thoughts to be expressed, whereas a quantitative research approach is based on numbers and statistics to explain information (Brooker and Waugh 2007). By using Hermeneutic phenomenology the authors were able to gain an understanding of the human experiences. Moule and Goodman (2009) show that Hermeneutic phenomenology is an understanding of human experiences and it allows opinions and thoughts to be portrayed without being dismissed. Fraser et al (2006) express that having trust between the researcher and the participant is important and Moule and Goodman (2009) agree.
The study population was drawn from caseload of patients attending the respiratory clinic. The target population was drawn from a purposive sample and this was 10 patients. The characteristics of the sample were similar.
The participants were over the age of 55, English as their first language, living at home and able to openly talk about their experiences of living with chronic obstructive pulmonary disease. These participants were also categorised as these variables were the inclusion criteria. The category of very severe COPD was based on the Gold framework (2003). The group of participants were recruited by the involvement of being in the hospital’s case management or by being in the pulmonary rehabilitation programme. The potential participants were telephoned and asked if they would like to take part in the study. Before the patients were approved the authors gained ethical approval from their local ethics committee. Although the sample size could be regarded as small this is acceptable in a qualitative study. Parahoo (2006) states that a large group of participants is not always needed as this research study is an in-depth approach trying to obtain rich data. Blackler et al (2004) states that by using a small sample size, rich data would be obtained.
Fraser et al (2006) collected data in 2003 and interviews were completed. Reference PIS sheet. The interviews were semi-structured which allowed the participants to express their thoughts without having yes or no questions. The interviews were conducted within the participant’s home or at the hospitals pulmonary rehabilitation unit. The advantage of the interviews being conducted in the participant’s home allows the participant to relax and talk more freely. According to McDonald (2009) participants feel more in their own home and knowing their surroundings. The disadvantage of conducting the interviews in the participants own home includes people knocking on the door, the phone ringing and family or pets to look after. The advantage of conducting the interviews in the pulmonary rehabilitation unit allows the interview not to be disturbed. The disadvantage of the interviews being conducted in the pulmonary rehabilitation unit are, participants may have travel problems and may find it hard to get to the unit. Another disadvantage may be that the interview taking place in a hospital setting is too formal for the participant. All the interviews were recorded on audiotape. Consent would have to of been obtained for this. It is clearly stated in the article that consent was obtained. Lanoe (2002) states that the interference of white noise could affect the recordings, and if the interviews took place in the hospital setting then the white noise would be reduced. Once the tapes have been transcribed per verbatim, both recordings and transcripts will be locked in a secure unit until they are to be analysed. After all the data has been analysed to maintain rigour they will be destroyed. (Data Protection Act 1998).
The authors used Colaizzi’s (1978) method. This method involves 7 steps for the researchers to follow. The steps in order are 1. Reading the transcripts to gain an understanding of the participant’s experiences. 2. Using phrases to describe the experiences of living with severe COPD. 3. Deciphering meanings for phrases used. 4. Sorting meanings into themes. 5. Comparing themes with phrases. 6. Describing themes founds in the transcripts. 7. Showing the participants the results of the interviews. Since two independent researchers analysed the data, discussed the data and were then able to identify the themes present. Two out of the ten participants had their data shown to them to review the information and make sure it was correct. These two participants who reviewed their data showed there was no difference in the participants and researchers evaluation. Within the findings the authors together stated the three main themes and in the article participants quotes have been used.
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Fraser et al (2006) reported their findings and came to the conclusion that there were three main themes. These themes are ‘Knowing What Works’, ‘Hanging On… Barely’ and ‘Losing Control – Gaining Control’. The article explains these themes and with the use of participants dialogue allows the reader to have an understanding of the situation. Fraser et al (2006) displayed the three themes vividly by having them as sub sections. These show the reader that the next piece of article is specifically about that theme and that it is going to be explained in detail. As the approach is qualitative Fraser et al (2006) have displayed the use narratives and quotes from the participants. Ryan et al (2007) state that the findings should relate to what has been already found. Within this article the findings have already been displayed and explained within the article. By showing quality throughout the article Astin (2002) says this can show trustworthiness and by using quotes from the participants allows the readers to see the information taken.
LIMITATIONS OF THE STUDY
The limitations within this study include having participants who are willing to talk about their experience of living with the disease, being conducted within the southern United States of America and participants had to be diagnosed with ‘Very Severe’ chronic obstructive pulmonary disease. Fraser et al (2006) stated these limitations within the article along with participants having no cognitive impairment. The researchers also state how this is a very small sample of the overall population who suffer with the disease. It is also stated that a general population of sufferers of the disease in the United States of America is unknown.
Fraser et al (2006) have shown throughout this study that nursing staff are able to give a better standard of care to patients who suffer with this disease. This is due to nursing staff being able to have a better understanding of the impact this disease has on patients. By the nursing staff and patients working together the effects of chronic obstructive pulmonary disease can be reduced and this in turn can lead to patients having a better quality of life. As stated by Fraser et al (2006) the effect that the nurse and the patient can work through together include dyspnoea. The nurse can help manage this symptom with the patient by using inhalers to help relieve stress or by preparing the oxygen for the patient. The Nursing and Midwifery Council (2008) state that it is the nurse’s responsibility to uphold and deliver the best care to the patient with best practice and evidence which is available.
To conclude this article has expressed the need to have an understanding of a participant who suffers from the disease. Chronic obstructive pulmonary disease is a disease which not only can reduce the life span of a participant but one which can reduce the quality of life. This is a problem which will one day be reduced to give the participant a better life with a better understanding of the disease.
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