Critiquing a research article requires the understanding of different standards and criteria. The diversity of qualitative methods available can make the appraisal tough, as it needs knowledge and skills to evaluate the research process. The article chosen for critique is "The Role transition of Nurses in a University teaching hospital in Pakistan." This article was written by Lalani & Dias in 2011. The purpose of this qualitative research critique is to present a critical appraisal of the research problem, literature review, theoretical and conceptual framework, population and sampling, research design, data collection and analysis, human rights protection, rigor, conclusion and recommendations.
The title of the article very well portrays the content of the research. The transition role from "student nurses" could have been added to give a clear picture to the readers that it is about "transition from a student nurse to a staff nurse." Because, just reading the title, doesn't give an idea as to what transition the author is talking about, as there are several role transitions a nurse endures in her professional life. The addition of the name of the city, "Karachi" would have further specified the study setting. The abstract of the study although brief, gives the reader an overview of the topic of study, the study setting, participants and the outcome. Whereas, according to Haynes et al. (1990), abstracts should be comprehensive and give details of the study such as the objective, research design, and information about clinical setting, participants, outcomes, results and conclusion. Therefore, a more elaborate abstract could have served the purpose.
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The research problem stated in the study is significant and related to the nursing context, as it is addressing the transition of nurses from the role of a student to a staff nurse. When this transition phase would be dealt with attention, there would be more satisfied nurses and low turnover. The researcher has emphasized the significance of the problem in the context of nursing by sharing that the faculty and administrators in this discipline are really concerned about the new graduates who are facing difficulties in their new role adjustment period and how this problem is leading to high turnover rates among novice nurses. The purpose of the study have been explicitly mentioned in the paper and addressed as the needs of the new graduates and how this transition phase could be facilitated strategically. The problem statement has been very well introduced through the objectives.
The assumptions have not been mentioned explicitly but could be inferred that the researcher assumed that the novice nurses faced difficulties adjusting to the new role. The limitations expressed in this study are that some of the transitional experiences would have been elapsed or forgotten; the study participants might have felt compelled to offer socially acceptable responses or would have been swayed by the researcher.
Review of the literature
The article has used literature moderately, as the author has focussed mainly on the substantive theory derived from the study. The article encompasses both theoretical and empirical literature review. The researcher started with the problem and has even emphasized on the increased turnover rate, but reference for the data hasn't been given, which seems imperative in relation to the problem. The researcher has otherwise integrated pertinent research studies and theoretical articles and books, by citing relevant material. She has not used any quotations except the verbatim quotes by the study participants
The search strategy is not mentioned in the article. To replicate this study the researcher would have to perform literature search again as the search strategy has not been elaborated and this study is pertinent to the Pakistani context. The literature that has been used is from 12 references of which 5 books and 7 journal articles are used, and these include both old and recent literature from 1974 to 2005. The book that was used from 1974 appears to be a classical one and discusses in contrast with the study topic. Operational or conceptual definitions of terms are not included in the study. Researcher has integrated the references throughout the article and the reference list is provided at the end of the article.
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The grounded theory approach has been utilized, and its use is clearly justified as it has been derived from the sociology perspective (Creswell, 2007). The study has been conducted using the naturalistic method of inquiry which is a way of exploring the human complexity (Polit & Beck, 2008) by qualitative methodology. The description of the frame work and conceptual underpinnings are explicitly described under the heading of methodology. Being a grounded theory approach, the researcher relied on data from interviews, participant observations, and confirmed by further clarification obtained for the meanings of words used during the interviews. Even non-verbal cues were considered and notes made during the interview process. For grounded theory approach, four properties need to be evaluated which include fitness, understanding, generality, and control (Polit & Beck, 2008). The substantive theory derived from the study is commendable and it fits like a glove to the experiences that novice nurses encounter during the adjustment phase and it is generable to novice members of other professions as well. This substantive theory is easily understandable with the analogy of sailing. The derivation of this substantive theory is a clear evidence of moving from a descriptive to theoretical conceptual framework. Altogether four themes emerged from this derivation, which will be discussed in the findings portion.
Population and Sampling
The methodology part comprised of the details of sampling strategy and recruited population. The sampling strategy appears to be purposive sampling where participants were chosen from surgical, medical and intensive care units so that the required data could be yielded from these participants. This sampling can also be called theoretical sampling as themes were explored in depth to formulate a theory (Fossey et.al. in Ryan, Coughlan & Cronin, 2007). Both purposive and theoretical sampling can be used in grounded theory researches. The inclusion criteria is clearly mentioned, where 7 nurses were chosen, who had recently graduated from the diploma program of the Aga Khan University school of nursing and had been working at the hospital for a period of 6-12 months. This sample size is adequate according to the qualitative study. During the process of recruitment, the principle of saturation was followed and it is considered that saturation is reached when no new material is emerging from the data and here data gathering is usually stopped (Polit & Beck, 2008).
The variation in the samples was not defined, especially the gender of the participants should be included to find out which gender found the adjustment period more problematic. It was not indicated but it seemed that the majority of the participants belonged to the Ismaili community (a sect in Islam), so to achieve a variation of sample, nurses from other communities could have been taken for the study. The researcher used a formal unstructured interview strategy to obtain data, which is appropriate for a qualitative study where experiences of individuals need to be focussed. According to Kahn (2000) in Polit & Beck (2008), unstructured interviews should resemble normal conversations. The interviews in the study lasted for 50-90 minutes, which were tape recorded and transcribed maintaining anonymity. It is stated in the article that non-verbal cues of the participants, setting, and interruptions during the interviews were all taken in the form of notes which ensured rigor and transferability. The individual characteristics of the participants have not been defined, so it was difficult to infer about the negative or discrepant cases.
The researcher has used a grounded theory design and has applied principles of qualitative research. The rationale for this approach was used to develop a theory and to explain the key concepts and processes involved in role transition. The researcher has not mentioned about the research question in the article nor has she given any questions which guided her unstructured interviews. The research is replicable in terms of research design, sampling, data collection method and analysis.
The researcher used a formal unstructured interview guide to obtain the data, but the rationale for using this method was not stated in the article. Each interview was for a time period of 50-90 minutes, and was tape recorded. The time allotted for each interview was adequate to explore the topic of research which could be examined in a single interaction (May, 1991). At times such interviews might miss important information from a participant whom the researcher has rarely met may fail to extract information which would emerge from multiple interviews (Mishler, 1986). The interviews prove to be strong if the researcher herself conducts the interviews and that would eliminate person to person biases. In qualitative research, data collection is often done by single researcher although self-training and preparation is required (Polit & Beck, 2008). In this study, it is not mentioned as to who conducted the interviews, whether there were one or more interviewers and they were trained or not (Polit & Beck, 2008). Details about the interviews and description of how they were conducted are stated in the paper. This data was then transcribed maintaining anonymity. The language used to conduct interviews is not mentioned; that could have elaborated the comfort level of the participants with the language for expression. Notes were made for the participant's non-verbal behaviours, interruptions faced, and other significant incidences during the interviews. The details about the setting where the interviews were conducted are not stated. The method of data collection was congruent with the study and its objectives.
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The participants were included in the study on a voluntary basis and consent for participation was also obtained and there was no evidence of fraud or intimidation with the participants. There is no mention about the invitation of participants for the consent at a particular time. All personal identifiers were removed when interviews were transcribed to maintain anonymity of the participants. So, principles of voluntary participation, consent taking and anonymity were followed. The ethical approval acquisition for the study has not been stated in the article. This is an important aspect which needs to be declared in the study (Burns & Grove, 2007). The study has been conducted to maximize benefits not only to the participants, but to the entire nursing community.
Analysis of data started from the first interview, and then continued throughout the process of data collection. The researcher has not explicitly defined the type of content analysis but it can be inferred that constant comparative method was used for data analysis till concepts were connected and hypothesis were formed. This can be accomplished by constantly comparing the new information gathered with the previous one (Chioviti & Piran, 2003). The expressions, observations, and testimonials of the participants were classified into groups. During the interviews clarification of meanings of words were pursued and the thoughts about emerging themes were acquired. At the same time notes were taken to develop on the ideas, to build on the themes that emerged from the conversations.
For Data analysis it hasn't been specified as to whose guidelines were used, but by the references in the analysis part, it can be assumed that guidelines from Strauss & Corbin (1998) were used. There was theoretical coding and sorting of data which helped derive themes from the raw data and the organization of data lead to a theoretical framework. Overall, the data analysis was superbly presented in a rationale and plausible way.
In this study, tape recorded interviews were used which are reliable and verifiable. The researcher has also used field notes throughout the interviews about non-verbal responses, setting and any interruptions during the interview which are the strengths of the interview strategy. It appears that interviews were only done once with each participant, so prolonged engagement did not occur. Extended engagement with the participants would increase trust between the researcher and the participant, which would in turn develop rigor in the study (Polit & Beck, 2008). The settings or environment in which the interviews were conducted is not stated in the article. It has not been specified as to how many researchers performed the analysis and if more how differences in interpretations resolved. Both positive and discrepant results obtained from the study have been fully addressed in the findings, such as happiness among the graduates for their convocation and financial stability and the difficulties faced in the new work areas.
The researcher has not mentioned about the framework used to sustain the rigor of the study but it seems that she has used guidelines by Lincoln & Guba (1985), which are assumed to have facilitated in achieving rigor. Trust worthiness is quite evident from the article and the truth is revealed through this study and so this study is dependable as trust worthiness and dependability go hand in hand. The aspect of conformability has also been catered by the verbatim quotes of the participants mentioned in this article. Another feature of transferability can be evaluated and conclusion drawn from it that it can be applicable to other private university hospitals and this concept of role transition can be applied to other settings as well.
The researcher has not given her perspective nor has reflected regarding this study, while reflection is an important concept in qualitative studies and researcher needs to be elaborative about her perspective and the role she played as a researcher throughout the research process (Polit & Beck, 2008). The researcher has not revealed her personal biases anywhere in the article except that at a point she has mentioned that participants might have been influenced by the researcher.
The findings of the study are presented in the form of a theoretical framework and through themes emerging from the study. The core category has been named as "sailing forward" which is linked to the transition phase from student to a staff nurse including the effects of transition on their personal and professional lives expressed by further categories and sub-categories. The themes that emerged from the study are stepping into the new role, initial adjustment, support systems, and the resolution phase. These phases have been explained in depth and elaborated in terms of all apprehensions and contentment encountered in the beginning, problems faced when maintaining balance between personal and professional responsibilities, seeking help from professional buddies and family, and finally being able to speak for own rights for a positive adjustment. The findings of the study were consistent with researches conducted regarding transition, where the phase of transition was considered as a stressful process. A salient aspect that surfaced from this study was the feeling of spiritual distress experienced by these novice nurses which suggested investigation of how spiritual care could be provided by a nurse to her patient who herself feels spiritually discontented.
Conclusion and Recommendations
The results of the data analysis have been explicitly explained in the findings and discussion part linking the objectives of the study. The recommendations suggested after this study were to have collaboration between the institutions for nursing education and practice for teaching and practice settings. The participants of the study suggested that there should be increased clinical hours and extended post conferences. Other recommendations to improve the transition period of novice nurses are to have a warm welcome for the new graduates, effective orientations, mentorship and preceptor ship programs, support and appreciation from managers, and improvement in working conditions. These recommendations are justified in the findings voiced by the participants. Recommendations for future studies were specified in the direction of exploration of how nurses can provide spiritual care when they themselves are not spiritually satisfied. The findings of the study are transferable and applicable to other private hospitals and other settings as well because every new nursing graduate would experience the difficulties of transition phase.