Qualitative Research Critique Essay

Qualitative Study

“Kirby, E., Broom, a. & Good, P. (2014). The role and significance of nurses in managing transitions to palliative care: a qualitative study. BMJ Open, 4(9), e006026. doi: 10.1136/bmjopen-2014-006026”

Background of Study:

The research study was conducted with the intention exploring nurses’ opinion on the role that they can play to facilitate effective palliative care transition. The authors acknowledged that nursing personnel are typically present at all levels of patient care and are even involved in offer support and acceptance of the condition’s futility for both the patient and family. In this case, the nurses get to explain that palliative care is akin to terminal care since it addresses terminal ailments with treatments options only capable of slowing down the disease progression and addressing the symptoms presentation with no real cure in sight. Besides that, they play an integral role in supporting other medical professions to communicate with patients. Despite the nurses’ presence at every role of palliative care provision to include supporting other medical professions, their roles and significance in ensuring timely and effective palliative care. This is against the backdrop of knowledge that transitioning between life prolonging intervention and palliative care can be a challenge since the patient and family must accept that treatment is futile and the next step is to ensure that the patient is comfortable over the remaining course of the disease progression until the patient dies. Although clinical studies show that early transition is beneficial to the patient since it improves both quality and quantity of life, getting the distressed patient and family to accept the change is a challenge that is made more difficult if the nurses are absent. That is because the nurses are involved in sensitively communicating and negotiating the futility of proceeding with life prolonging interventions while recommending a transition to palliative care. While nurses play a role in the transition, their exact role is not well explored. The study explores this role by systematically examining nurses’ opinions and self-reports about how they support the transition to achieve time and effective changes that improve quality and quality of life. The study addresses this gap by collecting nurses’ opinion to explore how they experience the change from life-prolonging care (hope for treatment and cure) to palliative care (no hope for treatment and cure), as well as how they can facilitate more effective care transitions. Qualitative Research Critique Essay

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Method of Study:

The study applied a qualitative research approach that used semi-structured interviews that were completed by the nurses. The interviews were the data collection tools that were managed by the researcher and presented to selected nurses as participants. The specific question was how they approached transition in palliative care in terms of referring and transferring patients. The study setting was in a major metropolitan center in Australia. Two medical facilities were identified with the two offering both public and private clinical environments. The study initially approached all the facility nurses concerned with offering referral services and managing palliative care transition. 20 nurses consented to participate in the study and complete the interviews. The 20 nurses were comprised 6 senior coordinators and nurse unit managers, 10 clinical nurses, and 4 newly qualified and junior nurses. In terms of gender, there were 2 males and 18 females. The participants’ ages ranged from early 20s to late 50s. Prior to the interview, they provided written consent. The interviews were structured to run for between 30 minutes and 60 minutes and recorded using audio digital recorders. The interviews were designed to include questions that explored four domains. The first domain asked about the basis for nursing practice at the transition point. The second domain asked about interactions with patients and families concerning end of life and palliative care. The third domain explored the interpersonal, intra-professional and inter-professional dynamics that exist in transition to palliative care. The final domain explored how the transition emotionally and inter-professionally impacted the nurses. The interviews proceeded until a thematic saturation was achieved. The interviews reliability was enhanced through interview techniques that summarized and queried the points to confirm what the nurse intended to express. Once the interviews were completed and transcribed, the collected data was them subjected to systematic thematic content analysis using NVivo 9 software. The software conducted five activities. Firstly, it familiarized the information. Secondly, it identified frameworks to include key issues and themes to direct data organization. Thirdly, it indexed the data by applying the themes. Fourthly, it charted the data using headings and subheadings. Finally, it mapped and interpreted the data by clarifying and explaining its implications. All the audio recordings, reports, notes and any other documentation concerning the research were retained and stored securely to facilitate research audit efforts. Qualitative Research Critique Essay

Results of Study:

All the participants provided extensive information that advanced the research efforts. They all concurred that their professional work was time-intensive, emotionally draining, and complicated relationships with patients, other health professionals and nurses. The thematic analysis identified four predominant themes. The first theme concerned nurses’ role in transition to palliative care. The second theme concerned emotional support and effective transitions. The third theme concerned managing task-oriented nursing and support for the patients during the transition. The final theme concerned the emotional burden that the transition placed on the nurses. Overall, the nurses concurred that they occupy a critical and complex role in the management of care futility and transition to palliative care since they have the most contact with the patients, and are best positioned to offer trusted advice. Other than the role that nurses played, they also experience emotional burdens from balancing the interpersonal and inter-professional relations during the transition. The study determined that it is necessary to formalize the nurses’ role in the transition period. It also showed a greater need to create inter-professional teams to address the transition to guarantee that a patient-centered approach would be adopted with the inclusion of perceptions from different medical professions. Still, additional research is necessary to identify the role of other health professions before identifying the exact role of the inter-professional team.

Ethical Considerations:

The article presents details on the ethics procedure applied during the study. It first notes that ethical approval was sought from the University of Queensland Human Research Ethics Committee to imply that the study did not place the participants in intentional harm. Secondly, it notes that the participants signed a consent form to imply that they voluntarily participated in the study. Thirdly, all records concerning the study have been stored to create an audit trail that would verify the research procedure and results. Qualitative Research Critique Essay

Conclusion:

The study applied a qualitative approach that relied on interviews to collect primary data from 20 participants selected from among the study population identified as nurses concerned with transition to palliative care. The intention was to identify the role of nursing personnel in the transition. It concedes that nurses play a unique role since they have close contact with other medical personnel, the patients and their families. However, the role is limited by the emotional burdens nurses face. Still, the best results would be achieved by including nurses as part of an inter-professional team.

Qualitative Research Critique Essay

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