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Andrew Dimech’s Research on the Critical Care, Article Critique Example

Pages: 10

Words: 2757

Article Critique

Introduction

An evidenced based practice is important for nursing because the decisions that should be made in relation to their profession should be well-informed. Also, it is important that nursing is an evidenced-based profession because people in the nursing profession deals with health care methods and administering treatments for patients. Note that evidences are derived from rigorous scientific method which will then generate broader implications from research findings that can assist in policy and guideline developments. The more well-informed a decision is, the more that decision will be likely to succeed.  The weight and strength that can be provided by evidences make a decision well-founded or well-informed. Evidences provide the objective account derived from testing the assumption that multiple realities exist. These realities are derived or constructed from research participants. In other words, evidences are the backbone of well informed decisions and claims.

This paper criticizes Andrew Dimech’s research titled “Critical Care Patients’ Experience of the Helmet Continuous Positive Airway Pressure”. The phenomenon studied was critical care patients’ experience of the helmet continuous positive airway pressure (CPAP). This was clearly identified in the title of the research as well as in the rationale and background of the study. The research is an attempt to provide evidences that can support broader implications derived from the research findings for policy and guideline developments and also for developing future patient focused care. The evidences were derived through approaching the collected data through qualitative research principles utilizing descriptive phenomenological methodology. This paper criticizes the integrity of the research design and the validity and reliability of the research findings using Ryan, Coughlan, and Cronin’s (2007) article as primary guideline.

Critique

Literature Review

There is no section in the research article for review of related literature. The reason might be the dearth of studies on the phenomenon being studied: “There is minimal evidence to date explaining the patient’s experience of the new helmet modality.” Though no section for literature review is present in the paper, the studies cited to support the assumptions of the paper [e.g. each patients’ “… experience was unique, interchangeable, contradictory, and paradoxical at times” (Dimech, 2012, p. 36) even though their experience “could be explored [by means of] looking at physical and psychological impacts” (Dimech, 2012, p.37) among the patients.] met the philosophical underpinnings of the study, which is phenomenology. For instance, studies (Antonelli, et al., 2002; Taccone, et al., 2004; Patroniti, et al., 2003; Fabrizio, et al., 2005) were cited in order to show the physical impacts of CPAP on patients and proceeds to claiming that though these studies shows that helmet CPAP provides better tolerance and fewer complications compared to facial CPAP, such studies were not able to explore the patients’ experiences. These realities established the rationale for venturing into a research exploring the experiences of patients who were exposed to helmet CPAP treatment.

Research Design

Andrew Dimech’s research follows the paradigm of interpretivism. This kind of paradigm concerns itself with the “understanding” rather than “explaining” the subject of research (Hughes, 2010). The research design takes a qualitative approach, utilizing descriptive phenomenological methodology. Considering Dimech’s aim of understanding how patients experience helmet CPA, the paradigm of interpretivism is appropriate for the research. In other words, the researcher was able to establish the integrity of his research through using a paradigm that is appropriate for the purpose of his research. Note that design of a research study should be evaluated according to the criteria of critical paradigm (Hughes, 2010).

Judging Dimech’s research through the criteria of interpretivism, the researcher was able to follow a research design that allows him to collect the data needed for an analysis that underpins phenomenology. Phenomenology aims to describe the intentional experience without prior knowledge, bias and explanations (Cohn, 1997, p. 55). However, it is impossible to fully apply the rule of bracketing. In every encounter one brings a fraction of his previous knowledge and perceptions. One cannot totally disconnect himself from his own experience. Although this proposed research aims to describe the experience of human beings and phenomenology is the suitable way to do it, one should also be aware of its limitations. In order to achieve a sound phenomenological analysis, one must use reduction where everything that is not actually experienced is suspended. Assumptions, prejudices and expectations when facing other’s experience are bracketed. By doing so, one can get an immediate contact with the experience itself (Cohn, 1997, p.70). The research allows the reader to evaluate its integrity in relation to the factors that may impact the interpretation because it provides a research and reflective diary, which will be further discussed later in the critique of Dimech’s research’s validity and reliability.

Sample, Sampling Method, and Sampling Size

The sampling method and sample size were identified. The sampling method is also appropriate. Moreover, the participants were suitable for informing the research. The sampling method is through recruitment of patients via the critical care outreach team five days post-discharge from the critical care unit. Eight patients were recruited. The sample size was six male patients. The participants were suited for informing the research because of their exposure to or their experience with the phenomena in question. The participants were patients who had undergone active treatments that involve wearing helmet CPAP.

Methods of Data Collection and Data Analysis

Data collection strategies were described. The strategies used to analyze the data were described. Furthermore, the researcher followed the steps of the data analysis method described. The data collection strategy was through conducting interview, which is appropriate for the philosophical underpinnings of the study (e.g. phenomenology). Also, Dimech was able to justify his use of phenomenological research interview (Lowes & Prowse, 2001) as the data generating process. The interview is loosely structured, face-to-face and audio-recorded, and conducted “away from the critical care environment but within the Trust in a private relative’s area” (Dimech, 2012, p.38). Planned broad interview were also conducted to make the data richer. The rationale was provided for choosing such data collection method; that is, to let the agenda flow, providing rich source of data, and also to uphold the participant’s confidentiality. The data analysis used a thematic network approach that allows “salient themes to be unearthed from qualitative data that shares the key features of hermeneutic analysis… and aims to explore the significance of an idea or understanding of an issue” (Dimech, 2012, p.38).

Validity and Reliability

The researcher discussed how rigour was assured. Credibility, dependability, transferability, and goodness were also discussed. The researcher adopts some strategies suggested by Parahoo (2006) in order to ensure rigour in his research. The reader is able audit the actions and developments of the researcher because a research diary was utilized. This diary includes “details and rationales of all actions and decisions thus supporting decisions made throughout the study. In addition, a reflective diary was provided to ensure reflexivity. The reflective diary acknowledges the “researcher’s background and beliefs and how they may impact on the research” (Dimech, 2012, p.39). The recording of the development of the research as it was being conducted supports the dependability of the research as the research diary provides the reader with evidence of decisions regarding methodological issues throughout the process of research. Goodness was also ensured as the internal validity of each transcript “was offered to the patients to review after the interview” allowing them to “comment on how things really were during the treatment with helmet CPAP” (Dimech, 2012, p.39). This also supports the credibility of the research. Credibility is also discussed as the researcher mentions that two of the participants read the transcript and felt it was a true reflection of their experience. This shows that there is consistency between the participant’s view and the researcher’s reflection on them. The research was also able to prove that its findings can be applied outside the context of the study situation, hence establishing its transferability. The findings of the study have implications that are transferable “to the wider critical care environment” (Dimech, 2012, p.41) such as understanding a patient’s experience of critical care intervention. The broader implications derived from the study can also be taken into account in training programs for healthcare professionals trained using medical equipments.

Ethical Issues

The participants were fully informed about the nature of the research. Also, the participants’ autonomy was guaranteed. In addition, all the participants were protected from harm. An ethical permission was also granted for the study. The critical care outreach team informed patients who have met the inclusion criteria of the study, supplied them with information sheet, and sought each patient’s interest to the study. The researcher then conducted an interview with the patients where questions were answered prior to gaining informed written consent. The participants were protected from harm as the researcher followed the principles of beneficence and non-maleficence. An ethical permission was granted for the study by the Local Research and Ethics Committee, and local trust Research and Development.

Findings and Discussion

The findings are presented appropriately. The original purpose of the study has been adequately addressed. The presentation of the findings was able to capture the qualitative and experiential dimensions of psychology. It concerns with detailed examination of the individual lived experience and how people are making sense of that experience. At the same time, it still does maintain its dialogue with the mainstream psychology. As mentioned, the interview is loosely structured, face-to-face and audio-recorded, and conducted “away from the critical care environment but within the Trust in a private relative’s area.” This enables the researcher to to conduct examination in a way which as far as it is possible will enable the participant’s experience to be expressed in its own terms, rather than according to predefined category system (Smith & Osborn, 2008). Nevertheless, interpretation is a necessary part of phenomenology because the entity’s mode of appearing may conceal something that is hidden (Shinebourne, 2010; Shinebourne, 2009). It is clear, therefore, that the wish to capture the individual personal phenomenological experience will involve a certain degree of interpretation, as analysis always involves interpretation. The researcher was able to do this by utilizing a thematic network consisting of three-tiered web-like map which includes the basic theme, the organizing theme, and the global theme.

To sum up, the researcher was able to focuses on the detailed exploration of the unique personal lived experience of each participant/patient on helmet CPAC and explore how each participant make sense of their experience. It concerned with trying to understand the experience from the point of view of the participant. Note that Delany (2005) maintains that if a topic of research belongs to an institution of society (e. g. medical institution); some social science principles are relevant.  At the same time it is aware and acknowledges the fact that understanding the event must be mediated by the context of gender as all the participants were male. It is interpretative as it recognizes the role of the researcher in making sense of the participants’ experiences.

The discussion of the findings shows that the data analysis is an iterative, complex, and creative process. It requires the researcher’s reflective engagement in the dialogue with the participant’s narrative and meaning. The process remains flexible (the interview was loosely structured) to enable following up interesting possibilities emerging during the interview. The researcher’s strategy leaves room for fluidity and flexibility but at the same time offers a frame for the analysis the data was analyzed using the three-tiered thematic network. How the researcher utilized the thematic framework is consistent with the philosophical underpinnings of the research in relation to interpreting the collected data (Shinebourne, 2010; Smith et al, 2009). There are four stages of this analysis: (1) reading the transcript and searching for meaning and initial coding, (2) returning again to the transcript and especially to the initial notes taken in the previous stage, aiming to develop emerging themes, (3) finding patterns in the emerging themes, and (4) producing a table of themes, showing the structure of super ordinate themes and sub-themes where Dimech show how the global theme was achieved through the global and organizational themes. Through following the method of data analysis and using the paradigm appropriate for the objective of the study, the original purpose of the study (i.e. to explore critical care patients’ experience of the helmet continuous positive airway pressure) has been adequately addressed.

Recommendations

The importance and implications of the findings are identified. Recommendations are suggested on how the findings of the research can be developed. The importance and implications of the findings are identified through highlighting the broader implications of the findings and how these implications can be transferable to wider critical care environment. This is also how the researcher was able to provide recommendations on how the findings of the research can be developed. That is through considering the findings of the research and the broader implications derived from the findings for policy and guideline developments and also for developing future patient focused care.

Conclusion

In sum, Andrew Dimech’s research on the patients’ experience on helmet CPA was able to reach its original purpose. This is because the research design, method, and philosophical underpinnings were appropriate to the objective of his research. Andrew Dimech follows a paradigm appropriate for his research objective. The sampling method and sample size were identified. The sampling method is also appropriate. Also, the participants were suitable for informing the research. Data collection strategies were described. The strategies used to analyze the data were also described. Furthermore, the researcher followed the steps of the data analysis method described. The researcher discussed how rigour was assured. Credibility, dependability, transferability, and goodness were also discussed. The participants were fully informed about the nature of the research. In addition, the participants’ autonomy was guaranteed. An ethical permission was also granted for the study. The findings are presented appropriately. The original purpose of the study has been adequately addressed. The importance and implications of the findings are identified. Finally, recommendations are suggested on how the findings of the research can be developed. With the research, Dimech was able to demonstrate how important it is for nursing to be an evidenced-based profession, as he was able to present the findings in such a way that scientific evidences derived from his rigorous method of analysis are suggested to have broader implication in wider clinical environment.

References

Antonelli, M. et al., 2002. New treatment of acute hypoxemic respiratory failure: noninvasive pressure support ventilation delivered by helmet-a pilot controlled trial. Critical Care Medicine, Volume 30, p. 602–608.

Baptiste, I., 2005. Developing a Research Design. [Online] Available at: http://www.liberty.edu/media/1106/Baptiste%20research%20design.pdf

Baslanti, U. & McCoach, B., 2006. Factors Related to the Underachievement of University Students in Turkey. Roeper Review, 28(4), pp. 210-215.

Cohn, H., 1997. Existential thought and therapeutic practice. London: Sage.

Delaney, A. M., 2005. Research Design Ideas for Institutional Researchers. [Online]  Available at: http://www.inair.org/images/2005AIRWrkshp_trainthetrainer.pdf [Accessed 31 July 2011].

Dimech, A., 2012. Critical care patients’ experience of the helmet continuous positive airway pressure. Nursing in Critical Care, 17(1), pp. 36-43.

Fabrizio, R. et al., 2005. Effectiveness of mask and helmet interfaces to deliver noninvasive ventilation in a human model of resistive breathing. Journal of Applied Physiology, Volume 99, p. 1262–1271.

Griffiths, M., 1998. Educational Research for Social Justice: Getting Off the Fence. Buckingham: Open University Press.

Hughes, C., 2010. Teaching: Research Process. [Online]  Available at: http://www2.warwick.ac.uk/fac/soc/sociology/staff/academicstaff/chughes/hughesc_index/teachingresearchprocess/

Lister, D. & Ansalone, G., 2006. Utilizing Modality Theory to Achieve Academic Success. Educational Research Quarterly, 30(2), pp. 19-29.

Lowes, L. & Prowse, M., 2001. Standing outside the interview process? The illusion of objectivity in phenomenological data generation. International Journal of Nursing Studies, Volume 38, p. 471–480.

MacLeod, S., 1997. Johnny could do better: understanding underachievers. Today’s Parent, October, 14(8), p. 30.

Patroniti, N. et al., 2003. Head helmet versus face mask for non-invasive continuous positive airway pressure: a physiological study. Intensive Care Medicine, Volume 29, p. 1680–1687.

Prahoo, K., 2006. Nursing Research: Principles, Process and Issues. London: Palgrave MacMillan.

Ryan, F., Coughlan, M. & Cronin, P., 2007. Step-by-step guide to critiquing research. Part 2: Qualitative Research. British Journal of Nursing, 16(12), pp. 738-744.

Shinebourne, P., 2010. Interpretative Phenomenological Analysis. In: N. Frost, ed. Qualitative Research Methods in Psychology:  Combining Core Approaches. Buckingham: Open University Press.

Shinebourne, P. & Smith, J., 2009. Alcohol and the self: An interpretative phenomenological analysis of the experience of addiction and its impact on the sense of self and identity. Addiction Research &  Theory, 17(2), pp. 152-167.

Smith, J. & Osborn, M., 2008. Interpretative Phenomenological Analysis. In: J. Smith, ed. Qualitative Psychology- a practical guide to research methods. London: Sage.

Taccone, P., Hess, D., Caironi, P. & Bigatello, L., 2004. Continuous positive airway pressure delivered with a helmet: effects on carbon dioxide rebreathing. Critical Care Medicine, Volume 32, p. 2090–2096.

Wolf, R., 2005. Judging Research Based on Experiments and Surveys. [Online] Available at: http://www.unesco.org/iiep/PDF/TR_Mods/Qu_Mod4.pdf.

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