The research paper chosen for critique is Closeness and Distance: A way of Handling Difficult Situations in Daily Care by Blomberg, K. and Sahlberg-Blom, E. of the Department of Health Sciences, University of Örebro, Sweden. This research paper was published in Journal of Clinical Nursing Vol. 16 Feb 2007.
This paper is chosen because of its implications and relevance in current nursing practice.
The research appears to be well conducted following qualitative design and the researchers have analysed the accumulated data in a systematic and reproducible manner to arrive at a credible conclusion.
Research Paper Critique: Closeness and Distance: A Way of Handling Difficult Situations in Daily Care.
Title of the Research Article
The title is concise and captures the key concepts, but does not identify the population under study. The Abstract adequately summarises the research problem, study methods and important findings. The study was approved by an Ethics Committee.
Introduction
The study focuses on the psychological stress experienced by care team members caring for terminally ill cancer patients in three different palliative care units in two different Swedish cities and how they handle difficult situations during work. The phenomenological philosophy that underpins the research is well brought out. Qualitative design is appropriate for this study as it helps to explore and obtain a deeper understanding of the problem under study.
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Purpose of Research/Research Problem/Hypothesis
The aim of the study is to describe how care team members caring for patients with advanced cancer describe how they handled difficult situations during daily care.
The study focuses on the psychological stress experienced by care team members while handling difficult situations ranging from encountering multiple dimensions of suffering, confronting feelings of relatives and the moral conflicts resulting from having to compromise on care due to financial or organisational constraints. The need for professional and emotional support to the staff is advised to help them in developing proper coping strategies.
The purpose of the research is well stated and the researcher has well purported the relevance of the topic in nursing especially Palliative Care Nursing. The care of critically ill patients is demanding work and coping strategies have to be resorted to so as not to compromise the quality of care as well as the psychological wellbeing of the care staff.
The report does not formally state any hypothesis and the conclusion is derived in the context of the focus group discussions. Theoretical flexibility is maintained as no hypothesis was stated previously.
The coverage of literature seems sufficient to strengthen the topic under discussion.
The framework of the research is consistent with qualitative paradigm and the research question appears to be congruent with the research tradition. The research design is described well and the design enables a thorough examination of the phenomenon of interest.
Method
The method used to collect data was through focus group discussions [FGD]. Sixteen focus group discussions (FGD) comprising care team members caring for patients with advanced cancer were conducted in 2000 and 2001. The FGDs included care team members at three different care units in two Swedish cities. A total of 77 persons took part and each focus group comprised two to eight participants. All team members were women and they varied in terms of age and work life experience. Each focus group was composed of persons from the same care unit and comprised a mix of professions that included nurses, assistant nurses, psychologists, occupational therapists, occupational therapist aids and physiotherapists.
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Focus group discussions are advantageous in collecting data in qualitative studies as the interaction among the participants brings out different perspectives of the problem. Multiple meanings are revealed as different participants interpret the topic of discussion in different ways.
Drawbacks of FGD have to be considered and include the potentially strong influence of the moderator whose personal views may direct the discussion and the difficulty of obtaining an individual viewpoint from a collective view point. Individuals may be less willing to reveal sensitive information in a group context.
The conceptual and theoretical framework is consistent with the research paradigm. The conceptual definitions that emerge during the study such as Identity, Meaning, Limit setting and Touching, Prioritization, The Team and Organisation are clearly detailed.
Sampling
The sample population included care team members caring for terminally ill cancer patients at three different care units in two Swedish cities. This is an example of purposeful sampling as the focus groups can outsource comprehensive data in conjunction with the research problem. Chances of sample bias are reduced as each focus group comprises a mix of professions that included Nurses, Assistant Nurses, Psychologists, Occupational Therapists and Physiotherapists.
Sample size of 77 members grouped into 16 focus groups is sufficient and does not limit the data quality and given the needs of the study the sampling approach seemed appropriate.
Data Collection
The collection of data was by focus group discussions led by moderators. The moderators were all trained nurses whose aim was to pose open ended questions and stimulate the whole group to involve themselves. An observer took part with the aim of observing the participants activity and supporting the moderator in activating the whole group.
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Six different moderators conducted the FGDs. Each different FGD was tape recorded transcribed word for word by a professional transcriber, then read and corrected by the moderator and the observer. The participation of the observer enhances the credibility of the data.
Possibility of researcher bias enters all qualitative studies. As the researchers did not take part in the FGDs bias is reduced during data collection.
The data collectors were qualified for their role as they were all trained nurses and therefore able to gather high quality data.
Efforts made to enhance the trustworthiness and reproducibility of the data is discussed by the researchers like recording of the discussions, transcription and corrections.
Analysis
Analysis is done by phenomenological method which is compatible with the purpose of the study. Initial categorization scheme appears logical and the scheme was developed by more than one person collaboratively and thus validated.
The data is displayed adequately to allow the reader to verify the researchers’ conclusions. Inclusion of a conceptual map or model to display the processes during analysis would have helped to clarify the concepts better.
The report describes well and in detail the process of integrated thematic analysis. The theme can be defined as a concept, trend or distinction that emerged from the data [Bogdan and Biklen, 1985]. The themes that emerge during analysis are Identity, Meaning, Limit setting and Touching, Prioritization, Team and Organization.
Analysis was carried out in a number of steps inspired by the phenomenological method (Giorgi 1985, Giorgi & Giorgi 2003) and applied by Sahlberg-Blom, et al. (2000. The meaning of the original text was condensed in several steps so that variations and the essence of the studied phenomenon emerged (Giorgi 1985, Giorgi & Giorgi 2003).
The context of the phenomenon was adequately described and the researchers are able to project an insightful picture.
The researchers have addressed the credibility, auditability and fittingness of the data efficiently.
Results
The phenomenon’s essence, Closeness and Distance, emerged on analysis. The researchers refer to this as a scale where care team members described their strategy as a balance between being close and distancing themselves. They find that in most situations their choice of strategy seemed spontaneous rather than being a conscious decision, although it was sometimes described as a more conscious approach.
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Different variations of the essence emerged was divided into seven groups: Identity, Meaning, Limit-setting and touching, Prioritization, the Team and the Organization. These could also be described as tools which in themselves facilitated or impeded the use of closeness.
The phenomenon of closeness and distance is widely practiced by all people in different aspects of their life. Therefore the results are relevant in other care contexts as well as other personal and professional relationships. Conceptualizations of the researchers appear true to data and reader is able to grasp the essence.
Conclusion/Implication/Recommendations
The researchers does discuss the implications of the study in nursing practice and the research does have the potential to lead to more effective coping strategies for staff working in stressful situations. The researchers find that the care team members described handling difficult situations both by being close and by distancing themselves. The results can concern the health and well-being of care team members as well as of the patient and relatives. Too much closeness can lead to emotional commitments with patient and relatives and can lead to stress and burnout. Distancing themselves from the patient and relatives by evasive behaviour can lead to lack of humanistic approach and thus compromises the care. A balance between closeness and distance is required for optimal function in personal as well as professional life.
Interpretations seem consistent with the results and due consideration to the limitations of research methods was given such as the potential strong influence that the moderator can have on focus groups and the debatable issue of focus groups being unsuitable for phenomenological analysis.
The evidences in support of the interpretation include findings from another study [Glaser and Strauss 1965] where closeness and distance has been described as types of awareness contexts in the interaction between hospital staff and dying patients. Alternative explanations of findings are described as in the case of prioritization.
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The researchers offer recommendations for future study. Examples of research issues recommended include how care team members handle difficult situations in other care contexts and how they can be given support and stimulation in order to attain professional and personal growth.
Very few grammatical errors can be detected.
On the whole the report is well organized and presented regarding a very relevant subject in current nursing practice and the conclusions and implications have a deep significance in supporting and stimulating care team members and improving the quality of work.
References
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Mastering research critique and statistical interpretation: Guidelines and golden rules, Nurse Educator, 26(3), 136-1.
