Qualitative_Research_Article

Qualitative Research Article Critique Evidence Based Nursing Research and Practice/NUR 443 Qualitative Research Article Critique: Nurse Characteristics and Inferences About Children’s Pain STANDARD 1: DESCRIPTIVE VIVIDNESS 1. Purpose: “The purpose of the study was to describe pediatric nurses’ projected responses to children’s pain as described in vignettes of hospitalized children and to explore nurses characteristics that might influence those responses” (Griffen, Polit, & Byrne, 2008, p. 298.) 2. Significance: Previous studies have been reviewed and evaluated of the nurse’s use and non-use of pain assessment tools consistently in the pediatric population. Reported nurse characteristics are inconsistent in pediatric pain management studies however, prior studies showed children’s pain and nursing characteristics did not influence treatment of pain. Similar results reported are nurse’s perceptions of pain levels for children do not correlate with the child’s report of pain, nurses’ under-prescribe pain treatment in children; and many non-pharmacologic measures are consistently underutilized. This study focused on the nurses with a varied education level, characteristics, personal experience with pediatric pain, and the proposed methods of pain relief for the pediatric child. Within this study the researcher examines many variables behind nurse and the pain treatment of the hospitalized child. 3. Interpretations and Analysis: As reported by Griffen, Polit, and Byrne (2008), “education, years of experience, personal pain experience, recent pain education, and whether respondents were currently practicing were not significantly associated with pain perceptions or with pain management choices” (p. 303.) However, clearly showed higher pain dosages were given by the higher education of a nurse, the Nurse Practitioner (NP); a Caucasian nurse practiced more non-pharmacologic pain management practices than other race or ethnicities. A significant factor in this study demonstrating a difference from many other studies in the area of pain is the large sample size of nurses. A major finding in the survey from the pediatric nurse population is the “dominance of responses that reflect awareness of appropriate treatment decisions related to children’s pain, regardless of the nurse’s characteristics” (Griffen, Polit, & Byrne, 2008, p. 303.) Nurse assessment and evaluation correlated with the child reported pain level resulting in the maximum pharmacologic treatment. This result is a major change a treatment as for many years children were under-medicated. Previous studies cited the use of non-pharmacologic treatment has been underutilized because of inadequate knowledge, lack of protocols, and workload barriers” (Griffen, Polit, & Byrne, 2008, p. 303). In contrast, Griffen, Polit, and Byrne (2008), on average per each vignette nurses report the use of at least four non-pharmacologic interventions involving both nurse coordinated methods (NCM) and nurse participation method’s (NPM). The authors openly discuss and acknowledge limitations within the study. Vignettes were brief and of acute situations, used school-aged children of similar developmental stage, high levels of pain evaluated, and the insinuation of nurses responding the same. Pain management of all age levels and both acute and long term would reveal a more in-depth view to help create better pain models in the pediatric population. STANDARD 2: METHODOLOGICAL CONGRUENCE Adequate documentation of the participants 1. Description of study participants: Three hundred thirty four nurses of 663 eligible nurses responded to the questionnaire send out. The questionnaire was sent out to registered nurses subscribing to pediatric journals or who had purchased pediatric books in January 2005. The nurse population broken down showed not all nurses specialized in pediatric care. The researchers had 31% of the responded nurse population as “other nursing specialty.” A more selective group of nurses involved in direct pediatric care would give more strength and reliability to the study 2. Selection of participants: To obtain accurate reports of pediatric pain knowledge the authors wanted a sample of nurses likely to be experienced, well educated, and well read. The researcher tried to obtain pediatric specialty nurses however, the American Nurse Association (ANA) did not cooperate and provide such names. They believed the population of 9000 pediatric nurses from a publishing company would be beneficial. However with preconceived knowledge of low response rates of mailed surveys, 700 nurses of the 9000 nurses were mailed the survey. As the questionnaires were voluntary and repeated mailing had to be sent to potential participants, researchers gained approval from the IRB to gain cooperation participants will be entered for a $200 gift certificate. 3. Application to other settings: Participants were generated form 39 states in the United States. The participant high weighed on a high number of NP’s (32%) as compared to a national survey by DHHS in 2000 with only 3% pediatric nurses. Nurses completed the survey in their own privacy, outside the clinical arena. It would be helpful to study how pediatric nurses would score the same patients, with the same scenarios, in a hospital setting. Can a face-to-face interaction provoke a different action in addition to the expedience of treatment' The study did not address an interest in a bedside practicum versus the paper survey. Careful attention to procedural approach 1. Articulation of assumption: The authors did identify nurses have considerable pain treatment variance and deficiencies. They determined if the deficiencies are identified, efforts be made to improve nursing knowledge and performance. 2. Establishment of trust: Mail questionnaires can be difficult due change of address, mislabeling of participant name, or the esthetics of the mailing to be perceived as junk mail, evidence of the multiple mailings of the questionnaire, and low eligibility of participants it can be assumed that nurses did not want to be a participant of this study. 3. Articulation of trust: An example questionnaire was not provided for review, only a sample vignettes. The vignettes included eight descriptions of the child patient: medical diagnosis, medical treatment, pain treatment, PRN pain treatment, pain level, age, sex, and weight. A pediatric pain specialist consulted for clinical validity of the vignette. The FACES pain scale was used due to the congruence and validity. As the FACES pain scale is commonly known in pediatric nursing, it is not the only pain assessment tool used for the pediatric population. Participants of the survey may not be knowledgeable to the full potential of the FACES and may have more experience using a different tool in their practice. This factor can limit the full potential to accurately assess pain in the pediatric patient. 4. Consistency of data collectors during the data collection process: The authors do not comment of their involvement in the data collection process. The researcher did state the use of a modified Dillman approach to enhance return rates of the questionnaire. Vignettes had similar scenarios with only one of the three with a different pain level of six and their definition of it being extreme pain. A pediatric nurse may evaluate the patient differently when in front of the child patient therefore evaluating a bigger picture therefore the possibility of a higher pain level. 5. Description of data collection process: The authors do not describe themselves as a large part of the data collection process. 6. Time spent with participants: The authors spent no time with participants. Again, perhaps if this study was done in a clinical arena, more accurate reporting and more variable can be identified for clarity. The study inquired to each participant about nurse characteristics: highest education level, age, sex, race/ethnicity, children of their own and how many, years as a nurse, current employment status, experience with pain management education. This could be considered time spent with the participant. 7. Similarity of approach: The author’s quote many-related studies to report similar and a few consistent findings such as increased clinical experience and increased personal experience indicate the nurse can manage pediatric pain. However, the authors further conclude all the cited studies are inconsistent across the board. Their study included the same inconsistencies and includes a sample bias of more Nurse Practitioner’s completing the survey than general Registered Nurse’s. 8. Rationale for selection method: The selection method for participation was poorly done. For this study to have a realistic and productive outcome in pediatric nursing, the sample population needs to be all pediatric nurses. The author’s rationale to accept nurses from a marketing survey rather than follow-up from the ANA demonstrates low selection standards. 9. Role of the researcher during the interview process: The researcher did not conduct an interview. Adherence to ethical standards The researchers had the study proposal approved by the Institutional Review Board prior to the mailing of the questionnaire. The authors can it clear in their study the questionnaires were voluntary and participant names and information secured. The appreciation for participation, a separate postcard was to be completed and returned to a different address. Audibility 1. Decision trail: The authors use t-tests and analysis of variance to analyze the nurse characteristics and the pain management proposal. This allowed researchers to further a meta-analysis of the descriptive information. The researchers have to change to use a simultaneous multiple regression analysis technique to analyze the nurse characteristics and this or her predictive pain perceptions and management choices. 2. Sufficiency of quotations: Participant quotations were not included on the questionnaire or the study. Respondent quotations will not help improve this study but could be helpful in future development for a more quantitative study. 3. Sufficiency of data: The data provided in the vignette were inadequate evidence by the lack of information provided. To enhance the vignettes sample vital signs, body language statements, and child’s comments or statements are a few additional description that can accurately describe a school child pain. STANDARD 3: ANALYTICAL AND INTERPRETIVE PRECISENESS 1. Picture of phenomenon: In the area of “descriptive findings in pain treatment,” it did yield a consistent and meaningful picture. The nurses pain perception, the findings of nurse to nurse rating differed but the nurse perception to child’s stated pain had consistency. However, this is a paper-situation study. To have a better understanding of the nurse to nurse and nurse to child relation perceptions, a hand on perspective can display a more accurate picture. In the area of “pain treatment and nurse characteristics” did not yield a clear understanding of the non-pharmacologic NCM and NPM use in pain management. The researchers expected nurse characteristics to correlate diretly with the pediatric pain management outcome. The researchers needed to complete a multiple regression analysis to straighten out certain correlations. The researchers concluded nurse characteristic were poor indicators for pediatric pain management. 2. Validation of findings: No findings in the study implying the authors provided the research finding to the nurse participants involved. 3. Multiple researcher participation: Three authors are involved in this study. An additional acknowledgement was generated to a “pediatrician who specializes in pediatric pain management to ensure clinical validity” (Griffen, Polit, & Byrne, 2008, p. 298). The study does not differentiate which author reviewed or analyzed which sections of the study. More details are needed in this area. STANDARD 4: PHILOSOPHICAL OR THEORETICAL CONNECTEDNESS 1. Clear connection between the data and nursing practice' No. The authors indicate the areas of flaws and bias in each area discussed. This disruption does not allow the reader to follow the study in a fluid approach. Rather, focus changes to a disbelief of the general research therefore decreasing the reliability and validity of the study. The reader can easily become disinterested. 2. Identification of study basis: The authors do not specify a clear philosophical basis however; the author’s findings and conclusions of nurse characteristics as predictors in pain management and education, year of experience, personal experience of pain can identify a theoretical basis, and current practice not significant with pain management treatment of the pediatric patient. Researches did not describe their study as a qualitative approach. The author’s study does generate essential evidence and theory for nursing practice. The research findings provide an understanding for nursing practice. The metasummary of this research offers a strong basis for the generalizations of pain management to nursing clinical practice. STANDARD 5: HEURISTIC RELEVANCE Intuitive recognition The strength of this study is that nurses have “absorbed knowledge and persuasion stages of pain treatment innovations and have moved into decision making consistent with the innovations” (Griffen, Polit, & Byrne, 2008, p. 304). Any nurse does not want his or her patient who is a child to experience pain. A nurse wants to ensure a positive and pain free experience for the hospitalized child. Relationship to the existing body of knowledge 1. Examination of the existing body of knowledge: The author incorporates findings from many other related study’s in their introduction, purpose, and finding’s. In the introduction the author demonstrated the need for this area of research due by citing related study’s that both correlate and contradict the study purpose. In the author’s conclusion, they comment of how this area of research remains to be learned. 2. Compare and contrast with other studies: The author’s findings compare many finding with previous research. 3. Description of lacunae: The distinct area of interest in this study is the “dominance of responses that reflect awareness of appropriate treatment decisions related to children’s pain, regardless of nurses’ characteristics” (Griffen, Polit, & Byrne, 2008, p. 303). The dominance is significant because the nurses made pain assessments congruent with the child self-report pain leading to adequate pain control and relief. Applicability to nursing practice, research, or education 1. Relevance to nursing practice, nursing research, or nursing education: These study findings can be supportive in the assessment and care of the pediatric child in pain. Some of the findings suggest an evolution in the assessment process about pediatric pain and its treatment. 2. Uniqueness of information: The authors finding are supportive and informative for to enhance pediatric pain education 3. Implications for the related cases: The findings may have implications for any nurse who may have to care for a pediatric patient. Besides the area of pediatrics, the operating room and the emergency department nurse are the areas to care for the pediatric patient who will have to be assessed and possibly treated for pain. These implications are relevant for related areas of practice and cases. 4. Suggestions for further study: Yes. The authors clearly state in their conclusion of the need for continued research in the area. If further implicates the need for actual clinical situation be of study. References Griffin, R., Polit, D., & Byrne, M..(2008). Nurse Characteristics And Inferences about Children's Pain. Pediatric Nursing, 34(4), 297-305. Retrieved from http://proquest.umi.com. ezproxy.apollolibrary.com/pqdweb'index=16&did=1552909011&SrchMode=2&sid= 1&Fmt=3&VInst=PROD&VType=PQD&RQT=309&VName=PQD&TS=1285259478& clientId=13118.