Concise Appraisal of Qualitative Research Article
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Concise Appraisal of Qualitative Research Article
| Title | Concise Appraisal of Qualitative Research Article | Prefered Language style | English (U.S.) |
| Type of document | Article | Number of pages/words | 2 Pages Double Spaced (approx 275 words per page) |
| Subject area | Nursing | Academic Level | Undergraduate |
| Style | APA | Number of sources/references | 4 |
| Order description: | |||
| Write a summary and concise appraisal of the study. Use the APA format with title page, 3-4 paragraphs for summary and critique (300-400 words), and the complete reference at the end. Utilize Chapter 14 in your Fain, (2017), book as your guide. First Paragraph: Write a brief description or summary of the work cited including:•the level of research evidence (based on Melnyk and Fineout- Overholt’s Level of Evidence Scale in Module 1 under Dr. Poole’s video link)•purpose•type of qualitative study•major findings or themes•author’s conclusionsRemember to cite the authors and year in the first sentence of the first paragraph. The summary should be primarily in your own words, with paraphrased segments, except for the purpose of the study which may be word for word.Paragraphs 2 – 3: Analyze the work’s quality using the Critical Appraisal Guidelines: Qualitative Studies section in Fain, (2017) Chapter 14 with additional guidance starting on page 325 for some sections. Answer at least ONE question under each category below:•identified problem for study•purpose and research questions•literature review•sample and sampling procedure/technique including protection of human subjects•methodology•data collection procedures•data analysis: organizing/categorizing/summarizing•scientific integrity: credibility/transferability/dependability/confirmability•results of the study•findings•discussion of findings•evaluation summary including applicability to replicate or apply study findings in your area of practice whether that be a hospital, home health or SNF, etc.Say what is good, but also be critical and find something wrong! Try to be concise and non-repetitive.Last Paragraph: In your own words, discuss how this study relates to evidence-based practice and its implications for or impact upon nursing. Comment on what unique findings or insights that this study provided. If you chose a study outside the United States, how does potentially socialized medicine affect whether the study could be conducted in the United States and if you believe the findings would be the same or different and whyORIGINAL ARTICLE Educational strategies and challenges in peritoneal dialysis: a qualitative study of renal nurses’ experiences Manuela Bergjan and Christiane Schaepe Aims and objectives. The aim of the study was to explore renal nurses’ experiences, strategies and challenges with regard to the patient education process in peritoneal dialysis. Background. Patient education in peritoneal dialysis is essential to developing a successful home-based peritoneal dialysis program. In this area research is scarce and there is a particular lack of focus on the perspective of the renal nurse. Design. Qualitative design formed by thematic qualitative text analysis. Methods. Five group interviews (n = 20) were used to explore the challenges peritoneal dialysis nurses face and the training strategies they use. The interviews were analyzed with thematic qualitative content analysis using deductive and inductive subcategory application. Results. The findings revealed the education barriers perceived by nurses that patients may face. They also showed that using assessment tools is important in peritoneal dialysis patient education, as is developing strategies to promote patient self-management. There is a need for a deeper understanding of affective learning objectives, and existing teaching activities and materials should be revised to incorporate the patient’s perspective. Patients usually begin having questions about peritoneal dialysis when they return home and are described as feeling overwhelmed. Adapting existing conditions is considered a major challenge for patients and nurses. Conclusions. The results provided useful insights into the best approaches to educating peritoneal dialysis patients and served to raise awareness of challenges experienced by renal nurses. Findings underline the need for nosogogy – an approach of teaching adults (andragogy) with a chronic disease. Flexibility and cooperation are competencies that renal nurses must possess. Relevance to clinical practice. Still psychomotor skills dominate peritoneal dialysis patient training, there is a need of both a deeper understanding of affective learning objectives and the accurate use of (self-)assessment tools, particularly for health literacy. Key words: chronic diseases, content analysis, end-stage renal disease, nephrology nursing, patient education, peritoneal dialysis What does this paper contribute to the wider global clinical community? • Findings illustrate the educational barriers that patients face and highlight the importance to take in a special kind of adult education for patients with chronic diseases. • A thorough assessment can help to identify resources and barriers to learning such as uremia, language barriers and physical limitations. • Overall, the results of the study highlight useful strategies of nurses when ‘doing patient education at home’. Accepted for publication: 5 December 2015 Authors: Manuela Bergjan, Dr. phil, RN, Senior Lecturer in Nursing Education, Institute of Health and Nursing Science, Charite – Universitaetsmedizin Berlin, Berlin; Christiane Schaepe, RN, MPH, Research associate, Institute of Health and Nursing Science, Charite – Universitaetsmedizin Berlin, Berlin, Germany Correspondence: Christiane Schaepe, Research associate, Institute of Health and Nursing Science, Charite – Universitaetsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany. Telephone: +49 30 450 529 098. E-mail: christiane.schaepe@charite.de © 2016 John Wiley & Sons Ltd Journal of Clinical Nursing, 25, 1729–1739, doi: 10.1111/jocn.13191 1729 Introduction End-stage renal disease is the fifth stage of chronic kidney disease (CKD) and the prevalence is expected to increase due to the rise of diabetes mellitus, cardiovascular disease and obesity, and the aging population (Kaptein et al. 2010). The options available for patients with CKD stage 5 include transplantation, peritoneal dialysis (PD), haemodialysis (HD) or conservative care. While PD patient outcomes are at least as good as with HD (Lameire & Van Biesen 2010), PD offers several benefits. It allows patients to perform and self-manage their treatment and care in their own home (Curtin et al. 2008), and it means they are not dependent on healthcare staff and do not have to travel to the clinic several times a week. It has been shown that PD can reduce costs e.g. in the UK healthcare system (Baboolal et al. 2008). However, although the benefits of PD are abundant and well documented within NICE guidelines 2011 (NICE 125), in particular patient education raises multiple demands for patients and nurses as educators. The biggest is probably to enable PD patients to handle over 90 percent of their care by themselves (Hall et al. 2004) while leading a normal life and dealing with the stress caused by the changes to their previous routine. Although adult patients are usually motivated to learn, in particular their characteristics and possibilities are very heterogeneous and challenging. Barriers to learning in PD patients might include cognitive impairments caused by advanced uremia (Crowley 2003), physical impairments caused by chronic fatigue and loss of strength, energy (Borras et al. 2006) or motivation (Paudel et al. 2014). Loss of memory is a source of frustration for both the learner and the teacher, especially when other barriers to learning are present (Thomas 2013). Vulnerable patients such as those with lower educational status, the elderly and those with multiple comorbidities need more time to acquire self-care skills and are more likely to develop peritonitis (Borras et al. 2006). The complex language used in PD therapy can cause problems in training, and some patients might be frightened about dialyzing themselves at home (Thomas 2013). Furthermore, in PD patient education it should be considered, that patients might be suffering from psychological issues related to the loss of self-esteem and selfimage, worrying about the future, and having to make psychological and behavioral changes (Kaptein et al. 2010). Being dependent on technology for survival is also a psychological burden, and the presence of the abdominal catheter might disrupt the patient’s body image (Partridge & Robertson 2011, Tong et al. 2013). Background Professional PD patient education is key to addressing these aspects and responding adequately to the educational challenges. The International Society of Peritoneal Dialysis (ISPD) recommends that nurses provide the education (Bernardini et al. 2006). Nurses therefore play an important role in PD therapy, as patient education is crucial to reducing the occurrence of peritonitis and dropouts, improving technique survival and other outcomes such as non-adherence and quality of life (Piraino et al. 2011, Schaepe & Bergjan 2015). Worldwide there is a wide variation in practices for PD patient training programs, especially in time and duration, methods and teaching aids and setting (Schaepe & Bergjan 2015). However, there is more accordance about the content of PD training recommended by the ISPD (Bernardini et al. 2006). Content focused mainly on technical skills such as aseptic technique, hand washing, masking, steps in exchange procedures, exit-site care, complications and troubleshooting. Case and disease management programs have been shown to have positive outcomes for individuals receiving PD (Schaepe & Bergjan 2015). Current recommendations say that principles of adult learning are the best basis for effective PD education programs (Hall et al. 2004, Bernardini et al. 2006, Finkelstein et al. 2011). The study of Hall et al. (2004) showed that applying adult learning theory and educational principles improves some but not all patient outcomes. In part, the study focused on the learners’ needs and used different strategies for different levels of learning in the cognitive, psychomotor and affective domains of learning. It also provided tools to engage learners according to their perceptual style (Hall et al. 2004). An important aspect to consider is that the learner in PD therapy is a patient with a long term condition who requires a special teaching method. Ballerini and Paris (2006) proposed the term nosogogy to describe the science of teaching adults (andragogy) who have a chronic disease (derived from the ancient Greek word ‘nosos’, meaning ‘disease’). There are differences between andragogy and nosogogy. Adult patients with a long term condition ‘will be asked to adhere to multiple life requirements’, because PD therapy influences all aspects of life such as habits, relationships or work. They strive to be less dependent on health professionals, but often have less learning resources as healthy adults. Patients cannot choose their learning contents and objectives. They learn what nurses expect them to and what they need to know, in © 2016 John Wiley & Sons Ltd 1730 Journal of Clinical Nursing, 25, 1729–1739 M Bergjan and C Schaepe order to be able to perform the therapy (Ballerini & Paris 2006: 124–125). The ISPD’s recommendations for PD patient education (Bernardini et al. 2006) are mostly based on theory and opinion and little empirical research has been done since then (Bernardini et al. 2006). Evidence-based PD patient training is therefore lacking, and there is a recognized need to promote PD by stimulating relevant education and research (Lameire & Van Biesen 2010). Furthermore, previous studies on educational interventions in kidney disease have been classed as suboptimal (Mason et al. 2008). Thus, qualitative research is needed to provide a deeper understanding of this complex nursing task. The perspectives of PD nurses on their experiences of PD education, the strategies they apply and the challenges they face can provide valuable insight into their knowledge and expertise. This could help develop future PD curricula and educational interventions for other chronic diseases. This study therefore aimed to explore PD nurses’ experiences, strategies and challenges with regard to the patient education process. Methods Participants and setting This study used a qualitative research approach to meet its aims. The underlying theoretical framework of qualitative content analysis is communication theory (Watzlawick et al. 1967), which benefits are acknowledged for nursing research and education by Graneheim and Lundman (2004). The communication act between researcher and participants goes on during describing, structuring or interpreting the texts based on interviews. The researcher must ‘let the text talk’ and can get valuable insights into participants’ knowledge and expertise in PD patient education. The participants all had experience of PD patient and nurse education. To get a broad perspective, they were recruited from nephrology wards in a university hospital (n = 3, group interview 1), from Baxter Germany (n = 9, group interview 2 and 3) and from dialysis clinics (n = 8, group interview 4 and 5). The hospital participants were selected on the basis of their positive responses to study information provided in their workplace. The participants from the dialysis clinics and from Baxter Germany were asked if, given their long experience of PD education, they would like to participate voluntarily. It is their ordinary task to train patients, which takes place either at the clinic or occasionally at the patient’s home. The interviews were pilot-tested with four participants. Two researchers were always present during the interviews, which each lasted around 90 minutes. Notes were taken directly after the interviews to record key statements made by the participants. Data collection Five semi-structured group interviews (n = 20) were conducted with the PD nurses between May and June 2013. An interview guide provided direction for the interview, which used open-ended questions to elicit information. The main topics addressed in the interview guide were: the participants’ strategies for teaching patients; the educational challenges that patients face when learning new skills; the challenges that trainers face when educating patients; positive and negative learning conditions; strategies for training PD trainers. This last theme will be presented elsewhere. Ethical consideration The study was granted permission to collect data and received approval from the data protection supervisor and from the staff council representatives of the participants’ employers. Due to the reason that no patients were involved in the study, it was not mandatory to seek ethical approval from a research ethic committee. However, we followed the Ethical Principles for Medical Research Involving Human Subjects, which were adopted in the Declaration of Helsinki (World Medical Association 2013). It was emphasized that participation was voluntary. All participants received oral and written information on the aim of the study and on the data security procedure. Written informed consent, including consent to audiotaping, was obtained from all participants via the signing of a consent form prior to each session. To ensure privacy and the quality of the data, the interviews took place in a quiet room, away from the participants’ place of work. Data analysis All interviews were taped and transcribed verbatim. Identifying information, such as name and place of work, was replaced with code numbers. Analysis was done with the software MAXQDA 11 VERBI Software GmbH, Berlin, Germany and carried out by both authors. Two data coders were involved in each step of analysis and consulted with one another to reach consensus where necessary. The interviews were analyzed with thematic qualitative text analysis using deductive category and inductive subcategory application (Kuckartz 2014). This is illustrated in Fig. 1. The first step involved reading the transcripts several times to obtain a sense of the whole and to become immersed in the data. © 2016 John Wiley & Sons Ltd Journal of Clinical Nursing, 25, 1729–1739 1731 Original article Educational strategies and challenges in PD Next, a categorization matrix (see Table 1) was developed by choosing nine main categories (‘wh-questions’) based on the common components of the education process used in, e.g. the ASSURE model (Bastable 2003) and the ISPD guidelines for PD patient training (Bernardini et al. 2006). Two further categories were chosen that were based on the nursing didactics described by Fichtmuller and Walter € (2007). They use the term ‘critical action problems’ (CAPs) to describe the challenges and uncertainness that arise in clinical learning contexts and to which learners can respond by engaging in training that will adapt their skills. Our assumption is that the learning activities developed by PD nurses in CAP situations will be beneficial to managing challenges in PD patient education. The two researchers agreed on the definition of the mutually exclusive main categories, example quotes and coding rules. They coded independently and deductively according to the wh-questions and CAPs, and reviewed their work jointly. A second step involved inductively generating subcategories. To improve the presentation, the CAP categories were assigned to the respective wh-question categories. Results This section presents the main findings of the interviews. CAPs will be presented together with the wh-questions based on the components of the education process. For the purposes of readability, some of the main and the subcategories are presented under the same heading (non-professional actors, learning content and objectives, teaching activities and instructional materials and learning environment). This is illustrated in Table 1. Non-professional actors Patients |
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