Concepts in Nursing Research Methods

Concepts in Nursing Research MethodsCritique criteriaThe criteria used for this critique were derived from relevant nursing literature (Feninstein Horwitz, 1997 Cormack, 2000 caravan inn et al, 2003). About a dozen criteria were specified design, sample, inclusion/exclusion criteria, time frame of study, information collection, reliability hardness, and info analysis.Study DesignCatlette (2005) used a qualitative design. While this approach has its merits, principally a greater degree of realism and richer selective information, it has a number of signifi shadowt drawbacks (Coolican, 1994). Observations are typically unreliable. In some other words, if the same nurses were interviewed on several contrastive occasions, about workplace violence, using the same open-ended interview protocol, their responses may vary somewhat. Various biases creep in, very much caused by situational factors (e.g. open-ended questions, a very violent week followed by a particularly calm week), or personal considerations (e.g. memory deficits). Furtherto a greater extent in that respect is low internal validity. This federal agency that it is difficult to establish with some(prenominal) certainty the relationship between proteans, receivable to the deficiency of statistical analysis (which can augur the probability that results occurred by chance). For example, Catlettes interview data suggests a link between workplace violence and feelings of vulnerability amongst nurses. However, the extent to which the former variable causes the latter cannot be reliably established in a qualitative study. Winstanley and Whittington (2004) enjoy the precision of a quantitative design. While internal validity is high, the level of realism is questionable. Participants were agonistic to respond to predetermined questions (e.g. on bodily assault) using a fixed response format (e.g. Once, More than once). Thus, the data obtained was heavily influenced by the kind of questions asked a nd the particular response format used. In the real world, health care staff may perceive the level of aggression in price that dont match the questionnaire format. For example, a nurse may perceive physical assaults as sporadic or once in a sacrilegious moon. Since these categorisations werent available in the questionnaire, the study effectively lacks a certain degree of realism. In a qualitative design, subjects describe the world as they see it, rather than via terms imposed by the researcher.SampleIdeally a sample should be randomly selected so that it is exemplification of the population from which it was drawn, in this case nurses or health care professionals. This allows findings from a single study to be generalised to the wider community. Catlette (2005) used a convenience sample, meaning it wasnt vocalization of nurses in general. Granted there are considerable practical and logistic difficulties in trying to recruit a random sample of nurses. Their busy schedules and casual shifts, for example, hamper proper scientific selection. It is to a fault quite common for small convenience samples to be used in qualitative studies, since it is often impractical to exact in-depth interviews with large groups. Nevertheless, Catlettes findings, while relevant to the particular trauma centres involved, are unlikely to apply to nurses in general. This is a serious limitation, since Catlettes stated objectives suggest a general interest in the level of violence in hospital emergency departments, rather than the particular trauma units from which subjects were drawn. Winstanley and Whittington (2004) also appear to gestate a used a convenience sample they simply invited health care staff working in a general hospital, and who had regular contact with patients, to participate. Although the purport sample was quite large (a bigger sample improves representation), barely a minority of staff actually completed and returned questionnaires. All in all, particip ants werent recruited randomly, and so the findings cannot be generalised to the wider population of health care staff.Inclusion/Exclusion CriteriaBoth studies seemed to require clear inclusion/exclusion criteria. Catlette (2005) only recruited and interviewed nurses who were registered, worked in a level 1 trauma centre, and had experienced workplace violence. A clear definition of what constituted violence was developed, helping to minimise either ambiguities about eligibility. Winstanley and Whittington (2004) also specify inclusion criteria. Only health care staff that had regular and substantial contact with patients were invited to participate. What constituted regular and substantial contact was well outlined (e.g. daily contact with patients). The advantage of having clear inclusion/exclusion criteria is that it helps the researcher recruit a homogenous sample. If the participants in a study are excessively diverse, this effectively introduces additional sources of error that may obscure raise themes, or relationships between variables. Findings may be more difficult to interpret. However, a major outrage of a homogenous sample is that it is incessantly ad-hoc, that is special or unique, and hence unlikely to reflect the wider community. Nevertheless, it can be argued that sample homogeneity isnt problematic if the wider community of interest exactly matches the inclusion/exclusion criteria. For example, Winstanley and Whittingtons (2004) study was about patient aggression towards health care staff. Thus, the population of interest was invariably going to be staff that had regular contact with patients. In this respect the sample selected corresponds with the population of interest. However, randomly selecting nurses from the designate population would have provided a representative sample that permits useful generalisations. Simply using volunteers, as Winstanley and Whittington did is unscientific.Time frame of studyWinstanley and Whittington s (2004) study was effectively a retrospective (i.e. cross-sectional) survey. This means that data was collected at one point in time, specifically an 8-week period. Retrospective designs are considered inferior to prospective (i.e. longitudinal) designs in which data is collected on two or more occasions, over several weeks, months, or even years (Coolican, 2004). This manner allows tentative causal inferences to be made if a variable thrifty at Time 1 predicts or correlates with a factor measured at Time 2, then there is a possibility that former variable affected the latter, but not vice versa. Retrospective designs dont allow for such inferences. Any correlations between variables are just that correlations There is no sequence that may help delineate possible causality. For example, in their introduction and statements of study aims, Winstanley and Whittington imply that particular professions (e.g. nurses, doctors) and hospital departments (e.g. medical, A E) may elicit antithetic levels of physical aggression experienced by staff. Thus, profession/department seemed to be conceptualised as causal factors. However, although data analysis revealed relationships between these factors and physical aggression, there is no provision in the retrospective design to infer causality, since all the variables are measured simultaneously. A prospective method in which profession/department predicts experiences of physical assault several weeks subsequently would be more conclusive. Catlette (2005) doesnt explicitly state the time frame for her study, albeit interviews typically take several days, weeks, or by chance months to complete. Notions of prospective and retrospective designs are typically associated with quantitative studies, and rarely applied to qualitative research. This is because qualitative studies are often exploratory, merely seeking to identify interesting phenomena rather than establish causal relationships between variables. Nevertheless, interviewing participants on two or more separate occasions can be used to demonstrate the validness and reliability of some(prenominal) themes observed. For example, if the same themes emerge during interviews conducted at two different points in time, this would suggest that the themes are significant rather than fleeting.Data CollectionCatlette (2005) appears to have used semi-structured interviews for data collection (Coolican, 1994). By asking every interviewee pre-set but open-ended questions in a particular sequence, she avoided the inconsistency and sloppiness often associated with exclusively unstructured (i.e. casual) interviews. It is possible the interviews were informal but guided, meaning that pre-set questions were asked, albeit in no particular order. Either way, a guided or semi-structured interview suffers from certain constraints. petition specific questions, albeit open-minded ones, restricts the interviewers flexibility to ask follow-up questions depending o n the interviewees response. Interviews are also heavily affected by interpersonal factors, such as lack of rapport, physical attraction, and psychological manipulation. Winstanley and Whittington (2004) collected data via a questionnaire. This method has a number of limitations. One is the typically low response rate. Of 1141 questionnaires posted out to participants, only 375 (33%) were returned, denoting a considerable waste of resources. Often the questionnaires returned represent an unusually keen sub-sample that may differ in key respects from the original target group. This means that the researcher has to devote time and resources establishing what these differences are, and how they might affect the results. Furthermore, because the final sample is smaller, statistical power is reduced, increasing the possibility of a type II error. other limitation of questionnaires is the use of restricted (or forced choice) response format. For example, subjects in Winstanley and Whitti ngtons (2004) study were forced to choose from three options none, one or more than one. Thus, there is no room for participants to qualify their answers, for example by pointing out memory lapses (e.g. I cant remember), or indicating forked experiences (e.g. not sure). All in all, these restrictions reduce the realism and richness of data collected. Interviewing subjects on the same issues, but using open-ended questions, will in all likelihood yield slight different outcomes to those reported by Winstanley and Whittington (2004). Another limitation is that the bulk of questionnaire communication is written. There is no provision to measure visual cues and gestures, which typically bill for much of human communication, or even auditory cues. For example, a frown or grunt, may signify a particularly traumatising experiencing, which simply cant be detected from questionnaire responses. Finally, questionnaires are often completed in the absence of the researcher (e.g. postal quest ionnaire), making it difficult to supervise the proceedings, or wander whether the subject is the same person who completed the questionnaire. Overall, these constraints negate the conclusiveness of Winstanley and Whittingtons (2004) findings.Data AnalysisIn line with standard procedure in qualitative research Catlette (2005) performed thematic analysis to identify recurring patterns in the data. Meaningful information was extracted from the interview transcripts, after which themes were identified using a coding system. Although a highly useful procedure, Braun and Clarke (2006) note that thematic analysis has certain disadvantages. One is the possible overlap between themes. Catlette identifies two themes vulnerability and inadequate prophylactic measures. Categories, and subcategories reported suggest considerable overlap between these dimensions (e.g. the sentiment feeling unsafe may depict both feelings of vulnerability and an unsafe environment). Another failing is the high correspondence between the data collection questions (i.e. interview guide) and themes identified. In other words, the themes reported merely reflect the questions asked during the interview (e.g. questions on safety, such as How do you feel about the safety of your workplace? are bound to produce safety-related responses, and hence themes). This suggests very limited analytic work was through with(p) to identify themes independent of the interview format. Another shortcoming of thematic analysis is failure to incorporate alternative or contradictive data in the results reported. Catlette offers little if each account of oddities in the data that dont necessarily fit the two emerging themes. For example, the interviews revealed that violence wasnt a concern during interactions with co-workers. Clearly this manifestation is incompatible with the notion of vulnerability and lack of safety in the workplace. Yet, little is made of this inconsistency, making Catlettes rather tidy the mes appear rather suspicious. Few data sets in qualitative research are completely harmonious with no contradictions, so a study that fails to report these oddities is highly questionable. Winstanley and Whittington (2004) employed an inferential statistical test to analysis their data, consistent with the quantitative design of their study. Chi-square was used to test for significant trends in the frequency of physical assaults as a function of different health care professionals (e.g. nurses and doctors) and hospital departments (e.g. medical, surgical, A E). Chi-square was appropriate given that the data was savorless (i.e. in the form of frequencies). However, as a non-parametric test, chi-square lacks sensitivity. This combined with the limitations of frequency data (e.g. it fails to account for subtle degrees of variation between individual subjects or groups for example, asking nurses if theyve experienced aggression once or more than once fails to take into account any dif ferences in the intensity and duration of these aggressive episodes), increases the risk of wrongly accepting the null-hypothesis.Reliability ValidityA major methodological concern in scientific research is reliability and validity. Reliability refers to the consistency of observations, while validity depicts the authenticity of observations. Both issues are particularly pertinent in qualitative studies, due to the lack of structure, precision, and quantification. Catlette (2005) appears to have taken steps to enhance reliability/validity. She kept a journal throughout the duration of the study, in order to identify any biases that may corrupt the data. Interviews were conducted using a standard protocol, then the data was transcribed verbatim, and analysed using regular procedures. However, these measures may be inadequate. Coolican (1994) identifies several procedures for ensuring good reliability, none of which appears to have been used by Catlette triangulation, analysis of neg ative cases, repetition of research round of golf, and participant consultation. Triangulation involves verifying emerging themes using another data collection method other than open-ended interviews. For example a questionnaire measure of perceived workplace violence and safety strategies could have been administered or close-ended interviews conducted. Data from these alternative methods could then be compared with the original observations to gauge the degree of consistency in emerging themes. Analysis of negative cases involves scrutinising cases that dont fit the emerging themes. Repetition of research cycle entails repeatedly reviewing assumptions and inferences, to further verify emerging themes. Finally participant consultation involves communicating with participants to see if observations from the study match their own experiences. None of these measures seem to have been applied in Catlettes study, raising serious concerns about the stability and authenticity of her obse rvations. Winstanley and Whittingtons (2004) study doesnt appear to have fared much better. Although the numeral precision inherent in quantitative designs offers some degree of reliability and validity, this is by no means guaranteed, and has to be demonstrated empirically. They fail to report any Cronbach Alpha reliability coefficients for the questionnaire used. Thus, it is unclear if the items in this instrument were internally consistent. Test-retest reliability wasnt reported either, again raising questions about the consistency of participants responses over time. A badly designed questionnaire (e.g. one with ambiguous statements, or grammatical errors) could easily confuse participants, leading to irregularities in their responses over time. No information on validity is provided either. Normally, validity could be demonstrated by correlating data from the questionnaire with data from another measure of experiences of aggression (a high correlation would indicate good valid ity), submitting the questionnaire to a group of judges to ascertain if the content addresses all forms of human aggression (e.g. indirect forms of aggression, such as spreading rumours or social exclusion dont appear to have been assessed), and even performing factor analysis to establish construct validity (i.e. verify the dimensions of aggression assumed to be measured by items in the questionnaire). These inadequacies render the findings from Winstanley and Whittingtons (2004) study inconclusive. For example, the claim that aggression is widespread is questionable because not all forms of aggression were measured.Overall, both studies are fairly categorical in their conclusions. Winstanley and Whittington (2004) surmise that their data demonstrates the significant levels of aggression to which hospital staff are exposed. Catlette (2005) reaches a similar conclusion, emphasising the vulnerability and lack of safety perceived by nurses. However, both studies suffer from various a nalytic and methodological constraints. Perhaps the most serious of these is the apparent absence of reliability and validity measures that may reveal any volatility or misrepresentations in the data. These limitations mean that any conclusions have to be regarded as tentative, subject to further research.BibliographyBraun, V. Clarke, V. (2006) Using thematic analysis in psychology. qualitativeResearch in Psychology, 3, pp.77-101.Catlette, M. 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