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Solution
Qualitative Critique
Summary
This paper delves into critically analyzing the article by Rolland (2016). The article by Rolland is focused on identifying the need to support emergency room nurses who care for dying patients who are unable to respond to curative care positively. This analysis, therefore, critically examines the methodologies used, the conceptual frameworks, and credibility of the sources of data, data collection, documentation and analysis processes, rigor, and finally the findings. Essentially, this analysis attempts to find out how genuine is the article presented by Rolland. Notably, the article is considerably valid having ticked all boxes according to the outcome of this analysis.
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Research Problem
Rolland’s (2016) research attempts to understand the transition of Emergency Room (ER) nurses from curative care to end-of-life care for dying patients. The study contributes to practice by investigating why ER nurses do choose to give end-of-life care to patients instead of focusing on getting them back to good health. In particular, the study aims to identify the core practice areas that nurses need most support when caring for dying patients. The research problem of the study was the succession of rural ER nurses from curative care to end of life care, which has implications to the patient. Rolland (2016) incorporates the use of conceptual frameworks, which develop and provide a theoretical understanding of the research problem and help answer the central question of the study. The research explores the characteristics of rural care settings and rural nurses and underlines the challenges as well as opportunities in curative care to dying patients.
Review of the Literature Review of the Literature
The study has used both secondary and seminal literature. Seminal literature works are researched pieces of work that have lasted for more than five years (Houser, 2018). However, they remain relevant and can be used on any new studies to support various concepts. On the other hand, secondary sources are research papers that have used different primary sources to prove a given theory. In this study, most of the sources used are not more than five years old. Notably, the sources incorporated in this research paper are entirely relevant to the topic. The keywords of the literature review were nurse, end-of-life, and emergency. The findings of the literature review point out that time and workload are the key hindrances to meeting the needs of patients and families at end of life. Family understanding of life-saving measures was attributed to conflict while limited support and resources was identified as an impediment to effective palliative care in the ER. The review also points out at consensus issues between the patients, families and health professionals to be among the challenges facing curative care. Moreover, on analyzing end of life care, the review cites the need to appropriate manage nursing workloads to allow for attention to patients and families dealing with the end-of-life.
Research Design
Research design is a chosen technique chosen by any given researcher in willingly using various sources in a logically coherent way to support their studies (Houser, 2018). The study, nonetheless, used the grounded theory methodology. The research design involves the development of theory through the collection and analysis of data. In the design, Rolland (2016) utilizes the design because it allows her to understand symbolic interactionism that proposes that a person’s reaction is based on the meaning of another’s action or interactions. This allows the researcher to formulate the nurses’ transition from curative care to end of life care.
This study, similarly, uses existing studies to gain insight into the topic of Emergency Room Nursing. In the beginning, the study defines the topic clearly and can produce a research question and thesis statement. However, the need to prove its concept lets it choose this kind of research design since; enough research work has been done on the topic, and the right information can be extracted from them. As such, the study successfully manages to prove that it is okay to offer end of life care. Through the study, one can now easily see the logic in allowing the extremely ill to die honorably and their right to receive the best the world can give to them at the last moments of their lives.
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Sampling
Houser (2018) noted that sampling entails the strategic collection of valuable materials, objects, or persons from a cluster for examination. In this study, the researcher used a systematic sampling technique to gather participants necessary for the study. The systematic sampling technique allows for a carefully planned selection of participants based on the size or quality of influence. In this study, the researcher used individuals from four upstate New York health facilities. From across four countries, the study encompassed hospitals in urban and rural areas to broaden diversity. The criteria for selection were limited to admitting only registered nurses, not below 18 years, English speakers, and had at least one year of experience in the emergency room. Invitation letters were sent to the respective hospitals, and those willing to participate made contact and were then invited over for an interview.
Ethical Consideration
The study made ethical considerations that accounted for its participant’s voluntary engagement and also took confidentiality measures. As previously mentioned, the researcher goes the informed consent of participants after educating them on the research, their role, their rights to take part voluntarily and the potential implications of the study. No personally identifiable information was collected, thus upholding anonymity. The data collected was stored securely to maintain the confidentiality of the data.
Data Collection
After selecting the participants and attaining their consent, data collection was conducted through interviews and stored in recordings. Ten interviews over a 13-month period, ranging 30–50 minutes with follow-up interviews (n = 2) ranging 10–30 minutes. The interviews were semi-structured and had open-ended questions that allowed the researcher to obtain comprehensive data from the participants. The recordings were later converted to text for analysis. The researcher crosschecked the transcribed data to ensure that the transcription was error-free and then readied for analysis.
Data Analysis
The analysis of data for this study was done through constant comparative analysis. The first analysis encompassed open coding. The subsequent in-depth analysis utilized axial coding, then a more composite analysis included conceptual understanding. Some of the critical components for the analysis were journaling, field notes, and memos. Consequences were later incorporated through a transitional process developed by a matrix soon as the theoretical work was presented, and categories were well-known.
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Rigor
It is the researcher’s role to maintain the trustworthiness of the research (Houser, 2018). This study used rigor through three distinct criteria, which are confirmability, reliability, and constancy. Rolland (2016) supported credibility y the degree of involvement with participants. The support for constancy was dependent on the extent to which the participants engaged in the study. A trail of clear audits such as notes, journals, and memos was used to prove how reliable the information had been. Seasoned experts with experience on were later incorporated in the process checking the confirmability.
Findings (themes/sub-themes)
The central theme was realized is the theme of nurses being as protectors and two subthemes, which were a conflict of care and peace. Rolland (2016) found that the transition of rural ER nurses from curative care to end of life care is significantly influenced by resources, familiarity, and the concept of distance. Despite the transition from curative care to end of care, the findings showed that nurses maintained hope, gave their all, and immersion. Aspects of care such as engagement, customizing needs, family involvement and consensus, and reflection were adequately executed. However the findings also pointed out that it is important to improve readiness, knowledge as this was associated with frustration and distractions, and the need to improve judgement. Providing nurses with the support and resource that empower their self-reliance trait is integral in the care of dying patients and their families in rural communities.
Nursing Implications
Some of the strengths of this study include the fact that it presents the need to provide support to nurses who provide care to dying patients by improving staff resources, access to education, and mentoring. The only limitation is that it does not consider to identify how those nurses administering such services do feel about the practice. It fails to answer whether these nurses feel when they see patients die before them on almost a regular basis. The study has positively impacted my perspective on nursing.
Because as a nurse in curative care, I understand the need to improve my understanding of care processes and take part in educative efforts that improve my competence, skills, and knowledge in practice to empower how I care for dying patients and families. Improving the competencies and skills of nurses is critical in this case as it empowers and enables each nurse to act decisively, learn to prepare, assess, and reflect on each patient’s needs extensively.
References
Houser, J. (2018). Nursing Research: Reading, Using And Creating Evidence (4th ed.). Jones and Bartlett Learning.
Rolland, R. A. (2016). Emergency room nurses transitioning from curative to end-of-life care: the rural influence. Online Journal of Rural Nursing and Health Care, 16(2), 58-85
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