Introduction
Qualitative research is normally performed for various purposes. To begin with they are normally conducted when there is minimal knowledge concerning a phenomenon or concept due to inadequate previous research, because it is a recently established area of concern, or if it is an area that change and the prior research and/or theory is no more relevant to the phenomenon, thereby necessitating a qualitative approach. Second, a qualitative approach may be chosen based on the phenomenon of interest. Various concepts and phenomenon are simply inappropriate for quantitative approach (Burns, & Grove, 2009).
Certain characteristics which distinguish qualitative from quantitative approach include (Burns, & Grove, 2009):
- Inductive: – the researcher starts from data and uses it to develop theory, models, hypothesis, categories and concepts;
- Deals with process and implication from the participants’ (emic) perspective: the focus is on how the subjects perceive their world other than elucidating casualty or findings;
- Done in the filed or naturalistic context: there are no controls placed the variables or the background, the variables are entangled with the phenomenon of interest such that they contribute to the understanding of process and implication; and
- Employs the researcher as an instrument for gathering and analyzing data: this demands that the researcher distinguishes her or his reality from that of participant at the same time maintaining a close connection with the participants’ world in order to appreciate and describe it (Creswell, 1998; Morse & Field, 1995: Polit & Beck, 2004 cited in Burns, & Grove, 2009).
The preceding paragraphs examine the various approaches employed in qualitative research.
Phenomenology
This refers to a qualitative method which is centered on philosophy. Phenomenology focuses on understanding and subsequent detailed description of the essence of the experience based on the individual (Munhall, 1994; Van Manen, 1990 cited in Burns, & Grove, 2009). The objective of this approach is to provide a comprehensive description of the phenomenon of interest and to present the live experience through textual expressions such as writing, pictures, music among others. The phenomenon is described as per the experience of the participant regardless of use of theories, and possibly without the researcher’s presumption and preconception. Also, data collection is through numerous deep discussions with the subject(s); the researcher is the primary tool for data collection (Frank-Stromsburg, & Olsen, 2004.
Grounded theory
The primary goal of this approach is synthesis descriptive models of human characteristics that are reflected in the data. Preexisting theories are not relied on such that the researcher assumes an open minded state to enable concepts to develop freely (Frank-Stromsburg, & Olsen, 2004).
Moreover, data collection is via interview, field notes and observations. A consistent comparative method is employed for data collection and evaluation. In this regard data are assorted and evaluated in alignment. Hypothesis are evaluated and examined with arriving data. This approach also at some extent employs theoretical sampling consistent with the demands of the developing theory.
Ethnography
The objective of this approach is to narrate the experience of the subject’s live with regard to the culture they belong (Fetterman, 1989 cited in Burns, & Grove, 2009). Thus, this approach deals with an in-depth survey of the cultural population as reflected by the participant. The research is often required to spend a substantial amount of time with the population and be alienated with the cultural setting so that he or she is able to gather data and appreciate the population of interest.
A deviation from the traditional ethnography is termed focus ethnography, and is more applicable to nursing. In this regard the participants are recruited by location but not by anthropological residence or culture, although they share characteristic norms and a common language (Morse & Field, 1995 cited in Burns, & Grove, 2009). For focused ethnography, the topic of interest is decided upon before data collection as opposed to traditional ethnography which theory is derived from data collection. In addition, data collection via observations and interviews is restricted to specific incidents and topics connected with the incident. The outcome reflects an appreciation of critical cultural schemas.
Identification of the article
The article selected for critique is titled “strategies for clinical decision making”. The article explores the principles for understanding decision making strategies and procedures critical for in health care delivery. Particularly this article focuses on promoting decision making in critical healthcare nursing, using a qualitative explanatory research design (Lincoln & Guba, 1985; sande3lowski, 2000). The authors of this article are Ramezani-Bedr and colleague. A complete reference for the article is available in the reference section of this critique. Also, the various perspective of qualitative research will be examined in the subsequent paragraphs.
Research design
This research study adopted purposive method of sampling. The researcher recruited 14 nurses from four critical care department educational hospitals associated with Tehran University of Medical Sciences (TUMS) to take part in the study. The subsequent protocols were adopted in the recruitment of the participants: working under the normal work routine when collecting data; having a minimum of three years of experience in critical care nursing, and be a bachelor’s nursing degree holder in the least. The samples involved both genders who volunteered to participate in the research study. The participant also possessed special demographic characteristics.
Data collection
The major technique employed in data collection involved the utilization of in-depth, semi-structured interviews. The interview conducted in the relevant unit starting from September 2007 up to March the following year, 2008. Each individual interview was documented and transcribe accurately. The rationale behind the interview was to evaluate the reasoning stratagem employed by nurses in their decision making and the guideline for picking and verifying their decision. Additionally, the interviews were performed on a basis of the interaction between the subjects and the interviewer. Systematically the interviewer begun with a basic inquiry concerning the number of the years of experience of the nurse in critical care setting and the latest patient she or he attended. More specific questions followed the initial question, like how they discovered the patient was sick, they methods they adopted in arriving at their decision, and how they chose their alternative of care.
The interval of each interview differed from the other ranging between 45 to 60 minutes based on their free time and their endurance. Every participant was interviewed through sessions with exception of two participants.
Data analysis
Content analysis model was employed in the data analysis (Lincoln & Guba, 1985; Sandelowski, 2000). Subsequent to every interview, the tapes were recorded verbatim and analyzed in conjunction with the data collection. Every interview was analyzed and index prior to performance of the next. Key phrases and concepts were highlighted following a comprehensive review of the transcript. The following step involved the identification and aggregation of significant units and initial themes. The analysis method used was iterative, which facilitated the development of theme and appraisal was finalized and analysis continued. The proceeding step dealt with the regrouping of key domains into the central theme.
To promote the rigor and the trustworthiness of the results, various processes of including the peer checking and member checking were integrated. The proceeding precautions were implemented: interacting with the participants twice or more, undertaking several interview sessions with majority of the participants, taking regular note while collecting data, intimate and lengthened interaction of the research group with the volunteering nurses to promote more truthful interpretation of the data in its analysis, and seeking the opinions and ideas of the participants and three supervisors to substantiate the interpretations of the researchers. To promote the authentication of the result concerning the interpretation and the analysis mechanism, researchers and the supervisors proficient in qualitative data examination were sought for advice and opinion. Eventually, the transcripts, codes, and ideas were appraised and the study team together with the supervisors expressed a higher agreement, while the elements of disagreement were discussed to attain a consensus.
Result
Six primary themes were developed from the analysis of the data as contributing majorly in critical care decision making by the nurses. Three primary themes associated with reasoning strategies included hypothesis formulation, recognizing similar circumstances, and intuition. Three additional primary themes concerning the subjects’ criteria for making decision, included alternative sources of information, organizational requirements, and the patient’s risk-reimbursement.
Logic strategies
When the participants made subjective choices regarding the patient’s condition, they used a set of reasoning strategies. Such strategies involved intuition, hypothesis testing, and detecting like circumstances. The following paragraphs distinctively examine these strategies.
First, intuition is a strategy applies when some of the participants used phrases like; “certain feeling” or “it suddenly crossed my mind” to refer to the clinical reasoning strategy they employed to establish the patients problem and subsequently giving him or her proper care. They supposed that this type of reasoning had minimal connection with the results of the patients’ condition and could not explicate it and probably regarded it as a gut sensation.
Further, according to one of the participants her reasoning strategy when compelled to make decision and treat the patient’s abnormalities via an intricate and unsure circumstances as an idea “that crosses the mind” associated the ability to her past exposure and knowledge. In addition she also admitted that it could not take long before she arrived at her decision.
Second, recognizing similar situations as a reasoning strategy used by nurses to arrive at decision is common perspective of decision making. This usually present when nurses relate the condition of their patient with previously like one. Majority of the participants adapted the experiences from previously like case to base their decision in regard of their patients. Such reasoning strategy was adapted by nurses when they realized that the clinical symptoms of a certain patient were congruent with what they visualize in their mind.
One participant admitted that this reasoning strategy is often drawn from past experiences with similar patient. The participant further asserts that she majorly attributes choice of reasoning strategy to her previous exposure to such situations. She admits that all her undertaking on the patient had occurred in the past and that she ultimately based her de
The third reasoning strategy was hypothesis testing. The findings of this study revealed that some nurses formulated hypothesis subsequent to an initial evaluation and focus on the indication of the patient’s, prior to their hypothesis testing so that to establish the main problem and give the proper care. The nurses employed two distinct methods to rule out different alternatives and decide on one. In certain situation, nevertheless, basically gathering extensive data can be expedient in choosing the best alternative, while in other cases nurses undertake implementation of some solutions and appraising the patient’s response in order to arrive at the conclusive decision. The nurses also could apply the two methods simultaneously for their hypothesis testing as was evident in the response of one of the participants.
Decision-making criteria
In this regard the volunteer nurses applied definite criteria in decision-making concerning in regard of the patient’s condition and choosing the appropriate measures and verifying if they should or should not implement their care decision. The criteria concerned certain factors including; alternative information resource such as nursing books and articles for substantiating their decisions; discussion with peers and physicians; patients’ risk-benefits; and institutional requirements. Noteworthy, when applying the hypothesis testing in decision making regarding determination of the patient’s problem and the necessary care measures, the volunteer nurses could employ the whole or specific criteria. Nevertheless, in deciding if they should or not execute their chief decision, nurses often focus on the organizational expectation and patients’-risk benefits. Importantly, prioritization of criteria choice(s) by the critical care nurses was determined majorly by the situations in the critical care background, including the characteristics of the relationship between the physician and the critical care nurses and the level of power conferred to the nurses by physician. In setting where the nurses were given sufficient power, the patients’ risk-benefits become priority criteria for basing their decision making, relative to the organizational expectations and their routine work lists and the physician’s instructions. On the other hand, in situations where the nurses were conferred little authority, they based their primary decision on decision-making strategies focused majorly on demands of their duty roster and other institutional expectations.
The nurses’ duty rooster forms the major domain of nurses’ legal power for patients care upheld by the Iranian Ministry of Health and Medical Education. A nurse duty roster constitute various legal duties such as; evaluation of a patient’s health condition; identification of the problem and medical demands; execution of the physician’s instruction in the assigned limit; attending to the patient’s physical care demands such as rest, nutrition and defecation; as well as patient’s and family guidance and counseling. Nevertheless, certain critical care nursing duties such taking arterial blood samples, intubation, adjusting the ventilator limits, extubation, drug prescription, and disorienting the patient from the ventilator, must be mediated by the physician. The author observes that the limit of an Iranian critical care nurse’s duty roster corresponds with those of the nurses in other departments.
Patients’ risk-benefits
One of the top major criteria used by nurses in deciding if they should or not execute their primary decision is their benefits and drawback; the related advantages or disadvantages. Noteworthy, nurses sometimes would be obliged to make the decisions in circumstances outside the range of the duty list. Owing to exclusion of such situation in the nurse’s legal responsibility, harming the patient whatsoever could result in the nurse’s legal penalty. Hence, nurses depicted an intimate concern for the risk level and patient’s optimal benefits subsequent to the choice of a primary decision.
Reference List
Burns, N., Grove, S.K. (2009). The practice of nursing research: Appraisal, synthesis, and generation of evidence (6th ed.).St Louis, MO
Frank-Stromsburg, M & Olsen, S. J. (2004). Instrument for clinical health-care research. London; Mississauga; Jones and Bartlett publishers, Inc.
Ramezeani-Badr, F., Nasrabadi, A., Yekta, Z., & Taleghani, F. (2009). Strategies and criteria for clinical decision making in critical care nurses: a qualitative study. Journal of nursing scholarship, 41(4), 351-358. Web.
Stommel, M. & Wills, C. E. (2004). Clinical Research: concepts and principles for Advanced practice nurses. Philadelphia; Lippincott Williams& Wilkins.