This paper will critique a qualitative research study published in the Journal of Medical Ethics in 2004, By Dr Helen Aveyard, about how nurses manage patients who refuse nursing care procedures. The article explains how nurses view informed consent as not being essential to nursing care procedures. Problem Statement
The clinical problem being examined in the research study is the way in which nurses obtain consent prior to administering nursing care procedures, and the way nurses manage patients who refuse any nursing care procedures. By stating that nurses “do not regard obtaining consent as an absolute requirement” also stating that “consent is preferred but no considered essential” the significance is established and a clinical problem identified.(Aveyard, 2004, p. 346) The author identifies the need for further education of nurses on the need to obtain informed consent for nursing care procedures, and the need for more research of this topic. Purpose and Research Questions
The study clearly identifies the aim of the study as “to examine the way in which nurses manage patients who refuse nursing care procedures.”(Aveyard, 2004, p. 346) The study identifies two main purposes for the research study as: 1- To examine how consent is obtained prior to nursing care procedures, 2- To explore the ways in which consent could be approached by clinical nurses.”(Aveyard, 2004, p. 347) The author provided clear purpose or aim of the research problem, “the way in which nurses manage patients who refuse nursing care procedures.”(Aveyard, 2004, p. 346) And related the problem to the questions of how consent is obtained, how obtaining consent can be
approached, and at the extent to which consent remains voluntary. The qualitative method is appropriate for this study as the information needed was obtained through interviews, observations and focus groups to answer the question of how nurses obtain consent and for exploring ways consent could be approached in the future, due to the lack of discussion in nursing literature on obtaining consent prior to nursing care procedures.(Aveyard, 2004, p. 346) Literature Review
The author cites qualitative research articles and nursing education manuals and training manuals from many different authors and time periods. There were no quantitative studies cited. All research article referenced were relevant to the study, most were greater than seven years old and older. No evaluations of strengths or weaknesses were available for referenced material. The limitations of this study were named as: “data was exploratory, It was not the specific intention to explore the management of the patient who refuses care; the topic came from the inductive data analysis.(Aveyard, 2004, p. 349)
It is relevant as this is a previously unexplored area of nursing.(Aveyard, 2004, p. 349) The author builds a logical argument through discussion of nursing education, and the fact that nursing education and the focus of informed consent in nursing education is on the nurse’s role in obtaining consent prior to medical procedures and research procedures, and not prior to nursing care procedures. The author uses the argument that the lack of discussion on informed consent does not negate its importance and it purpose which is to protect a patients autonomy .(Aveyard, 2004, p. 346) Conceptual/ Theoretical Framework.
There is no specific perspective identified within this study. There was no diagram or conceptual framework in the study. The results are clearly defined and sample was described as being purposive sample of qualified nurses from two teaching hospitals in England. (Aveyard, 2004, p. 647) The author used a grounded theory type of qualitative research study. Through observation of how consent is obtained, nurses’ interpretations of why consent is obtained, six focus groups, and in depth interviews, data was collected and analyzed. (Aveyard, 2004, p. 347) The sampling was purposive, and was said to consist of qualified nurses who were “willing-and able- to
recall and discuss critical incidents. (Aveyard, 2004, p. 347) The interviews were tape recorded and transcribed focus group and interview data were combined in data analysis and transcripts were analyzed using a constant comparison.(Aveyard, 2004, p. 347)