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This paper presents a critique of a qualitative research article titled: ‘Perceived support from healthcare practitioners among adults with type 2 diabetes’ (Oftedal et al, 2010) (appendix 1). To enable the critique of this article the Caldwell critiquing tool (2005) will be utilized. (Appendix 2)
Research critiquing is a valuable skill, to gain as it enables student nurses to develop and improve knowledge and skills and also adheres to the NMC code of conduct (NMC, 2008). Polit and Beck (2006) emphasis the ability to analyse research enables individuals to gain knowledge.
A great importance of research is that it introduces improvements and changes into practice based from evidence based practice (EBP). According to Pioneer David Sacklett (2000). EBP can be defined as “the integration of the best research evidence and clinical expertise, and patient values” (Sacklett,2000). This article was selected as diabetes is becoming an international epidemic affecting all healthcare professions (WHO,2012).
First point of interest to a reader is the title; giving clear indication of the subject (Polit and beck, 2012).
It should grab the attention of a reader as discussed by Parahoo (2006). A good title should contemplate all aspects of the above, also considering Polit and Becks (2012) thoughts on the title being with a 15 word limit. This title is very clear to the reader, in relation to the subject under study being short, concise and use of good language.
Appropriate selection for a research paper relies highly on validity and reliability, which can be shown via credentials of authors.
Working statues within health studies and behavioural research within university of Stavanger clearly quoted against each of the authors. This article has clearly labelled, educational status and working status of all authors.
Willis (2007) believes that an author’s academic background can give validity and credibility within the research itself. Education held by authors was ‘MSc, PhD, RNT’ being of an university level (Oftedal et al, 2010).
Further interest to a reader commences from the information shown within an abstract. This has to hold enough information for it to show a brief understanding of the study in place. Holloway and Wheeler (2010) recommend a clear, concise summary of the research and how it should be implemented. Burns and Grove (2007) mention good abstracts convey findings and capturing attention of a reader. A benefit to this article is that it is clear, readable and structured with subheadings providing a deeper structured understanding.
The introduction of this article evidently outlines the rationale for the study; with reference of findings from other relevant studies completed. Holloway and Wheeler (2010) declare authors have to provide awareness of their subject and reasons for their study. Suggestions made indicated that it is paramount for study for the improvements to be made, emphasising on the rise in statistics from the condition (Oftedal et al, 2010).
Within the article, there is no clear indication of a literature review. Although, through reading this it has become apparent that it has been included within the background section. Polit and Beck (2012) discuss a literature review being a summary of previous research. Explanations are given within reference to other studies such as Schilling et al (2002) which has shown to lack empirical evidence.
However, Thorne and Paterson (2001) look at aspects, but indicate more research can be done. The purpose of a literature review is essential as it gives more emphasis on why the study is important; for instance lack of previous research on the subject. Within this article has an disadvantage, because there is no clear stating of a literature review, which would in some circumstances confuse a reader. Research referenced within the article was between the years 1992-2008; mentioning the need for further research (Oftedal et al, 2010).
A purpose for an article is to generalise there aims, informing subject under study stating what is likely to be achievable from the study; Polit and beck (2012) emphasis this being an importance. The aim is clearly sub headed giving the reader clear positioning within the report, it is short and concise with relevant information; indicating the subject of study and what is desired. The aim being ‘perceived support from healthcare and different attributes, that influence people’s self-management of the disease’ (Oftedal et al, 2010).
The study is complete by using participants. Ethical issues have a vast importance relating to the validity and credibility of the research. Approval of ethical committee’s is exceptional, including reference. Legal rights and ethical aspects for all research methods have to be considered (Holloway and Wheeler, 2002; Moule 2011; Strubert, 2011). The study appears to have been approved by Norwegian regional committee for medical and health research ethics, social science data services all having reference provided.
Implications can be studied at length but four rights are paramount in research: the right not to be harmed, the right of full disclosure, the right to self-determination and the right to privacy, anonymity and confidentiality (ICN, 2012). It is apparent from the study that informed consent was gained from participants, as an invitation was sent, and approval from participants was gained. The right to withdraw was shown as two participants never contributed from initial approval.
Methodology is discussed by Parahoo (2007) simply as a plan that describes, how, when and where data is to be collected and analysed. This article does not visibly show methodology but it is an interchangeable term such as research design is present. An advantage from the article is that further reading and comprehension is not necessary as it obviously indicates this research as “interpretive and descriptive qualitative design” (Oftedal et al, 2010). Holloway and Wheeler (2002) state it gives an understanding of human experiences, giving an advantage to this research as it is what they wish to achieve.
Additionally, Holloway and Wheeler (2010) discuss, how roots with philology and the human science, especially in history, centring the way humans related to their subjective reality and attaching a meaning
to it. Approach taken solely on world life context rather than individuality; allowing more of an understanding of human experiences at a whole. This type of research allows authors to gain characteristics within this field. Usage of the data is to develop theories and identify problems with current practice (Burns and Grove, 2007; Gerrish and Lacey, 2010).
Outcomes achieved five themes, namely: an empathetic approach, practical advice and information, involvement in decision making, accurate and individualised information and on-going based support (Oftedal et al, 2010). These are gained via interpretive and descriptive qualitative design, as it focusses more natural environments rather than cause and effect which is quasi-experimental. This concept being noticeably identified via the research, this was conducted.
Details of the participants can be found within the article visibly labelled participants. A participant enables the researcher to conduct the study; Burns and Grove (2012) suggest participants are selected due to experience, knowledge and views related to the study in the progress aiding the researcher to gain accurate information. Within this article, the type of sampling which has been declared is purposive sampling; Parahoo (2006) suggests that this type of sampling conducted is chosen because it provides more reliable and valid data as it is represented by participants diagnosed with the condition. Furthermore the participants, who were invited to take part, were recruited via referrals, from local organisations relating to diabetes such as learning and coping. Ability to speak Norwegian and be within an age bracket of 30-65 allows the data to be more accurate.
As discussed, sampling was purposeful; therefore it emphasises the reliability. The sample size used for this research was 19 participants recruited from 3 organisations, unemployed to reduce bias. Mixed gender, aged 30-65 and all participants had the condition for a minimum of one year. Although, purposive sampling is used it does not indicate which strategy; for instance, Patton (2002) allocates more than 12 for qualitative research, Polit and Beck (2012) note there being no fixed rules for sample size, although Morse (2000) mentions how much broad the scope, reflects in the sample size. This research has an advantage as it focussed on participants whom are diabetic. However limitations being restricted are age group, and metabolic generalisation. For example: participants within the study all had the controlled blood glucose levels, there was no sample members who shown uncontrolled or unstable diabetes.
Data collection from the research conducted was presented within a table. Collected via focus groups, consisting of 6-7 person per session, participants were interviewed at the workplace of the authors and mixture of genders per group. Although as mentioned by Polit and Hungler (1997) advantage being that it increases dialogue; disadvantage being an decrease for those not comfortable voicing within a group. As it has it pros and cons we can establish that all participants’ had type 2 disease therefore would not have much influence on responses.
Limits of time, and for 2 sessions was placed by researchers. The authors recommended time for reflection between sessions. The models used, were identified with the data collection section being expectancy-value and social support theory for questions within the focus groups. All the participants spoke one language; Norwegian which is an advantage to others as it is easier to transcribe.
The focus groups explained in data analysis was audiotaped and transcribed verbatim, creating auditability. The analysis was as stated “Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness” (Graneheim and Lundman, 2004; Oftedal et al, 2010, p1503). Processes took place for this study, unmistakably shown as coding to breakdown text into parts; identifying patterns within the data (Burns and Grove, 2006; Holland and Rees, 2010). After identifying codes, this enables the themes to be developed which was interrelated as findings of the study. Furthermore, data management requires clear processes to ensure methodological rigour and credibility of the findings (Burns and Grove, 2007). According to Polit and Beck (2006) a reader should consider if the data is adequate, to be published in a clear and efficient manner. This article has appropriately labelled correctly making it readable and understandable.
The results gained from the data analysis, is clearly drawn within the article under the findings section; providing the established themes, creating an understanding for the reader of how and why they found referenced themes. Polit and Beck (2013) discuss how a reader should notably find limitations within the study. this article presents a limitation section outlining a discussion of how it affects the results and further addresses possible queries that can be made such as, different attributes that can be found from people without stable metabolic ranges as it was limited to acceptable metabolic levels (Oftedal et al, 2010). The impact of results found can construct towards EBP. Additionally, the authors have discussed implications for practice within the study. This advantage is a favourable point as it leads the reader of the implications and how it can be implemented. It focuses hugely on how beneficial it is when it comes to practice.
According to transferability of these findings it becomes apparent that type 2 diabetes is a worldwide increasing problem. Results can be transferrable to any country to improve better care for those with type 2 diabetes. The study was conduct in Norway, although it is based within another country the prevalence is still applicable in the UK. Holloway and Wheeler (2010) discuss the meaning of transferability as “findings of one context that can be transferred to similar situations or participants” diabetes is a worldwide known disease (WHO, 2012) it can be transferred.
Polit and Beck (2013) reference that for the generalisation of the study; it has to be valid and reliable for this to take place. The role of a nurse becomes paramount within this section. Whether the results can be implemented by a nurse in practice, such as supporting patients in a better manner and referring if needed for more education, giving more individualisation to self-management programmes as discussed within the article (Oftedal et al, 2010).
In relation to the conclusion within the article it clearly sums up the findings and how it can be implemented within practice. It states that further research is necessary before definite conclusions can be retained. Transferability of the research to other chronic illness similar to type 2 diabetes was also mentioned. Burns and Grove (2010) express that the findings and the meaning of the research should be placed within the conclusion.
The assignment has explored the significance within research and EBP, transferability of research and recommendation have an importance in this. Overall, this article was clear with good use of words, presentation was greatly achieved, allowing the reader to be more focussed. It discussed within itself the limitations, recommendations and the need for further research for this to become meaningful. Recommendations can be viewed as knowledge and implemented within practice from this study. Also showing that evidence based practice does start from research; it is shown that studies are required in some circumstances to gain more knowledge to improve services.
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