Introduction
Critiquing a qualitative research is fundamental to nursing research utilization and evidence based practice. The process of qualitative research is an intellectual activity which investigates human experiences in naturalistic settings, pursuing meanings that inform theory, practice and which will help one decide as to what extent research maybe useful in practice; to see if the findings are trustworthy, and be able to compare it with other related research.
While the term “research” has been used rather freely in the past, there has also been a tendency to perceive research as an end in itself rather than as a means to an end, namely improvement in the quality of care provided to patients. As LoBiondo-Wood et al. (2002) mention, “the meaning of quality research in nursing should contribute to knowledge relevant to health care and service.” Further, nursing research should provide a specialized scientific knowledge base that empowers the nursing profession to anticipate and meet these challenges and maintain our societal relevance”. This paper will critique the study, “Learning to think like a Nurse: Stories Form New Nurse Graduates” by Sharon A. Etheridge, PhD, MSN, BSN (2007).
Problem
The research problem is a “situation in need of a solution, improvement or alteration or a discrepancy in the way things are or the way they ought to be” (Burns & Grove, 1993). This study, “Learning to think like a Nurse: Stories Form New Nurse Graduates.” by Sharon A. Etheridge, PhD, MSN, BSN (2007) would like to answer the question: What are the perceptions of new nursing graduates about clinical nursing judgments and the education involved in learning how to make such judgments? It explicitly aims to explore the experiences of the new graduates considered helpful in learning to make clinical nursing judgments and their beliefs about their role in making clinical nursing judgments. This problem is an important one for nursing to study because the results of this study is useful in identifying strategies to help new graduates make the transition from students to registered nurses specifically in their role in making correct clinical judgment.
Study Purpose
According to LoBiondo-Wood et al. (2002), and in-depth research providing an understanding of the nursing practice is necessary to develop nursing and health care interventions, outcome studies, and policies that are congruent and sensitive. A qualitative, descriptive, longitudinal research approach based on the tradition of phenomenological life-world portrayal facilitates this goal, hence this study was done. This study, “Learning to think like a Nurse: Stories Form New Nurse Graduates.” by Sharon A. Etheridge, PhD, MSN, BSN (2007) concentrated on describing the contexts in which the new nursing graduates learned to make clinical nursing judgments (p.25). The purpose of the study was to explore the experiences of the new graduates which are considered helpful in learning to make clinical nursing judgments and their beliefs about their role in making clinical nursing judgments. In addition, this study sought to determine the new nursing graduates’ perceptions of how they learned to think like nurses. Further, this study proposed some plan to help new nursing graduates make the correct clinical judgments.
Research Question
According to Burns & Grove (1993) “establishing the research question directs the focus of the study toward an expected outcome.” Etheridge (2007) addressed the following question: “What are the perceptions of new nursing graduates about clinical nursing judgments and the education involved in learning how to make such judgments?” To state the question broadly enough for a qualitative study, the researcher further added that, “By addressing the question, this study also explored experiences the new graduates considered helpful in learning to make clinical nursing judgments and their beliefs about their role in making clinical nursing judgments.”
Study Design
A descriptive, longitudinal, phenomenological study using semi-structure interviews was used to frame the design of the study (p.25). The method used was appropriate for this study as it sought to examine the meaning of experiences of new nursing graduates in making clinical nursing judgments. In addition, the qualitative interviews were undertaken to understand the experiences and all that they entail.
Subjects and Setting
The study used non probability, purposive type sampling of subjects as someone uses knowledge of the population to hand-pick the units to be included in the sample. The researcher selects the subjects who are considered to be “typical” of the population. (Benner, Tanner, & Chesla, 1996). There were only few subjects (only 5 new nurses), so the study population was small. The participants were selected by the researcher on the following criteria: new nursing graduates who graduated from a 4-year college with baccalaureate degrees in nursing, passed the NCLEX examination on the first attempt, participated in a nurse intern program after graduation, and no longer worked with a preceptor. The size of the sample may be adequate as the five subjects fulfilled the criteria. The setting where the data were collected was appropriate for the study. The setting was in West Michigan, in adult-surgical units. Since the major aim of the study was to explore the experiences of the new graduates which are considered helpful in learning to make clinical nursing judgments, an acute care institution is the most appropriate setting.
Data Collection Methods
Data collection procedure used which was the semi-structured interviews was consistent with the purpose of the study since the study was a qualitative, descriptive, longitudinal, and phenomenological. The life-world portrayal is most appropriate to ensure that nothing would be taken for granted in the study (Bengtsson, 1998). The qualitative tape-recorded interviews was also undertaken to understand thoroughly the experiences of new graduate nurses.
To assess whether or not ethical standards are met in relation to the protection of the rights of human subjects, the researcher assured the participants full confidentiality by letting them use fictitious names. Moreover, the participants gave a written informed consent specifically for the three tape-recorded interviews to be used for this study.
Data saturation was achieved as tape-recorded interviews were done. Moreover, the participants’ interview occurred on three times on different occasions: within a month after the end of the experience with a preceptor, 2 to 3 months later, and approximately 8 to 9 months after the first interview. Moreover, the tape-recorded interviews were transcribed verbatim, validated by another nurse, and then examined for themes (p.25).
Data Analysis Procedures
Etheridge (2007) data analysis procedures were appropriate for the data collected as the interviews occurred in three different occasions. The tape-recorded interviews were transcribed verbatim, validated by another nurse, and then examined for themes. Hence, rigorous steps were taken to analyze data collected. This data analysis procedure was consistent with the qualitative method used in the study as qualitative research investigates human experiences in naturalistic settings, pursuing meanings that inform theory, practice and further research. Though generally, qualitative research is very lengthy and often explores cultural themes, this research was not.
Strengths/Limitations
The major strengths of this scientific study are: first, its extensive discussion of the perceptions of recent nursing graduates about learning to make correct clinical judgments. Second, this research has identified that the transition from being a student nurse to working as a staff nurse as a time when they learn to think like a nurse is characterized by the emergence of confidence, the acceptance of responsibility, the changing relationships with others, and the ability to think more critically within and about one’s work.
The two major limitations of this study were; first, the study was limited only to the account of five new nurse graduates. Second, it is prone to mistakes or misinterpretation and that the possible sources of misinterpretation for this study include situational contaminants such as the quality of the interviewer’s interaction with the subjects. Use of similar questions with a larger population of new graduates should validate the findings of this research about how new graduates learn to think like a nurse.
The study findings may be valid to any new fresh graduates nurses as this is the first study describing the experiences of the new graduates considered helpful in learning to make clinical nursing judgments and their beliefs about their role in making clinical nursing judgments. Use of similar questions with a larger population of new graduates should validate the findings of this research about how new graduates learn to think like a nurse.
Conclusion
The analysis of the study presented in the article, “Learning to think like a Nurse: Stories From New Nurse Graduates,” a study by Etheridge, S.A. (2007) conclude the following:
1. Nursing students and new graduates are often unaware of the level of responsibility
required of nurses and lack confidence in their ability to make clinical judgments;
2. The process of learning to think like a nurse is characterized by building confidence,
accepting responsibility, adapting to changing relations with others, and thinking more
critically;
2. Multiple clinical experiences, support from faculty and experienced nurses, and
sharing experiences with peers were critical in the transition from student nurse to
beginning practitioner.
This kind of study is very important especially that it proposed plans so new nurses could make correct clinical judgments. Some of these plans are: 1) staff development educators and preceptors should assist the new graduates in determining answers to the questions and thus help them enhance and construct their knowledge; 2) new graduates could be brought together for frequent short discussions about the patient care situations they are learning; 3) new graduates could have a shared list server or chat room so they can talk about what they are learning; 4) experienced nurses should be assigned to the same shift with the new nurses so that support systems are available.
Further, these plans about how to help new graduates think like a nurse offer a potential improvement so that they can detect quickly a life-threatening complication, how quickly patients leave the hospital, or how patients learn to take care of themselves. All these, for the quality of care and care delivery to the patients` entrusted to new nurse graduates care.
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