Article Critique

Introduction

In the nursing arena, nursing research plays a paramount role in understanding the calling of nursing duties - Article Critique introduction. The aim of nursing research is to understand issues that are related to nursing practice, to analyze these issues and arrive at a position that will improve the requirements of nursing practice, nursing education and form the foundation for further research. Thus, a successful research is the foundation and reference for research opportunities and helps in the improvement of nursing practice. A successful nurse should be able to critique a research article and at the same time able to utilize the research findings. Therefore, the aim of this paper is to critique a research article and to understand its contributions to the nursing community. Each component of the research study is critiqued and brings into consideration analysis of methods that were used to accomplish the requirements of the paper.

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Analysis of Research Article

Problem Statement

In the fifth paragraph of the paper, the researchers define the problem statement of the research. This foundation explains why the research that was carried out plays an important role in nurse practice. The actual problem statement that the authors used was “This paper describes a story how a small group of primary healthcare (PHC) nurses with varying skills in management, education and research combined efforts to design, implement and evaluate an outreach program on 211 farms in the Western Cape of South Africa” (Dick et al, 2007, p. 384). This problem statement clearly defines the aim of the paper and illustrates what the researchers researched. Moreover, this problem statement was carried out clearly throughout the research process.

Study Purpose

The study purpose is illustrated in the sixth paragraph. The introduction of the research article brings into focus the complications that are faced by the poor people in rural settings in South Africa that have no access to proper healthcare (Dick et al, 2007). In the sixth paragraph, the researchers analyze the need for urgent intervention to improve PHC activities throughout the country ensuring that integration of community resources with the public facilities is concurrent.  The researchers illustrate the complications that are faced by the agricultural farm communities towards achieving appropriate health care. This was possible through understanding the achievements that the lay health workers (LHWs) that were selected by their peers achieved. The purpose statement is related to the problem statement in trying to understand the linkage and improvement of relation between the agricultural farm communities and health care.

Research Hypothesis or Questions

            This research was a combination of qualitative and quantitative study with three clear questions. The first question was the interest of the health authorities in the effectiveness of the intervention to help in enhancing TB case finding and holding. The second question was the cost of the health system in the implementing further expansion interventions. Lastly, the third question was to answer the question that the stakeholders required to understand the success of the intervention of the LHWs, employers- farmers and the public health sector personnel (Dick et al, 2007). These questions originate from the problem statement in specifying the variables that affects the agricultural farm communities in relation to the impact of health care system specifically the TB complication.

            In this case, the independent variables are the health care system for people with TB that are located in the rural settings especially agricultural farms. The dependent variables were the inclusion of LHWs, the cost of the system and the success of the intervention (Dick et al, 2007). The variables played an important role through out the paper and it directly relates to the problem of the statement, which brings into focus the impact that the agricultural farm based workers in relation to health care system and TB.

Conceptual Model/Theoretical Framework

The study was a two way in that it brought into consideration the qualitative and quantitative approach towards addressing the problem statement. In the case of quantitative section, the researchers utilized a pragmatic, un-blinded cluster randomized trial in determining the extent in which the cost and the effectiveness of the intervention. The qualitative researcher utilized a content analysis research approach in which the stakeholders were interviewed and the researchers employed other methods such as participant observation, field notes and focus groups to understand the perceptions of the LHWs, public health sector personnel and the employers – farmers. The strategy that was used to collect qualitative data may be affected by certain variables such as bias, validity and reliability. Nevertheless, the models that were used played an important role and helped in the development of the study through linking the variables and effect towards the poor farmers in relation to the health care system.

Review of Related Literature

            The authors have devoted a large section in reviewing previous works that relates to the hard life that is experienced by the agricultural farmers in rural settings of South Africa. The researchers refers to the writings of Fast (1997) indicating the difficulties that are faced by farm dweller communities. The author (Fast) states that the hard life is attributed to lack of proper infrastructure and poor provision of services by the employers and public health system. The authors illustrate the failure of the mobile and fixed clinics that were supposed to visit the farms individually due to lack or merge resources. Moreover, the authors discuss the contributions of ABE Development Service Trust (2003) in the way that the achievements and methods that the stakeholders operated to ensure that health care system are improved. Moreover, the authors reviewed the writings of Calrke et al (2005), Friere (1973) and Favish & Plasket (1997) in the way that the farm workers received their health care system.

            The literature review had a relationship with the complications that the farm workers faces in receiving medical care and revolved on the variables that guides the development and completion of the study and providing measures that have been put in place to address these problems. However, the authors were not able to define clearly the extent and studies that have been carried out in addressing the problem. In addition, the authors did not illustrate the position of government and the employers in addressing these problems.

Study Design

The design of the study was clearly identified and was in two parts: randomized control and cross-sectional design. This type randomized controlled trial tries to identify the effectiveness of the intervention and thus the main aim of some of the research questions was answered. The use of the cross-sectional design was indicated by the use of interviews, which revolved on surveying the sample to ensure whether the LHWs achieved their goals and impact towards current health care system. Thus, this design structure and design helped in underpinning the effectiveness of LHWs in the way that they contributed in the treatment of people with TB.

Target Population and Sample

            The target population was rural farming communities that were located in 211 farms and were situated in Boland Health District in Western Cape Province of South Africa. It is estimated that the population is 73,511 spanning an area of 1661 sq. km by 2002. The sample was obtained from the 211 farms in which 106 farms were used for intervention while 105 acted as a control group. The people who were in the study were supposed to be older than 14 years and the treatment occurred between November 2000 and October 2001. The study was able to collect 164 TB cases in which 89 were new smear-positive cases. The treatments of TB patients that were located in farms, which had LHW, were compared with those farms without LHW intervention. For cost-effectiveness, the data of direct nursing time cost was obtained from the beginning that a TB patient received treatment until the end of the six month. This was then compared with the cost of involving LHW in treatment of the TB patients within the same period and with the inclusion of findings of the randomized control trial. Three different researchers analyzed the data that they received from the qualitative process.

            The criterion that was used to pick the sample was clearly identified in terms of age and extent of treatment that the patients received. The researchers clearly described the sample and the way that they analyzed the sample. However, the researchers could have grouped the data in terms of female and male – since females did not receive the same benefits with male within the same working conditions and other benefits such as housing or maternal leave. The setting of the study was appropriate since the aim of the research to analyze the impact of TB in those areas that have poor people and without proper infrastructure.

Data Collection Methods

The data collection methods were clearly indicated. The quantitative data was collected by means of randomized control trial. This data was collected from cost effectives and contribution of the LHWs. The quantitative data was collected through tape recordings and later were transcribed and was analyzed by the use of qualitative research approach. For credibility and reliability purpose the researches stated, “These transcripts were analyzed by three different researchers” (Dick et al, 2007, p. 387). This was the right strategy in data collection of this kind. Thus, the methods that were used to collect the data addressed the aim of the research study and placed into consideration the research questions to describe the complications that dwellers in agricultural farms had to face regarding health care system and especially in the TB cases.

Findings and Recommendations for Future Research, Education and Practice

            The result that was obtained from the RCT cluster within the period indicates that the success of treatment had increased by 18.7% in those regions that had LHW intervention compared with those regions without. Moreover, finding new cases, which were associated with the TB increased by 8%. From this analysis, it is feasible to initiate a program in which LHWs are included into healthcare system. Nevertheless, the cost effectiveness in terms of direct costs decreased by 74% compared to the District Health Authorities that received cases from the control farms. This is attributed to the decision that farmers meet their bills to reduce the effect of absenteeism and improvement of morale. Additionally, the community was happy because medical cost had decreased and with the idea that there was somebody within the community that could provide assistance. The data that was obtained through qualitative process indicates that the use of LHW improved the healthcare system of the community and at the same time improved personal skills and improvement in self-confidence. However, some members of the community viewed the success negatively because they believed that the LHWs received favors, elevated relationship with the employer and the relationship that existed between the LHWs and the nurses.

            The findings that were obtained answered the research questions and addressed all problems that were in the statement. This indicates that the research article exhausted all its requirements. The researchers understands that the use of LHWs play an important role, but are not supposed to be left alone. This means that innovation should not develop faster that the resources that are available. However, the community-based support should work in hand with the public based nurses. Thus, the inclusion of LHWs in the health care system relieves public nurses to address more important or regions that require their expertise. However, the researchers did not present the base in which future research can be carried out. Thus, it could have been important for the authors to present it as a foundation of future research and in which sectors should the project processed through. The research article plays an important role in the way that nurses well employ their merge resources in ensuring that health care services reach poor and people who cannot have access of medical facilities due to infrastructure or constrained budgets.

Summary

            This research study that brought into consideration quantitative and qualitative has a well defined research problem, research questions, the type of sample that was used, appropriate methods used in collecting the data and the method in which the data was presented. In the article, there are three main research questions: effectiveness of the intervention, impact on cost and view of shareholders. The authors carried out the research with a sample of 211 farms bringing into consideration 164 cases. The researchers found out that the inclusion of LHWs improved on the treatment of TB and it also proved been cost-effective, resulting in an important community-based social development program. This article is paramount in developing the nursing knowledge in that it expands on the possibilities of nurses assisting people who are within settings that they do not receive the appropriate medical care; it is crucial for the nurses to work together with the community in improving health care within their areas. However, the authors did not present the basis in which research could be carried out nor indicate the shortcomings that are associated with the project.

Reference

Dick, J., Clarke, M., Vinyl, H. & Daniels, K. (2007). Primary Health Care Nurses Implement and Evaluate a Community Outreach Approach to Health Care in the South African Agricultural Sector. International Nursing Review, 54, 383 – 390.

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