Qualitative Critical Appraisal, Attitudes Knowledge and Skills Needed in Mental Health Nursing

I have chosen to critique Rydon’s (2005) article ‘The attitudes, knowledge and skills needed in mental health nurses: The perspective of users of mental health services’ because I am interested in finding out service user’s outlook of mental health nurses. When I qualify as a mental health nurse I would need to acquire the correct attitudes, knowledge and skills as this would make the nursing process more effective, because as McCabe and Timmons (2006) suggest I will be more sensitive to the client’s needs and preferences. Therefore being able to transfer findings to my own practice is highly substantial.

The Author of the article, Sharon E. Rydon, has undertaken this research as a partial fulfilment of a Master’s degree, training to be a researcher. Being a novice to research can present lack of self-awareness. Therefore I would have liked to have seen a pilot study be conducted in this article. Pilot studies are used as part of a research design, to check sampling techniques, to test the validity and reliability of data collection tools and to allow the researcher to practice skills such as interviewing techniques (Hek et al, 1996).

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Conjointly it would have been helpful to see the decisions taken during the project, the process of reflexivity and her involvement in the research. Watt (2007) states audiences should have the opportunity to see how the researcher goes about the process of knowledge construction during a particular study. This would also determine whether she has insight of how research should be conducted. The article identified the use of a qualitative descriptive methodology to gather data. According to Burns and Grove (2011) Qualitative research is a systematic, subjective approach used to describe life experiences.

It should increase understanding of something that is abstract and unknown by asking for, or looking for specific examples, experiences, or perceptions (Macnee & McCabe,2008), this is an appropriate method used. On the other hand the research questionnaire used with participants is not available, therefore the identified phenomenon of interest that has directed the progress of the research cannot be reflected upon (Moule & Goodman, 2009). Whether or not she uses “descriptive” methodology is questioned due to the lack of rich data.

Despite this, the analysis potentially uses rich data by quoting some responses from participants. But using quotations does not necessarily provide a justification on whether the participant’s voice is being heard or the researchers. Even though the article mentions the support of the participants, consumer consultants and coordinators of the support groups contributing to the reliability and trustworthiness of the study. The article does not justify whether the researcher has seen what was said in a different perspective making the result unreliable.

Also other factors still cast doubt on the authenticity of the article. Furthermore the message portrayed by the article is of an inductive process, and theory is generated based on the data collected (Hays & Singh, 2012). This is much like a grounded theory, yet the article has failed to state this and only clearly tells me the data collection method. To collect the data she states of using focus groups but this left me confused as she also contradicts herself by saying group interviews. A group interview is a different methodology to focus groups.

Focus group participants provide a flow of input and interaction related to the topics that the group is centred on (Edmunds, 1999). Focus groups tend to be more structured; it has more control of what is going to be said, which leaves less room for discussion and individual’s experiences are not fully heard, it usually generates information which the researcher is interested in, whereas group interviews are particularly suited for obtaining several perspedrctives about a topic (Whittaker & Williamson, 2011).

In addition to this she fails to mention the triangulation of data collection method; she uses two groups with individuals who experience mental health and one group with family member, this means a multi layered sample has been used, and all members do not share the same characteristics. In consequence of that, differences may have influenced the outcomes of the results and bias may have formed (Parahoo, 2006). This type of bias is called selection biases. Some research bias is inevitable but the researcher should have shown their understanding of this and taken this into account in the data analysis.

Therefore it also clearly indicates the researcher has failed to maintain consistency in the article and because of the errors the validity of the article has also been threatened. Further clarification is needed to understand what she actually did (Whittaker & Willamson, 2011, Parahoo, 2006, Litwin, 1995). It is imperative for a study to be valid, for the results to be accurately applied and interpreted. From this article it is difficult to say whether the study reflects the truth. Insufficient information on how the participants were selected; how participants got involved in the study; what questions were sked; whether or not the researcher’s body language and style of questioning influenced the results; and how trust was gained with participants leaves the reader questioning the validity of the article (Litwin, 1995, Merriam, 2009). The researcher “drew on the experience of 21 participants” although a small sample it is adequate to gaining rich data (Moule & Goodman, 2009), But “focus groups lasting approximately 1 hour in duration” would articulate 3 hours in total with 3 focus groups. Therefore I would like to have known how the researcher built trust with the participants in a short period of time.

A strong foundation of trust promotes comfort, honesty and security (McCabe and Timmins, 2006). Although ethical considerations have been taken into account it does not determine whether trust was built for the participants to cooperate and willingly express their views. Several interactions are needed to build trust as it builds over time (Bach and Grant, 2009). Interaction with participants in this research is limited therefore further justification is required to show validity of the rich data quoted and trustworthiness of the research (Merriam, 2009).

To analyse and examine the transcripts Rydon uses the process of reading and group discussions to find common properties. She then grouped the findings to develop categories which were predetermined by the questionnaire. This yet again has casted doubt and I would question whether the 6 subcategories that emerged are actually correct, or did she impose the 6 subcategories to fulfil her master’s degree. Additionally lack of a questionnaire in the article undermines any potential audit trail of what actually happened at the data collection stage.

Audit trails are records that are kept regarding what was done in an investigation (Powers & Knapp, 2011). Researchers recommend the development of a research audit trail for example Koch (2006) suggests that a study’s trustworthiness may be established if a reader is able to audit the events, influences and actions of the researcher. The study taking place in New Zealand raises concerns regarding transferability of the findings, as their cultural and environmental factors may contribute to the findings. The Guidelines in New Zealand for MHN may differ, also making a contributive factor to the study.

Although subcategories which emerged in this study are expected in MHN in the UK, I still feel the need to look for other studies to enhance my knowledge and understanding on the matter, as the research is not spontaneous because she does not state what she actually did and this is necessary (Ellis, 2010). Also the participants are discussing the nurses in New Zealand as opposed to the UK. MHN in the UK may deliver effective care and may consistently interact in a therapeutic manner but may be inadequate in other categories therefore the findings are not transferable.

Despite all of this one finding which emerged from the study in which I believe would influence my collaborative practice was, the need for nurses to support people through processes such as organising respite care, visiting agencies, appointments, speaking to doctor’s, education on medication and assisting families. Therefore the need to collaborate and liaise with other professionals is crucial to gaining greater knowledge and understanding when expertise is beyond owns limits (NMC, 2008).

I would need to have self-awareness and realise my own boundaries, enabling me to communicate effectively with other professionals. Different professional knowledge better informed clients about issues and their rights. I also need to liaise with other professionals and agencies to help mediate the impact of change on users (NMC, 2008, Day, 2007) At the end of my educational years the need for positive attitudes and creating a therapeutic practice is vast as proven by the article.

As a nurse I would be spending the most time with patients therefore enhancing my communication and observational skills would allow accurate transfer of findings to other professionals and agencies which in return would enhance the care of patients (NMC, 2008, McCabe & Timmons 2006, Bach & Grant 2009). To conclude this essay, the chosen journal has failed to provide adequate information on how the study was conducted, questioning the validity and trustworthiness of the study.

Also findings may have been influenced by various factors which may differ in New Zealand than the UK which also question’s the reliability of the findings. Rydon failed to maintain consistency throughout the article and further studies need to be read to gain a better understanding on the subject. Collaboration is needed with other agencies and professionals as various knowledge and expertise optimise the care for service users (NMC, 2008).

References

Bach. S and Grant. A. (2009) Communication & Interpersonal Skills in Nursing. 2nd edn. Exeter: Learning Matters ltd. Burns, N and Grove, K. S. (2011) Understanding Nursing Research: Building an evidence based practice. 5th edn. America: Elsevier. Day, J. (2007) Expanding Nursing and Health Care Practice: Interprofessional Working. Hampshire: Cengage Learning EMEA. Edmunds, H. (1999) The Focus Group Research Handbook. America: Mcgraw-Hill. Ellis, P. (2010) Understanding research for nursing students. Exeter: Learning Matters Ltd. Hays, D.G and Singh, A.A. (2012) Qualitative inquiry in clinical and educational settings. Newyork. The Guilford Press. Hek, G. Judd, M and Moule, P. (1996) Making Sense of Research: An introduction for nurses. London: Cassell. Koch, T. (2006) ‘Establishing rigour in qualitative research: the decision trail’, Journal of Advanced Nursing, 53(1), pp. 91-100. Litwin, M.S. (1995) How to measure survey reliability and validity. London: Sage publications, Inc. Macnee, C.L and McCabe, S. (2008) Understanding Nursing Research: Reading and Using Research in Evidence Based Practice. 2nd edn, Lippincott Williams & Wilkins a Wolters Kluwer business. Philadelphia.

McCabe, C and Timmins, F. (2006) Communication Skills for Nursing Practice. Hampshire: Palgrave Macmillan. Merriam, S.B. (2009) Qualitative Research: A guide to design and implementation. San Francisco: Jossey-Bass. Moule, P and Goodman, M. (2009) Nursing research: An introduction. London: Sage publications. Nursing & Midwifery council (2008) The Code. Available at: http://www.nmc-uk.org/Nurses-and-midwives/The-code/The-code-in-full/ (Accessed: 18th June 2012). Parahoo, K. (2006) Nursing research: Principles, Process and Issues. 2nd edn. Hampshire: Palgrave Macmillan. Powers, B. A and Knapp, T.R. (2011) Dictionary of nursing theory and research. 4th edn. New York: Springer publishing company. Rydon, S. E. (2005) ‘The attitudes, knowledge and skills needed in mental health nurses: The perspective of users of mental health services’, International Journal of Mental Health Nursing, 14, pp. 78-87. Watt, D. (2007) ‘On Becoming a Qualitative Researcher: The value of Reflexivity’, The qualitative report, 12(1), pp. 82-101. Whittaker, A and Williamson, G. R. (2011) succeeding in research project plans and literature reviews for nursing students. Exeter: Learning Matters Ltd.

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