Essay On Critical Appraisal Of a Research Arti

	Essay On Critical Appraisal Of a Research Arti Van der Cingel, M. (2011) ‘compassion in care: A qualitative study of older people with a chronic disease and nurses’, Nursing Ethics, 18 (5), pp.672-685.
I have chosen the above article to critique because of the wide media interest and the public perception of nurses failing to meet the basic need of patients, especially elderly and vulnerable patients (BBC, 2011).
The author starts with a clear statement of the aims of the research-“to understand the benefit of compassion for nursing practice within the context of long term care” (van der Cingel, 2011). The aim especially emphasises the relationship between older people and nurses in the context of compassion. The author has used a qualitative analysis of in depth interviews to attain this knowledge. The research finds that compassion has seven dimensions- attentiveness, listening, confronting, involvement, helping, presence and understanding. The research concludes that compassion is of value to nurse and patient as it motivates both in forming a partnership to achieve the best outcome of care.
Research Design.
Qualitative research is the best method of gathering in-depth understanding of emotions, feelings and behaviour (Macnee & McCabe, 2008). The author further explains that the use of grounded theory and in particular the emergent fit mode- in other words gathering theory from data and then clarifying that theory. Constant comparative analysis, analytical induction and oretical sensitivity are then used in order to interpret the empirical data. However, there are dangers in using the emergent fit mode. Artinian and Giske (2009) state that although this approach allows the author to build upon the work of previous research, if the variables of the research were obtained from the literature review then they may be wrong. The author admits that the literature review revealed little research had been completed in this field, and so bases her concept of compassion upon the work of the philosophers Frederick Nietzsche and Martha Nussbaum. I do not want this to become a philosophical debate but some mention should be made of using one philosophical train of thought over another. Firstly Nussbaum- the author uses Nussbaum’s statement of compassion being a truly altruistic event as a basis for the author’s core concepts that are later developed. However, other philosophers do not accept this (Fox, 2011). In her book on Models of Charitable Care, Annelies van Heijst argues that it was Nussbaum’s dislike of institutions and rationalisation, and her love of the Catholic Church, that led Nussbaum to emphasise the altruistic aspect of compassion (van Heijst, 2009). Secondly, Nietzsche- the author cites work by Roeser and Willemson about Nietzsche as her evidence that imagination and not projection are needed in compassion (Roesur and Willemson, 2001). This is a secondary reference, not a primary source, and should therefore be used with caution. A simple literature search provides information on Nietzsche’s criticism of compassion as a hindrance to the development of the ‘superman’- for example Michael Fraser’s work on Nietzsche (Frazer, 2006). This directly contradicts the authors assertion that compassion is a necessity in development.
Recruitment Strategy.
The author describes why these particular people were chosen for the study but not how. The study focuses on older people living with a chronic illness and so only clients over the age of 65 (with a chronic illness) were chosen. In some cases clients were proposed by nurses to the author, this in my view may leave the results open to question- bias could unwittingly occur.
Data Collection
The setting for the data collection was threefold - 1) a rehabilitation centre for chronic diseases, 2) a home care organisation, and 3) an outpatient’s clinic. This is justified by the author’s statement that compassion is not common in professional settings. However, this is based on findings published 6 years ago (van Heijst, 2005). Additionally, this data has come under criticism due to van Heijst’s dislike of nationalisation and rationalisation in health care (van Vugt, 2009).
It is made explicit that data was collected in semi structured interviews conducted by the author, assisted by students, and based on a questionnaire that is published in the article. The interviews were tape recorded and then transcribed until data saturation was achieved. However, there is no indication of how these interviews were conducted.
Relationships.
It is important for the author to examine their own role in the collection of data and in how the research questions were formulated. If this is not adequately addressed then the research is open to critique of bias (Macnee & McCabe, 2008). The author does admit that in the end the interpretation of the results is down to the researcher, and can therefore be open to critique. However, the author does not explain adequately (in my opinion) their role in influencing the students who assisted with the interviews. It is stated that the students were hand-picked and then trained extensively in interview skills by the author. It has been shown that students can be influenced both positively and negatively by mentors (Bradbury-Jones, C. et al, 2010). It could be argued that students would be influenced even further just by their participation in a research project that would end up in print. It would be in their best interests for the research to reach a satisfactory conclusion, but nowhere in the article is this mentioned.
Ethical Considerations.
Ethics in research is of prime importance. The World Health organisation state that ethical considerations should be described (WHO, 2011). They further state that not only should a description of how approval was achieved be included, but also a description of how informed consent was given. The only reference to ethical considerations occurs when the author states that “after nomination patients were asked to sign a letter of informed consent to participate” (p.675). It is not made clear if the patients were in the presence of professionals when signing the letter of informed consent-if they were then the criticism of coercion could be levelled. Furthermore, it is not stated how it was ensured that the patients understood what it was they were being asked to sign. No mention is made of how the research was explained to the patients or how the patients may have handled the effects of the study.
Data Analysis.
The author does however, provides an in depth description of the process of data analysis. Data was recorded and transcribed then analysed with a computer software programme (Atlas-Ti). This software is used widely in qualitative research and data analysis (Atlas.Ti, 2011). This helped the author to develop a list of concepts common in compassion- attentiveness, listening, confronting, involvement, helping, presence and understanding. Unfortunately, data gathered by the students (memos made of the students interpretation of interaction between patients and nurses) was also used to achieve a “hypotheses that helped to steer the analysis” (van der Cingel, 2011, p.675). In my opinion, there are two main problems with this. Firstly, as I mentioned earlier there is the problem of bias from the students. Secondly, the idea of using this data to achieve a hypothesis seems to contradict the concept of grounded theory itself. Grounded theory should not start, but rather end with the hypotheses – a reverse engineered hypotheses (Mcnee & McCabe, 2008). I can understand why the author used this approach- after all, a split has developed with the two founders of grounded theory ( Glasser and Strauss) over the use of the coding paradigm e.g. should it look at casual conditions or coding families (Kelle, 2005).
The author uses key phrases used by the interviewees to complement each concept that emerged. The author admits that the amount of data used as an example can be open to question, and describes how she did not wish for the paper to become a diary of anecdotes- “interpretations of the researcher, the level of data saturation and the amount of quotations per group of participants’ must be open to judgement” (van der Cingel, 2011, p.676). The presentation of this data is a positive of this research in my opinion. However, it would have been advantageous if the author had explained to what extent contradictory data had been taken into account.
Findings.
The findings of this research are explicit. The author lists the seven core concepts that she believes have emerged from the data, but there is no discussion of any evidence against the findings. It is possible that no such evidence emerged, however the author should have mentioned this.
Research into this field could produce valuable results to enhance existing knowledge and understanding; however because of the flaws in research and the potential for bias the results produced here cannot be used. The authors do not discuss how these findings could be transferred to other populations or even if the research could be used in any other way.
A major problem that I have concerns the credibility of their findings. If the initial literature review was flawed, as I believe I have demonstrated, then the findings themselves are flawed. In other words, the research is not rigorous and is therefore not valid.

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