Beatrice J. Kalisch, PhD, RN, FAAN, reports her qualitative study “Missed Nursing Care” on medical-surgical items within the Journal of Nursing Care Quality. In the article, ” Nursing Care: A Qualitative Study,” the researcher helps us understand what nursing care often missed on medical-surgical unit and what are the explanations nursing staff give for not completing these elements of care. The reader will study her use of grounded concept qualitative research methodology based mostly on the guidelines provided by Geri LoBiondo-Wood and Judith Haber (2014).
This analysis report will be analyzed utilizing the criteria found in the Critiquing Criteria box on p. 135-136 in Nursing Research: Methods and Critical Appraisal for Evidence-Based Practice.
Statement of the Phenomenon of Interest
In Research: Methods and Critical Appraisal for Evidence-Based Practice, the authors outline phenomena as these things which are perceived by our senses (LoBiondo-Wood & Haber, 2014). The analysis clearly states the phenomenon of internet within the introduction, “…specific elements of nursing care missed routinely and nursing staff reasons why these parts of care are prioritized as much less essential than others” (Kalisch, 2006, p.
306). Beatrice Kalisch (2006) used the qualitative research methodology as a end result of the she had to uncover information about her phenomenon from nurses experiences of their medical-surgical items.
Kalisch (2006) defined, “A literature search revealed an absence of studies…” about “The specific elements of missed nursing care” and “the association between less staffing and the negative outcomes” (Kalisch, 2006, p. 306). The researcher realizes present relationship between nursing staff and poor patient outcomes. Kalisch discovered there was a spot and needed to find what “the lacking nursing care” was and why it is missing.
Kalisch helps her viewers perceive the philosophical underpinnings by explaining the utility of grounded concept in phenomenal sense making. The authors of Methods and Critical Appraisal for Evidence-Based Practice differentiate ground theory from different qualitative analysis methods by stating that floor theory give attention to process. The analysis identifies the process elements of her phenomenon quite than just describing it (LoBiondo-Wood & Haber, 2014, p.153).
Kalisch tells the reader the purpose in her first line of her summary which is “…to decide nursing care often missed on medical-surgical items and reason for missed care” (Kalisch, 2006, p. 306). ). Kalisch conveyed to the reader, “Ensuring quality nursing care and patient safety is a serious challenge going through nurses and nurse leaders today” (Kalisch, 2006, p. 306). Thus, this research is finished to find what can change nursing practice to ensure higher affected person outcomes.
The authors of Research: Methods and Critical Appraisal for Evidence-Based Practice defines grounded concept as “different types of qualitative analysis method in that it goes beyond the normal methods of phenomenology and ethnography, which focus on the process that’s at the coronary heart of the inquiry” (LoBiondo-Wood & Haber, 2014, p.154). According to Glaser and Strauss (1967), grounded principle methodology was “developed initially as a sociologist’s tool” and Denzin and Lincoln (1998) add “researchers…use the grounded principle technique when they are interested in social process from the perspective of human interactions…” (LoBiondo-Wood & Haber, 2014, p. 116). Kalisch analyzed social course of amongst nurses who are divided by job title into focus teams. She properly use grounded principle methodology to discover the phenomenon and gather knowledge for the stated objective. However, it is unclear if the study adopted the rules of the grounded principle technique.
In Methods and Critical Appraisal for Evidence-Based Practice, LoBiondo-Wood and Haber (2014) explains “In qualitative research, the researchers are normally looking for purposive sampling…a specific sort of one that can illuminate the phenomenon they wish to study” (p. 100). The reader knows Kalisch (2006) purpose is concerning the views of nurses on medical-surgical items, and the author does interviews with “A whole of 107 registered nurses, 15 licensed practical nurses, and fifty one nursing assistants, working in medical-surgical affected person care units…” from two different hospitals (Kalisch, 2006, p. 306).
These nurses stay the experiences of “missed nursing care” and might shed light on why care is missed on medical-surgical unit; subsequently, they are an appropriate sample for this phenomenon of study. However, Kalisch could made a stronger pattern for the grounded principle methodology if she included the words “purposive sample” , defined why this group of nursing employees was chosen, and given details in regards to the inclusion/exclusion criteria for the sample (LoBiondo-Wood & Haber, 2014, p. 100).
The description of information collection lacks details in Kalisch (2006). The reader is aware of the author interviewed “25 focus groups” using “semistructured design and every interview “lasted 90-120 minutes” and the interviewees “were asked to commit to confidentiality” (Kalisch, 2006, p. 306-7). The information collection did include human expertise which was the nursing staff. Though the author states asking the interviewees to “commit to confidentiality”, however this is not sufficient to guard them from disclosure. In addition, data saturation isn’t confirmed and little identified in regards to the information assortment course of. The writer should have said in the course of the interviews “nothing new is emerging” (LoBiondo-Wood & Haber, 2014, p. 101). Furthermore, the writer ought to included clues about questions that had been asked and if anything collected from the interviews centered her examine.
The creator used “qualitative evaluation software” to apply “a grounded theory approach by which empirical information are thematically categorized by induction” (Kalisch, 2006, p. 307). There are two analyses of the “tape-recorded, totally transcribed” interviews, and “to be included as a theme, supporting information had to be contained… in all the focus groups” (Kalisch, 2006, p. 307). The reader identifies the analysis to be true to information as a end result of, as the two analyses “extracted the identical points from the empirical material” (Kalischp. 307). Trustworthiness, generally recognized as rigor for qualitative analysis, is established by way of credibility, auditability, and fittingness, none of which is communicated by Kalisch (LoBiondo-Wood & Haber, 2014, p. 126). Credibility requires that the “informants acknowledge the experience to be their own” (LoBiondo-Wood & Haber, 2014, p. 155). The writer never discussed taking the themes obtained from the interviews again to the nurses to permit the interviewees the chance to verify the findings. Nor does the creator give any indication that sufficient time was allowed for full understanding of the phenomenon.
Auditability requires that others, “not engaged in the research, have the flexibility to comply with the auditrial of the first researcher” (LoBiondo-Wood & Haber, 2014, p. 155). The writer ought to have described knowledge saturation as talked about previously. In the data analyses section of Kalisch (2006) the writer talked about grounded theory method was used for extraction of themes from the interviews. However, the reader doesn’t know the systematic process used, if there was “open coding” and “constant comparative method” (LoBiondo-Wood & Haber, 2014, p. 117). The neglect of giving the step-by-step process inhibits the reader’s ability to follow the thinking of the researcher.
Fittingness is the “criterion that gives the reader with a possibility to discover out the usefulness of the information exterior of the study” (LoBiondo-Wood & Haber, 2014, p.156). The reader knows the writer chose grounded concept method appropriately for the aim of Kalisch (2006); however, due to lacking data the reader is uncertain if this is research is repeated in different hospitals or different units if the identical themes would evolve (LoBiondo-Wood & Haber, 2014, p. 117-120). If the creator gave the systematic course of the research could presumably be replicated. This essential data would permit wider application to different professions.
The creator offers nice particulars within the findings part of Kalisch (2006) permitting the reader “to apprehend the essences of the experience” (LoBiondo-Wood & Haber, 2010, p. 130). Use of quotes from the interviews allowed the reader to know how the themes emerged (LoBiondo-Wood & Haber, 2010, p. 108). The author’s conceptualizations are sincere to the findings. The “Nine components of often missed nursing care…and 7 themes relative to the reasons for lacking this care…” described in Kalisch (2006) summary is clearly defined all through the findings section (p. 306-310). Additionally, within the discussion part the author relates the findings to the literature evaluation (Kalisch, 2006, p. 310-311). The creator mentioned how different analysis “corroborate[d] these findings” and “many studies have pointed to the relationship between number of sufferers per nurse and negative outcomes” (Kalisch, 2006, p. 311).
Conclusions, Implications, and Recommendations
In the implication part, the author expresses the use of her findings to vary nursing practice and “decrease the issue of missed nursing care” (Kalisch, 2006, p. 312). The creator continues to maintain up confidence about her findings in the conclusion, “it is clear that nurses are sometimes distracted for care…and ought to be engaged in delegation training and efficiency follow-up” (Kalisch, 2006, p. 312). Yet, the author declares a necessity for additional research as a outcome of “only 2 facilities” have been studied and “additional research are wanted to determine the validity of these findings” (Kalisch, 2006, p. 312). The creator recommends implications for nursing follow by the details to look at this phenomenon on their unit by doing “root cause and different analyses…to decide the causes of the issue and methods to handle them” (Kalisch, 2006, p. 312). Plus, the creator gives recommendations about “development of a tool to measure missed care” and questions to answer in future analysis.
After scrutiny of Kalisch (2006) the reader has an understanding the creator used qualitative, grounded concept methodology to review “missed nursing care” and “staff causes why” they had been missed. However, earlier than application of those findings the reader should conduct more research and more analyses because Kalisch (2006) findings usually are not conclusive. Also, the reader would have to do extra literature evaluation and even contact writer if possible to realize more information about her strategy of sampling, collection and analyses so the study may be repeated and validity of the findings could be affirmed.
Denzin, N.K., & Lincoln, Y.S. (1998). The landscape of qualitative research. Thousand Oaks, CA: Sage. Glaser, B.G., & Strauss, A.L. (1967). The discovery of grounded theory: Strategies for qualitative research. Chicago, IL: Aldine. Kalisch, B.J. (2006). Missed Nursing Care: A qualitative study. Journal of nursing care high quality, 21(4), 306-13. LoBiondo-Wood, G., & Haber, J. (2014). Nursing research: Methods and critical appraisal for evidence based mostly follow (8th ed.). St. Louis, MO: Mosby-Elsevier.