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, “The handover process and triage of ambulance-borne patients: the experiences of emergency nurses. ” 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, “The handover process and triage of ambulance-borne patients: the experiences of emergency nurses” by Karen Bruce, RN, MSc and Bjorn-Ove Suserud, PhD. 2004) would like to answer the question: How staff handle patients within the emergency health care system specifically on the period covering the patient’s arrival by ambulance to the ED and nurse turnover.
It explicitly aims to explore the experiences of emergency nurses receiving patients who were brought into the hospital as emergencies by ambulance nurses/crews through an analysis of the handover and triage process. (p. 201). In addition, the study further aims to identify the patient’s path from the pre-hospital field into the emergency department (ED) of the hospital.
This study is important for healthcare professionals especially to the emergency nurses, ambulance nurses and other emergency staff to improve efficiency and still maintain the quality of care for all cases of ambulance handovers. Moreover, this study offers greater possibilities to the nurse to assess a patient from a holistic perspective. Further, it also offers increased medical knowledge as well as knowledge of how to provide psychosocial support if nursing care is to be holistic.
In addition, this study is also important for patients as the handover of the patient from the ambulance personnel to the emergency staff is a patient-focused process (p. 201). Purpose of the Study 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 research approach based on the tradition of phenomenological life-world portrayal facilitates this goal, hence this study was done.
This study, “The handover process and triage of ambulance-borne patients: the experiences of emergency nurses” by Karen Bruce, RN, MSc and Bjorn-Ove Suserud, PhD. (2004) concentrated on describing individual incidents as experienced by emergency nurses (p. 202). The purpose of the study was to explore the emergency nurse’s work when a patient arrived at a hospital by ambulance. In addition, this study sought to represent the daily reality of the emergency nurse and gain an understanding of the phenomenon of handover.
Further, this study examined the issues for nurses on the other side of the handover procedure. Research Question According to Burns & Grove (1993) “establishing the research question directs the focus of the study toward an expected outcome”. Bruce & Suserud (2004) did not explicitly formulate research questions. In this qualitative study, the research questions could be: 1) What are some individual ED incidents as experienced by emergency nurses? 2) What are some daily realities of an emergency nurse and 3) How can emergency nurses gain understanding of the phenomenon of handover?
However, since the authors employed qualitative interviews, it is assumed that of course they formulated questions for the written and oral interview. But these questions were not stated broadly enough for a qualitative study. Study Design A qualitative, descriptive approach (Dahlberg, 1995, 2001) based on the tradition of phenomenological life-world portrayal (Dahlberg and Drew, 1997) was used to frame the design of the study ensuring that nothing would be taken for granted (Bengtsson, 1998).
The method used was appropriate for this study as it sought to represent the daily reality of the emergency nurse and gain an understanding of the phenomenon of handover. In addition, the qualitative interviews as used by Dahlberg (2001) and Kvale (1996) were undertaken to understand the experiences and all that they entail. Further, the study was approved by the Research Ethics Committee of Western Sweden (p. 202). Subjects and Setting There were only few subjects (only 6 emergency nurses), so the study population was small.
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. Somebody selects the subjects who are considered to be “typical” of the population. (Wood & Haber, p. 254). The participants were selected by their superiors on the following criteria: nurses with at least 3 years experience in the speciality and were currently working in the ED.
The method of obtaining the subjects was appropriate as the 3-year experience was based on the Dreyfus brothers’ model of skill acquisition (Benner et al. 1996), in which they stated that this amount of experience was a prerequisite to an holistic appreciation of the patient’s condition and understanding of the long-term objectives of that condition (Benner et al. , 1996; Benner, 2001). The size of the sample may be adequate as the six subjects fulfilled the criteria. Five of the nurses had a 1-year specialist programme of education in emergency care and, three of these had a 2-year specialist training. The setting where the data were collected was appropriate for the study. The setting was in Sweden in an Emergency Department (ED).
Since the major aim of the study was to explore the experiences of nurses receiving patients who were brought into the hospital as emergencies, the ED is the most appropriate setting. Data Collection Methods Data collection procedure used was consistent with the purpose of the study. Since the study was a qualitative, descriptive approach, the phenomenological life-world portrayal is most appropriate to ensure that nothing would be taken for granted (Bengtsson, 1998). The qualitative interviews, both written and oral were also undertaken to understand the experiences of emergency nurses.
To assess whether or not ethical standards are met in relation to the protection of the rights of human subjects, the authors seek approval to the human ethics committee. The study was approved by the Research Ethics Committee of Western Sweden. Data saturation was achieved as written and oral interviews were done. Moreover, the participants interview lasted for 50–90min. During the interview, probes such as ‘What do you mean? ’, ‘Could you develop that? ’ and ‘What does that involve? ’ were used to facilitate the interviewee develop their descriptive accounts and make clear their meaning (p. 202). Data Analysis Procedures
Bruce & Suserud (2004) data analysis procedures were appropriate for the data collected as they have undertaken three stages of data analysis. Hence, rigorous steps were taken to analyze data collected. Further, to obtain a deeper understanding of the data, it was further described in the form of meaningful units and the questions of the study were juxtaposed with the text and was then reproduced as correlated units to produce coherent units and clusters of meaning (Drew, 1997) about how the nurses perceived and experienced the handover of patients who had arrived at the emergency section by ambulance.
The meaningful units were then organized into themes, describing the handover process from the view of the emergency nurse (p. 203). 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 is not.
Strengths and Limitations The major strengths of this scientific study is first; its extensive discussion of findings which have shed light on the handover phenomenon. They discussed that the handover function was pivotal in ensuring that the patient received the correct care and that care was provided at the appropriate level. Second, this research has identified areas where this triage function of the emergency nurse is pivotal in ensuring that patients receive the appropriate level of care.
The two major limitations of this study were; first, the study was limited only to the account of six emergency nurse informants. Second delimitations include only one ED in Sweden. The study findings may be valid in any ED of a hospital as this is the first study describing the handover of patients from the ambulance nurse to the emergency nurse at the ED. So the authors suggest more research is needed to throw light on this aspect of the emergency chain, something that is planned for a future study (p. 208).