The aim of this assignment is to critique a chosen piece of research from the field of mental health nursing, published within the last year. The assignment will be presented in two parts; part one will discuss the critique process and part two shall be
a demonstration of the critique process through the critique of the chosen article.
One of the first tasks of critiquing a research article is to try to explain the performance and tasks that have taken place. Critiquing research involves a careful examination of all aspects of a study in order to judge its strengths, limitations, meaning and significance (Hek, 1996).
The Royal College Of Nursing (RCN, 1993) suggests that for nurses to be able to expand their understanding and be able to make changes within their practice it is essential for nurses to have the skills of reviewing and evaluating research studies. Nursing is striving for evidence-based practice; this involves finding, critiquing and applying the evidence within the practice.
Burns & Grove (1999) explains that to enable one to move on to a practice based on empirical evidence it is essential to critique research. Although critique is linked to ‘criticize’ which is often viewed as negative, it is important to identify the research strengths as well as weaknesses as all studies have weaknesses. If all studies that had weaknesses were disregarded then there would be no evidence to use in future practice. Being able to recognise certain flaws in studies can enable the next study to become stronger.
Parahoo ( ) explains that research papers are organised into sections which presents the key points from each section.
Papers can be read by asking oneself a series of questions about each section this forms the critique process as follows:
Title and abstract – Is it of interest?
Introduction – Why was it done?
Literature review – Is there one? Does it provide a biased or balanced perspective of the issue?
Methods and ethical considerations – How was it done? Was consent given?
Data analysis – What has it found? How are results presented?
Discussion – What are the implications?
Conclusion and application to practice – What else is of interest?
The questions that go along with each section of the critique process lead towards an informed judgement on the meanings of the findings and their relevance for clinical practice.
Research is critiqued to enable the individual to gain a wider understanding, identify evidence for use in practice and to provide a setting for conducting a study. Being able to critique a piece of literature effectively can enable the reader to have more understanding rather than seeking out help from others. This builds up confidence and knowledge. (Thomas, 1990)
The details or the vagueness within the title alone can decide whether the research document is read or not. (Parahoo ). Millward et al (2005) title ‘Depression and the perpetuation of an incapacitated identity as an inhibitor of return to work’, may put people off reading it, as it sounded rather in-depth and can make the reader believe that the document itself would be like that also. Each of the authors’ profession and place of employment were shown with the title.
Researchers are aware of the fact that some people may only read the abstract, therefore, many researchers will provide readers with information usually about 100-200 words which is enough for them to decide if the study is of any interest to them (Parahoo ). Parahoo also suggests that the abstract should briefly state the problem to be studied, the design the setting, the population and its sample size, the methods used to collect the data and the main findings.
Millward et al (2005) have written around 200 words with enough information for the reader to decide if the study is of any interest to them. The abstract was not titled however what was mentioned does generally meet the criteria, it discusses the problem to be studied, it also identifies design as a qualitative research using Interpretative Phenomenological Analysis (IPA). The methods chosen to collect the data and the sample size are indicative of qualitative research (Crookes & Davis 1999). The abstract summarizes the main points, it is easy to read and understand.
INTRODUCTION TO THE STUDY
The introduction may not alway be labelled ‘introduction’ and can also be included within the abstract (Polit, Beck & Hungler 2001). For the purpose of this study Millward et al (2005) have chosen to keep the introduction separate. According to Burns & Grove ( ) Heck (1996) a general introduction to the study should identify the research intent. A rational discussing the purpose and importance of the study to be researched should support this. The research problem has been identified according to Millward et al (2005)participated with an investigation process, which clearly encouraged an initiation of the research.
The purpose of the study has been clearly identified and Millward et al (2005) provided a rationale for why they chose to carry out the study. Part of their information sources came within a press release from the Royal College of Psychiatrists document where Millward (senior lecturer), Lutte (trainee clinical psychologist), Purvis (research psychologist) are all linked with the source. The press release highlighted the financial cost of adult depression in the year 2000 but only within England. Previous research is discussed which supports the purpose and significance of the study. According to Cormack (2000) references of previous research should be used to support all aspects of the introduction, particularly the assertion by the researcher that there is a need for the subject to be researched.
Millward et al (2005) have chosen a qualitative approach. Thompson & Phil (1999) suggest that qualitative research methods aim to develop concepts that help one to understand social phenomena in natural surroundings, and not experimental settings indicative of quantitative research methods. The aim of a qualitative researcher is to explore people’s experiences, feelings and beliefs so that statements about how people interpret and structure their lives can be made (Holloway & Wheeler 1996).
The Interpretative Phenomenological Analysis (IPA) approach is used for this study and will provide an insight and understanding into the role played by illness in attitudes to recovery amongst people who have been diagnosed with clinical depression.
IPA was chosen over the ‘Grounded Theory’ approach (Glaser & Strauss 1967), as they did not want to develop their theory but to understand and explore how the participants understood their personal and social environment and what experiences and events meant for them.
Nineteen participants aged 28-52 (6 males & 13 females) were recruited through local advertising within Primary Health Care Centres. The ethical committee within the University of Surrey granted approval. All participants were given information sheets explaining the procedure. Before giving signed consent, participants were also advised that they were free to leave at any time. Pilot studies were done of the questions being asked to check the clarity of the language.
Carrying out research has many ethical implications and nurses must ensure that patients’ rights and safety are considered at all times (International Council for Nurses,1996). Parahoo ( ) and Polit, Beck & Hungler (2001) suggest that four ethical principles must be considered when participating in research: (1) the right not to be harmed, (2) the right to be fully informed on all aspects of the study, (3) the right to decide to take part or not (and the right to withdraw at any time), (4) the right to privacy, anonymity and confidentiality, Parahoo ( ) highlights that it will affect the outcome of the data if confidentiality and anonymity are not guaranteed.
The most common forms of collecting qualitative data are participant observation and in-depth interviewing (Kenworth, Snowley & Gilling 2004). The nature of collecting data in Millward et al`s (2005) study is to seek to promote the understanding of the individuals’ perceptions. A semi-structured interview was used with the same researcher to ensure consistency, all interviews were audio taped with consent and lasted between 20 & 60 minutes. However there was no mention of what questions were asked. In conjunction with Burnard (1991) theoretical framework, the reliability of Millward et al (2005) has been enhanced by audio taping the interviews.
Using semi-structured interviews in a study enables the interviewer to be guided by the participant who should be encouraged to talk freely, even though the interviewer may have certain points to cover. (Parahoo ).
Although Millward et al (2005) has only provided a small amount of information of their data collection and fail to provide information concerning what questions were asked, the tools that were used to collect the data were appropriate for the study. Parahoo ( ) states that the methodology should clearly identify the research design used, the chosen sample size and selection, the research tools used and the ways of collecting and analysing the data.
Parahoo explains that with a qualitative research, commences during the process of data collection. While the researcher processes the information patterns are then looked for during the interview or observation and then select a theme to follow. The data analysis continues throughout the interviews and also once data is collected.
Two researchers independently undertook the analysis and checked and re-checked with each other for emergent themes. Millward et al’s written presentation of the results is clearly understood in straightforward, objective, well-organised understandable language.
The results were set out in the form of five sub-themes, which provide in-depth discussions that have been identified using the coding system mentioned in Burnards theoretical framework (1991). Each theme has been supported with narrative objective accounts from the participants about their thoughts and feelings on returning to work although being diagnosed with clinical depression.
According to Hek (1996) the use of direct quotes can be a powerful factor when presenting depth and recognition of individual experiences, which has been achieved by Millward et al (2005). The presentation of the identified themes highlighted participants thoughts and feelings concerning the ‘sick role’. Those who were becoming ‘well’ preferred to move away from the ‘sick role’ and opted to be ‘recovering’, which highlighted new hope. It is also believed that prescribed medication should be seen as a ‘tool’ to assist with the recovery process rather than a reinforcement of illness identity, or a reason for the ‘sick-role’.
Millward et al (2005) present the negative and the positive issues that the participants raised concerning the ‘sick role’ and returning to work. Parahoo ( ) states that it is of great importance that the results and the significance of the study are discussed, whether positive or negative. This confirms the statement made earlier, that participants being interviewed using a semi-structured technique should be encouraged to talk freely.
Millward et al (2005) have included when appropriate, recommendations for further study, they also pointed out limitations concerning many of those who were off work and were recruited for the research were actually recruited from the same day centre on the same day. It was also highlighted to consider that these participants who came forward may have actually been feeling better, thus indicating that they may not have on a whole represented the full range of the illness spectrum.
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