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Pressure Ulcers and Their Treatment… Qualitative Research Critique Report (Assessment)

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Table of Contents
Statement of the Phenomenon of Interest
Purpose
Method
Sampling
Data Collection
Data Analysis
Findings
Conclusions, Implications, and Recommendations
References

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Statement of the Phenomenon of Interest

The article clearly indicates, even from the title that it aims to investigate how pressure ulcers and their treatment affects the quality of life of patients. It also gives credence to the viewpoints of the patients themselves as they are the best authority on the issue since they are the ones directly affected by it. Hence, a qualitative format is called for, using interview data as the basis of analysis. Regarding philosophic underpinnings, the researchers have done a thorough job reviewing the literature for each of the concepts of pressure ulcers and quality of life.

Purpose

Having given the justifications of the study, the researchers went on to reasonably explain the purpose of conducting the research. It emphasizes its significance to nursing with the implications that practitioners need to be more aware of the effects of pressure ulcers on patient care, as it is mostly the nurses who are concerned with checking up on the status of the sores and changing the dressing and of course helping patients manage the ulcers with or without nursing care.

Method

The methodology used is appropriate for the purpose of the research, as it provided the relevant themes and subthemes intended to fill the meat of the data. The interviews were free-flowing, although the researchers tried to stay within the themes to meet the information they set out in their goals. Patients suffering from pressure ulcers indeed were the best people to report their subjective experiences with the illness in terms of how it affects their quality of life. For this reason, the qualitative method of inquiry was most appropriate. Any other information yielded from the interviews may just be a bonus.

Qualitative research uses a naturalistic approach in search of truth. It seeks to understand phenomena in observed in specific settings. In contrast, quantitative methods are, in general, supported by the positivists’ paradigm, which characterizes that the world is made up of observable and measurable facts. Positivists assume that a fixed measurable reality exists external to people (Glesne, 1999). On the other hand, qualitative methods are generally supported by the interpretive (also referred to as constructivist) who portrays the world in which reality is socially constructed, complex, and ever-changing.

Strauss and Corbin, (1990) argue that qualitative research is any kind of research that unearths data that is not arrived at by quantitative procedures. If quantitative researchers look for causal determination, prediction, and generalization of findings, qualitative researchers look for clarification and understanding to similar situations. Therefore, it can follow that varied results come out of qualitative analysis and quantitative inquiry.

Straus and Corbin (1990) claim that qualitative methods can be used to better understand any phenomenon about which little is yet known. They can also be used to find new insights or alternative explanations on things about which much is already known, or to gain deeper information regarding those that may be difficult to be explained quantitatively, or where the researcher has determined that quantitative measures do not adequately describe or interpret a specific phenomenon.

Sampling

Purposive sampling was used. All 23 subjects were recommended by clinical research nurses from medical, elderly care, orthopaedic and vascular surgery wards in four NHS hospitals. They reflected the core characteristics of the study population as indicated by Patton (1990). All ethical considerations were given to the participants who came to the research fully knowing what to expect and signing a written consent of their participation. They were aware that the study was to benefit them because it was designed to understand their experiences of developing a pressure ulcer and their experiences of pressure ulcer care and treatments. This was their chance to express themselves and to maybe make a difference for others who are suffering from the same predicament.

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Data Collection

This qualitative study thoroughly brought out the experiences of the subjects interviewed. The demographics of each subject were considered and charted down in case they would affect the results. The interviews were done by two people who were not the researchers themselves to add to the objectivity of the data. The interviews were recorded and the data were coded according to the themes/subthemes established in the beginning. It was noted in the article that the methodology used was approved by the Multi-centre Research Ethics Committee. It was likewise endorsed by the Local Research Ethics Committees as well as the research governance and management departments of the participating centers. This fact alone is enough evidence that the safety, protection and human rights of the subjects were assured. The subjects are not obligated to continue with their participation if they, in any way, feel discomfort in the way things are going. They can quit anytime they feel like it. The data gathered may be more than what is necessary for the study. Thus, the researchers know which ones to use in order to meet the objectives of the study.

Data Analysis

The researchers ran the process of analysis of data clearly to the readers. It justified each step as in using external interviewers to maintain the objectivity and credence of the interviews. The themes and subthemes were distinctly enumerated at the beginning of the data-gathering stage in an attempt to predict which ones may come out. True enough, the data met the objectives of the study, as the subjects shared their experiences with pressure ulcers.

Readers will have no difficulty understanding the data analysis and its link to the findings of the study. It also states a waiver that although it may not be generalizable to the entire population, there is still value for certain groups of patients and settings (Lincoln & Guba, 1985).

The data suggests that the participants were fully aware of their experiences with pressure ulcers, as they were able to recount not only their experiences but also some probable causes for them. Hence it can be said that the data was credible because it reflected the truth based on the participants’ own experiences, as told by them first-hand. In terms of auditability, readers benefit from the clear flow of the writing of the study as they do not get side-tracked by other extraneous factors. The researchers were meticulous in reporting the process every step of the way that readers are kept organized in the flow of the unraveling of information.

This study’s findings, no matter the limitations it has reported, can be applied to other study settings related to nursing care. It thoroughly investigates the participants’ views on the existence of pressure ulcers and how it affects their quality of life, and it clearly points out logical causes for both. Readers, especially nurses, can take home a lot of wisdom from reading the article as it points out a lot of loopholes many practitioners fall into in the delivery of quality service to their patients. Hearing the patients’ perspectives makes practitioners evaluate their own practice and motivates them to further hone their nursing care skills. The strategies used for analysis are effective, as it presents patient views with regards to various themes and concerns effectively. The purpose of the study was clearly met.

Findings

The context in which the findings were presented was clearly defined. Patients suffering from pressure ulcers shared consistent views on their predicament, with some variations in perspectives that would now depend on the participant’s personality and background. Since the participants’ own words were used, and not totally edited by the researchers, the readers have free access to the participants’ genuine experiences and take for themselves the learning they need from the findings.

The findings were consistent with the researchers’ conceptualizations of the data, as presented in their aims for the study namely to explore the following questions in hospital inpatient settings:

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How do people with pressure ulcers rate their health and quality of life?
What are patients’ experiences of developing a pressure ulcer?
What are patients’ experiences of pressure area care and treatment?” (Spilsbury, Nelson, Cullum, Iglesias, Nixon & Mason, 2007, p. 495)

The data derived from the interviews met the aforementioned aims and generally, the participants were able to consistently discuss the themes set forth. Apart from bewailing their experiences with the pressure ulcers, the majority identified the causes for it; some blamed themselves for coming up with the ulcers (improper hygiene, neglect of health, etc.); some blamed the ulcer itself and vented their anger on its existence and some complained of poor nursing care (neglect of changing dressings, insensitive treatment of patient).

The researchers were diligent enough to spell out what is already known about the issue of pressure ulcers as such:

Pressure ulcers are a significant health problem.
Nursing staff have a major role in the prevention, treatment, management and care of pressure ulcers.
There is limited research on the impact of pressure ulcers and their treatment on quality of life.

They were also able to contribute additional information to the field with this study:

Pressure ulcers have a physical, social, emotional and mental impact on patients.
Pressure ulcers can be essential in patients’ progress from illness to full recovery, and may be perceived to increase hospital stays, and result in ongoing treatments.
Pressure ulcers cause much pain, discomfort and distress that is not always recognized or adequately treated by nursing staff.” (Spilsbury, Nelson, Cullum, Iglesias, Nixon & Mason, 2007, p. 502)

In itself, this study asserts its significance to the nursing field. It provides a lot of information valuable to practitioners in carrying out their duties and responsibilities to their patients.

Conclusions, Implications, and Recommendations

The article wraps up the study very well in a succinct conclusion that covers all the learnings derived from the research project. It clearly communicates to the readers the significance of proper nursing care to provide a high quality of life for patients in general. For this particular study on pressure ulcers, the researchers specified that management of dressings of the pressure ulcers, providing information to patients and family members (in particular about realistic time expectations for healing), undertaking preventative interventions regarding the ulcers and understanding the importance of comfort and positioning for patients. In addition, healthcare professionals need to respond to patients’ criticisms of their lack of involvement, or poor standards in the treatment, management and care of pressure ulcers” (Spilsbury, Nelson, Cullum, Iglesias, Nixon & Mason, 2007, p. 502-503). Being conscientious in the implementation of their duties is essential to the nursing profession. A study by Jensen and Lidell (2009) yielded findings that nurses considered that their conscience worked for them in three ways: as a driving force, as a restricting factor and as a source of sensitivity. The participants of this study perceived that their conscience is an asset that guided them in how they deal with their patients and their families and in their efforts to provide high-quality care.

Practically, it is also recommended that “using support surfaces, repositioning the patient, optimizing nutritional status, and moisturizing sacral skin are appropriate strategies to prevent pressure ulcers” (Reddy, Gill & Rochon, 2006. p. 974). This conclusion was arrived at from the study findings based on the participants’ reports themselves. It serves not only as a conclusion but also as reminder for nursing practitioners to be more sensitive and diligent in their practice. Bailey (2006) enumerates three things that nurses should take into consideration when ensuring a good quality of life for patients namely: pain and suffering, body functioning and autonomy. An efficient and sensitive nurse discerns well when she can give life-saving treatments which are applicable to her patients. With pressure ulcers, she needs to consider the degree of discomfort the patient experiences, if any, the body functioning of the patient, or if he has some organ failure, and of course, how independent the patient can move around with the least possible discomfort. Of course, a nurse should secure consent from the patient before administering nursing care. Aveyard (2005) did a study that evidenced that most nurses do not obtain permission from patients before providing care and refusals were ignored. The participants of the study did not know how to deal with the situation of proceeding with care when the patient was unable to give consent. Such a dilemma should be discussed in training nurses so a harmonious professional relationship with patients can be established. Patients may be helpless, but they do deserve to keep their dignity intact (Wainwright & Gallagher, 2008).

Nurses have the moral responsibility to ensure that their patients receive utmost care which includes teaching patients the ability to manage the disease on a daily basis. Educating patients on self-management is very effective in the recovery or at least the ease of pain of patients that health care professionals are advocated to include it in the routine care of individuals with chronic disease (Redman, 2005).

Although the study has covered much ground on the topic of pressure sores and its effect on patients’ quality of life, the researchers recommend future studies on its long-term effects on patients along with its treatment and prevention, specifically the costs it will entail for the patients, both monetary and non-monetary. The researchers foresee great challenges in these future research prospects.

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References
Aveyard, H. (2005) “Informed Consent Prior to Nursing Care Procedures”, Nursing Ethics: An International Journal for Health Care Professionals, Vol. 12, Issue 1.
Bailey, S. (2006) “Decision Making in Acute Care: A Practical Framework Supporting the ‘Best Interests’ Principle.”, Nursing Ethics: An International Journal for Health Care Professionals, 13(3)
Buss, I. C., Halfens, R. J., Abu-Saad, H.. Kok, G. (2004) “Pressure ulcer prevention in nursing homes: views and beliefs of enrolled nurses and other health care workers”.,Journal of Clinical Nursing, Vol. 13 Issue 6
Degenholtz, H. B., Rosen, J., Castle, N., Mittal, V., Liu, D. (2008) “The Association Between Changes in Health Status and Nursing Home Resident Quality of Life”, Gerontologist, Vol. 48 Issue 5
Dharmarajan, T. S. & Ahmed, S. (2003) “The growing problem of pressure ulcers”. Postgraduate Medicine, Vol. 113 Issue 5,
Glesne, C. (1999) Becoming Qualitative Researcher: An Introduction 2nd Ed. Longman, An imprint of Addison Wesley Longman, Inc.
Jensen, A. & Lidell, E. (2009) “The Influence of Conscience in Nursing.” Nursing Ethics: An International Journal for Health Care Professionals, Vol.16, Issue 1.
Lincoln Y.S. & Guba E.G. (1985) Naturalistic Inquiry. Sage, Beverley Hills, CA.
Levine, J. M.,Totolos, E. A.(1994) “Quality-oriented approach to pressure ulcer management in a nursing facility”. Gerontologist, Vol. 34 Issue 3
Patton M.Q. (1990) Qualitative Evaluation and Research Methods (2nd ed.). Sage, Newbury Park, CA.
Reddy, M., Gill, S. S. Rochon, P. A.(2006) “Preventing Pressure Ulcers: A Systematic Review”. JAMA: Journal of the American Medical Association, Vol. 296 Issue 8.
Redman, B. K. (2005) “The Ethics of Self-Management Preparation for Chronic Illness”, Nursing Ethics: An International Journal for Health Care Professionals, Vol. 12, Issue 4.
Schnelle, J. (2004) “Determining the Relationship Between Staffing and Quality”. Gerontologist, Vol. 44 Issue 1
Spilsbury K., Nelson A., Cullum N. , Iglesias C. , Nixon J. & Mason S., (2007) “Pressure Ulcers And Their Treatment And Effects On Quality Of Life: Hospital Inpatient Perspectives”. Journal Of Advanced Nursing 57(5), 494–504
Strauss, A. & Corbin, J. (1990). Basics of qualitative research: Grounded theory procedures and techniques. London: Sage.
Wainwright, P. & Gallagher, A. (2008)”On Different Types of Dignity in Nursing Care: A Critique of Nordenfelt”, Nursing Philosophy: An International Journal for Healthcare Professionals, Vol. 9, Issue 1.
Zeller, J. L.(2006) “Pressure Ulcers”, Journal of the American Medical Association, Vol. 296 Issue 8

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