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Discuss about the Analysis Of A Qualitative Research In Nursing Practice.

Critique of journal articles is important for nurses for bringing improvement in their practice. Insights from research articles are to be applied in practice as best available evidence. The present report is critical analysis of a qualitative research article relevant to nursing practice. The article presented by Broadbent et al., (2014) investigates the implications of emergency department triage environment on triage practice for patients presented with mental illness. The article had been published in Australasian Emergency Nursing Journal, which is the official journal of the College of Emergency Nursing Australasia (CENA) (journals.elsevier.com, 2017). The journal has recognized credibility since it is internationally peer-reviewed.  Further, the authors are doctoral degree holders from reputed schools of nursing, rendering integrity to the article.

According to Jelinek et al., (2013) Australian emergency departments (ED) are the first line of care services that patients with mental illness have access to. Considering this fact, initiatives have been taken for bringing improvements in the provision of mental health service in EDs in Australia. Nevertheless, there is no certainty regarding a number of mental health presentations to Australian EDs. It is known that ED triage nurses need to care for patients with mental illness presenting at the ED until a clinician arrives. This is a serious concern for nurses at these departments at they are faced with challenges while making decisions that are in alignment with principles of optimal quality care delivery. A better triage environment would possibly provide better positions to triage nurses at ED to care for patients.

The researchers of the present paper had the prime focus on understanding the relation between emergency triage environment and the experience of nurses who are compelled to care for patients suffering from mental conditions. For ensuring that the research paper is comprehensive and provides the readers with sufficient background information, the researchers have attempted to present the background information and past literary work on the same topic. The literature review of an article aims at identifying the gaps in existing literature. The sole purpose of the literature review is to highlight the areas that have not been addressed in previous research and need immediate attention (Parahoo, 2014). The present article, however, does not have a section on identified gaps in existing literature. The researchers in here have failed to present the particular areas that have remained unexplored in previous literature, presenting a limitation to the literature review. Nevertheless, the researchers were successful in setting up the stage for the present study, and the research aim was accurately outlined. The objective of the research to be undertaken was to undertake an in-depth exploration of the issues pertaining to triage assessment and suitable milieu required for managing it.

Methods: Research design

According to Nieswiadomy and Bailey (2017), the research design of a study determines whether the findings of the research would be able to address the research questions or not. It is important to decide on the appropriate research design aligned with the research objectives. The study by Broadbent et al., (2014) considered an ethnographic research design to understand the relationship between different aspects of triage environment and concerns and performance of triage nurse in ED. Lewis (2015) highlight that ethnographic research design is advantageous for exploring or finding the influence of a certain phenomena on the concerned participants. The authors further highlight that ethnographic research is valuable for facilitating interaction between different groups of people and observing the association between them. In real settings, such research design permits optimal information collection on the issues and challenges faced by the participants in relation to a certain aspect. The decision to collect data for the research through the interview and open observations was in harmony with the ethnographic research design. It can be considered as a right approach to understand the natural process prevailing in the setting. The research design also had reflexivity imbibed in it as documents were maintained along with field notes for later references. The negative aspect of the research was that the time frame for conducting the study was not sufficient. The research considered the evaluation of one particular aspect from a wider perceptive; interdisciplinary relationship existing between mental health triage nurse and those who are ED triage nurse.

The research conducted by Broadbent et al., (2014) contributed to an examination of one particular aspect from the inferences drawn from wider observation ethnographic study. The study setting was a regional hospital situated in Australia having an emergency department with sufficient resources. At this setting, about 4.5% of the patients coming for care services had mental health issues. The patients taking part in the study were 45 qualified professionals apart from one ED nurse working in night and morning shifts and two nurses working in afternoon shifts. The sample and setting were adequately described by the researcher. The sampling technique used was purposive sampling with the aim of conducting an interview of the nurses. As opined by Houser (2016) purposive sampling is beneficial for selecting a sample that is a representation of the broader population of interest. There are, however, certain points of limitation presented in the sampling method. The hospital setting had limited number of patients coming in with a mental illness. It would have been desirable if the flow of patients suffering from mental health disorder was more, thereby augmenting the research validity (Merriam & Tisdell, 2015).

Sample and setting

Houser (2016) advised that validity of qualitative research is to be established through analysis of the study from multidimensional perspectives. This enables identification of any underlying inconsistencies in the research. Triangulation is the best method for maintaining validity (Caretr et al., 2014). In the present research, these techniques were adhered to. Informal and formal semi-structured interviews, participant observation and examination of field notes and documents were the aspects of triangulation.

The key strength of the research under scrutiny lies in the fact that the focus of the researchers was on extracting in-depth data. The richness of data was also beneficial. The participant observation led to the collection of data related to the extent to which triage practice environment influences triage nurse practice. The interview method was a promising opportunity to contextualize the data. It formed the basis for understanding the issues faced by the triage nurses at the time of patient assessment.

The trustworthiness and credibility of research are reflected from the proficiency of the researchers carrying out the study (Nieswiadomy & Bailey, 2017). In the present case, the researchers had a similar interest in mental health care services and had sufficient knowledge on the concerned subject. Further, the decision to use both interview method and participant observation renders credibility. The trustworthiness of the data collection is reflected from the emphasis given on responses of triage nurses and operational efficiency.

A thematic approach was utilized for the data analysis step. Since the data collected was wide, other approaches could have made the process of analyzing it much more difficult and complex. Since the study was an exploratory one, highlighting the perceptions of the triage nurses, thematic analysis allowed the researchers to bring into limelight the themes underpinning the data extracted. According to Maltby et al., (2014) thematic analysis is useful for providing a comprehensive research result addressing the research questions. Moreover, systematic inductive method reduced the chances of bias. Theoretical coding and continual comparison by the three authors in a separate and independent manner was justified (Parahoo, 2014).

The study under examination gave rise to themes such as client management, triage assessment, and triage environment. It is easier for a reader to understand the study findings if the same are presented in an organized manner (Day et al., 2017).  The categorization into the themes was therefore effective. While reflecting on the ability to capture the meaning of the collected data, it can be commented that a summary of the elaborated feelings and experiences of the nurses were presented addressing the research aims. For instance, the study revealed that non-sound attenuating ceiling in the triage area is responsible for decreasing the ability to engage in a private conversation. Such attribute also hampers the control over movement and has a negative influence on the decision making procedure. The reliability and consistency of the result of the study are apparent from the research conducted by Craig et al., (2016) highlighting the fact that environmental context and resource makes an influence on documenting, screening, and restructuring behavioral changes. Further, the practice environment was found to affect ED triage assessment process in nurses. Lastly, the study indicated that the practice environment has a deep impact on ED triage assessment process of nurses.

Data collection

In summary, it can be stated that the research was helpful in identifying the architectural aspects related to the triage area that has a profound impact in clinical settings. But what remains a point of criticism is that confrontational arguments have not been presented for supporting or refuting the outcomes of the study.

The research paper put forward by Broadbent et al., (2014) was a valuable one as it presented accurately the concept that architectural environment of the ED triage area is to be considered as a key factor acting as a challenge for triage nurses while caring out assessment and delivering optimal quality care. Data collected during the research highlighted that a nurse working in the triage area needs to consider the environmental characteristics as they act as a barrier in developing a therapeutic relationship with patients. The findings of this study are reliable and credible since other researchers have undertaken an evaluation of the data and rigorous comparison before coming to the conclusion (Tappen, 2015). The limitation of the study that impairs the transferability of the research findings in different settings is the sample size. In the present case, the sample size was too small. Further, cultural, historic and social links were pointed out as factors behind triage assessment. Nevertheless, the study has been a useful one to gain knowledge of the process by which nursing practice can witness development in the triage area. The meaningful insights received can be used as the foundation for future research on the same context with special reference to triage area nursing.

The research article put forward by Broadbent et al., (2014) was considered for reviewing for solving the issues faced in the case scenario. The scenario relates to the concern that individuals suffering from mental illness seek help and care from the professionals of the ED in the first place. The challenge lies in the fact that the EDs do not have the sufficient resource, both human and non-human, for managing the increased number of patients presenting to the ED with each passing year. In such a scenario, the issue relates to the privacy of the patients having diverse mental health issues and safety of the individuals as well. The research undertaken by Broadbent et al., (2014) is an appropriate ray of light that would guide authorities to solve the arising issues since it deals with the concept that triage nurses are to be appointed at the ED for addressing needs of patients coming in with mental health conditions. The primary implication of the inferences drawn from the study is that a suitable triage environment would serve as the resolution to privacy issues of the patients as well as the safety concerns. Respect for patient values can be demonstrated by eliminating all sources of distraction from the triage area. A noise-free area that also has no barriers for movement would be suitable since the nurses would be in a position to communicate closely with the patient. The competency and skills of the triage nurses can also witness advancement if communication is strong and a suitable environment supports their need for concentration. Enhanced decision making power would be the key advantage for the nurses as they would be better able to make significant clinical decisions.

Procedures

At this juncture, it is to be noted that the results contributed by the study is not suitable for utilization in informed, evidence-based practice since it did not consider researching about the feelings and experiences of the patients. The prime focus of the study was on the triage nurses, and their viewpoints were only discussed. There is an urgency to carry out further research on the experiences of the patients in the triage area. This would act as the foundational base for coming up with strategies for providing comprehensive care to these patients. More novice recommendations would come up in due course of research on the same field that is precious.

References

Australasian Journal (2017). Australasian Emergency Nursing Journal. [online] Journals.elsevier.com. Available at: https://www.journals.elsevier.com/australasian-emergency-nursing-journal [Accessed 13 Oct. 2017].

Broadbent, M., Moxham, L., & Dwyer, T. (2014). Implications of the emergency department triage environment on triage practice for clients with a mental illness at triage in an Australian context. Australasian Emergency Nursing Journal, 17(1), 23-29. DOI: 0.1016/j.aenj.2013.11.002

Carter, N., Bryant-Lukosius, D., DiCenso, A., Blythe, J., & Neville, A. J. (2014, September). The use of triangulation in qualitative research. In Oncology nursing forum (Vol. 41, No. 5).

Craig, L. E., McInnes, E., Taylor, N., Grimley, R., Cadilhac, D. A., Considine, J., & Middleton, S. (2016). Identifying the barriers and enablers for a triage, treatment, and transfer clinical intervention to manage acute stroke patients in the emergency department: a systematic review using the theoretical domains framework (TDF). Implementation Science, 11(1), 157. DOI: 10.1186/s13012-016-0524-1

Day, J., Lindauer, C., Parks, J., & Scala, E. (2017). Exploring the Best Practices of Nursing Research Councils in Magnet® Organizations: Findings From a Qualitative Research Study. Journal of Nursing Administration, 47(5), 253-258. DOI:  10.1097/NNA.0000000000000475.

Houser, J. (2016). Nursing research: Reading, using and creating evidence. Jones & Bartlett Learning.

Jelinek, G. A., Weiland, T. J., Mackinlay, C., Gerdtz, M., & Hill, N. (2013). Knowledge and confidence of Australian emergency department clinicians in managing patients with mental health-related presentations: findings from a national qualitative study. International journal of emergency medicine, 6(1), 2. DOI: 10.1186/1865-1380-6-2

Lewis, S. (2015). Qualitative inquiry and research design: Choosing among five approaches. Health promotion practice, 16(4), 473-475. DOI: 10.1177/1524839915580941

Maltby, J., Williams, G., McGarry, J., & Day, L. (2014). Research methods for nursing and healthcare. Routledge.

Merriam, S. B., & Tisdell, E. J. (2015). Qualitative research: A guide to design and implementation. John Wiley & Sons.

Nieswiadomy, R. M., & Bailey, C. (2017). Foundations of nursing research. Pearson.

Parahoo, K. (2014). Nursing research: principles, process and issues. Palgrave Macmillan.

Tappen, R. M. (2015). Advanced nursing research. Jones & Bartlett Publishers.

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