Critical Analysis Of Research Questions, Methods, And Findings On Beginner Prescribers: An Essay.

To critically examine the relationship between research questions, methods of inquiry, findings/results.

To identify and critically analyse relevant evidence which may be applied to clinical practice.

Focus

The article that I choose for the critical appraisal for the qualitative analysis is “Beginners in prescribing practice: Experiences and perceptions of nurses and doctors” by Lim North & Shaw published in 2018. The article provides insightful information on the perceptions and experiences of nurses plus doctors towards becoming professional prescribers. The article was appropriate for the study since it captures first-hand experiences in addition to perceptions of the nurses as well as physicians as beginner prescribers in challenging environments beside provides solutions to the challenges faced by these healthcare professionals (Lim, North & Shaw, 2018, 1103).

The article investigates and compares the perceptions, as well as experiences of nurses along with doctors in becoming prescribers. The authors clarify the needed skills, experience along with attitudes as a prescriber being amongst the current foci in health education, as well as the needs of continuous mentorship in the healthcare settings. This topic investigated by the authors is important given the growing importance of medical prescribers in the healthcare environment. The study will be important towards helping medical and nurse prescribers in education preparation in improving clinical experience and mentorship (Lim et al., 2018, 1103).

In my view, the research question regarding the comparison of the perceptions, as well as experiences of nurses along with doctors in becoming prescribers is valid because it tries to investigate a practical problem. This is clearly seen in the need for the nurses and doctors to acquire skills development in prescribing.

Background

The authors using their research authority emphasize the importance of prescriptive medicine in modern healthcare settings. It is apparent from the article that the authors underscore the importance of prescribers because both nurses along with doctors have the same experiences plus sustain needs when new to the prescription role. In my view, the authors believe that the topic of the need to ensure that nurses and doctors develop the necessary prescription skills and knowledge towards safe prescribing. This will be attained through additional educational training in pharmacology along with therapeutics beside knowhow of diagnosis (Creswell, 2009, 43). I strongly concur with the authors emphasize that there are gaps in awareness of bioscience in addition to the absence of pharmacology training at the undergraduate stage can result in challenges for different nurses and doctors taking on extended duties, particularly prescribing (Heaton, Webb & Maxwell, 2008, 129).

In my opinion, the authors further underscore the importance of the topic by claiming that developing the necessary curricula for prescribing roles should be made in postgraduate level. The qualitative research employed by authors greatly tackles the topic through the research design process that adequately explores all the aspects of the topic (Lim et al., 2018, pp. 1104).

Aim

The aim statement of the research is clearly stated by the authors at the abstract that offers the audience to understand the purpose of the data collection. The aim of the research is to examine and contrast the perceptions plus experiences of nurses besides doctors in an endeavour becoming prescribers (Lim et al., 2018, 1103). This aim statement of the purpose of data collection is clearly stated by the authors in the aim and objectives part of the abstract.

Research Question/Problem

The qualitative study that the researchers used was directed by a constructivist narrative method utilizing a multiple case narrative approach. This approach was effective in addressing the aim of research in investigating and comparing the perceptions and experiences of nurses, as well as doctors in becoming prescribers. The significance of the multiple cases was to provide the knowledge of the respondent’s experience, since they observe it, not to study the theories accrued from the hypothesis (Aronson, 2006, 487). This approach was important because it is supple and does assume a linear rational, where each stage of data collection is interrelated and relies on each other (Lim et al., 2018, 1104).

In my view, the authors clearly justified how the research problem will be tackled. The approach will be qualitative method directed by constructivist narrative technique using multiple case narratives. I believe that this approach is correct since multiple case narratives is important as compared to other techniques because it has the capacity to deal with many cases and offer a more comprehensive analysis of the happening under enquiry, whilst maintaining the narrative-qualitative nature of the results (Polit & Beck, 2014, 37).

In order to collect reliable and accurate data, the authors selected a purposive sampling method to collect the data needed to investigate the phenomenon under investigation. The purposive sampling method was appropriate in this study to select the right participants to take part in the study. The method was effective and the authors recognized that this technique could allow the participants to greatest elucidate the knowledge of the first practicing prescribers. Because this was a qualitative study, the authors decided not to recruit a great or countrywide representative sample (Aveyard, 2010, 41). The selection criteria that were used include authorized prescribers; willing to take part in the research; and in a position to reflect their experiences as novice prescribers. These selection criteria created an effective way that improved the credibility of the data collected. In addition, the researchers used in-depth interviews that were appropriate for this qualitative study that allowed the understanding of the experiences in addition to perceptions of the participants in the study and the meaning that they made from their experiences (Brown & Kaplan, 2012, 98). The interview schedule comprised of open-ended questions.

I believe that interviews were mainly used to collect data that was appropriate and I believe this was an excellent method to collect data through open-ended questions. These open-ended questions played an important role in allowing the participants to give more information regarding their experiences and perceptions as beginning prescribers.

The researchers analyzed the data that was collected through the interview sessions among the 26 participants in the study. The analysis of the multiple case narrative design followed a four-step process: preliminary phase analysis, then categorization, followed by the mapping stage, official categorization, as well as defining different themes as groups, focused phase of analysis, and lastly a hypothetical analysis phase (Kaplan et al., 2007, pp. 185). This implies that the new data-informed analysis plus initial analysis informed the interview process. The analysis was carried out using the “NARRALIZER®” software to generate, as well as develop the categories and allowed the linking of the data extracted. The emerging themes from every participant in the study were categorized within-group, looking for similarities along with differences (Greenhalgh, 2010, 15).

Background

The method used to analyze the data was done through four processes in iterative manner and I was happy with the process since it was appropriate for the study. The use of NARRALIZER®” software to generate categories and allowed linking of the data was the most appropriate software that resulted in better analysis of data.

In the study, 26 participants were selected for the study who was mainly nurses and doctors in Auckland, New Zealand (NZ). The nurses were selected from communal website lists that have the phone particulars of all the nurses registered in NZ comprising their addresses and names. During this period, there were eleven nurses who were duly registered and all were invited for the study, but one declined. Thus, the 3 groups of physicians were recruited where 16 resident medical officers (RMOs) plus senior medical officers (SMOs) for the study (Lim et al., 2018, 1105). The researchers in the study used specific selection criteria that allowed them to include the right participants for the study that will provide in-depth responses based on their experiences and perceptions. The following criteria were used by the researchers: certified prescribers; willing to take part in the research; and in a position to reflect on, as we; as articulate their experiences as novice prescribers (Cook, Netuvalin & Sheikh, 2003, 32).

In my opinion, the authors adequately addressed how they addressed how they accessed through appropriate criteria where they used communal website lists and a clear criterion was used to select the participants in the study, where purposive sampling method was used. The participants selected for the study were appropriate to answer the research problem since they were mainly nurses and doctors with prior experiences that provided valid and reliable data.

The study was approved by the Auckland Human Participants Ethics Committee (Ref. 2007/249). All the subjects that were invited for the research signed a consent form before the interviews, comprising consent to record interviews. The participants in the study were assured of confidentiality and anonymity and that their identity will not be disclosed (LoBiondo-Wood & Haber, 2010, pp. 75).

Main Findings

The findings of the study common in both the nurses plus doctors as novice prescribers’ fall into four thematic areas: fear, as well as anxiety while performing prescribing role; the approach of utilizing an individual list of drugs to promote safe care; the list this list was extended over time; as well as presenting senior equals in prescribing while making decisions. Doctors claimed that their prescription was guided, as well as directed as they establish their personal list. Both nurses and doctors supported the fact that the personal list was a strategy that was best in differentiating the different drugs (Ross & Yoon, 2009, 663).

The other theme that became apparent in the article was expanding the list and consolidating familiarity with drug profiles. Thus, beginner prescribers including both nurses besides doctors explained a process of looking for knowledge on other drugs from more knowledgeable prescribers (Denzin & Lincoln, 2011, 69). The final theme of referring to experience prescribers towards decision-making process was evident in the interviews. Skills in decision-making in balancing plus profit were vital in prescribing along with the features was acknowledged in more knowledgeable prescribers. Therefore, there is the need to develop curricula that will promote skill development in prescribing for both nurses and doctors (Lim et al., 2018, 1108).

Aim

In my opinion, the findings of the structure were comprehensive and clearly answered the research question. I understood the findings and the discussion because the language used was very effective and easy to understand while interpreting the results of the study. Therefore, the findings of the study were genuine and authentic that was relevant to the research problem.

Conclusions

The article offers a clear picture of the experiences along with perceptions of nurses in addition to physicians as beginner prescribers.  This is reflected through the findings of the research are in consistent with the aims and objectives of the study. The study is effective in demonstrating that the encounters of the nurses along with the physicians as beginner prescribers share several comparisons; however, there are some few variations that were noted during the interview (Holland & Rees, 2010, 86). However, the ground theory is not explained in the study regarding the reasons that lie behind the results of the research.

I believe that the recommendations and conclusions of the research were crucial because it summarized the entire article founded on the aims of the study that was highlighted in the abstract. The recommendations and conclusions was within the scope of the article and they provided adequate summary of the study; thus, answering the research problem. The recommendations show that there is the need for future research on the problem to gain more insight (Lim et al., 2018, 1110).

Overall Strengths and Weaknesses

One of the strengths of the article was that it used different groups of prescribers through the interviews that allowed similarities across the different groups, which allowed further comparison. The major limitation of the research was a small size sample that the authors used where it limited the generalisability of the findings (Parahoo, 2014, 27).

Application of Practice

The findings of the study were relevant to doctors, as well as nurses as beginner prescribers because they share general perceptions plus experiences in the healthcare setting. Thus, nurses’ initial medical experiences offer them with a clinical background for prescribing, which represents most variations among nurses plus doctors. Finally, beginner prescribers need ongoing education plus support to promote the development of skills in prescribing roles.

I believe that the research was useful and will inform future research. The study provided a critical analysis of the different experiences and perceptions of both doctors and nurses that provided clear experiences.

References

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Aveyard, H. 2010. ‘Doing a literature review in health & social care’ 2^nd  ed. Maidenhead, OU Press.

Brown, M. A., & Kaplan, L. 2012. ‘The advanced practice registered nurse as a prescriber’. Chichester: John Wiley & Sons.

Cook. A., Netuvali, G. & Sheikh, A. 2003. ‘Basic Skills in Statistics: A Guide for Health Care Professionals’. Class Publishing: Aberdeen.

Creswell, J. 2009. ‘Research design: Qualitative, quantitative, and mixed methods approaches’, 3rd ed. Thousand Oaks, CA: Sage.

Denzin, N. K. & Lincoln, Y. 2011. ‘The SAGE Handbook of Qualitative Research’, SAGE Publications Ltd.

Greenhalgh, T. 2010. ‘How to Read a Paper: the basics of evidence-based medicine’ 4^th  ed Blackwell: Oxford.

Heaton, A., Webb, D. J., & Maxwell, S. 2008. ‘Undergraduate preparation for prescribing: The views of 2413 UK medical students and recent graduates’. British Journal of Clinical Pharmacology, 66(1), 128–134.

Holland, K. & Rees, C. 2010. ‘Nursing: Evidence-Based Practice Skills’, Oxford University Press.

Holloway, I. 2010. ‘Qualitative research in nursing & healthcare’ 3rd ed. Wiley-Blackwell Chichester, West Sussex.

Kaplan, L., & Brown, M. A. 2007. ‘The transition of nurse practitioners to changes in prescriptive authority’. Journal of Nursing Scholarship, 39 (2), 184–190.

Lim, G.A., North, N. & Shaw, J. 2018. ‘Beginners in prescribing practice: Experiences and perceptions of nurses and doctors’. Journal of Clinical Nursing. 27(1):1103–1112.

LoBiondo-Wood, G. & Haber, J. 2010. ‘Nursing research: methods & critical appraisal for evidence- based practice’ 7th ed. St. Louis,Mosby/Elsevier.

Parahoo, K. 2014. ‘Nursing Research Principles, Process and Issues’, (3rd Ed.) Basingstoke. Palgrave Macmillan.

Polit, D. & Beck, C. 2014. ‘Essentials of nursing research’. 8th ed. China: Wolters KluwerHealth Lippincott Williams & Wilkins.

Ross, S., & Yoon, L. 2009. ‘Do educational interventions improve prescribing by medical students and junior doctors? A systematic review’. British Journal of Clinical Pharmacology, 67(6), 662–670.