Discuss about the Nursing Research for Methods and Critical.
The purpose of this report is to find and evaluate a research article from the journal of clinical nursing. This form of critical appraisal is necessary to analyze the importance of research findings and its applicability in different setting according to the context of research. The reviewer used appropriate framework to analyze the content, presentation and clarity of work. This form of systematic evaluation highlights the strength and weakness of the research and to identify the best current practice (LoBiondo-Wood & Haber, 2014). This report specifically focuses on the comparative study of stressor in clinical environment experienced by student nurse and newly qualified general nurse. This is descriptive mixed-method research based on cross-sectional survey design to compare level of stress in different nurse group. It provides initial appraisal relating to the rationale for choosing the article along with structured appraisal using the CASP tool (Suresh, Matthews & Coyne, 2013). Finally, the applicability of the research finding in clinical context is discussed to assess its importance for health organization.
Finding evidence, evaluating evidence and making recommendation
Finding evidence, own view on article and rational for choosing it
The research article chosen from the journal of Clinical Nursing is a mixed-method study which compares the level of job stress in nurses in the clinical environment and explores the views of participants on their perception of stress in work. Both descriptive qualitative analysis as well as quantitative analysis had been conducted through open-ended questionnaire and use of stress assessment tool. The main group participants included new qualified nurse and final year student nurse to identify the perceived difference in opinion regarding the level of stress and stressors in clinical environment. The survey with the participants helped in identifying different themes leading to stress such excessive work load, increased demand and expectation of patients and care providers, complex work relationship and gap in clinical nursing. A relation between academic demand and clinical placement was also found in nurses of both groups (Suresh, Matthews & Coyne, 2013). Therefore, if the reliability of the research literature is identified, it can act as an effective framework to bring about positive change in clinical environment for nurses.
I have chosen this article as it is clinical importance piece of research to bring improvement in nursing performance. It has been found that nurse performances in hospital are often affected because of stress in the job. There is immense stress in the job due to increase in disease, work hours, shortage of staff and poor interpersonal relationship. The level of stress has also escalated due to increased use of health information technology, rise in medical cost and complex work environment (Hayes, Douglas & Bonner, 2015). Stress has adverse consequences not just on the individual nurse, but also on the health outcome of patients and reputation of health organization. Nurse experience burn out due to stress and cannot focus on task thus compromising the health of patients. It leads to errors in professional practice as well as physical deterioration of health and psychological well being of nurse as well as patients (O Donovan, Doody & Lyons, 2013). Hence, seeing this problem faced by clinical nurse and its significant impact on the patients and performance of hospitals, I feel this article is useful as it provides insight into the issues faced by nurses. This research article can have positive implication to address stress and stressors in nursing environment.
On analyzing the article chosen from Journal of Clinical Nursing, I observed that the researcher carried out both quantitative and qualitative research to analyze all aspects of stress. I found the article to be reliable and trustworthy piece of evidence as the result accurately presented different themes of stress and it will be useful in determining the appropriate support structure in hospital that can enhance the performance of nurses. The two main hypothesis of the research was that stress level is higher in newly qualified nurse compared to student nurses and the perception of stress for both groups will be different. The factors used in nursing stress scale gave the research its rigor and trustworthiness of results. Use of this stress scale gave the research the required validity and reliability to be accepted (Mertens, 2014). The main factor covered in the stress scale included work load, death and dying, lack of clinical preparation, uncertainty in treatment and its outcome, conflict with physician and other nurses. A detailed quantitative data was provided regarding the perceived range of each factor in qualified nurses and student nurses (Suresh, Matthews & Coyne, 2013). Therefore, the first hypothesis was proved, however the result was against the second hypothesis as statistical analysis showed that there was difference between stress score the different group of nurses.
After analyzing the results of the article, it can be confirmed that stress remains a cause of concern for clinical environment. Both quantitative and qualitative results of the research showed that workload has impact on retention and performance of nurses (Reeve et al., 2013). The suggestion provided by the researcher is also useful to manage stress and provide proper counseling support to nurses. Continuous stress management intervention followed by regular evaluation of nursing performance can help in improving quality of nursing performance and create a positive stress-free work environment. Due to the increased demand of the health service, it is also apparent that some level of stress will always be present in nursing, however, nurses need to learn the skills of proactively managing stress within the clinical environment (Pines et al., 2012). This article will be an effective step to improve the provisions of quality care in nursing.
Appraisal of article through CASP tool
Systematic review of article is an approach to critically appraising research findings through defining the research question and identifying the eligibility criteria for the search. The subsequent steps are to synthesize the data and interpret the results to determine the credibility and significance of the research in different context (Taylor et al., 2014). The three broad issues that will be considered for appraising the research article through CASP tool-
- Analyzing the validity of the research
- Describing the results of the study
- Explaining the importance of research locally
Screening question of CASP tool
Clear statement of aim of the research- yes
The article by Suresh, Matthews & Coyne, (2013) clearly stated the aim of the research by stating that they want to identify and compare the perceived level of stress in final year nursing students and newly qualified nurses. This research was thought importance because adverse impact of stress in nursing environment such as error in nursing practice, poor patient health outcome and psychological stress (Johnston et al., 2013). Stress particularly prevails in the first six months of after placement in hospital, therefore this comparison was important.
Is qualitative method appropriate?- No
Qualitative method will help in determining the cause of stress and identification of major themes. For this research, qualitative method was not appropriate and quantitative data was also necessary to statistically evaluate the response rate to stress as well as compare the issues related to stress among two groups of nurses. Mixed method study was also important because of lack of adequate quantitative data to support qualitative research on the same topic (Creswell, 2014).
Continuity question of CASP tool
Appropriateness of research question in relation to aim of research- Yes
The researchers have appropriately justified the rational for doing descriptive mixed method study as it was necessary to compare the stress level in two groups. Therefore, for getting the data on perceived level of stress, cross-sectional survey design and self-reporting questionnaire was taken to compare stress level in nurses working in Ireland.
Appropriateness of recruitment strategy according to aim of research- Yes
The selection of participant was relevant to the aim of the research and the detail on recruitment process was briefly provided by the researcher. 120 newly qualified nurse and 128 student nurse were recruited from six hospitals in Ireland. The inclusion strategy for sampling was to select those qualified nurse who were working in full capacity in acute care setting and nurse student must be working in acute general ward (Suresh, Matthews & Coyne, 2013).
Reliability of data collection to address the research issue- Not appropriate
The research article clearly stated data collection through cross-sectional descriptive survey design through postal survey, however the rational for this method of data collection was not provided. Although complete detail on method of conducting survey was provided by different means of distribution of questionnaires in different hospital, however the questionnaires lacked detail on demographic data. This was the limitation of the method as it would have lead to further insights into the results (Suresh, Matthews & Coyne, 2013).
Consideration of relationship between researcher and participants- Partly done
The researcher tried to maintain credibility of research by taking ethical approval from Research Ethics Committee and by taking steps to minimize the biasness in result by taking a neutral stance on the topic. This had minimum impact of result and true perceptions of nurses were only defined. However, the researcher made sure to take those participants who were willing to take part in the survey (Ritchie, et al., 2013). No change to research design were made, however data collection approach was different for different hospital.
Consideration of ethical issues- Yes
The ethical standards of research were maintained at different stages of research. Firstly nurse will for participating was considered and it addressed the issue of informed consent and maintaining confidentiality in research. Secondly approval for research was also sought fron University Research Ethics Committee. During collection also, ethical and access approval was taken from all six hospital in Ireland (Suresh, Matthews & Coyne, 2013).
Strength of data analysis- Yes
Thematic analysis was done by means of identifying different themes through nursing stress scale. The complete detail of quantitative analysis through mean score was done by SPSS software package. In qualitative analysis, a sequential pattern was followed according to different theme or cause of stress. Suresh, Matthews & Coyne, (2013) also put stress on minimizing biasness by removing their own personal view on the topic and concentrating mostly on verbatim response of participants. Sufficient data and statistical analysis was done and contradictory finding according to the hypothesis was also analyzed.
Clarity of research findings- Yes
There is clarity in research finding as the qualitative and quantitative results were clearly discussed separately in different sections. Every step had been taken to maintain clarity in results. For example, to facilitate comparison of score, the researcher took steps to assign mean score as to help in thematic as well as numerical analysis. It gave the research validity as major issues leading to stress were identified according to high and low score for each group. Through the verbatim comments of student nurses and newly placed nurses, appropriate themes was presented and discussed separately. The Suresh, Matthews & Coyne, (2013) also took steps to discuss the credibility of findings by comparing it with previous study on similar topic.
Reliability of the research- yes
Suresh, Matthews, & Coyne, (2013) reported the about the viability of researched compared to other studies. Contradictory findings according to different themes of stress were explicitly discussed. For example level of stress in relation to lack of preparation, staff support, uncertainty in treatment and conflict with health staffs was high in student nurses, however stress related to workload and conflict with physician was high in newly qualified nurse. The researcher clearly stated the significance of study in bringing changes in nursing education and clinical environment by giving an insight cause of stress in clinical environment. They gave the implication of study for bringing improvement in nursing education and workforce management in hospital.
Application of evidence in clinical context
The purpose of critical appraisal of research article is to assess the whether the research is a reliable and trustworthy source of information and discuss whether the research finding can be realistically applied in clinical context. After the critical appraisal of the article on comparing the perceived stress level among newly qualified nurses and student nurse, many factors have been identified that lead to stress and hampers performance of nurse in clinical setting. If relevant health care organization is aware of this barrier in care, then they can take steps to address them and enhance the work environment and psychological well being of nurse. It can also help in improving the confidence level of the nurse and the ability to cope with stress in the job.
The themes identified from survey of nurse’s perception on stress can be useful in bringing change in particular hospital. For example, Suresh, Matthews, & Coyne, (2013) showed that stress is present irrespective of different group of nurse, however nature and level of stress changes during academic phase of nursing and during clinical placement phase. The major cause of stress and burnout among nurses according to the research included excessive load, poor interpersonal skills and work relationship, unmet clinical needs, inadequate nursing skills and uncertainty in treatment. There were issues related to lack of empowerment as nurses reported they are forced to listen to physician to maintain professional relationship even when they do not agree with them. Some lacked confidence due to feeling of isolation and some were anxious to to assuming a new responsible role after placement.
Therefore findings can be applied in real clinical context by addressing issues of retention difficulties and lack of staffs in nursing. The health care organization and clinical leaders can take steps to evaluate rate of turnover and the reasons for it. This would help in identifying the issues related to turnover and proposing appropriate policy changes to improve retention and enable availability of adequate number of staffs according to patient ratio at the hospital. Some relevant policy changes to improve retention and staffing issues may include change in recruitment strategy, orientation and training and taking steps to improve the work culture of hospital and propose regular quality assessment to maintain quality of care (Li & Jones, 2013).
Lack of clinical skill also act as stressors in nursing practice, therefore this provides future implication to review the nursing curriculum and placement procedure to ensure that nurses with adequate clinical skills work at the general ward level. This will help to reduce stress level in the job and improve clinical competence of newly qualified nurse. A research study by Cheng et al., (2014) is also the best evidence which showed that a pre-graduate clinical training program given to students before placement helped to increase the competence of nurses and changes their intention to leave the job. Therefore, if nurse educators and health care administrators take steps to provide such clinical training to nurses, then it will be conducive for nurse to adapt to the job and they will develop high self-esteem due to enhance performance and patient’s health outcome due to their nursing care.
The findings of the research article by Suresh, Matthews, & Coyne, (2013) can also be applied in the clinical context to bring changes in induction period of nursing placement. The survey through questionnaire revealed that many newly qualified nurse wished to have a buddy in their first clinical placement as they will not dominate over them and also guide them in case of any issue they face in nursing practice. The hospital managers or nurse leaders can learn from this and introduce such systems for newly placed nurse to reduce their stress level and enhance their first clinical experience in the job. There is also evidence from study by Schmutz & Manser, (2013) which demonstrated that if team work process in hospital is improved, then it lead to better coordination in health service and also help to reduce conflicts of nurse students with others nurse and physician. It will lead to a positive outcome for patients due to improvement in performance of nurses.
Evaluation of applicability of evidence in clinical field
If the above evidence-based intervention is effectively applied in clinical setting, it will soon enhance the reputation of the hospital due to delivery of high quality of care. However, before implementing any such change in the organization, the application process must be evaluated to ensure the purpose of change is achieved. This evaluation can be done by clinical reasoning skills and finding other similar research studies which supports efficacy of such results. The evaluation process is not easy, and many hospital administrators fail to embed evidence based practice into routine clinical practice due to lack of knowledge in interpreting research studies and inability to take time out to carry out such evaluation. The attitude of hospital administrators can also be a barrier in evaluation of intervention as they mostly perceive that research studies are separate from actual clinical practice and this cannot be realistically applied (Scott et al., 2013).
Evaluation of the efficacy of the intervention can be easier if health care organization become accountable to ensure delivery of safe and high quality care. They will have to embrace evidence-based practice to challenge traditional work process and address issues that exist in nursing practice since the inception of service. Therefore, the organization’s readiness to change can have impact on successfully bringing new innovation in health practice. The success of applicability of research finding is also dependent on alignment of change with evidence-based practice. Analysis of any intervention based on best evidence based research will help the nurse to ease the pressure in practice and improve the coping skills in clinical practice (Woods, 2013).
The report critically evaluated the credibility and applicability of the research article on comparison of stress and stressors experienced by newly placed nurse and final year nursing students. The rational for choosing the article was explained and this article was chosen due to the increased report of shortage of nurses and burnout issues in nurse in clinical setting. A systematic and structured evaluation of the research article was done by critical appraisal through CASP tool. This step was effective in assessing the clarity, strength and weakness of the research study. Finally method of applicability of research finding in clinical context helped to determine how understanding of factors associated with stress can help health administrators to address the problem and bring change in work process and health policy in particular hospital. Embedding evidence based practice in routine clinical practice can serve to address the issues in clinical context (French et al., 2012).
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