Qualitative Nursing Research Report Analysis - Essay Example

A D Paul Analysis of Qualitative Research Report: The Right Approach In their practice, nurses advocate for their patients in every possible practice settings. The practice of patient advocacy is, in general, thought of occupying an important place in the nursing curricula. It is also assumed that it is found in a reasonable way in the ground reality of clinical practice. However we hardly find any serious presence of the theory and practice of advocacy in the curriculum as followed in most nursing schools. However the concept of advocacy of patients is not alien in nursing practice. Military nurses understood what advocacy is and practiced it in their nursing career. However there has to be a methodology to integrate the practice of advocacy as integral part of the nursing curriculum. Moreover there is greater need for institutional support in practicing advocacy. Objectives of the Study Nurse's role of advocacy is as old as scientific nursing profession. Florence Nightingale advocated for the victims of Crimean war by insisting on the need for clean patient care environment. Advocacy was also obvious in the efforts of Clara Barton and other nurses during the American Civil War (Rogge, 1987). In the 70s the zealots in human rights movements took special note of the need for fighting for the rights of the patients. Nurse's perspective as one of the most important stake holders in health care, has a better role to play in this. The military model of health care with its language of loyalty and obedience primarily to the physicians and the legal model, where the focus is on the right of the patient, are the two models described in the nursing literature now. The complete patient centered healthcare is possible only with the realization of the unique identity of a nurse. The realization of the absence of thrust for advocacy in the nursing education should not deter the nurse from practicing it as has been done in the practice of military nursing in recent wars. Military and Legal Models of Nursing Practice The military tradition of nursing focused on loyalty and obedience to the physician. Winslow (1984) shows the military metaphor of loyal soldier, "to engender a sense of purpose and to explain the training and discipline of the nurse" (p. 33). This tradition of nurse started losing its popularity with the patient's rights movements in the late 1960s and early 1970s. Advocacy as a cardinal role for nurses was formalized during the 1970s when terms such as "loyal obedience" and "obeying physicians' orders" disappeared from the literature of the International Council of Nurses (International Council of Nurses, 1973) and the American Nurses Association. Nursing from then onwards took a new direction centered on the advocacy of the rights of patients as the important aspect of nursing practice. Empirical Research Segesten (1993) found that advocacy situations sprang from the helplessness of the patients. Millette (1993) highlighted the need for choosing the client advocacy model faced with choices like bureaucratic advocacy and physician advocacy. Snowball (1996) interviewed nurses concerning advocacy in their practice. She found that the important aspects leading to advocacy included nurses and patients sharing a common humanity and the cultural milieu being one of care. Snowball concluded that a therapeutic relationship was fundamental to advocacy. Conclusions drawn from the literature are that advocacy was initially included into nursing practice at the time when nurses developed a sense of service more for their patients than for physicians. Little empirical knowledge has been produced on the concept of nursing advocacy even though nurses consider advocacy to be central to their career. It is an anomaly that the empirical articles concerning advocacy contain no mention of how advocacy is inculcated or how advocacy is learned. Thus, the purpose of this study is to describe how nurses learn the skill of advocating for patients. Study Design A Heideggerian hermeneutic phenomenological approach was found to be the most appropriate in this enquiry. Many feel that advocacy is integral to nursing and hence find it difficult to articulate advocacy as a separate entity from their service. In such situation a phenomenological approach is very ideal. The nurses were interviewed individually for the purpose of this study. Subjects and Setting The investigator chose to study U.S. military nurses' advocacy role during an operational mission. These nurses often fulfilled dual advocacy roles. During an operational mission, hospitalized military personnel were far from family and friends. Military nurses protected the military patients from incompetent practice. Military nurses often substitute for family and friends in an advocating capacity. Army nurses were chosen because they were supporting the operational mission in Bosnia at the time of the study. There were 62 participants. Procedures Participants were chosen purely on the basis of their willingness to take part in the study on a non-remunerative voluntary basis. The interviews were unstructured and open ended. Some interviews were short and others long their time spans ranging form 30 minutes to 12 hours. The clients had to tell how they learned the skills for becoming their patient's advocates. Data Analysis and Trustworthiness The investigator and two phenomenological researchers conducted data analysis. The data was first analyzed individually and then in groups. Transcriptions of the interviews and the field notes were analyzed using the interpretive method of hermeneutics, as initially used in nursing research by Benner (1984a, 1984b, 1985; and Benner & Wrubel, 1989) and further refined and delineated as a seven-step process (Diekelmann & Allen, 1989). Many stages of interpretation were used to expose any conflicts or contradiction by allowing for reappraisals and comparisons. The aim was to identify unsubstantiated and inaccurate interpretations not supported by the interview text. Continuous examination of the whole and the parts of the data with constant reference to the interview text was done to ensure that all interpretations were grounded and focused on the issue under examination. Different methods were used to ensure trustworthiness or authenticity in qualitative work. Guba and Lincoln (1989) suggested that credibility is the criterion for the validity of qualitative research. In this study, the credibility of the interpretations was confirmed in different ways: (a) two methods of data collection were used (in-depth interviews and field notes), (b) more than one researcher participated in the analysis to ensure proper objectivity. (c) multiple stages of analysis were used, (d) The results also were further verified by external researchers. Strength and Weakness of the Approach There is much strength for the scientific merit of this study. The nurses get a strong identity about them (Who am I). This identity sense identifies, caring as the most aspect of one's career. Heidger calls it solicitude development. Nurses also learn to observe other people and learn to integrate their observations in their daily life. The observation also helps in developing confidence as you see the success of other people. The need to stand up for others provide a new meaning for the nurse herself and make hr work meaningful. They also realized that Health care helped them to see the broader concept of life. Conclusions The findings indicate that nursing students learn about "patient advocacy" in their nursing education programs but such values were based on family and community experiences. The findings also show that nurse educators should impress upon students the importance of advocating, even though the process of advocating might not be formally taught in a classroom. The military nurse volunteers in the study learned advocacy in a half hazard manner from situations that presented before themselves. Mallik (1997), The nurses who had strong skills in advocacy were capable of intervening in difficult situations. Nurse educators and nurse administrators need to find ways to teach, model, and support advocacy, in both the educational process and in the work environment. Nurses will have a stronger foundation in advocacy when nurse educators consciously teach advocacy skills and when nurse administrators consciously support nurses' advocacy in the work environment. References: American Nurses Association. (1976). Code for nurses with interpretive statements. Kansas City, MO: Author Benner, P, & Wrubel, J. (1989). The primacy of caring: Stress ad coping in health and illness. Menlo Park, CA: Addison Wesley. Diekelmann, N., & Allen, D. (1989). A hermeneutic analysis of the NLN criteria for the appraisal of baccalaureate programs. In N. Diekelmann, D. Allen, & C. Tanner (Eds.), The NLN criteria for Guba, E., & Lincoln, Y. (1989). Fourth generation evaluation. Newbury Park, CA: Sage. International Council of Nurses. (1973). Code for nurses. In A. Davis & Mallik, M. (1997). Advocacy in nursing: A review of the literature. Journal of Advanced Nursing, 25, 130-138. M. Aroshar (Eds.), Ethical dilemmas (13-14). Norwalk, CT: Appleton & Lange. Millette, B. (1993). Client advocacy and the moral orientation of nurses. Western Journal of Nursing Research, 15, 607-616 Segesten, K. (1993). Patient advocacy: An important part of the daily work of the expert nurse. Scholarly Inquiry for Nursing Practice, 7 129 135. Rogge, M. (1987). Nursing and politics: A forgotten legacy. Nursing Research, 36(1), 26-30. Snowball, J. (1996). Asking Nurses About Advocating for Patients: Reactive Winslow, G. (1984). From Loyalty to Advocacy: A new Metaphor for Nursing. Hastings Repoprt,14,32-40. Read More