Critique of a Qualitative Research: Preceptors and Patients

The purpose of this critique is to evaluate the methodology and findings of a qualitative study to establish the level of evidence and its transferability. This critical analysis evaluates the article "Preceptors and patients - the power of two: Nursing student experiences on their first acute clinical placement," a 2010 article by James and Chapman the journal Contemporary Nurse. The article presents the findings of a qualitative study of second-year undergraduate students doing nursing in a rural university in Australia. The study aimed to establish reasons why undergraduate nursing students discontinue their education and whether the experiences of the nursing students during placement influence their decision to terminate their studies. The article presents low-level evidence on the subject due to an unreliable method of data analysis and a heavy reliance on subjectivity in both data collection and analysis but also presents findings that may have far-reaching consequences with appropriate refinement of the study. The appraisal will first evaluate the methodology of the research and then analyses the sample and the sample selection technique. The next sections will then consider the data collection and analysis methods before analyzing the findings of the study and highlighting any limitations and recommendations that arise. The final part will then look at the implications of the research in light of the evaluation of the article.

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Qualitative methodology

The researchers used a naturalistic inquiry to explore the phenomenon of interest, which is the decision-making by the nursing students on the matter of whether or not to continue with the nursing profession. The naturalistic inquiry builds on the researcher's non-interference with the natural environment of the study subjects and their observation of outcomes within this environment (Salkind, 2010). A naturalistic inquiry is primarily qualitative and suited for the observation of psychological and social phenomena, as it encourages the observation of subjective phenomena and experiences.

The researchers clearly articulate that their study takes a qualitative approach. More specifically, the study used naturalistic methods of inquiry including taking a phenomenological approach where lived experiences of the participants were analyzed to generate the results in the form of overarching themes. The researchers identify the Heideggerian philosophy as the guiding principle where empirical data is collected by capturing the experiences of different students in the same situation. As the study draws its data from the lived experiences of the students, the study design is appropriate as it can collect personal information. Additionally, the design was applied correctly since the experiences of each of the six students are captured after going through the acute nursing placement. This practice is in keeping with the Heideggerian philosophy where experiences are collected after the event. Also, since the Heideggerian hermeneutic phenomenology is widely practiced especially in health research to understand the meanings behind the lived experiences of people, the design is appropriate for the field of study.

Description of sample and target population

The target population in this study was nursing students in their second year of study who were going through the acute nursing placement for the first time. The selection of the target population was appropriate for the realization of the research objectives. Since the aim was to identify the relationship between the experience in the acute nursing placement and the decision to proceed with the studies, it follows that the best population to demonstrate this relationship is that of the students in this specific rotation who have had enough exposure to the field and who are faced with the decision of whether or not to continue with their studies.

The sample population was restricted to one campus in one university in Victoria, Australia. James and Chapman (2010) note that the sample size was small with the participants having being drawn from only one clinical context.

The recruitment strategy was to use advertisements that were put up on student notice boards and during teaching sessions. The first inclusion criterion was that the participants were to be students in the nursing profession. This is appropriate as the content being analyzed is the relationship between acute nursing placement and the decision to continue nursing. Secondly, only students who were joining the acute nursing placement in the 8th week of the semester were recruited. All the students who were repeating the acute nursing placement were excluded from the research since they had already experienced their first acute clinical placement and had conditioned themselves to the environment. Hence, collecting the information from them may not give accurate results. The authors used the corrected method as Holloway and Galvin (2016) states that small sample studies are appropriate when nursing studies. The participants had to read an explanation of the research and give their informed consent before participating in the study. Of the 17 respondents in the study, the researchers sought to establish their interest in the study, ensuring that the results will be relevant. Only 11 signed the consent forms, and only six happened to be rotating in the acute placement stations at the start of the study.

Ethical issues

The researchers have considered ethical issues since the University ethics committee approved the research. The researchers demonstrate the ethical principles of respect and non-maleficence since the participants were given the liberty to quit from the research at any given time during the study without academic victimization or any future consequences. The research also demonstrated confidentiality as the researchers maintained anonymity throughout the study by using pseudonyms instead of the participants' names. There was also full disclosure as the participants were informed about the details of the study before signing the informed consents to proceed with the study.

Data analysis and quality

The data collection was by interview and the data collected was interview transcripts. The open-ended nature of the interview is good for the following thematic analysis but has the weakness of being liable to conversation that is off-topic and which may even confound the relevant findings. This may reduce the relevance of the data and its dependability. However, given that the information was supposed to be subjective experiences, this is the right method of data collection to use as it allows freedom of expression.

During the study, Max van Manen's (1990) analytical method was used. The technique involves selecting and highlighting the data into thematic headings. The analysis involves reading through the scripts to identify phrases, statements, and ideas that recur. The emerging themes and ideas are then coded using keywords. By using the coding system to group the responses, the researchers can come up with themes that recur. The dependence on the subjective analysis of the data by the researchers makes the confirmability and trustworthiness quite questionable. There is no mention of regulation systems by the researchers to ensure that there was no deviation from the standards and that the process was reproducible.

The reliance on subjective interpretation also makes the confirmability of the results very much questionable since there is no clear mention of what constitutes a keyword that is used to code the statements. It is possible that some words that may have impacted the theme differently may have been omitted either intentionally or accidentally. However, with the limited information and unavailability of the interview transcripts, it is impossible to verify the results and methods of the researchers.

Description of findings

The findings of the study indicate that nursing students have the same experiences when going through acute clinical placements. Their feelings and how they want to be addressed also show a convergence pattern. The nursing students demonstrated a need to be accepted, welcomed and respected in the clinical placements. The general feeling among the participants was that the nursing culture needs to change to develop a positive beginning for the nursing students. However, the consensus amongst the participants without mention of the degree of variability comes across as suspicious. The quality of the findings could be improved by the inclusion of this attribute. Triangulation is considered by the researchers. However, they declare that one should be cautious when applying these findings to clinical placement.

The findings address the purpose of the study. The objectives of the study are outlined explicitly. The first is to describe experiences of the second-year undergraduate nursing students and the second is to attach meaning to these experiences while also identifying the positive and negative experiences. The six participants give accounts of their experiences, and these are successfully coded by the researchers into overarching themes. Hence, the results effectively address the first aim of the study. Through the analysis, the second objective is also discussed. Negative experiences of the students are classified under the themes of being overwhelmed and confronted, and perceptions of preceptors. Positive experiences were organized under the theme of seeing patients as people. Under the umbrella of being overwhelmed and confronted, the patients report that the nursing experience is different from their expectations and the workload was too much to bear at times. The perceptions of preceptors were overwhelmingly negative, and there was little encouragement. Also, a lot of negative remarks were issued to the participants. These two factors demoralized and devalued the students. On the other hand, the theme of patients as people embodies a realization of the human nature of patient management. Under this umbrella, the patients were more than just conditions with tags.

The findings are relevant to the study population. However, the limited sample size also reduces the representative power of the results on the nursing students. James and Chapman (2010) note that the sample size was small with the participants having being drawn from only one clinical context hence the results are unlikely to be a representative of second-year nursing students. However, the research itself does not have elaborate data collection procedures, and there is little description of the data itself. As such, the evidence needs further investigation and verification before the results can be accepted into other clinical areas. In their current state, the transferability of the findings is limited. James and Chapman (2010) infer transferability by implying that the findings can be applied to tertiary institutions, placement areas and preceptors with a view of enhancing positive experiences among the students and motivating them in future placements.

The researchers also recommend further research to be done in the enrollment of undergraduate nursing courses and chances of these nurses gaining employment in the healthcare industry and if there is any influence on experience in clinical placement. James and Chapman (2010) also recommend the need for the current research to be applied to clinical placement from the perspective of the preceptors rather than the students.

Implications for nursing practice

The researchers express confidence in their study by stating the need for undergraduate nursing courses to include comprehensive education on the patients' illnesses from the invalid's perspective as a way of providing insight on how patients cope or fail to deal with their situations. Th...