Stress Management for Patients With Rheumatoid Arthritis

A Summary and a Response to the Case Study Titled "Stress Management for Patients with Rheumatoid Arthritis"

The case study focuses on some of the psychological and behavioral stress management techniques that can be employed to manage stress among patients with rheumatoid arthritis. The case centers on a 40-year-old patient with rheumatoid arthritis (RA). The regular visits of the patient trigger symptoms that she might be suffering from stress due to her workplace; therefore, increases the severe symptoms of RA. After being diagnosed with moderate RA 18, the patient is treated using methotrexate. After receiving a promotion at work, the patient begins to suffer from job-related stress, which results in higher levels of inflammatory markers. The patient complains about the costs of the medication and seeks help regarding other stress management techniques. Purposive sampling, especially typical case sampling was used to select the individual for the research. Etikan, Musa, and Alkassim (2015) define purposive sampling as the deliberate choice of choosing a participant due to the characteristics they possess. The method is a non-random technique that does not require theories or a significant number of respondents. In this case, a typical case sampling was used to compare the results of the findings with other studies. The case study mentions various psychological and behavioral techniques that can be used in the treatment of stress among patients suffering from RA. Some of the approaches highlighted in the case study include cognitive behavioral therapy, Tai Chi, yoga, and education. It was identified that psychological and behavioral stress management techniques could not perform better than biological interventions. It was also concluded that when mental and behavioral techniques were utilized as alternative modes of treatment, they reduced the symptoms of RA significantly.

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According to Golafshani (2003), reliability is the extent to which the results of a study are consistent over time and can represent the actual population of the study. The author further defines validity as the evaluation whether the research measures what it is intended to assess. In the research Stress Management for Patients with Rheumatoid Arthritis, the reliability and the validity of the study are not consistent. The Study only focuses on how other researchers have used psychological methods such as cognitive behavioral therapy. The case study fails to put the selected participant on either CBT, Tai Chi, or Yoga to determine the effectiveness of the interventions in the treatment of stress among patients with RA. For this case, it is difficult to conclude that the discussions of the case study are reliable and valid. The study contains various flaws and discrepancies. The researcher fails to put the participant on any psychological or behavioral intervention to determine the effectiveness of the method in stress management. The discussion part of the research should focus on the data obtained after assessment rather than mentioning facts without referring back to the findings of the study

Mackusick and Minick (2010) conducted a qualitative study to evaluate factors that cause registered nurses to leave their positions after working for a while. The purpose of the study was to identify the factors influencing the decision of registered nurses to abandon clinical practice. The authors adopted a phenomenological design, which was used to provide an in-depth understanding of nurse's decisions to quit clinical practice. The research question of the study was what the experience of registered nurses who leave clinical nursing is. To answer this question, the researchers conducted semi-structured interviews with nurses who abandoned clinical practice. Purposive sampling was utilized for the recruitment of participants. The inclusion criteria of the study consisted of registered nurses with a minimum of one year of clinical practice and no clinical practice in the past six months. The second category in the inclusion list consisted of registered nurses with more than one-year experience. Registered nurses in supervisory roles and those who allowed their licensure to expire were excluded. Snowballing technique was used in the recruitment process. The recruitment process was done over the telephone. Participants used a pseudonym during the interviews for confidentiality. Ten semi-structured interviews were conducted and audiotaped during the process.

The researchers identified three primary factors that caused registered nurses to leave their positions. The elements were a hostile workplace, fatigue and exhaustion, and emotional distress related to patient care. All the registered nurses in the study reported that being lonely and ignored by the supervisors as a new registered nurse fueled their decision to leave clinical practice. Other incidences include sexual harassment, lack of support, belittling confrontations, and gender abuse. The respondents also noted that overly aggressive treatment and the lack of collaboration between the physicians and the staff caused emotional distress among the registered nurses. Working in an unfriendly environment with recurring emotional distress caused the participants to experience feelings of fatigue and exhaustion. A participant with the pseudonym Alice, records being bone tired for six months before quitting clinical practice. The researchers proposed the development of cultures that embrace diversity and provide support to registered nurses to retain them in their positions.

Shenton (2005) argues that the trustworthiness of a qualitative study is determined by its credibility, transferability, dependability, and confirmability. In the research by Mackusick and Minick (2010), the authors focused on the four-mentioned aspect to achieve trustworthiness of their work. Shenton (2005) defines credibility as the ability of the findings to agree with the reality. Mackusick and Minick (2010), achieved credibility in their research by using actual participants, in this case, registered nurses, who provided a narration of their daily experiences in their roles. The researchers also used triangulation to obtain the relevant data for their research. However, the researchers should have used random sampling instead of purposive sampling to minimize bias in their work. Transferability in the research study was evident as the findings provided room for other scholars to conduct further research to agree or disagree with the previous research. Mackusick and Minick (2010) noted that one of the limitations of their study was the use of a small sample size. They, therefore, proposed other scholars to conduct similar studies with large samples to identify whether the same results can be replicated. Such an instance is an indication that their findings encourage transferability.

Dependability was a problematic notion in the research as the authors suggested that it was unknown whether the findings would be replicated in a similar study. However, Mackusick and Minick (2010) propose further research to be conducted to determine whether the same results would be realized. The investigation by Mackusick and Minick (2010) achieved confirmability by employing triangulation during data collection and analysis. The researchers used individual interviews via telephone, applied snowballing technique for recruitment, and utilized interpretive scrutiny to ensure appropriate interpretations were being made without the influence of the researchers. For this case, Mackusick and Minick (2010) managed to establish trustworthiness in their research by adhering to the four primary aspects mentioned in this section.

References

Golafshani, N. (2003). Understanding reliability and validity in qualitative research. The Qualitative Report, 8(4), 597-606.

Etikan, I., Musa, S., & Alkassim, R. (2015). Comparison of convenience sampling and purposive sampling. American Journal of Theoretical and Applied Statistics, 5(1), 1-4.

MacKusick, C. I., & Minick, P. (2010). Why are nurses leaving? Findings from an initial qualitative study on nursing attrition. Medsurg Nursing, 19(6), 335- 340.

Shenton, A. K. (2004). Strategies for ensuring trustworthiness in qualitative research projects. Education for information, 22(2), 63-75.