Critical Appraisal and Discussion of Nursing Values - Essay Example

Essay (Critical Appraisal) and Discussion of Nursing Values Table of Contents Introduction 3 Part 4 Part 2 10 Nursing Values 10 Conclusion 14 References 16 Introduction Research studies are mainly conducted with the intention to understand any unknown aspect that is yet to be explored (Greenhalgh, 2010; Barton, 2006). Research can be of numerous forms based on the subject matter as well as significance of the study (Holloway & Wheeler, 2013; Davies & Mosdell, 2006). It must also be mentioned that the type of research followed by any particular researcher is also largely based upon the aims and objectives of his/her research (Fink, 2010). In order to have a better comprehension of the aforementioned aspects, this particular essay will critically appraise the study in Brown & et. al. (2011) for the research titled “Identifying care actions to conserve dignity in end-of-life care”. In this study, Brown & et. al. (2011) mainly discusses about the importance to conserve dignity in the end-of-life care treatment with the adoption of appropriate care actions (Martyn, 2009; Parahoo, 1997). The study affirmed that as the end life of an individual is mostly spent at home under the supervision of professional health care team or family members, it is important that the aspect of dignity in the care provided be assured (Mccarthy & Rose, 2010). Critical appraisal is often regarded as a particular process to systematically review particular evidence established on the basis of firm guidelines (Robotham & Frost, 2005; Marchevsky, 2000; Crombie 1996; Parahoo 1997; Department of Health 1998). There are a number of tools through which, the research can be conducted, which includes SIGN (2013), PHRED (Hamilton 2014) and CASP (Casp-UK 2012; Burls, 2009). Subsequently, the CASP model ensures a systematic model or process, which can be helpful in gaining a better insight on research articles (Casp-UK 2012). With this particular framework, i.e. CASP, it can be ensured that a robust appraisal and examination of each aspect of the findings argued in Brown & et. al., (2011) is performed. In addition, performing appraisal through CASP will also help evaluating the study to ensure whether it delivers outcomes in alignment with its determined aims and objectives (University of South Australia, n.d.). Hence, the CASP model has been considered in this particular essay to critically assess the study in Brown & et. al. (2010). Contextually, the aim of this particular essay can be considered as twofold. In the first part, a critical appraisal of the research conducted by Brown & et al., (2011) will be provided, which was primarily designed to identify the care actions required to protect the dignity of patients during the end-of-life care procedure. In the second part of the paper, focus will be rendered on exploring the role of some of the key nursing values identified in this research with regard to collaborative decision-making in the health care setting (Bowling, 2002). Notably, the critical appraisal will be conducted based on the CASP (Critical Appraisal Skills Programme) appraisal tool (Abbott & et. al., 2013; Taylor & et. al., 2004). The tool will be used in this essay owing to the aspect that it will allow the researcher to determine the extent to which, the key issues has been addressed as relevant to the evidences presented. Part 1 Aims and Methodology As per the model of CASP, for this particular one needs to identify the appropriateness of the goals of the research along with its validity and importance with regard to the subject matter (Burnard & et. al., 2010; Public Health Resource Unit, 2010; Bowling, 2002; Denscombe, 2002). Analysing the study of Brown & et. al. (2010) it can be stated that a clear and specific statement of its aims and objectives was provided in the journal. This is quite important in context to any particular research, as it is with the help of the goals of the research that one can determine the direction through which the research would be executed (University of Southampton, n.d.). Though the author attempted to present a brief overview in the ‘Abstract’ section, with regards to the importance of the subject matter of this research, the aspect shall not be considered as appropriate (Holland & Watson, 2012). However, the omission might be a result of the fact that this particular research forms part of a “multi-phase project” focused on assessing how local community nursing experiences and practices can aid the development of a “care pathway” that conserves “dignity in end-of-life care” (Brown et al., 2011: 238). Hence, a succinct mention of the aim and objective in the study of Brown & et. al. (2011), it was also quite apparent that the researchers intended to use a qualitative evidence-based approach to guide the development of an appropriate framework for collaborative decision-making in the end-of-life care pathway (McCarthy and Rose, 2011; Barker, 2010). Observably, the goal of the study was to identify the role of the nurses in ensuring proper end-of-life care of the patients and helping the same to die with utmost dignity during their end life. Contextually, the subject matter or the goal of the research can be considered as highly important in the present day healthcare setting. In this regard, Chochinov (2009) suggested that End-of-Life Care of patients is important in order to comprehend the psychosocial, existential and spiritual behavioural aspects of the dying experiences of the patients. The study of Brown & et al., (2011) also intended to provide a clear understanding of the role played by nurses in proper execution of the aforementioned aspects (Chochinov, 2009). These factors also reveal that the goals of the study are important and are in alignment to the present healthcare environment. The study also intends to understand the theme for clinical guidelines and quality standards expected from healthcare professionals while dealing with patients in their end life (DOH, 2009). This particular research aim might act positively, as the outcome of the study shall be fruitful to determine the role and importance of healthcare professionals, especially those including nurses in the domain end-of-life care. In this regard, the National Institute for Health and Clinical Excellence (NICE, 2013: 26) confirms that this approach should result in a supportive local environment for “people approaching the end of life that provide privacy and dignity”. Treating patients/carers and families with dignity and respect is also central to the nursing codes of professional conduct, which is confirmed by the Royal College of Nursing (RCN, 2014; NMC, 2009). Contextually, the research in Brown & et. al., (2011) shows resemblance with such aspects using the practical experiences of key palliative care stakeholders, wherein it endeavours to develop a framework that places dignity in end-of-life care at the centre of the intervention care packages adopted and implemented by nursing and other healthcare professionals. Research Design, Recruitment Strategy and Data Collection The research took the form of a qualitative descriptive design and used focus group interviews for data collection. Hence, the researchers recruited 14 Community Nurses (CNs), 3 General Practitioners (GPs), 8 patients and 5 carers (Brown & et. al., 2011: 238-239; Sandelowski, 2000). The researchers confirmed that all the mentioned interviews were tape-recorded and were transcribed verbatim (Brown & et. al., 2011: 239). This approach allowed an in-depth examination of the perceptions of those intimately involved with end-of-life care (Burnard & et. al., 2007). It also helped identifying compliances with the evidence-based approach to nursing and healthcare practice (Barker, 2010), wherein some areas of concern were noted. However, different authors hold different viewpoints regarding the efficacy of qualitative descriptive design in nursing practices and other healthcare researches. According to Hancock & et. al., (2009), qualitative descriptive design often shows problems relevant to accuracy of the data obtained through this sort of researches. It has also been comprehended that statistical validity is one of the prime concern of the data that are obtained from descriptive design, as raw data received are hard to manage. Similarly, Denscombe (2002) also provides some criticisms about the research design used in the study of Brown & et al., (2011). Correspondingly, the arguments mostly concentrated on the fact that focus groups method can be easily replaced by survey questionnaires and/or individual interviews, which are deemed to be easier methods as compared to others, whereby the results obtained through focus group are easy to generalise (Greenhalgh, 2010). Again, on a generalised approach, the research design of Brown & et. al., (2011) can be criticised owing to the aspect that it discusses little about the cost, time and other constraints of the study, which are among the most important parts of research methodology. Since the research questions were not tested for reliability, the results obtained from the same might not reach upto its expected level of widespread validity (Brown & et. al., 2011: 238). This aspect might give rise to chances of research biasness (Denscombe, 2002). It is thus argued that the inclusion of these explanations would have added weight to the validity of the choice of focus group. However, ignoring the negative aspects or limitations of the method, many positives about the design becomes apparent that can act as rationale for their selection. As per Neergaard & et. al. (2009), qualitative descriptive design is important in researches that require first hand data. Since empirical study is involved in the research of Brown & et al. (2011), the choice of the design by the authors can be justified. Thus, since the process takes lesser time as compared to other methods, time efficacy can be attained in this research. Researcher Relationship and Ethical Considerations Considering the researcher relationship, it has been observed that a Macmillan nurse, providing services in the local community, has been selected in Brown & et. al., (2011: 239). The selection was entirely performed on the basis of Purposive sampling where the perception of the research is bestowed with the topmost priority (Lund Research Ltd, 2012). However, in such scenarios, the aspect of biasness is seen to be prevalent in the study to an apparent extent (Denscombe, 2002). On the other hand, Brown & et. al. (2011: 238) ensured utmost focus on presenting the ethical consideration of the research. The authors did confirm that “ethical approval was obtained from North of Scotland Research Ethics Committee” and that “NHS R&D approval was obtained from NHS Highland Research & Development office”. This aspect also shows that ethical issues were appropriately considered while conducting the research. Rigorousness of Date Analysis and Statement of Findings As often argued, data analysis process is considered one of the most vital issues in any research, in context to ensure the reliability and validity of the research. It acts as the foundation for proving the reliability of the study and its outcomes accordingly (Greenhalgh, 2010; Taylor & Feld, 2007). The researchers analysed the data using a framework analysis process, which was tried and tested with positive results in previous studies comprising Ritchie & et. al. (2003). Again, since the study used a thematic approach for analysing the data, maximum reliability was deemed to be attained (Ritchie et al., 2003). Furthermore, the findings were clearly identified in the study and related to the three main categories noted in Chochinov (2002) model of dignity. These categories include illness-related concerns, dignity conserving repertoire and social dignity inventory. The study also dealt with the importance of nursing communication skills in patient care focused on identifying the level of independence, symptom distress, dignity-conserving perspective, dignity-conserving practices, social dignity inventory, privacy boundaries, social support, care tenor and burden to others. The Value of the Research Form the overall analysis, a thorough insight was gained as relevant to the elements of the critical appraisal along with their importance for examining the research of Brown & et al., (2011; IARU, n.d.). In this regard, it will be crucial to discuss the findings and outcomes of the research and the extent up to which, it is aligned with the goals set by the study (Ross, 2011). The results obtained will be vital to conclude the importance of professional nursing practices in conserving dignity for end of life patients. In Brown & et. al., (2011), proper nursing communication skills and manners is reflected as one of the prime elements conserving the dignity of patients and carers in end-of-life situations. Part 2 Nursing Values With consideration to the above analysis, the evidences obtained through the research study of Brown & et. al. (2011) were more or less appraised (Brown & et. al., 2011: 244). The findings of the appraisal and the research study are deemed quite crucial in determining an appropriate conclusion about collaborative decision-making process in situations of end-of-life stage. Consequently, the findings of the research are also believed to be important towards improving the value and quality of the nursing skills and competences in the domain of end-of-life situations of patients (Burnard & et. al., 2010). In this respect, the study of Brown & et. al. (2011) identified several specific areas of end-of-life palliative care where nursing communication and engagement skills are critical to the development of a collaborative evidence-based decision-making amid patients and nurses. This aspect is most likely to meet the needs and demands of the patient in the most effective manner. In context to the above mentioned facts it can be affirmed that the values relevant to importance of nursing communication skills and respect of privacy is primary in ensuring conservation of the dignity of a patient during end-of-life care. These values form essential and interrelated elements that directly correlate with decision making amid clients and nurses (Taylor and Field, 2007). Notably, communication skills for nursing professionals are an essential element in the development of a positive relationship with the patient (Linsley & et. al., 2011). As per the indication of Webb (2011: 3), “communication and interpersonal skills are essential components in delivering good quality nursing care”. In particular, these skills enable the nurses to understand the needs of the patients, which further enables him or her to address the patient requirements accordingly, in an emphatic and appropriate manner altogether. Emphasizing more on this particular point, Webb (2011) depicts that the needs of the patients are not only related to the physical nature but it includes the emotional aspects as well. In this respect, it is important for nursing professionals to recognise patients’ needs to be included in conversations and decision making relevant to the process of care delivery (Brown et al., 2011:241). Similarly, DOH (2010a) mentioned that good communication between the nurse and the patient forms the very essence of providing appropriate quality of care during end-of-life situation. Communication skills, in this context, are simply related to the manner in which, the nurses talk and respond to the patient. Although this is important, it is equally critical that these nurses involve the patients in conversations, listens to them, and design their approach accordingly (McCarthy & Rose, 2010). Walczak & et. al. (2014) has also indicated that communication between the nurse and the patient is of critical importance in an end-of-life care situation. Communicating with patients at the stage of their illness and involving them closely with the decision-making, helps to enable the nurse to provide interventions that will improve their quality of life at the final stage of life. As indicated in the research conducted by Walczar & et. al. (2014), it is at this stage that patients wish to avail themselves of their prognosis for the future, which they may need during this period. To achieve this objective the suggested viewpoints by the NMC (2009) will be crucial to be taken into consideration. As per the report, it is important for nurses to build a relationship with the patient that is based on an empathetic approach. This indicates that literature communication between the nurse and the patient needs to be bi-directional. As a first stage in this process, it is important for the nursing professionals to learn to ask the appropriate questions of the patient in a manner that will enable them to understand the deeper concerns that they may be feeling or the challenges they are dealing with (Webb, 2010). There are two main reasons for this form of communication. The first is the aspect that communication forms the core requirement of patient-centred care policy adopted by the government, as it serves nurses in understanding the emotional needs of the patient (NICE, 2013; DOH, 2010a). More importantly, it is also integral to the process of improving the patient’s understanding and knowledge about their conditions and gaining their consent for the interventions to be implemented, which may help to relieve them from fear and distress to an extent (Fernandez et al., 2006). Privacy is another important concern for many end-of-life patients. As per Chochinov (2002), one of the major issues that is likely to have the most severe impact on a patient’s dignity is the invasion of the personal and intimate areas of care, such as bathing, dressing and cleansing of private areas (DOH, 2009; Feilding & Gilbert, 2006; Chochinov, 2002). Patients in an end-of-life situation are likely to be aware that they will continue to require increased physical support from nursing professionals, especially as they become unable to help themselves owing to their deteriorating health conditions. In these unbearable and trying physical circumstances a patient can be provided necessary comfort through focusing on ensuring their and respecting their privacy. In this regard, nursing professionals hold the prime position to ascertain and fulfil the desire of the patient by bringing to the forefront the need for privacy of them into the forefront. These professional should imbibe upon themselves the utmost value of patient care with a key focus on privacy of the ailing patient so that all concern individuals also focus upon privacy as a major factor to be looked upon in both short and long run especially for end-of-life patients (Webb, 2011). However, they will wish to be assured that as the time progresses, they will continue to be treated with dignity and respect (Barker, 2010). It is therefore critical for nursing professionals to place themselves in the position of the patient, so that they can understand how embarrassing and potentially degrading intimate care of this nature can be to the patient. NICE (2013) also confirms that there are several ways in which, actions aimed at minimising the care impact on patients’ privacy can be affected. To reduce the psychological impact of privacy invasion, it is also important for the nursing professional to understand the need to approach caring for end-of-life patients with an appropriate and empathetic attitude rather than being patronising, which complies with the objectives of current palliative care guidelines (NICE, 2013; Department Of Health, 2009). This applies that irrespective of whether these facilities are practical, such as home-focused aids like stair-lifts and hoists, or they are related to the care services including monitoring of the medications provided for the patient (DOH, 2010a). Privacy of patients during their end-of-life care is also regarded as their human rights. It has been noted that during their end days, patients become unable to conduct their daily personal activities like bathing and cleaning, owing to their unstable health conditions. In this context, they need the help of their family members or healthcare specialists like nurses in performing these daily tasks. In such scenario, the nurses will have the need to respect and comply with the privacy and confidentiality of the patients, which is also one of their rights. In such scenarios, nurses should ensure utmost dignity for the patients and their closed ones. It is in this regard that the importance of collaborate decision making comes into importance. Through such collaborative efforts, interpersonal relationship between the nurses and the patients might come handy, as the latter will feel less hesitated to collaborate with the nurses to complete his/her daily activities. However, nurses should form a limit, up to which, they would intervene into the privacy of the patients and should be adequately aware in accordance with the health conditions of the patients (Feilding & Gilbert, 2006). Again, as per a particular study of Shaw (2012), in order to ensure utmost privacy of the patients and their daily activities during their end-of-life care, it is suggested that patients should be given with a choice to select the ways they would be treated or managed by the nurses. This particular approach is quite important when dealing with the privacy concerns of the patients during their treatment (Shaw, 2012). It is only through the application of appropriate interactive communications and discussions that the patient/carer can make informed decisions as to which of these facilities would serve best in enabling them to retain the level of independence that they desire (Burnard & et. al., 2011; Chochinov, 2002). Conclusion From the overall analysis, it can be comprehended that the end life period of any patient is quite critical and the healthcare professionals who are involved in the day-to-day management of the same will have the needs to attain greater awareness of their ethical responsibilities. Provided if the nurses have the skills and values discussed above, the patients will be able to take an active role in the collaborative decision making process related to their care (RCN, 2014). More importantly, the nurse will then be in a better position to be able to ensure that these decisions are shared with other members of the team who may be involved with the interventions required to address the patient’s needs. As indicated in the research conducted by Brown & et. al. (2011). 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