What suggestions would you make based on your knowledge of the determinants of healthy aging?
June 15, 2021
Critical Appraisal Order Description You are asked to critically appraise the research using the Critical Review Form Version 2.0 (Letts et al 2007). Attached are the Article to be critically appraisal Guidelines and the critical review form. Task 1: Critical Appraisal Length: 1000-1200 words Detailed description for each criterion of the Critical Review Form. Critical discussion of the strengths and weaknesses of sampling data collection and analysis. Critically discusses conclusion and implications of the reviewed study. Task 2: Phenomenology and qualitative research Length: 250 words Describe the phenomenological approach to qualitative research. Detailed description of phenomenology and detailed comparison to other qualitative approaches. Identifies research problems suitable for a phenomenological study. Identifies research problems suitable for a phenomenological study and basic description of bracketing. Identifies research problems suitable for a phenomenological study and detailed description of bracketing. I have attached the paper (Joanasson et al 2011) you are to review; the Critical Review Form and some Guidelines to help you with the task. Using the form helps you structure your review and cover the most important aspects for describing and appraising a piece of qualitative research. You are using the critical review tool to guide YOUR evaluation of the quality of the report. This task shouldnt require lots of references. References may be included in the relevant question box. In reviewing the paper give the paper credit where you think it is due but dont be scared to find fault if you think that some aspect of the study or the report fails to measure up (using the criteria of the CR from). Current references If you are experiencing difficulty inserting X in to the checkboxes delete the options that are not applicable EMPIRICAL STUDIES Corroborating indicates nurses ethical values in a geriatric ward LISE-LOTTE JONASSON MSc14 PER-ERIK LISS Professor2 BJO RN WESTERLIND MD3 & CARINA BERTERO Professor4 1Department of Nursing Science School of Health Sciences University of Jonkoping Sweden 2Department of Health and Society Linkoping University Sweden 3Department of Geriatrics County Hospital Ryhov Jonkoping Sweden and 4Department of Medical and Health Sciences Division of Nursing Science Faculty of Health Sciences Linkopings University Sweden Abstract The aim of the study was to identify nurses ethical values which become apparent through their behaviour in the interactions with older patients in caring encounters at a geriatric clinic. Descriptions of ethics in a caring practice are a problem since they are vague compared with the four principles of autonomy beneficence non-maleficence and justice. A Grounded Theory methodology was used. In total 65 observations and follow-up interviews with 20 nurses were conducted and data were analysed by constant comparative analysis. Three categories were identified: showing consideration connecting and caring for. These categories formed the basis of the core category: Corroborating. In corroborating the focus is on the person in need of integrity and self-determination; that is the autonomy principle. A similar concept was earlier described in regard to confirming. Corroborating deals more with support and interaction. It is not enough to be kind and show consideration (i.e. to benefit someone); nurses must also connect and care for the older person (i.e. demonstrate non-maleficence) in order to corroborate that person. The findings of this study can improve the ethics of nursing care. There is a need for research on development of a high standard of nursing care to corroborate the older patients in order to maintain their autonomy beneficence and nonmaleficence. The principal of justice was not specifically identified as a visible nursing action. However all older patients received treatment care and reception in an equivalent manner. Key words: Ethical values geriatric wards grounded theory nursing ethics nurses behaviour (Accepted: 8 August 2011; Published: 14 September 2011) In a study about satisfaction (Kahn Hassan Anwar Babar & Babar 2007) patients felt that nurses were good at providing privacy and there were regular vital sign check-ups. However the patients were dissatisfied with the nurses behaviour. In other studies satisfaction depends on the patients ability to participate and being involved concerning their own care (Ford Schofield & Hope 2003; Larsson Sahlsten Segesten&Plos 2011). Different demands on nurses by patients affected them in their work situation and make them feel powerless in caring (Berg Berntsson & Danielsson 2006). Nurses are dependent on collaborative interaction (Bischop & Scudder 1985 1996) and they should meet patients and relate to the older patients situation. This collaborative interaction (i.e. a caring relationship) is expressed by Gaut (1983) as caring for and caring about. Caring for is a one-way relationship in which the nurse is responsible. Caring about is a quality found in the relationship between nurse older patient and next of kin; that is treating them with respect and dignity. A caring relationship is characterised by promise and involvement (Hjelm Hartwig & Bertero 2007). In (page number not for citation purpose) Correspondence: Lise-Lotte Jonasson Department of Nursing Science School of Health Sciences University of Jonkoping SE-551 11 Jonkoping Sweden. Tel: 46 36 101242. Fax: 46 36 101250. E-mail: Lise-Lotte.Jonasson@hhj.hj.se Int J Qualitative Stud Health Well-being #2011 L-L. Jonasson et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial 3.0 Unported License (http://creativecommons.org/licenses/by-nc/3.0/) permitting all non-commercial use distribution and reproduction in any medium provided the original work is properly cited. 1 Citation: Int J Qualitative Stud Health Well-being 2011 6: 7291 DOI: 10.3402/qhw.v6i3.7291 a caring relationship the nurse must have an ethical responsibility. Ethical responsibility depends on personal responsibility and this responsibility cannot be avoided ignored or transferred (Clancy & Svensson 2007). Individual responsibility is connected with nurses behaviour ethical values and morals and these are important aspects that influence their actions which in turn influence the quality of care (Schluter Winch Holzhauser & Hendersson 2008). Values represent the basis of ethics as they form the backbone of how we act behave and address different moral situations (Kalvemark Hoglund Hansson Westerholm & Arnetz 2003). Care is both thought and action*which are interrelated (Tronto 1993). Care ethics aim to increase ethical reflection focusing on values such as engagement solidarity and moral sensitivity (Vanlaere & Gastmans 2005). As explained by Cronqvist Burns and Lu tzen (2004) caring about someone rests on moral grounds because moral obligation is inherent in the notion of caring and assumes personal ability to know what is morally right in the caring encounter. The nurses attitude values self-respect and so on influence the choice of a care plan (Gustafsson & Parfitt 2002) and choices are made apparent in communication with the older patient and care plan documentation (Gunhardsson Svensson & Bertero 2008). Nurses behaviour may have revealed ethical values that were interpreted by patients hence the dissatisfaction (Castledine 1996). Older patients are sometimes vulnerable and do not have much to decide about in caring. It is important to monitor the nurses performance because it affects the older patient. A nurses performance is made apparent in verbal and non-verbal ways of communicating (Noddings 1984; Orlando 1961 1972). Important aspects when caring for older patients are security trust integrity and personal decision-making (SFS 1982; National Board of Health and Welfare 2005) in order to carry out good health care (SFS 1982; ANA 2001; ICN 2002). There is also a connection between the patients experience of value the nurses work and the ethical environment (McDaniel Veledar LeConte Peltier & Maciuba 2006). There are different versions of ethics in care which complicates the picture of ethical theories in nursing. Descriptions of ethics in a caring practice are another problem since they are vague compared with the four principles of autonomy beneficence non-maleficence and justice (Edwards 2009). These four principles are central components of nursing and health care ethics (Beauchamp & Childress 2001). Again nurses individual ethics depend upon each persons upbringing and the atmosphere of the caring situation (Edwards 2002; McDaniel Veledar LeConte Peltier & Maciuba 2006). Authors explain nurses actions in different ways for example the caring interaction must be permeated by a belief in the older patients and their capacity and nurses ought to support the patients in realising their own vitality ambitions (Nordenfelt 2000). The nurses openness and sensitivity can affect older patients so that they open up and share difficulties with the nurse (Eriksson & Naden 2002). This support could consist of the professionals presence touch and listening; the creation of a base for a caring relationship (Fredriksson 1999) and strive to understand patients perspective (Covington 2005). The ideal nurse is an eager loving sympathetic and supportive person; the care ability depends on how helpful the nurse is (Bischop & Scudder 1985; Tarlier 2004). These descriptions of the nurses characteristics lead up to supporting the patients identity by strengthening the patients involvement and participation in their own health i.e. confirmation (Gustafsson & Parfitt 2002). Study findings indicate the importance of supporting the patients in their own situation to achieve their own goals. Nurses need to change roles to make a patient active even if the patient is in palliative care (Hjelm et al. 2007). The nurse has to develop an approach of humility and carefulness when trying to help patients so that they preserve their activity and dignity. Nurses must also demonstrate knowledge as it influences their action in practice (Purkis & Bjornsdottir 2006). Concrete caring actions only have an ethical value in the light of the quality of the caring attitude of which they are the expression (Gastman 1999). Studies of this sort are important as ethical studies are almost always examined indirectly i.e. how nurses act are unclear and know the complex reality of ethical practice (Goethals Gastmans & de Casterle 2010). The study Aim The aim of the study was to identify nurses ethical values that become apparent through their behaviour in the interaction with older patients in caring encounters at a geriatric clinic. Design In order to understand human behaviour a qualitative approach was used influenced by symbolic interactionism. Gestures attitudes and the control of attitudes between people are important components in symbolic interactionism (Blumer 1962 1969 1986). As this study is based on symbolic L-L. Jonasson et al. 2 (page number not for citation purpose) Citation: Int J Qualitative Stud Health Well-being 2011; 6: 7291 DOI: 10.3402/qhw.v6i3.7291 interactionism through which researchers identify the ethical values visible in nurses actions and behaviour the methodological approach was Grounded Theory (GT) using observations and follow-up interviews (Glaser & Strauss 1967). The intention of such a method is to achieve a deeper understanding of concerns actions and behaviours of groups of individuals through the nurses own words and actions. It is an inductive general method in which theory is generated (Glaser 1978; Glaser & Strauss 1967). Setting The setting for this study was a geriatric clinic in a medium-sized Swedish city. The geriatric clinic is a stroke and rehabilitation ward with 22 beds. Geriatrics is a branch of medicine devoted to prevention diagnosis and treatment of disorders affecting old people (Geriatric Medicine in Sweden 2009). The average caring time for older patients is approximately 18 days and after discharge they go home or to another caring facility. The words older patient as used in this context define people aged 65 years or above with varying needs of care (WHO 2008). Participants and ethical considerations Approval was obtained from the clinic manager the department director the personnel department and the unions involved. While conducting the study consideration was given to The Declaration of Helsinki (World Medical Association Declaration of Helsinki 2008) law of research ethics (SFS 2003:460) which concerns the ethical cornerstones of empirical research (SFS 2003:460). Approval for the study was obtained from the Regional Research Ethics Committee at Linkoping University Hospital Dnr.170-06. All older patients were asked if they agreed to the observations of caring encounters between themselves and the nurses. All patients agreed verbally. The sample population were staff nurses at the geriatric clinic. Before data collection commenced a meeting was held in which the nurses were given verbal and written information. Written and verbal informed consent was obtained from all nurses. A total of 20 nurses participated in the study i.e. all invited nurses. The nurses comprised 19 females and 1 male ranging in age from 25 to 62 years with a median age of 45 years. Twelve of the nurses were registered nurses and eight were enrolled nurses. Their experience ranged from 1 year to 40 years with a median of 19 years. The nurses had different backgrounds; some had engaged in other occupations before working as nurses and some were foreign born. In the investigated clinic the competence mainly concentrated on medical investigations medical treatments and rehabilitation of patients with stroke dementia osteoporoses and fractures. Older patients should receive care and rehabilitation suitable for their needs and they should also have an individual caring plan. Health care professionals in geriatric clinics have a holistic view and the interactions with the patient should appear as teamwork (National Board of Health and Welfare 2011). Observations and follow-up interviews Empirical data collection took place between February and May 2008. The researcher was nonparticipant; that is was dressed as a health care professional but did not work as one although at times the researcher assisted the health care professionals. The researcher listened watched and had conversations with the participants in the study (Morse & Field 1996). The researcher accompanied the nurses on the ward and 65 different caring encounters were observed. A follow-up interview was conducted directly after the observations (Berg 1995). In the follow-up interviews the nurses were asked Can you tell me what happened in this caring encounter? The follow-up interviews (210 min) were conducted in private and away from the other person involved in the encounter. These follow-up interviews were tape-recorded and transcribed verbatim. Transfers events information social intercourse and so on were recorded on a pocket-tape recorder as well as in a notebook as field notes. This was done immediately after every observation verbatim and as scrupulously as possible (Patton 2002). Approximately 85 h of observation were included divided into 4-h shifts. Data analysis All data observations and follow-up interviews were transcribed and used as a unit. The transcribed text was analysed using Constant Comparative Analysis an inductive analysis method (Glaser 1978 1992). The analysis began by openly encoding the first observation/follow-up interview. The next step was to capture the substance in the data to break it down into identifiable substantive codes that illustrated the influence of caring situations. The different codes and interviews were compared to each other to strengthen their identification. The codes were labelled with origin words from the data (Glaser 1978; Glaser & Strauss 1967). The second observation/ Corroborating indicates nurses ethical values Citation: Int J Qualitative Stud Health Well-being 2011; 6: 7291 DOI: 10.3402/qhw.v6i3.7291 3 (page number not for citation purpose) follow-up interview was analysed and compared with the first one. All data were processed the same way. Thereafter the analysis continued with the aim of reaching a higher level of abstraction of the material thereby allowing identification of categories. The codes were analysed and similar meanings in the codes were identified and clustered together into categories. The categories were labelled with more abstract concepts. These categories were also compared with the codes and the other categories. The gathering of data and analysis continued until a saturation point was reached after 65 observations/ follow-up interviews. Nothing new emerged in the analysis that enabled identification or creation of new codes or categories. The number of concepts/behaviour created saturation not the number of nurses. The final level reached involved identifying a theoretical construction*a core category*that answered possible questions and explained the phenomenon under study (Glaser 1978; Glaser & Strauss 1967). Categories were related to each other and scrutinised to verify their relevance. A core category was the major category found in all data (Glaser 1978 1992). Validity The findings of GT do not take the form of the reporting of facts but are a set of probability statements about the relationship between concepts or an integrated set of conceptual hypotheses developed from empirical data. Validity in GT should be judged by fit relevance workability and modifiability (Glaser 1978 1992; Glaser & Strauss 1967). This study is fit as data are linked to their sources (Berg 1995; Glaser 1992). Conducting observations with follow-up interviews as confirmation is a triangulation technique imbedded in GT. This method strengthens the relevance of the findings in the study (Glaser 1978 1992; Glaser & Strauss 1967). Relevance is when the findings are recognisable for people. Since data are derived from empirical data the findings could be useful and fulfil requirements for workability (Berg 1995; Glaser 1992; Glaser & Strauss 1967). Findings Three categories were identified during the analysis: showing consideration connecting and caring for. These categories formed the basis of the core category: Corroborating (see Figure 1). The core category corroborating explains how nurses ethical values are made apparent through their behaviour in the interaction with the older patient in caring encounters at a geriatric clinic. All three categories are related and thus influence each other but are separate aiming to generate the core category. The core category and categories identified and described are abstracted to a theoretical level. Some sequences from observations and quotations from the followup interviews are provided from the empirical data. Corroborating Corroborating means that one person has a responsibility to promote a relationship confirming a person and making the person feel more secure. This relationship is based on support and giving strength; that is nurses have an obligation to do good from the account of patients own values and necessity. Consideration and thoughtfulness must be shown towards the other party. This also involves having good manners towards someone else. The nurse is responsible for the other person and care and treatment must as far as possible be designed and given in consultation with that person. Corroborating indicates nurses ethical values that are apparent through their behaviour in the interaction in caring encounters. In corroborating the focus is on the person who needs integrity and selfdetermination; that is it involves application of the autonomy principle. Corroboration places a responsibility on the nurse to promote another persons well-being (beneficence) and health through support and giving strength. As with caring encounters the foundation is based on a corroborative relationship. The actions in caring encounters are both verbal and physical. Corroborating means being sensitive to another persons gestures listening to the person and trying to understand his/her thoughts. It also means giving priority to the persons needs in the situation a form of benefit. Corroborating means to act in such a way that time is given to the older person aiming to maintain the persons self-control Showing consideration Connecting Caring for Figure 1. The three categories: showing consideration connecting and caring for are related to and affect each other. These categories generate the core category Corroborating. L-L. Jonasson et al. 4 (page number not for citation purpose) Citation: Int J Qualitative Stud Health Well-being 2011; 6: 7291 DOI: 10.3402/qhw.v6i3.7291 and strength. This is done to benefit the person. This means paying attention to the other persons condition and encouraging them in order to motivate them. Encouragement is central to corroborating. Encouragement can be expressed verbally through words or physically through a pleasant demeanour. Corroboration is based on experience and knowledge about the patient as a person and on paying attention to reactions in different caring situations (beneficence non-maleficence). It is also about having good intentions and creating something good.