Journal Critique 1 Appraisal of Qualitative Research
This is an academic essay. You are required to conduct a critical appraisal of a primary research paper (qualitative).
You should follow the format of an academic essay and use well-structured headings (for example, as you see in a journal article). Headings are signposts and give clarity to writing.
We suggest the critical appraisal has headings for the following areas:
- The research problem and its significance
- The research design and the methods.
- Findings and their relevance to contemporary nursing policy and practice
Journal Critique Appraisal of Qualitative Research
This essay presents a
critical analysis of the article ‘Sense
making and the co-production of safety: a qualitative study of primary medical
care patients’ by Rhodes et al., (2016). The article discusses patient
safety from the perspective of patients, by assessing how patients make sense
of safety within a primary care setting. This essay presents a critical
appraisal of the topic and methodology adopted by the authors in their study.
The essay begins with an evaluation of the study’s research problem and its
significance. Next, the methods and design of the study are discussed. The
findings of the research and their likely influence on nursing policy and
practice are then reviewed. Finally, the essay is concluded with a summary of
the main concepts and issues emerging from the critical analysis of the
The research problem
The research problem that the article addresses is patient safety, particularly in terms of how patients perceive and define safety. Moreover, how patients make sense of their experiences within primary care settings (Rhodes et al., 2016). Further, the authors also seek to investigate the impact that this sense making has on how they conceptualize safety. Finally, they also evaluate the similarity between these experiences and those reported by patients within a hospital setting.
Rhodes et al., (2016) indicate the significance of the research problem by highlighting the contribution of patient towards patient safety, as well as by providing an evaluation of sense making as a framework for professional patient safety. In this regard, Rhodes et al. (2016) note that sensemaking is an important approach since it provides an opportunity for patients to express themselves, which facilitates an opportunity to implement an action. This statement is consistent with Doherty and Saunders (2013), who report that patient narratives are important in providing healthcare professionals with a deeper and more subjective understanding of patients’ experiences.
The authors provide appropriate justification for the significance of their study. However, they fail to highlight the difficulties associated with obtaining patient feedback and the risks associated with the approach. According to Hrisos and Thomson (2013), some patient-oriented approaches evoke mistrust and suspicion between patients and health professionals. Patients are usually concerned that they may come across as rude or that they will upset staff. On their part, staff were suspicious of patient motives in making enquiries, fearing that such patients were preparing to lodge complaints (Hrisos and Thomson, 2013). According to Vaismoradi, Jordan, and Kangasniemi (2015), however, most patients are usually willing to share their input particularly where they perceive that this will lead to improved health outcomes.
The research design and the methods.
The research was qualitative in nature, involving the use of semi-structured interviews(book). The interviews were kept open, which was essential as the authors tried to give participants greater freedom over the topics discussed in the interview (Rhodes et al., 2016). The interviews were audio recorded and later transcribed (Powell & Davies, 2012). The study catered for consent and confidentiality using consent forms for the former, and anonymization of transcripts. The gender was used to code responses and provide a unique identification number for each.
The data collected was analyzed using a qualitative data analysis software (NVivo10). This software has also been used by Burgess, Cowie and Gulliford (2012), in their study on patient perceptions of student error. The analysis involved themes and iterative techniques, targeted at generating open codes. Some initial themes were identified through a coding system, and these were later refined into three core themes. It is important to note that the authors have discussed these results elsewhere (Rhodes, Sanders & Campbell, 2014; Rhodes, Campbell & Sanders, 2015).
Research rigor entails ensuring a high level of validity and reliability. According to Taylor (2008), some of the characteristics of rigor in qualitative research are openness, thorough data collection, and a stringent adherence to philosophical perspective. In their research, Rhodes et al., (2016) ensure stringent data collection through their target demographic whereby their sample was adequately representative and authentic. To do so, the researchers attempted to ensure maximum variability in terms of age, career status, education level, socioeconomic level, and ethnic background. The sample size for this study was 38, comprising 14 men and 24 women. Participants ranged from 18-78 years. For starters, they sought ethical approval, which is important for a research as sensitive as this study. Despite the indication of an attempt to guarantee variability against the other demographic elements mentioned above, the authors do not provide a breakdown of the exact figures.
Findings and their relevance to contemporary nursing policy and practice
The authors discuss sense making and the articulation of safety, noting that most respondents associate safety with the quality of care received and professionalism of the care provider (Rhodes et al., 2016). Another important issue that has also been reported by Rhodes, Campbell and Sanders (2015) is the importance of both psychosocial and physical aspects of safety in primary care. Another issue is sense making from experience. Participants draw on experiences to articulate themselves or to justify their opinions, views, or decisions (Rhodes et al., 2016). The role of experience is validated by Doherty and Saunders (2013), who indicate that individuals will usually rely on their experiences, as well as their experiences and beliefs. Rhodes et al., (2016) also note that psychosocial competence improved patient’s confidence in the doctor’s ability to address physical health issues. The implication for nursing policy is that nurses need to display a high level of awareness of medical procedures in order to instill a sense of psychosocial safety in their patients.
Finally, the authors also discuss the proactivity of patients and their role in co-producing safety. The findings indicate that patients’ experiences played an important role in influencing their continued use of primary care services (Rhodes et al., 2016). More experienced users were more knowledgeable about how to use medical services, taking proactive measures such as checking prescriptions and monitoring their own drug use (Rhodes et al., 2016). Social distance is a significant impendence to patient safety, whereby according to Hor et al. (2013), cooperation by medical staff was vital in improving patient’s self-initiated safety behaviors. Nursing policy therefore needs to facilitate the cooperation of nurses. Patient safety has a huge impact on nursing policy by necessitating a shift to patient-centered approaches. This framework is necessary to ensure that nurses receive feedback on safety from patients. The importance of this approach is underscored by the fact that patients have a greater capacity to identify adverse events, and that patients rely on different criteria than clinicians (Hor, Godbold, Collier & Iedema, 2013). According to Ulrich and Kear (2014), patient centeredness is one of the important subcultures of a patient safety culture.
This essay has provided a critical analysis of the
article Sense making and the
co-production of safety: a qualitative study of primary medical care patients
by Rhodes et al., (2016). This analysis has evaluated the problem statement,
noting that the study investigates patient safety from a patient perspective
through a sense making framework. The authors utilize a qualitative study
approach, involving the use of semi-structured interview to collect responses
from a total of 38 respondents. The study discussed the methods and designs of
the article. The study also presents important findings for nursing, such as
the close association between safety and quality in patient’s interpretation of
Burgess, C., Cowie, L., & Gulliford, M. (2012). Patients’ perceptions of error in long-term illness care: qualitative study. Journal of health services research & policy, 17(3), 181-187.
Doherty, C., & Saunders, M. N. (2013). Elective surgical patients’ narratives of hospitalization: The co-construction of safety. Social Science & Medicine, 98, 29-36.
Hor, S. Y., Godbold, N., Collier, A., & Iedema, R. (2013). Finding the patient in patient safety. Health:, 17(6), 567-583.
Hrisos, S., & Thomson, R. (2013). Seeing it from both sides: do approaches to involving patients in improving their safety risk damaging the trust between patients and healthcare professionals? An interview study. PLoS One, 8(11), e80759.
Powell, A. E., & Davies, H. T. (2012). The struggle to improve patient care in the face of professional boundaries. Social science & medicine, 75(5), 807-814.
Rhodes, P., Sanders, C., & Campbell, S. (2014). Relationship continuity: when and why do primary care patients think it is safer?. Br J Gen Pract, 64(629), e758-e764.
Rhodes, P., Campbell, S., & Sanders, C. (2015). Trust, temporality and systems: how do patients understand patient safety in primary care? A qualitative study. Health expectations: an international journal of public participation in health care and health policy, 19(2), 253.
Rhodes, P., McDonald, R., Campbell, S., Daker‐White, G., & Sanders, C. (2016). Sensemaking and the co‐production of safety: a qualitative study of primary medical care patients. Sociology of Health & Illness, 38(2), 270-285.
Taylor, B. J. (2006). Research in nursing and health care: Evidence for practice. Cengage Learning Australia.
Ulrich, B., & Kear, T. (2014). Patient safety and patient safety culture: foundations of excellent health care delivery. Nephrology Nursing Journal, 41(5), 447.
Vaismoradi, M., Jordan, S., & Kangasniemi, M. (2015). Patient participation in patient safety and nursing input–a systematic review. Journal of clinical nursing, 24(5-6), 627-639.