work example of section 1, 2 and 3 Research Question: “What are nurses’ experiences of managing patients with osteoporosis/depression?” Table 1: PEO and Search Terms Question Search Terms Adult...

work example of section 1, 2 and 3

Research Question: “What are nurses’ experiences of managing patients with osteoporosis/depression?”

Table 1: PEO and Search Terms

Table 2: Inclusion and Exclusion Criteria

Table 3: Search Table

Essay Plan

Section 1

1. Introduce the essay – what have you been asked to do?

2. Introduce your subject area

a. Why is osteoporosis/depression an important subject area?

b. What are the main issues relating to osteoporosis/depression?

c. Why are you interested in this subject (do not use the 1^st person)?

3. State your question clearly

4. Discuss importance of using the PEO framework and why you chose it for your search.

5. Table 1 from above

6. Discuss the importance of using a range of search terms.

7. Table 2 from above

8. Discuss the importance of using inclusion and exclusion criteria

9. Defend your choice of CINAHL as your database

10. Discuss Boolean Variable (OR and AND in table above)

11. Discuss the use of truncation (using the * symbol at the stem of a word to include all variations).

12. Discuss the use of ‘limiters’

13. Table 3 from above

14. Discuss any problems you had searching

15. Rationalise how you got from the smallest number of hits on your search table to the two studies you finally chose. This will include reading title and abstracts and eliminating some (by matching against your question and your inclusion and exclusion criteria) if there is still quite a large number. Then you would read the final articles and again match against your question and inclusion and exclusion criteria to choose the final two papers.

16. Discuss the geographical origins of your papers and what this means for considering the findings in the UK healthcare environment.

Section 2

Critique your research studies using a critiquing tool (evidence of this must be placed in appendices)

Summary Tables (one is needed for each paper and these go in your essay)

Section 3

1. Choose two/three research elements that you feel you have the best understanding of. (NB: I advise to choose 2 elements so that you can demonstrate more depth in knowledge and understanding about each element – but speak to your supervisor or module team for their clarification and expectations).

2. It is a good idea to look at your critiques to help you decide on the research elements you are most confident about. Often, the more depth you have gone into when critiquing your studies, the better this section of the essay will be.

3. Do some extra background reading around the elements you have chosen. You will need evidence from the research literature to support your points and opinions in this section.

4. Think about structuring your Section 3 as follows

a. First Research Element – e.g. ethics

i. Write around half a page introducing this research element demonstrating some general knowledge and understanding of what is most important about this element. For ethics, this might be discussing why ethics is important in research and naming the main ethical principles that apply and the areas of a study where ethics are most important.

ii. Present an analysis of how your qualitative paper demonstrates that it has followed ethical processes within your study. What are the ethical strengths of this study and the ethical weaknesses?

iii. Present an analysis of how your quantitative paper demonstrates that it has followed ethical processes within your study. What are the methodological strengths of this study and the methodological weaknesses?

b. Second Research Element – e.g. methodology

i. Follow exactly the steps above – but for methodology – i.e. an introductory section for general points about why methodology is important within research, followed by analytical discussion about the qualitative methodology used and then the quantitative methodology used. Do try to make sure that you are applying what you say to the research studies.

5. I would write these sections separately as when students combine comment about qualitative and quantitative papers in the same paragraph, it can get quite muddled and confusing to read.

6. Try to maintain an objective approach. Usually for each research issue you include, there will be positive things to say and negative things to say. You should always try to include both sides of the argument.

7. For each research element and each study, at the end of the section where you are discussing it, and once you have presented your evidence, you need to think about whether you have an opinion about how good you feel the study is in relation to each element covered. Have you presented the evidence in a way that allows you to make a final point to this end?

8. Finally you need to save about XXXXXXXXXXwords to discuss the findings of each paper (you need to refer specifically to both qualitative findings and quantitative findings), to demonstrate consideration of the implication of the findings from both studies for practice.

University of Suffolk

Module Title:

Adult Nursing Theory Four: Evidence Based Practice & End of Life Care

NT4 Part 1 Assessment

Word Count: 3843

Date: 7^th May 2019

Student Number: S191239

Introduction

Statistical analysis and research in recent times have shown large increase in diabetes prevalence in virtually all regions of the world. The global increase shows that 415 million people now living with diabetes (Harding et al. 2019, p.3). According to Godlee (2018, p.363), type 2 diabetes affects nearly 10% of the world’s adults, and rates are rapidly on the increase especially in low- and middle-income countries.

People with diabetes need the skills and confidence to cope with the daily demands of self-management and avoid complications (Diabetes UK, XXXXXXXXXXTherefore, diabetes education is a key element in providing healthcare services to diabetic patients. Hence, my chosen topic for the purpose of this essay is “the effectiveness of diabetes self-management education for adults with type 2 diabetes”.

The intent of this topic is to critically explore the effects of education on diabetes self-management, that is, to ascertain whether education may result in improved patient perception of quality of life, improvement in HbA1C or improvement in the ability to efficiently self-manage diabetes. Thus, the following will be the research question:

What is the effect of education on type 2 diabetes self-management?

The PEO table below will help to manage and break down the research question. Although PICO format is most widely used for quantitative research, the application of PEO format was enough to identify the key concepts in the research question, hence, there was no need for two tables especially as quantitative elements was accommodated.

The database chosen for this literature search was British nursing database, considering the research question, the quality and relevance of the research paper, and the inclusion and exclusion criteria, the qualitative paper that matched the criteria was selected. However, it was difficult to get a quantitative paper that fits into the criteria from same database, a lot of time was spent searching but it was unsuccessful, the paper that matched the criteria was found from CINAHL.

The search and selection criteria were focused on all adults with type 2 diabetes. Type 2 diabetes, usually in adults, are the most common diabetes, and the prevalence of type 2 diabetes has risen drastically in countries of all income levels (WHO, XXXXXXXXXXDiabetes and diabetes education are same irrespective of country, cultures and settings; hence, my search was not limited to a population or country.

The prevalence rate of type 1 diabetes is much less than type 2 diabetes (Diabetes UK, XXXXXXXXXXJuvenile diabetes which refers to diabetes in children and young people, and common in type 1 diabetes, are included in my exclusion list because of its less prevalence.

In both databases used, each search term was search in Abstract. When searching for qualitative paper on BND, the result on S5 were filtered to peer reviewed, by date to less than 10 years, before finally selecting an article from 63 results. During the search of quantitative paper on CINAHL, the result at S7 was reduced to 158 after using the above search limits.

Although, the selected papers are non-UK research papers, the research findings and application to practice is transferable to any population and settings. The research papers were selected because of its quality and suitability for my chosen topic and research question. In addition, the papers represent other countries, economies, human cultures and societies, especially as research results are relevant to the global population. The selected qualitative and quantitative papers are focused on investigating the effect of education on the self-management capability of patients with type 2 diabetes, statement of the aim of each paper, to a large extent will give an answer to my research question.

Critiquing qualitative research using Holland and Rees framework.

Critiquing quantitative research using Holland and Rees framework.

Critical discussion of the selected research papers

This section of the essay will critically discuss key issues arising from the selected papers. The intent is to assess the quality of the papers, and critically analyse essential aspects of the research papers. The final element of this section will consist of discussion of the applicability and potential implementation of research findings to my relevant context. Due to the word limit of this essay, all the elements of the framework may not be addressed, emphasis will be on the important elements.

One of the aspects of the qualitative research paper to critically examine, is the tool of data collection. The researchers opted for in-depth, semi-structured interview as the tool for data collection. Although, semi-structured interview provides the opportunity to explore the in-depth and complexity of an issue from the perspective of individual participants (Gerrish and Lacey, 2010), many authors have questioned its reliability.

Gerrish and Lathlean XXXXXXXXXXbelieves reliability is less achievable with a more in-depth, semi or unstructured interview. They argued that interviewers may put their own views and perspectives forward or present incorrect/mis-presentation of participant’s accounts. Allmark et al. (2009) also believe when interviewing patients, the researchers risk losing the research role and slipping into that of a teacher, preacher or counsellor, they argued the risk is particularly dangerous in less structured interviews where the discussion is more in-depth. However, most authors agreed that semi-structured or unstructured interview is the most appropriate tool for data correction in a phenomenological qualitive approach. They also mutually believe that the success of semi-structure interview depends on the skills of the researcher or interviewer and the environment. The comfort of the environment is important as it makes interviewees feel relaxed and able to concentrate (Gerrish and Lacey, XXXXXXXXXXThe researcher used the right tool for data collection, and the interview was conducted by the researchers at the comfort of participant’s homes.

In sample aspect of the qualitative research paper, the researchers employed purposeful sampling strategy. Purposely or purposive sampling is based on the judgement of the researcher, participants are sampled for the information they can provide about a specific phenomenon (Holloway and Galvin, XXXXXXXXXXThe criticism in this sampling strategy is based on the belief of having high risk of sampling bias. Salazar et al XXXXXXXXXXdefined sampling bias as the difference between the sample and the population that is missed by imperfect sampling. In their opinion, sampling bias may yield inaccurate results that are not generalizable.

In this sampling technique, personal element of the researcher has a great chance of influencing the selection of the sample, the researcher may select a sample which shall yield results favourable to his point of view (Kothari, XXXXXXXXXXIn contrast, Robson (2011), argued that purposive sampling allows the researcher to select information-rich cases (participants and settings) for an in-depth exploration of the research topic based on their explicit characteristics.

Selection bias was evident in the selected qualitative research paper, the researchers used language (Danish language) as one of the criteria of participants selection. Selecting participants based on this criterion is apparently excluding potential participants who may have a good knowledge and experience of the issues being explored especially as experience or knowledge of a phenomenon is not hindered by the language you speak or understand, employing a translator would have helped to eliminate the selection bias. People’s experiences and perceptions are influenced by the circumstance in which they occur, and it’s also embedded in their culture and personal history (Johnson, 2000; Robson, 2011)

In addition, the researchers failed to state their reasons for the inclusion and exclusion criteria. All researchers need to clarify the rationale for inclusion and exclusion of particular people or other sampling units (Holloway and Galvin, XXXXXXXXXXAccording to Harvey and Land (2017), researchers must assess the positives and negatives and provide a rationale for the strategy they adopt so that they are able to obtain the necessary approvals for the study and recruit the required number of participants.

In methodology or broad approach of the qualitative research paper, the researchers adopted phenomenological approach. The aim of the study is to explore differences in how persons with diabetes experience diabetes-related patient education programmes. Phenomenology approach is used when researchers want to gain insight into the experiences of individuals and is based on the idea that a person’s reality is determined by their interpretations of their world (Harvey and Land, XXXXXXXXXXAccording to Brinkmann and Kvale (2015), Phenomenology enable participants to describe and explain their lived experiences. Clearly, according to the concept of phenomenology, and the aim of the study, it’s evident the researchers used the broad qualitative approach that matched the statement of the aim.

Furthermore, thematic analysis employed by the researchers to analyse the data, suits the phenomenological approach. Thematic analysis is the most common and efficient method in phenomenology (Harvey and Land, XXXXXXXXXXAccording to Taylor (2014), thematic analysis focuses on identifying behaviours, patterns and themes in participant’s experiences from interview data. Data analysis software package (NVivo) used by the researchers to manage the transcripts and organise the data analysis process, added value to the process and it’s beneficial to the researchers as they facilitate access by members of the research team working in different locations, and it also saves time, stores and retrieves data electronically (Moule et al XXXXXXXXXXHowever, Polit and Beck XXXXXXXXXXargued that the use of packages may reduce researcher absorption with the data as the process becomes more mechanical, less cognitive and more detached.

The research findings of the paper suggest that diabetic patients with better perceptions of their disease would adopt more appropriate self-management behaviours. Previous research on similar topic have shown same result. Programme facilitators in UK should be sensitive to the possibility that patients who have ill perceptions about their disease are less likely to perceive diabetes structured education as beneficial and implement new behaviours. The National Institute for Health and Care Excellence (NICE) guideline recommend healthcare professionals to develop an understanding of the patient as an individual, including how the condition affects the person, and how the person's circumstances and experiences affect their condition and treatment, it also recommend healthcare practitioners to listen to and address any health beliefs, concerns and preferences that the patient has, and be mindful that these affect how and whether they engage with treatment or interventions (NICE, 2012)

In critically analysing the selected quantitative research paper, one of the aspects of the research to critically discuss is the methodology. The researchers adopted experimental design (Randomised Controlled Trials (RCT) which seem suitable given the aim of the study. Experimental design is the most accurate or rigorous for certain types of research questions where the effects of treatments or interventions are being studied, RCT are used in health care to test interventions on people or patients (Harvey and Land, XXXXXXXXXXTherefore, this approach helped the researchers to find answers to their aim. Moreover, Gerrish and Lacy XXXXXXXXXXargued that RCT reduces the possibility of selection bias. RCTs are considered as the gold standard for all research (Bench et al XXXXXXXXXXOn the contrary, Parahoo (2014), states that systematic reviews of RCTs have shown number of deficiencies in the reporting of trials. In his view, the allocation of participants to the experimental and control groups can be biased.

The researchers adopted simple random sampling strategy to allocate eligible participants into one of two groups (intervention and control groups). The researchers chose a fair allocation strategy as simple random sampling gives potential participants an equal chance of being included in the sample (Kandola et al. 2014).

The researchers adopted strategies to avoid selection bias and ensure allocation concealment. First, random allocation was performed by a person uninvolved in sampling and data collection, secondly, the participants did not know at the time of registration whether they would be in the group discussion (intervention) or serve as controls. According to Harvey and Land (2017), one of the ways to reduce the risk of bias is when participants are randomised to determine which option they receive different treatments or interventions, that is, participants have an equal chance of receiving the different options and the researcher cannot decide which option the participant receives.

However, the researchers failed to state the reasons for using the sampling strategy. All researchers should clearly define their sampling strategy in the research report and a rationale given (Harvey and Land, XXXXXXXXXXThe researchers acknowledged there were dropouts but also failed to mention dropout rate, therefore, the impact this may have on the results could not be determined.

On the aspect of data analysis, the researchers used the appropriate method. Descriptive and inferential statistics was used for data analysis, the independent and paired t-tests were used to compare the mean scores of self-management status in different areas and the total self-management before and after the study in both groups. A p-value of et al XXXXXXXXXXargued that statistical findings maybe erroneously interpreted, with too much or incorrect emphasis on statistical significance and little discussion on clinical relevance.

The research findings show that group discussion education improved self-management and quality of life of patients with diabetes. This finding is consistent with the results from similar studies. Here in UK, the use of a group discussion method of education can be an effective approach for holding active training sessions and improving self-management. Nurses and other health care professionals should encourage diabetic patients, especially newly diagnosed to be involved in structured and organised diabetes educational programmes and interventions. NICE clinical guidelines recommend that structured education be offered to adults with type 2 diabetes and/or their family members or carers (as appropriate) at and around the time of diagnosis, with annual reinforcement and review (NICE, XXXXXXXXXXThe guideline also recommend that patient-education programmes should meet the cultural, linguistic, cognitive and literacy needs within the local area.

References

Allmark, P., Boote, J., Chambers E., Clarke, A., McDonnell, A., Thompson, A. and Tod, A.M XXXXXXXXXXEthical issues in the use of in-depth interviews: literature review and discussion. Research Ethics Review 5(2) pp. 43-88.

Bench, S., Day, T. and Metcalfe, A XXXXXXXXXXRandomised controlled trials: an introduction for nurse researchers. Nurse Researcher, 20(5): 38-44

Brinkmann, S. and Kvale, S XXXXXXXXXXInterviews: Learning the Craft of Qualitative Research Interviewing, 3^rd edn. Los Angeles: Sage Publications.

Diabetes UK XXXXXXXXXXDiabetes UK: Know diabetes. Fight diabetes. Available at: https://www.diabetes.org.uk/ [Accessed 2 March 2019].

Gerrish, K, and Lacey, A XXXXXXXXXXThe Research Process in Nursing. Somerset: John Wiley & Sons, Incorporated. Available from: ProQuest Ebook Central. [Accessed 24 April 2019].

Gerrish, K. and Lathlean, J XXXXXXXXXXThe Research Process in Nursing. 7^th edn. Chichester: John Wiley & Sons Ltd [e-book]. Available at: https://ebookcentral-proquest-com.uos.idm.oclc.org/lib/ucsl/reader.action?docID=1936761&query=research+methodology+in+nursing+ [Accessed 3 April 2019].

Godlee, F XXXXXXXXXXThe growing problem of diabetes. British Medical Journal XXXXXXXXXXpp.363. Available at: doi: XXXXXXXXXX/bmj.k4921 [Accessed 2 March 2019].

Harding, J.L., Pavkov, M.E., Magliano, D.J., Shaw, J.E. and Gregg, E.W XXXXXXXXXXGlobal trends in diabetes complications: a review of current evidence. Diabetologia.62. pp.3-16. Available at: https://doi.org/10.1007/s XXXXXXXXXX [Accessed 2 March 2019]

Harvey, M. and Land, L XXXXXXXXXXResearch Methods for Nurses and Midwives. Theory and Practice. London: SAGE Publications Ltd.

Holloway, I. and Galvin, K XXXXXXXXXXQualitative Research in Nursing and Healthcare. 4^th edn. Hoboken: John Wiley & Sons, incorporated. Available from: ProQuest Ebook Central [Accessed 4 April 2019].

Johnson, M. E XXXXXXXXXXHeidegger and Meaning: implications for phenomenological research. Nursing Philosophy, 1(2): XXXXXXXXXX.

Kandola, D., Banner, D., O’Keefe-McCarthy, S. and Jassal, D XXXXXXXXXXSampling methods in cardiovascular nursing research: an overview. Canadian Journal of Cardiovascular Nursing, 24(3): 15-18

Kothari, C XXXXXXXXXXResearch Methodology: Methods and Techniques. Daryaganj: New Age International Ltd. Available from: ProQuest Ebook Central. [Accessed 4 April 2019].

LoBiondo-Wood, G. and Haber, J XXXXXXXXXXNursing Research: Methods and Critical Appraisal for Evidence-Based Practice. Saint Louis: Elsevier. Available from: ProQuest Ebook Central. [Accessed 27 April 2019].

Moule, P., Aveyard, H. and Goodman, M XXXXXXXXXXNursing Research: An Introduction, 3^rd edn. London: SAGE Publications Ltd.

National Institute for Health and Care Excellence XXXXXXXXXXPatient experience in adult NHS services: improving the experience of care for people using adult NHS services. Available at: https://www.nice.org.uk/guidance/cg138/chapter/1-Guidance#tailoring-healthcare-services-for-each-patient [Accessed 25 April 2019]

National Institute for Health and Care Excellence (2017) Type 2 diabetes in adults: management. Available at: https://www.nice.org.uk/guidance/ng28/chapter/1-Recommendations#patient-education-2 [Accessed 27 April 2019].

Parahoo, K XXXXXXXXXXNursing Research: Principles, Process and Issues. Basingstoke: Palgrave Macmillan. Available from: ProQuest Ebook Central. [Accessed 27 April 2019].

Polit, D. and Beck, C XXXXXXXXXXEssentials of Nursing Research: Appraising Evidence for Nursing Practice, 8^th edn. Philadelphia, PA: Lippincott Williams & Wilkins.

Robson, C XXXXXXXXXXReal World Research. 3^rd edn. Chichester: John Wiley and Sons.

Salazar, L.F., Crosby, R.A. and DiClemente, R.J XXXXXXXXXXResearch Methods in Health Promotion. 2^nd edn. Somerset: John Wiley & Sons, incorporated [e-book] Available at: https://ebookcentral-proquest-com.uos.idm.oclc.org/lib/ucsl/reader.action?docID=1895452&query=research+methods+in+health+promotion [Accessed 3 April 2019].

Taylor, R XXXXXXXXXXThe Essentials of Nursing and Healthcare Research. London: SAGE Publications Ltd.

World Health Organisation XXXXXXXXXXWorld Health Organisation: Diabetes. Available at: https://www.who.int/news-room/fact-sheets/detail/diabetes [Accessed 5 March 2019].

Appendix 1

Appendix 2