The last year of life of COPD: A qualitative study of symptoms and services

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In this assignment I intend to critically evaluate a paper by Elkington et al. (2004) from the journal, Respiratory Medicine. This article is titled, ‘The last year of life of COPD: A qualitative study of symptoms and services. ‘ Before critiquing this paper I will discuss my rationale for choosing it. I will also discuss the critiquing process and why these skills are important to nurses. My assignment will conclude by discussing why Elkington et al. ‘s (2004) paper is relevant and the implications it has to adult nursing.

The main reason I picked this paper is because I have had a lot of experience caring for patients with COPD on placement. COPD is the abbreviation for Chronic Obstructive Pulmonary Disease. COPD is a group of respiratory diseases where airway resistance is increased with impaired airflow, e. g. chronic bronchitis and pulmonary emphysema (Mullally 2002). Research based on this disease is very relevant to future practice as the incidence of COPD is on the rise.

By 2020, COPD is expected to be the third most common cause of death worldwide (Murray and Lopez, 1997). Nurses need to be made more aware of this illness and its effect on patients and their carers as the rate of hospital admissions due to COPD is very high. COPD continues to be responsible for over 90,000 hospital admissions a year which, with an average duration of stay of 11 days, means nearly a million hospital bed days per year (Lung and Asthma Information Agency 2003). I also decided to choose this paper as it is a qualitative study.

Qualitative methods lend themselves to questions that seek answers from feelings, experiences and attitudes, while quantitative approaches necessitate answers that can be found in numbers or categories, subject to precise measurement and statistical analysis (Paniagua 2002). Qualitative research is more relevant to nursing as it helps the researcher to interact with the individual (s) involved in the study. Therefore the researcher can build up a rapport with their participant (s) and gain a greater insight into how they feel.

This methodology has a holistic focus, which allows for flexibility and the development of a deeper understanding of the subject than would be possible if using a more quantitative approach (Farley 2003). This is more relevant to nursing as nurses aim to offer a holistic approach to patient care, a wider knowledge base of a patient’s views and beliefs helps to provide this care. It is beneficial to nurses that they analyse views and criticisms of their practice so that they can improve upon this.

A research critique is a careful, critical appraisal of a study’s strengths and limitations (Polit and Beck 2006). Although the word critical is used, a critical appraisal of a paper should not just highlight all the negatives and mistakes made in the research. A critiquing process is necessary in order for a research article to be critically analysed. The process of critiquing involves an evaluation of each stage of the research process followed by the author (Carnwell 1997). The main role of a nurse is to insure they provide their patients with the best care possible.

Parahoo (2006) states that this involves creating and maintaining a safe, caring environment and using interventions which, to the best of their knowledge, are the most appropriate and effective in bringing about the desired effects. Research is one of the ways in which nurses can insure they are providing the best evidence- based practice. Sackett et al. (1996) state that evidence- based practice is, the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.

Evidence- based practice has been developed to improve nursing practice and to try and ensure that the best possible practice is used. This can only be a good thing as the care which patients receive will be of a higher standard. This evidence is mainly attained from research articles; this again highlights how important an understanding of the critiquing process is for nurses. There are a number of critiquing frameworks can be used to critique a research article, such as Polit and Beck (2006) and Parahoo (2006).

These two models have been developed to help critique both qualitative and quantitative research papers. I have chosen the qualitative section of Parahoo’s (2006) critiquing framework to help me critique Elkington et al. ‘s (2004) paper. I chose this model as I felt it offered a step- by- step guide, to the critiquing process, which is specifically aimed at beginners. Since the paper begins with a title this is the first part of the article to be critiqued. The title should accurately reflect the content of the study (Carnwell 1997).

The title of Elkington et al’s (2004) paper does not accurately reflect the content of this study. The title misleads the reader by stating it is about ‘the last year of life of COPD’. This leads the reader to believe the paper is about the experience of the patient with COPD, when in actual fact the article is based on the carer’s experiences. The title also does not mention the sample which has been used. The sample is a subset of the population, selected to participate in a study (Polit and Beck 2006). The title does not mention the class, gender or nationality of the population included in the study.

However, the title does clearly state that it is a qualitative study which helps the reader know from the start, what format the research may take. Although it is not mentioned in Parahoo’s (2006) framework, I feel it is important to discuss the author’s of the article. The author/ researcher should be appropriate and well qualified to conduct the study (Hek 1996). The author’s of the paper are clearly stated however it does not include their qualifications or if they have any previous experience conducting research.

I also noticed that the majority of the author’s are from St. Thomas’ school of medicine. This factor and the fact that the article is published in a medicine journal, leads me to believe that this article may be aimed at doctors and medical students. It is important to state this as it can show the quality and strength of the research topic. According to Polit and Beck (2006) a qualitative research article should contain an abstract. The aim of the abstract is to give readers an idea of what the article is about so they can decide whether or not they would like to read it.

The abstract should state briefly the background and aim of the study, the design, including the method (s), sample (s) and sampling, and the main findings (Parahoo 2006). The abstract in the article appears to be quite long and detailed. It is also very unclear and the first indication that the research is based on the carer’s point of view is not until the method section of the abstract. I feel that it would have been more appropriate to have stated this information in the aim at the start of the abstract.

The abstract states that the COPD patients had died 3- 10 months before the interviews were conducted; however in the methods section it states that it was 3- 9 months. This may be a misprint but it could mislead the reader and may lead them to query the validity of the study and its findings. The abstract also does not state if the paper has a systematic review or not. This is one form of literature review in which all available research studies on a particular topic are identified, analysed and synthesised (Parahoo 2006).

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