Critiquing a qualitative research is fundamental to nursing research utilization and evidence based practice. The process of qualitative research is an intellectual activity which investigates human experiences in naturalistic settings, pursuing meanings that inform theory, practice and which will help one decide as to what extent research maybe useful in practice; to see if the findings are trustworthy, and be able to compare it with other related research.
While the term “research” has been used rather freely in the past, there has also been a tendency to perceive research as an end in itself rather than as a means to an end, namely improvement in the quality of care provided to patients. As LoBiondo-Wood et al. (2002) mention, “the meaning of quality research in nursing should contribute to knowledge relevant to health care and service. ” Further, nursing research should provide a specialized scientific knowledge base that empowers the nursing profession to anticipate and meet these challenges and maintain our societal relevance”.
This paper will critique the study, “Learning to think like a Nurse: Stories Form New Nurse Graduates” by Sharon A. Etheridge, PhD, MSN, BSN (2007). Substantive and Theoretical Dimensions Relevance of research Problem and significance The research problem is a “situation in need of a solution, improvement or alteration or a discrepancy in the way things are or the way they ought to be” (Burns & Grove, 1993). This study, “Learning to think like a Nurse: Stories Form New Nurse Graduates.
” by Sharon A. Etheridge, PhD, MSN, BSN (2007) would like to answer the question: What are the perceptions of new nursing graduates about clinical nursing judgments and the education involved in learning how to make such judgments? It explicitly aims to explore the experiences of the new graduates considered helpful in learning to make clinical nursing judgments and their beliefs about their role in making clinical nursing judgments. According to LoBiondo-Wood et al.
(2002), and in-depth research providing an understanding of the nursing practice is necessary to develop nursing and health care interventions, outcome studies, and policies that are congruent and sensitive. A qualitative, descriptive, longitudinal research approach based on the tradition of phenomenological life-world portrayal facilitates this goal, hence this study was done. This study, “Learning to think like a Nurse: Stories Form New Nurse Graduates. ” by Sharon A.
Etheridge, PhD, MSN, BSN (2007) concentrated on describing the contexts in which the new nursing graduates learned to make clinical nursing judgments (p. 25). The purpose of the study was to explore the experiences of the new graduates which are considered helpful in learning to make clinical nursing judgments and their beliefs about their role in making clinical nursing judgments. In addition, this study sought to determine the new nursing graduates’ perceptions of how they learned to think like nurses.
Further, this study proposed some plan to help new nursing graduates make the correct clinical judgments. Therefore, this study is significant one for nursing to study because the results of this study is useful in identifying strategies to help new graduates make the transition from students to registered nurses specifically in their role in making correct clinical judgment. Appropriateness of the conceptual framework The author did not have an in-depth review of literature, hence she did not identify a theoretical or conceptual framework.
According to Wilson (1992), a theoretical framework for a study is an “essay that places the study in the context of existing related theory based on the literature that has been reviewed”. Hence, conceptual framework is implicit in this study. Congruence between research question and methods used According to Burns & Grove (1993) “establishing the research question directs the focus of the study toward an expected outcome. ” Etheridge (2007) addressed the following question: “What are the perceptions of new nursing graduates about clinical nursing judgments and the education involved in learning how to make such judgments?
” To state the question broadly enough for a qualitative study, the researcher further added that, “By addressing the question, this study also explored experiences the new graduates considered helpful in learning to make clinical nursing judgments and their beliefs about their role in making clinical nursing judgments. ” Literature review The author’s review of literature was incorporated in the introduction part of the article since she did not provide a review of literature part in her research. Previous studies were not referred to by specific articles and names but were provided in the references section of the study.
As mentioned by Wood & Haber (1998), “a review of the literature is a broad, comprehensive, in-depth, systematic and critical review of scholarly publications, unpublished scholarly print materials, A- V materials, personal communications”. This study on “Learning to think like a Nurse: Stories Form New Nurse Graduates” used previous relevant studies but theories involved were not described in- depth. Methodological Dimensions Research design A descriptive, longitudinal, phenomenological study using semi-structure interviews was used to frame the design of the study (p. 25).
The method used was appropriate for this study as it sought to examine the meaning of experiences of new nursing graduates in making clinical nursing judgments. In addition, the qualitative interviews were undertaken to understand the experiences and all that they entail. Population and sample The study used non probability, purposive type sampling of subjects as someone uses knowledge of the population to hand-pick the units to be included in the sample. The researcher selects the subjects who are considered to be “typical” of the population. (Benner, Tanner, & Chesla, 1996).
There were only few subjects (only 5 new nurses), so the study population was small. The participants were selected by the researcher on the following criteria: new nursing graduates who graduated from a 4-year college with baccalaureate degrees in nursing, passed the NCLEX examination on the first attempt, participated in a nurse intern program after graduation, and no longer worked with a preceptor. The size of the sample may be adequate as the five subjects fulfilled the criteria. The setting where the data were collected was appropriate for the study. The setting was in West Michigan, in adult-surgical units.
Since the major aim of the study was to explore the experiences of the new graduates which are considered helpful in learning to make clinical nursing judgments, an acute care institution is the most appropriate setting. Collection of data Data collection procedure used which was the semi-structured interviews was consistent with the purpose of the study since the study was a qualitative, descriptive, longitudinal, and phenomenological. The life-world portrayal is most appropriate to ensure that nothing would be taken for granted in the study (Bengtsson, 1998).
The qualitative tape-recorded interviews was also undertaken to understand thoroughly the experiences of new graduate nurses. To assess whether or not ethical standards are met in relation to the protection of the rights of human subjects, the researcher assured the participants full confidentiality by letting them use fictitious names. Moreover, the participants gave a written informed consent specifically for the three tape-recorded interviews to be used for this study. Data saturation was achieved as tape-recorded interviews were done.
Moreover, the participants’ interview occurred on three times on different occasions: within a month after the end of the experience with a preceptor, 2 to 3 months later, and approximately 8 to 9 months after the first interview. Moreover, the tape-recorded interviews were transcribed verbatim, validated by another nurse, and then examined for themes (p. 25). Etheridge (2007) data analysis procedures were appropriate for the data collected as the interviews occurred in three different occasions. The tape-recorded interviews were transcribed verbatim, validated by another nurse, and then examined for themes.
Hence, rigorous steps were taken to analyze data collected. This data analysis procedure was consistent with the qualitative method used in the study as qualitative research investigates human experiences in naturalistic settings, pursuing meanings that inform theory, practice and further research. Though generally, qualitative research is very lengthy and often explores cultural themes, this research was not. Ethical Dimensions Confidentiality was assured to the participants as fictitious names are used in the study. Then, participants were also given written, informed consent for three tape-recorded interviews to be used in this study.
The interviews occurred on three different occasions: within a month after the end of the experience with a preceptor, 2 to 3 months later, and approximately 8 to 9 months after the first interview. The study did not mentioned research ethics board approval. Interpretive Dimensions Discussion The study discussed the answer to the research question: How the new graduates learned? There were three areas explored how new graduates learned how to think like a nurse through clinical experiences with a variety of patients, faculty help, and discussions with peers.
New graduates consider clinical experience as the most helpful learning strategy for learning to think like a nurse. This is being in the clinical setting with patients and having varied experiences with patients. In the clinical setting, students practice nursing skills, they also had different experiences with a variety of patients, and interact with various team members—all experiences that have significance in completing their picture of how Faculty help by talking with the student nurses about how to make their own clinical decisions was very helpful in learning tot think like a nurse.
So was their discussion with peers by listening to and talking with one another. This lead the new graduates to develop self-confidence and how to cope with the responsibility of nursing. They learned to trust themselves to make decisions while still collaborating with other members of the healthcare team. Thinking critically became the modus operandi for the entire time spent caring for patients. Hence, some of the developmental changes that happened with these subjects were their developing confidence, acceptance of responsibility, and awareness of the importance
of thinking critically. As with the other components of development, incorporation of thinking critically into their modus operandi was a function of time (p. 29). Conclusion The analysis of the study presented in the article, “Learning to think like a Nurse: Stories From New Nurse Graduates,” a study by Etheridge, S. A. (2007) conclude the following: 1. Nursing students and new graduates are often unaware of the level of responsibility required of nurses and lack confidence in their ability to make clinical judgments; 2.
The process of learning to think like a nurse is characterized by building confidence, accepting responsibility, adapting to changing relations with others, and thinking more critically; 3. Multiple clinical experiences, support from faculty and experienced nurses, and sharing experiences with peers were critical in the transition from student nurse to beginning practitioner. Implications This kind of study is very important especially that it proposed some practice implication so new nurses could make correct clinical judgments.
Some of these implications are: 1) staff development educators and preceptors should assist the new graduates in determining answers to the questions and thus help them enhance and construct their knowledge; 2) new graduates could be brought together for frequent short discussions about the patient care situations they are learning; 3) new graduates could have a shared list server or chat room so they can talk about what they are learning; 4) experienced nurses should be assigned to the same shift with the new nurses so that support systems are available.
Further, these practice implications about how to help new graduates think like a nurse offer a potential improvement so that they can detect quickly a life-threatening complication, how quickly patients leave the hospital, or how patients learn to take care of themselves. All these, for the quality of care and care delivery to the patients` entrusted to new nurse graduates care. Presentation and Stylistic Dimensions This study is unique in the sense that it is a descriptive, longitudinal, phenomenological study.
Further it utilized semi-structured interviews so that the interviewees had discussed things that are relevant to the topic even if was not asked. Further, the presentation was very stylistic as participants interview scripts were also included as it sought to examine the meaning of experiences of new nursing graduates in making clinical nursing judgments. In addition, the qualitative interviews undertaken to understand the experiences and all that they entail were detailed. Strengths/Limitations
The major strengths of this scientific study are: first, its extensive discussion of the perceptions of recent nursing graduates about learning to make correct clinical judgments. Second, this research has identified that the transition from being a student nurse to working as a staff nurse as a time when they learn to think like a nurse is characterized by the emergence of confidence, the acceptance of responsibility, the changing relationships with others, and the ability to think more critically within and about one’s work.
The two major limitations of this study were; first, the study was limited only to the account of five new nurse graduates. Second, it is prone to mistakes or misinterpretation and that the possible sources of misinterpretation for this study include situational contaminants such as the quality of the interviewer’s interaction with the subjects. Use of similar questions with a larger population of new graduates should validate the findings of this research about how new graduates learn to think like a nurse.
The study findings may be valid to any new fresh graduates nurses as this is the first study describing the experiences of the new graduates considered helpful in learning to make clinical nursing judgments and their beliefs about their role in making clinical nursing judgments. Use of similar questions with a larger population of new graduates should validate the findings of this research about how new graduates learn to think like a nurse. References Bengtsson J. (1998). Fenomenologiska Utflykter. Goteborg: Daidalos. Benner P, Tanner C, Chesla C. (1996).
Expertise in Nursing Practice: Caring, Clinical Judgment, and Ethics. New York: Springer Publishing Company Incorporated. Bruce K. & Suserud B-O. (2004). The handover process and triage of ambulance-borne patients: the experiences of emergency nurses. British Association of Critical Care Nurses, Nursing in Critical Care; 10:201-208. Burns, N. & Grove, S. K. (1993). The practice of nursing research: conduct, critique and utilization. 4th edition. Philadelphia : W. B. Saunders. Etheridge, S. A. , PhD, MSN, BSN (2007). Learning to think like a Nurse: Stories Form
New Nurse Graduates. The Journal of Continuing Education in Nursing; Vol 38, No 1. Available at:http://www. michigancenterfornursing. org/ViewPage. cfm? NavID=88 LoBiondo-Wood, G. , & Haber, J. (1998) Nursing research: methods, critical appraisal, and utilization. (5th edition). St. Louis: Mosby. LoBiondo-Wood, G. , Haber, J. & Krainovich-Miller, B. (2002). Critical Reading Strategies: Overview of the Research Process. Chapter 2 In LoBiondo-Wood, G. & Haber, J. (editors). Nursing research: Methods, critical appraisal, and utilization. (5th Edition). St Louis: Mosby.