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A Critique of Research Paradigms in Medicine
Introduction
This paper is a critique of research paradigms from two articles: A randomized controlled trial of a community nursing intervention: improved quality of life and healing for clients with chronic leg ulcers (written by Edwards, Courtney, Finlayson, Shuter, and Lindsay) and Shifting priorities in multi-morbidity: a longitudinal qualitative study of patients prioritization of multiple conditions (written by Morris, Sanders, Kennedy, and Rogers). The first article is aimed at assessing the negative impact of chronic leg ulcers on patient health and quality of life but from a general point of view, the study is aimed at determining the best nursing model to care for patients suffering from chronic leg ulcers (with a keen emphasis on patient morale, self-esteem, social support, and other patient well-being guidelines) (Edwards, Courney, Finlayson, Shuter and Lindsay 2009).
The second article is written to assess patient self-management principles when patients are faced with several long-term illnesses, and how the self-management principles change over time (Morris, Sanders, Kennedy and Rogers 2011). From a general point of view, the study is aimed at analyzing the impact of multiple long-term illnesses on patient self-management principles; with a close emphasis on patient engagement with self-management principles and how they are influenced by long-term illnesses and lifestyle choices. A section of the study also seeks to understand what motivations affect patient prioritization of long-term illnesses, with regards to self-management principles (Morris et al. 2011).
However, this paper seeks to explain different aspects of the two papers analyzed above. In detail, this paper shows the strengths, weaknesses, similarities, and differences of the research designs, questions of analysis, samples, methodological approaches, presentation of results, methods of analysis, interpretation of findings, and implication of the papers findings on nursing. Thus, this paper is a research critique of the two studies analyzed above (Seale and Barnard 1998).
Type of Question
Edwards et al. (2009) seek to assess the negative impact of chronic leg ulcers on patient health and quality of life. Morris et al. (2011) seek to assess patient self-management principles when they are faced with several long-term illnesses and how the self-management principles change over time. These two research questions are meant to improve patient care and therefore, they are similar to one another, based on the fact that they are aimed at improving patient care. However, Edwards et al. (2009) seek to analyze two models which are already predetermined at the beginning of the study. Morris et al. (2011) on the other hand undertake a more open-ended question because their study seeks to understand the how of self-management when it comes to multi-morbidity (Morris et al. 2011).
Research Design
The article by Morris et al. (2011) is a qualitative research design. As mentioned in earlier sections of this study, their paper was aimed at understanding how patients with multiple long-term health complications cope with their condition, and how this process affects patient engagement in managing multiple morbidities. With this research question, a qualitative research design was appropriate because the research question was aimed at understanding how patients with multiple long-term health complications manage multiple morbidities. In this type of analysis, there is bound to be little reliance on statistics which is at the center of quantitative research designs. In this regard, there is a strong justification for the use of the qualitative research design. This is a strong strength of the study (Seale and Barnard 1998).
Morris et al. (2011) also used the longitudinal design to allow for the inclusion of other research issues (such as participants personal experiences) to be included in the final paper. Considering longitudinal studies are widely used to study human behavior, Morris et al. (2011) were justified to use this study design because it improves the credibility of their findings. For instance, the longitudinal study design is synonymous with high levels of accuracy because they are mainly used to study same group behaviors, and therefore, the findings cannot be influenced by other factors affecting human behavior, such as culture (Morris et al. 2011).
The paper written by Edwards et al. (2009) was a randomized controlled study aimed at assessing the effectiveness of two nursing models in taking care of patients with chronic leg ulcers. Morris et al. (2011) also conducted a randomized control trial where participants were selected, based on the fact that they had to have at least one long-term health complication. The randomization of the studies is a common feature among the two sets of authors and it poses several advantages to their findings (such as the fact that the overall findings are bound to contain unbiased data). The strongest disadvantage of randomized study is the fact that it is often time-consuming and may lead to costly repairs if it is done improperly (Seale and Barnard 1998).
Another similarity between the studies is that the researchers obtained ethical approvals. For instance, Morris et al. (2011) obtained ethical approvals from the Spiritus (formerly St Lukes Nursing Service), Human Research Ethics Committee, Queensland University of Technology and the Human Research Ethics Committee (Morris et al. 2011, p. 147). Edwards et al. (2009) also obtained ethical approval from the Oldham Local Research Ethics Committee reference (p. 1541) . This is a strong ethical requirement for all professional researchers and both studies met the standard. Moreover, in both studies, the consent of the participants was obtained before the study was undertaken. Edwards et al. (2009) affirms that,
Informed consent was obtained, where clients were informed that although the wound care in both control and intervention groups was the same, they would be randomized to receive this care in either their own homes or at the Leg Club location (Edwards et al. 2009, p. 1542).
Morris et al. (2011) also affirm that Consent was obtained from all participants before initial interviews (p. 149) . Observing the above ethical standards improves the credibility of the studies findings because it means that the participants understood the implications and consequences of participating in the research (Morris et al. 2011).
Samples
With regards to participant sampling, Morris et al. (2011) ensured that the participants were purposefully sampled to have at least one of three-terminal illnesses ( irritable bowel syndrome; chronic obstructive pulmonary disease; and diabetes (Morris et al. 2011, p. 148). The participants were also sampled across a range of ages and duration of illnesses. Gender balance was also evident in the study because Morris et al. (2011) sampled 21 participants (with morbid conditions) and ten of them were female while 11 were male. This represents an almost perfect equal representation of gender. This almost impartial inclusion of participants is a strong strength of the study because it means that the findings of the research can be generalized across several age groups and gender. Moreover, the findings are unbiased across age or gender lines (Adler and Clark 2008).
Edwards et al. (2009) used the group sequential analysis method to determine the sample size. The group testing method is a strong strength of this study because it is majorly used in nursing and clinical research, thereby making it appropriate for the paper. However, the testing method also poses as a strong strength to the study because it allows for interim results which may ultimately reduce the cost of undertaking the research and provide provisional results which may also ultimately offer a good direction to the research (Adler and Clark 2008).
Methodological Approach
Morris et al. (2011) used semi-structured interviews to obtain information from the participants but a follow-up was done using telephone interviews. The interviews were face-to-face (during the initial interview) but a year later, the same face-to-face interviews were conducted again. Edwards et al. (2009) used a different approach to data collection because it gathered background information about the patients, from health charts and baseline data. To gather information about patients well-being (including aspects such as self-esteem, depression levels, patient morale, patient functional ability, and the likes), a self-assessment questionnaire was used. The self-assessment questionnaires were designed in two forms. The first form included 80 short answer questions for older people and the second questionnaire included short-form versions for other participants (Adler and Clark 2008).
Here, there is a similarity in both studies, with regards to their data collection instruments because both sets of authors used questionnaires to collect primary data. The use of questionnaires poses various advantages and disadvantages to the studies. For instance, the use of questionnaires is likely to brush through the actual factors affecting the relationship to be analyzed in the study because questionnaires are normally issued after the occurrence of an event and therefore, patients may easily forget significant facts that transpired in the course of the examination period (Seale and Barnard 1998, p. 52). Questionnaires are also standardized in a manner that does not allow for the inclusion of information that is out of the issues examined in the questionnaire. For instance, Edwards et al. (2009) used 80 short answer questions to interview the respondents, and therefore, any issues which were not covered in the 80 questions were likely to be left out from the study. However, the use of questionnaires also poses several advantages to both studies because questionnaires are highly objective and therefore, the information gathered in this form is bound to be highly relevant to the topic studied. Moreover, questionnaires allow for easy gathering of information from participants and can be used in a large sample population where it is relatively easy to collect data using questionnaires (Seale and Barnard 1998, p. 52). This saves on the time and cost of collecting information (Adler and Clark 2008).
Method of Analysis
Edwards et al. (2009) used Spitzers quality of life index to measure the functional and psychological aspects of the patients, among other measuring tools including the Geriatric Depression Scale, Philadelphia Geriatric Centre Morale Scale, Rosenbergs Self Esteem Scale, the Medical Outcomes Study (MOS) Pain Measures, MOS Social Support Scale and the Index of Activities of Daily Living (Edwards et al. 2009, p. 157). The fact that several indexes were used, improves the credibility of the findings because the advantages of the various measuring indexes are bound to outweigh the disadvantages of the same. Also, it is crucial to note that, the reliability of the result is highly improved because the findings of one test measure are likely to be affirmed by others. Moreover, most of the test measures, such as the index of activities of daily living, have been used in community research for a long time and their reliability has been affirmed by several researchers (Richardson-Tench, Taylor, Kermode, and Roberts 2011).
Morris et al. (2011) used other authors to transcribe information obtained from the semi-structured interviews used to collect data. This process was done to identify running themes within the analysis. These themes were coded, but others still emerged after a complete analysis was done. The re-analysis was done to affirm that the previously identified themes were evident in all interviews. Deviations were noted. This information analysis method improves the credibility of the researchs findings, based on the fact that the results were peer-reviewed. Moreover, the re-analysis of the identified themes in the study ensured that the researchs findings were reliable because deviations were noted and inconsistencies were observed (Morris et al. 2011).
Interpretations of Findings
Morris et al. (2011) pointed out that the prioritization of one long-term health condition over another was an easy way for patients to manage the burden of managing long-term health diseases. This was established from the fact that patients transferred and replaced personal practices to achieve a level of comfort that allowed them to better cope with long-term health diseases (Morris et al. 2011).
Edwards et al. (2009) affirmed that the participants of the leg club model showed better results in personal quality of life as opposed to the traditional community nursing model. Since the leg club model was characterized by community support and socialization, there is an implicit reference to the fact that these two attributes are crucial in achieving a higher quality of life for patients suffering from venous leg ulcers (Edwards et al. 2009).
From the interpretation of the findings by the two sets of authors, we can establish that they were both specific to the research question and used supporting evidence from their studies to arrive at their conclusions. Edwards et al. (2009) wanted to establish which mode, between the traditional nursing model and the leg club model was more effective in providing a higher quality of life for patients suffering from venous leg cancer, and they were able to establish that the leg club model was more effective. From this finding, they were able to affirm that, support and socialization were crucial to providing patients with a higher quality of life, as opposed to frequent home visits which were characteristic of the traditional nursing model. This is a correct analysis of the research question and Morris et al. (2011) also affirm the same efficiency in arriving at their researchs objective from their assertion that, the prioritization of long-term health diseases was an easy tool to the personal management of multi-morbidity. However, it is impossible to overlook the fact that, the authors failed to emphasize the sustainability of their findings over a long period because their main objective stated: To examine what influences self-management priorities for individuals with multiple long-term conditions and how this changes over time (Morris et al. 2011, p. 160).
Implications for Nursing Practice
Morris et al. (2011) affirm that the understanding of their research finding was a step towards understanding how patients cope with the long-term health implications of multi-morbidity. They further affirmed that this understanding was aimed at improving patient-nurse engagement whenever multi-morbidity was analyzed. Edwards et al. (2009) explained that there was a strong need for more analysis of the Lindsay leg model because it was proved to be highly efficient. Both findings appeal to the nursing field because they are specific to patient care improvement. However, the latter is more nurse-centered as opposed to the former which is patient-centered (Edwards et al. 2009).
Presentation of Results
Edwards et al. (2009) uses charts, tables, and flow charts to explain the studys findings. Charts were used to explain the mean severity of pain subscale scores and the mean quality of life index scores. Tables were used to explain the quality of life measures and ulcer healing outcomes while flow charts were used to explain the characteristics of the patients. These tools of presentation improve the quality of presentation because they act as a platform where readers can visualize the findings of the study. Moreover, these presentation tools are more forceful and concrete in presenting the studys findings because they are more interesting than normal essay presentations (Dempsey 2009, p. 226). Morris et al. (2011) however use flowcharts only. Nonetheless, the studys presentation also enjoys the above advantages (Morris et al. 2011).
Conclusion
This paper notes that Morris et al. (2011) and Edwards et al. (2009) share similar methodological approaches, such as data collection and presentation tools. The two sets of authors also share similar presentation skills because they use visual presentation tools. However, there are some common differences in the methodological approaches used, such as the research design and tools of analysis. These differences offer a very small distinction in the methodological approaches used by the two sets of authors. However, comprehensively, the two studies immensely contribute to the nursing profession because they improve patient care. Their accuracy in answering the research questions was also commendable and therefore, the two studies are highly reliable (Morris et al. 2011).
References
Adler, E & Clark, R 2008, How its done: an invitation to social research, Cengage Learning, London.
Dempsey, D 2009, Legally Speaking: 40 Powerful Presentation Principles Lawyers Need to Know, Kaplan Publishing, New York.
Edwards, H, Courney, M, Finlayson, K, Shuter, P & Lindsay, E 2009, A randomized controlled trial of a community nursing intervention: improved quality of life and healing for clients with chronic leg ulcers, Journal of Clinical Nursing, vol.18, pp.1541-1549.
Morris, R, Sanders, C, Kennedy, A & Rogers, A 2011, Shifting priorities in multimorbidity: a longitudinal qualitative study of patients prioritization of multiple conditions, Chronic Illness, vol. 7, no.147, pp.147-161.
Richardson-Tench, M, Taylor, B, Kermode, S & Roberts, K 2011, Research in nursing and health care: evidence for practice, 4th edn, CENGAGE Learning, Australia.
Seale, J & Barnard, S 1998, Therapy research processes and practicalities, Elsevier Health Sciences, Amsterdam.
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