The Basic skill for nurses to realize death so as to give the required health care to their patients is important. It is important for nurses to make use of detailed and evidence based work to back their practice. An interview study was made by Taylor et al. (2017), to find out the factors that influence healthcare professionals when identifying dying in end-stage cancer and heart failure patients. This write up is to make a summary of the strengths and shortcomings of two of the study’s research processes- sampling and data collection, using the CASP (2017) critique model as a guide.Also, a critical look at the author’s understanding from the research article and how it can help and improve future practices, will be guided by the Rolfe, Freshwater and Jasper (2001;2011) model.
In recent times various models used are made up of a number of items which can be used to quarantine and check studies. The CASP checklist is made up of ten outlined questions arranged in order to take into consideration bugs in the study (Critical Appraisal Skills Programme, 2017). The Rolfe, Freshwater and Jasper (2001) reflective model assist and guide the reflection process and is based on three questions: what- which provides a description, so what- relating to theory, knowledge and reflection, and now what- which is the action or what will be done next (Rolfe, 2011).
“Clinical decision making in the recognition of dying: a qualitative interview study” (Taylor et al., 2017). The study discusses how it is relevant in recognizing dying in time dependent contexts, such as in oncology and cardiology, when dealing with end-of-life cancer and heart failure patients. The study highlights the strengths and weaknesses in the decision-making process and states that there can be uncertainty around these decisions, and that professionals should be able to inform this to their patients and carers.
Purposive sampling was used in this study. This method of sampling is a non-probability sampling style and is usually used in qualitative research. Participants are selected based mainly on the use of the study and the researcher is guided by their response to select those they know and trust are likely to give them the needed information.
The mixture in the various types of users is make use of this study, as the difference of the professions, makes the sample equally arranged and gathering of various point of views. This is backed by Cleary and Hayter (2014), as they mention that the choosing of participants should have a clear idea and be able to serve the purpose of the research question. This is further supported by C. Taylor (2010), as they state that effective team working amounts in improved clinical decision-making and more evidence based treatment decisions.Also, since the study is mainly based on the decisions of the individual clinicians, it fails to explore the stages of decision-making by teams and the effect they may have on the individual’s decision (Taylor et al., 2017).
The sample makes use of a phenomenological approach, where the participants are requested to describe and state clearly their views on their experiences (Ellis, 2016). This takes into account the essence of the person’s first-hand experience and makes the information gained, rich and unique, which is important in qualitative research (Lee-Jen Wu et al. 2014). Although the sample been used in this study is quite small in size, it was of good use, as it provides detailed information and can produce highly useful information for analysis. This is supported by Cleary and Hayter (2014), as they state that the key principles of participant selection are that participants are selected purposefully and small numbers are studied intensively.
In addition, a limitation of the small sample size, is that it may not be generalisable to a bigger population. The study only took into reference one hospital, so the result will not be enough to represent all professionals in England, working in palliative care. Cleary and Hayter (2014) support this as they state that a small sample size may risk enough depth and breadth. However, it can be argued that the research made do have replicability and transferability, as it can be applied to professionals working in this same contexts (Trotter, 2012). Emmel (2013) suggests that representativeness is not of main concern when choosing groups for purposeful sampling. McMillen (2008) further supports this by stating that generalisability is not of much importance in purposive sampling and that the collection of rich data and an understanding of the ideas of the participants is relevant. The sample size is justified given that the data is of high quality.
Data collection is the tools by which the information for an enquiry is grouped (Ellis, 2016). One to one interviews took place, with medical and nursing staff in an NHS trust, in England, which had referral centres for both cancer and cardiology. Interviews reflect on the participants perspective and produce rich data. They can gain a unique insight into a range of matters related to nursing (Gerrish & Lacey, 2013).
An interview arranged was used as a reference for the researcher. This enables the researcher to keep his or her focus, maintain the flow of the interview, cover important areas and not to miss out any key parts. The researcher undertook a literature search beforehand and designed the interview schedule based on decision-making literature (Taylor et al., 2017). Saturation was derived by the researcher, after gathering 19 participants. All questions had gone through exploration in detail, until no new themes were revealed. This means that the researcher was able to bring on board detailed information. If any new, unanticipated themes emerges, the researcher would consider to change the interview schedules (Mitchell, 2015).
The researcher used semi-structured interviews for their data collection, using broad, open questions, designed to prompt discussion and to further explore themes. This method of data collection is of good use, because it allows the participant to share their experiences on the subject of interest. Prompting allows the interviewer to get lots information from the participant, especially if they are not giving more detail. Open questions allow the discussion to go into more detail (Mitchell, 2015). However, a limitation is that the use of open-ended questions makes it difficult to find consistency across the participants responses, as responses can be diverse and hard to compare (Polit & Beck, 2010).
The researcher has proven using this method of data collection as semi-structured interviews which needs a certain level of knowledge in the research topic, and since he was a professional in palliative medicine, the interview questions could be centered on his previous knowledge (Kallio et al., 2016). However, a limitation to using interviews as a method of data collection is that, participants may see the interviewer as an authority figure and so they may feel that there is a power imbalance and may try to give feedback , which they believe to be desirable, rather than original. The effect on the behaviour of the participants, due to their awareness of the interviewer, is also known as the Hawthorne effect (Gardner, 2010).
This form of the data is shown clearly in this study. The interviews were audio recorded and converted into words. The researcher took notes during the interviews. Cleary and Hayter (2014) state that transcribing interviews are important as it helps the researcher to revisit, understand and reflect on the information. This is further supported by Mitchell (2015), as they mention that self-transcription is beneficial, as it enables the researcher to actively reflect on and maintain their closeness to the data. This leads to better, more meaningful results, as the researcher is able to capture specific detail.
Since, responses in qualitative data may be very different across participants due to different ideas, it is appropriate to have the data recorded and verbatim transcribed. However, a shortcoming of using this form of data is that, it could make the interviewee uncomfortable or even angry, which may question the authenticity of their answers. They may have been informed that they were being recorded, so may give a response not true to what they clearly believe. Whiting (2008) suggests that the participant and interviewer may feel inhibited by the presence of a recorder.
Death is to be expected when working in the adult nursing profession. Decision-making in end-of-life care remains a current issue in practice, as it could be hectic making decisions concerning a patient’s death. Nurses need to know when a person may be approaching their last days of life and be able to inform with their families (National Institute for Health and Care Excellence, 2015).
Whilst working in the acute stroke ward during my placement, I cared for a palliative patient, who was in their last days of life. I was informed that the usual one hourly assessment of vital signs for this patient were no longer compulsory . NICE guidelines (2015) states that palliative patients should be checked for any additional changes, at least every 24 hours. Even though the patient could not speak, we still communicated with her and treated her with compassion and dignity. The NMC code (2015) supports this, as it states that nurses “need to recognise and respond compassionately to the needs of those who are in the last few days and hours of life”. Communication was also made clear as possible to the patient’s family. Campbell (2012) states that effective communication needs to be timely and honest and means acknowledging the feelings of the patient and their family and involves listening as much as talking.
My thoughts on this experiences, was that, I felt like the decision-making made by the team was well planned. Regular multidisciplinary team meetings talked about the plan for the patient. Expertise and experience was brought into the decision-making process. Assessments were able to detect signs of deterioration. Documentations made enabled good communication between the team, patients and their families (Stewart et al., 2017). Moreover, the family of the patient and the patient herself were included in every possible way in the decision-making process. NICE guidelines (2015) state that information gathered from assessments, MDT team, close relatives/carers can help them to recognise if the person is deteriorating, nearing death, improving or stable.
Nurses need to be educated on the various wars to cater for the dying, as palliative care is a significant area of practice in adult nursing. This is important to me as a student nurse as it helps me come to terms with death and the possibility of death in patients I may work with. In practice, I have come to realize that basic postmortem care, but it would have been also been helpful to learn how to talk and listen to palliative patients and how to comfort close friends and family of the deceased. In the near future, I would want to to develop my own clinical judgement and decision-making and utilise it with confidence. The evidence from this paper allowed me to understand the importance of integrating clinical evidence from systematic research, to assist the decision-making process and ensure evidence based practice. It helped me to understand that recognising dying is not just a one-off decision, but an on-going, fluid and iterative process (Taylor et al., 2017).
Going forward , Nurses will need to be more reflective on their own experiences and I should be able to critically control and know their own knowledge and intuition, when faced with taking some decisions in practice. As a student nurse, I can improve my learning by, being more actively involved in the care of life – threatening patients, knowing how nurses and other professionals communicate with the patient and their families, and recognising the involvement from different professionals, family.
Nurses need to have a lot of confidence in their clinical judgment and demonstrate critical thinking and analysis. Our own clinical experience, along with the best external guidelines can help guide our decision making (Pooler, 2014). To make the best possible decisions about a person’s care after the end of life, we are expected to draw on the patient’s current information about their illness, treatment options and prognosis (Nyatanga, 2015). Their goals, wishes and preferences also need to be considered, when making decisions about their care (National Institute for Health and Care Excellence, 2015).
In conclusion, this write up seems to achieve is to consider and appraise the gathering and grouping of data collection methods in the qualitative study. It states how the selection of participants, sample size, method of data collection and form of data can impact good study’s findings in the research article. Furthermore, the reflection of the author’s understanding of the issue discussed in the article, emphasises the importance of evidence based practice in the decision-making process for end-of-life care.