Analysis and Implications of Qualitative Research Report Grand Canyon University NRS 433V: Introduction to Nursing Research February 27 2011

Critique of Qualitative Research Introduction Restraints are methods used in the medical field in an effort to restrict the movement of a patient in order to protect the safety of the patient, other patients, and caregivers. Since the onset of the use of restraints, this practice has been an ethical issue and topic for discussion. Further, it continues to be a concern in the health care industry because of the physical, emotional and psychological freedom involved. A study conducted by Hantikainen and Kappeli (2000) interviewed 20 skilled and untrained nursing staff from two nursing homes in a German speaking area in Switzerland. The authors concluded that there is no clear agreement on the definition of restraints and, as such, this lack of clarity translates to the nursing staff inconsistency and corresponding defensive behavior. Further, they felt the crucial component of establishing “restraint-free care” is nursing staff’s understanding of the impact of their personal perceptions of their thinking on their application of restraint policy. The intent of this qualitative research study was to discover nursing staff member’s perceptions on the use of restraints and how these insights affect their decisions at bedside (Hantikainen and Kappeli, 2000). This paper will review the above research article to critically analyze: the introduction and purpose of the research paper, the study design, methods, sampling data collection and analysis, and conclusions to determine whether they meet the rigors necessary to advance this contentious area of nursing care.

Analysis of Introduction and Purpose
The article in question is from the Journal of Advanced Nursing (2000) 32(5), 1196-1205 and is entitled Using restraint with nursing home residents: a qualitative study of nursing staff perceptions and decision-making. The authors of the study were Virpi Hantikainen and Silvia Kappeli. At the outset the authors focused on elucidating the purpose of the study to examine the perceptions of the nursing staff and how these perceptions influence decisions in when and where to apply restraints. They further underscored the relevance in nursing by looking into the history of restraints in nursing (Hantikainen and Kappeli, 2000). Review of the Literature The authors realized through what seems to be an intense examination of earlier restraint research study results that there were no clear and direct similarities because of differentiations in methods and the uncertainty of the idea of restraints. Despite the advance of knowledge and technology regarding restraint use, there is still a dearth of research done in the particular area of concern of relationship between staff perception and decision. Thus, the researchers found a limited amount of information to develop the basis for outlining how this subject is understood in the clinical setting and the corresponding ethical ramifications. One of the key notions they explore is the idea of restraint use as crucial to better understanding ways to reconcile the rights, duties and responsibilities between nursing staff and patients. So the authors realized these issues deserve to be explored in detail. Hantikainen and Kappeli (2000) cited a sufficient number of sources in their study to illustrate the fact that the understood their subject; and, this aided in understanding the concept of restraint use in long-term and acute care nursing settings and the need to look into a different aspect of the relationship, which had not been explored (Hantikainen and Kappeli, 2000). Study Design Phenomenological research approach was used as supported by the data collection, analysis and method of the study (Hantikainen and Kappeli, 2000). The people who involved in the study were from four long-term nursing units of two nursing homes in Switzerland. Data’s were collected from volunteers in unstructured interviews because of the topic of the study was ethically greatly complex. Twenty trained and untrained staff of Swiss and foreign nationals who worked full time and part time who were directly involved in patient care were the volunteers. “The choice of the approach was motivated by the aim of gaining a deeper understanding of nursing staff perceptions of the phenomenon under study, i.e. issues of restraint” (Hantikainen and Kappeli, 2000, p. 3). In harmony with the phenomenological perspective the researchers’ interest was in discovering what the participants’ view of their dilemma was rather than the researchers’ interpretation of their situation. Their goal was to center themselves in the experience of the nursing staff and they utilized a conversational style interview process to achieve this goal. Then, they were able to extract the common themes of these interviews to formulate the focus of the study. The researchers effort to obtain perceptions were inconclusive and as data collection advanced they determined that “there is no clear consensus on issues of restraint in elderly care” (Hantikainen and Kappeli, 2000, p. 10) and concluded further analysis needs to be done. Methods The researchers used sixteen female and four male among twenty nursing staff volunteers between age 20-55years who had 2-14yrs of experience. The participants were five registered nurses, six licensed practiced nurses, five certified nursing assistants, and four ancillary staff (Hantikainen and Kappeli, 2000). A major number of the elderly nursing home residents were suffering from physical instabilities and moderate cognitive injuries. The researchers used Golaizzi’s descriptive and interpretative phenomenology research study types for their study. Descriptive phenomenology research means, the pure description of the phenomena under study which consists of very little interpretation whereas interpretative phenomenology research targets for phenomenological interpretation in order to reveal the meanings of the phenomena studied. All the participants were informed about the purpose of the study, the methods, confidentiality, and the rights of the participants. Unstructured interview method was used for the purpose, to allow the participants to express their true feelings in the issue verbally. The participants were asked certain questions like “what the word restraint meant to them” and the participants were allowed to express their experiences that they have encountered with restraints (Hantikainen and Kappeli, 2000). Sampling The article clearly denoted under the Participants and procedure section method and rationale for sampling based on qualitative research methods. The researchers believed the ethical complexity of this issue merited the use of volunteers vs. selective methods appeared to be more appropriate in this study. The goal in enrolling participants was to make sure all the different professional groups who were involved in the direct patient care were represented in the sample study. The sample size was attained through “saturation point in data collection… reached after 20 interviews” (Hantikainen and Kappeli, 2000). All the volunteer participants were informed of their rights and principles of confidentiality before the interview and were asked to sign consent to give their approval to allow a third party to type up the interview (Hantikainen and Kappeli, 2000).

Data Collection Descriptive phenomenology research relies on the pure description of the phenomena under study which consists of very little interpretation whereas interpretative phenomenology research stresses interpretation and understanding (Polit and Beck, 2010). The study was based on the complexity of decision making regarding restraints use, the rights of staff and residents, and the duties, and responsibilities of the staff (Hantikainen and Kappeli, 2000). The researchers mentioned numerous sources on earlier studies made regarding intentions of restraint use, consequences of the use and specified a variety of settings. They concluded from their assumptions and biases stating that, there isn’t enough importance made on this topic specifically when it comes to understanding of restraint use, aim and justification. Data Analysis Inductive method was used for the data analysis and they utilized reasoning from some observations to more overall rules to the research type (Polit and Beck, 2010). The findings were consistent with the reflective data. Each interview was read through many times to establish a broad picture and to make sense of the material. They were able to formulate meanings out of the data collected and these formulated meanings were combined into groups to identify the main theme of the study. Three participants confirmed the interpretations in order to establish the relevance and truthfulness of the study and in this way the researchers verified whether or not the study displayed the intents of the researchers. In terms of trustworthiness, the data findings displayed congruence between the main themes and the ideas and beliefs of the study participants, which were confirmed by three respondents (Hantikainen and Kappeli, 2000). Conclusion The conclusions of this study were mirrored the outcomes of other studies which shows this study has applicability to the overarching issue. However, as is often the case with qualitative research care must be taken when generalizing the findings to other populations. The findings reveal that nursing staff decisions were often based on practices, feelings, and attitudes rather than evidenced-based, experimental facts. The study realized that among health care providers where this issue has broad reaching ethical and moral considerations, the lack of consistency in the meaning of restraints remains contentious and has the potential to produce negative patient outcomes. Some uncertainty again remains, when it is appropriate to apply the restraints and what circumstances. The indistinctiveness in the data and the results of the study may only mean that perceptions may need to be officially addressed. The findings of the research contribute to nursing knowledge in many ways since the restraint policies and procedures are strictly followed by every hospital in the country. Nurses play a major role in the use of restraints, decision making, its usage and any study on the issue improves nursing care. Ethical queries must remain a basic concern when it comes to its use because of the psychological impact.

References
Hantikainen, V., Kappeli, S. (2000). Using Restraint with Nursing Home Residents: A Qualitative Study of Nursing Staff Perceptions and Decision-Making. Journal of Advanced Nursing; 32(5), 1196-1205.
Morse, J. (2010). Merriam Webster’s Dictionary Online. Accessed on April 5, 2010 at http://www.merriam-webster.com.
Polit, D. F., & Beck, C. T. (2010). Essentials of nursing research: Methods, appraisal, and utilization (7th ed.). Philadelphia: Lippincott.