Running head: PART B: WRITTEN CRITIQUE OF PATIENTS AND NURSES PERCEPTIONS OF WARD ENVIRONMENTAL FACTORS AND SUPPORT SYSTEMS

IN THE CARE OF SUICIDAL PATIENTS 1

Part B: Written Critique of Patients and nurses perceptions of ward environmental factors and support systems in the care of suicidal patients. Dermot Connolly Stenberg College NURS 202-3 K. Bagshaw May 2013

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Part B: Written Critique of Patients and nurses perceptions of ward environmental factors and support systems in the care of suicidal patients. This paper is a critique of the qualitative research article patients and nurses perceptions of ward environmental factors and support systems in the care of suicidal patients by Fan-Ko Sun, Ann long, Jennifer Boore and Lee-Ing Tsao (2006). In their review of the literature, the authors determined that while nursing assessments of suicidal patients is well documented, the role of the ward environment and methods of intervention is not. (Sun, Long, Boore & Tsao 2006). A strong background in nursing education is evident in the qualifications of each of the contributors to the article boasting two professors, a honorary fellow and a director in the field of nursing education from Taiwan and Northern Ireland. Using the data collected from a qualitative study of psychiatric nurses and patients, a grounded theory approach is applied in an attempt to develop a substantive theory on suicidal nursing care. Grounded theory is better explained as the generation of theory from a systematic method of research. (Grounded Theory Institute 2011). The purpose of this paper is to critique this study using the Morrison approach to nursing research. The Morrison model uses a question approach, which encourages nurses to be objective in performing an unbiased and penetrating analysis of nursing research articles. (Morrison 1991). The approach asks questions of the authors, their backgrounds and their choice of references while comparing all conclusions with the original purpose of their research article. (Morrison 1991).

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Data was collected using a sampling method approach from thirty psychiatric patients and nurses from the psychiatric wards of Kaosiung in Southern Taiwan. A specific criterion was imposed during the selection of participants where only nurses with a minimum of 6 months psychiatric nursing experience and direct experience with suicide patients were considered. In addition, a triangular approach to data collection was implemented through the observation of each participant and the use of semi structured interviews. (Sun, Long, Boore & Tsao 2006). Two separate models were used to interpret and code the data collected, the Strauss and Corbins analytical framework and the Eaves 12 analytical steps. (Sun, Long, Boore & Tsao 2006). The categories of team work and ward environment both emerged from the data analysis which were further divided into sub categories and discussed individually throughout the article. As each category is examined, the authors compare their findings with their review of the literature allowing them to use a grounded theory to generate a substantive theory on suicidal nursing care. (Sun, Long, Boore & Tsao 2006). In analyzing the findings from any qualitative study, a certain amount of subjectivity is required. (Dixon-Woods, Shaw, Agarwal & Smith 2004). Through the interpretation of their findings, Sun, Long, Boore & Tsao were able to identify limitations within their study. These limitations are highlighted separately along with further recommendations designed to help strengthen and bolster their report. (Sun, Long, Boore & Tsao 2006). The problem under investigation is clearly stated within the abstract and introduction of the study. From their review of the literature, the authors provide a new slant on the topic of

PART B: WRITTEN CRITIQUE OF PATIENTS AND NURSES PERCEPTIONS OF WARD ENVIRONMENTAL FACTORS AND SUPPORT SYSTEMS IN THE CARE OF SUICIDAL PATIENTS 4

suicidal nursing where a perceived gap in research into the quality of nursing interventions and psychiatric ward environments is identified. (Sun, Long, Boore & Tsao 2006). As with all qualitative research, the selection of literature to be reviewed is particularly important to help provide logical information to the research in the absence of any quantitative data (Polit & Beck 2006). While the authors clearly draw on some relevant articles which are used to help bolster their findings, no evidence is presented which contradicts or refutes their analysis, suggesting strong evidence of bias on behalf of the authors. In addition, proper analysis of the literature is not always evident. For example, it is stated that 41% of people who successfully committed suicide received some form of psychiatric treatment in the year prior to their death. (Sun, Long, Boore & Tsao 2006). Whats not evident however is if this statistic relates only to the population of Taiwan or to the entire world. The design of the study along with the aims, method and data analysis is clearly outlined within its abstract with additional details supported within the body of the report itself. Positives can be taken from the use of two models to interpret and code the data collected and the selection criteria placed on each participant to determine sample size. Gaps exist however in the definition and explanation of some terms where the readers understanding is assumed. For example the terms theoretical sampling and semi structured interview are not defined, yet other terms such as time triangulation are thoroughly explained. (Sun, Long, Boore & Tsao 2006). Other limitations pertaining to the design of the study relate to length of study itself where each participant was observed for one day only between the hours of 8am and 4pm. (Sun, Long, Boore & Tsao 2006). The population size used is also open to interpretation where it is difficult

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to ascertain if the study was conducted across several psychiatric units within the city of Kaosiung or just one. In the absence of such information, it is difficult to justify the quality of the data collected or the validity of the sample size chosen. The authors analysis and interpretation of the data collected is commendable and was reviewed in considerable detail. Indeed the categories that emerged come directly from the participants themselves which is a credit to the design of the study. On the other hand, while every attempt was made to dissect the data into easy to follow categories, the introduction of sub categories serves only to confuse the reader. In addition, findings considered significant are not well represented in the data analysis of the report. For example, the first reference to the patients views towards the effectiveness of medications and psychotherapy are not presented until the reports discussion. Indeed the patients views on the side effects of their medications are not referenced until the conclusion of the report. Other limitations on the data analysis include the authors failure to acknowledge participant bias when answering interview questions. Participant anxiety and stress levels at the time of being interviewed could greatly influence the responses received, yet this is not acknowledged by the authors. The conclusions presented appear to align closely with the findings obtained. Several recommendations are suggested identifying the need to recognize the importance of the patients perceived loss of control and the importance of collaboration within a cross functional team. Other insights recognize the effects of a judgmental and non judgmental attitude in the quality of nursing care being administered to suicidal patients. (Sun, Long, Boore & Tsao 2006).

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In conclusion, I would suggest that this study is a good representation of what I perceive to be a thoughtful and insightful qualitative report. While several oversights are apparent, such as the first mention of pertinent data in the discussion and conclusion, other aspects spoke to the strength of the study such as the models used to interpret and code the data. On the whole I found the report to be well written, researched and presented. The authors make several strong recommendations from their analysis of data while recognizing the limitations of their research. What struck me the most from reading this study is the lack of collaboration that exists between each member of the psychiatric nursing team which has negatively impacting the quality of nursing care being administered to the suicidal patient.

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References Dixon-Woods, M., Shaw, R., Agarwal, S. & Smith, J. (2004). The problem of appraising qualitative research. Qual Saf Health Care. 13. 223-225. doi: 10.1136/qshc.2003.008714. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1743851/pdf/v013p00223.pdf

Grounded Theory Institute (2011). What is grounded theory? Retrieved from: http://www.groundedtheory.com/what-is-gt.aspx Morrison, P. (1991). Morrisons Approach to critiquing nursing research. Retrieved from: http://stenbergcollege.mrooms3.net/mod/page/view.php?id=26068&inpopup=1 Polit, D. F., & Beck, C. T. (2006). Essentials of Nursing Research: Appraising Evidence for Nursing Practice (6th ed.). Philadelphia, PA: Wolters Kluwer Health Lippincott Williams & Wilkins. Sun, F., K., Long, A., Boore, J. & Tsao, L., I. (2006). Patients and nurses perceptions of ward environmental factors and support systems in the care of suicidal patients. Journal of clinical nursing. 83-92.