This article covers a sample Quantitative Critique Paper.
The purpose of Wolf, White, Epstein, & Enfield, (2019) study is to investigate the critical care nurses’ perception of palliative care in their practice settings, their experiences with moral distress and determine the positive and negative relationships that may exist between the variables. With palliative care being centered on improving the quality of life of patients with serious illness and their families, this study is significant because it examines the approaches of optimizing critical care through the experiences and competencies of nurses to reduce existing barriers in palliative care. The research problem of the study is not clearly stated. However, the gap in the literature is identified to be the correlation between palliative care and use and moral distress among critical nurses. Besides, the study does not adopt a conceptual model in defining the variables or the research problem. The study collects the perceptions of critical care nurses and experiences with moral distress through validated questionnaires to shows the relationship between the two variables and identifies its implications on nursing education and practice.
Review of the literature
Wolf, White, Epstein, & Enfield (2019) use primary, secondary and seminal literature. Primary literature involves studies that contain original research and is widely used in the literature review to underline the current understanding of the variables and their relationship (Houser, 2018 p 168). Secondary literature entails resources that synthesize, summarize, and analyze primary sources (Houser, 2018, p 168). The study uses secondary sources to examine different frameworks of moral distress among critical nurses and their perceptions of palliative care, as individual variables and as issues in critical care. Seminal work stands out for its unique input that’s relevant over time (Houser, 2018 p 168). The study utilizes seminal literature to underline the critical issues associated with critical care. The seminal work and primary sources are more than five years old, but secondary literature included was conducted within five years of the study. The literature review underlines the factors that lead to moral distress and the associations the variable has with other factors such as emotional exhaustion. These findings help understand the need to investigate the perspectives of nurses on variation in palliative care and how it relates to moral distress. The review stands out as unbiased and consistent as the authors use sources from different types of literature, which is a comprehensive yet conclusive manner.
Houser (2018 p 442) notes that quantitative research designs are best applicable to representative samples as they allow findings to be generalized to larger groups of people while maintaining a high level of confidence that the study’s outcome will be the same. The study used a quantitative, descriptive study to assess the perceptions of critical nurses on different aspects of palliative care as well as their competencies in palliative care. The descriptive study, combined with a quantitative framework, was best suited for the study as it allowed the researchers to collect and analyze the perspectives of critical care nurses on the core domains of palliative care.
Houser (2018, p 229) defines a sample as a subset of a population that represents the composition of the population. The study was set in a 600-bed, level 1 trauma academic health center that employs more than 500 critical care nurses and operates 148 critical care beds among 7 ICUs. The study used a convenience sample of critical care nurses in one institution. In quantitative studies, Houser (2018, p 236) notes that having an objective sample selection strategy begins with the development and use of inclusion and exclusion criteria. The selected participants were licensed RNs, practicing in 1 of the 7 study ICUs, while nurses in nonpermanent positions were excluded from the study. The selection strategy resulted in 517 critical care nurses across the 7 ICUs. The inclusion and exclusion criteria were clearly stated.
Houser (2018, p 98) defines an ethical researcher as one that obtains proper and informed consent, explains the research procedures to the participants, and ensures the confidentiality of participants, among other attributes. In the study, Wolf, White, Epstein, & Enfield, (2019) are exempted from approval by the hospital’s institutional review board and note that consent was implied by completion and return of the survey questionnaires. Failure to collect informed consent before the administration of questionnaires shows that the researchers did not engage and explain the study to participants. However, the study maintained the privacy of the data collected by sending the questionnaires in privacy tinted envelopes. The measure ensures maximum privacy and confidentiality of the participants in the study.
Houser (2018, p 276) highlights that effective data collection approaches have to be designed to be clear, unbiased, reliable, valid, and answer the research question. The data collection method plays a critical role in determining the credibility of the resulting data as well as the extent of the measurement error. In the study, Wolf, White, Epstein, & Enfield, (2019) adopt a survey questionnaire that was administered through the mail to the critical nurses and collected after two weeks. The survey questionnaires were best suited for the study as they allowed the researchers to measure the perspectives of the participants on the core domains of palliative care.
The data collection was followed by data analysis using IBM SPSS Statistics, version 22.0. Houser (2018, p 401) notes that statistical analysis of descriptive data provides the basis for making decisions on the applicability and strength of the results to the specific population or practice area. Wolf, White, Epstein, & Enfield (2019) use descriptive statistics to arrange and input the survey data. To determine correlations, the variables, the study used independent t-tests and 1-way analyses of variance as well as the Mann-Whitney U test and Kruskal-Wallis test for the differences in non-normal distributions. The Pearson correlation coefficient was also used to determine the linear correlations between the variables. The researchers use different tests for normally distributed continuous variables, and non-normally distributed continuous variables to ensure maximum accuracy and effectiveness in the analysis. The authors fail to identify both type 1 errors and type 2 errors.
Validity and Reliability
Houser (2018, p 458) note that validity and reliability measures are important considerations to minimize measurement error. The study used a modified Palliative Care Competencies of Registered Nurses (PCCRN) survey with four sections: perceived importance of palliative care competencies, self-reported competence in palliative care domains, recent palliative care education, and perceptions of palliative care use. The instrument was validated and modified as it was adopted from another study that reported acceptable internal consistency and reliability. However, the researchers also acknowledge that despite the PCCRN survey being previously validated, the new approach of using aggregate scores was yet to undergo validity testing.
Wolf, White, Epstein, & Enfield, (2019) find that most respondents perceived each palliative care domain as a highly important competency, yet few felt highly competent in any domain of palliative care. This signaled deficiencies in palliative care education. The study also noted a high incidence of moral distress during the study process, and also linked this to unclear goals of care, prolonging the patient’s dying process and an unclear treatment plan. The findings highlight the correlation between the perception of nurses on palliative care and moral distress and offer an avenue of addressing the issue.
The limitations of the study were associated with the small sample population, low response rate at 32.5%, and relying on one institution as the setting. Besides, validity for both the PCCRN survey and MDT were limited. The researchers also acknowledge a response bias as moral distress was only measured at one point in time, yet it could have varied with repeated measures.
By underlining the link between moral distress and the perception of critical care nurses on their competencies, and use, as well as recent education, the study highlights the need for palliative care education. The study also helps to emphasize resources for preventing and managing moral distress and empower critical nurses to be able to overcome the barriers to high-quality palliative care. The strengths of the study are in its use of highly reliable instruments and offer avenues for addressing moral distress. The weakness of the study includes the low response rate that limits the generalizability of the findings. The study contributes to my understanding of how perceptions of care relate to moral distress and the importance of taking part in educational interventions.
Wolf, A. T., White, K. R., Epstein, E. G., & Enfield, K. B. (2019). Palliative care and moral distress: an institutional survey of critical care nurses. Critical care nurse, 39(5), 38-49.