Good Example Of Essay On Problemwhat Is The Problem The Study Was Conducted To Address?

Analysis of Qualitative Nursing Research Study

FULL AND COMPLETE REFERENCE FOR THE ARTICLEPhillips, J., & Cohen, M. (2011). The Meaning of Breast Cancer Risk for African American Women. Journal of Nursing Scholarship , 43(3), 239–247.

The high mortality and prognostic factors among African American women despite the generally lower incidence of the same (compared to white women). The risk perceptions and associated behaviours of high-risk, young black women are unknown and this study sought to fill this gap

Why is the problem an important one for nursing to study?

Breast cancer is one of the most prevalent and deadly diseases in the United States and elsewhere in the world but despite the advancements in the detection, diagnosis and treatment, African American women face a greater probability of dying from the disease, even when there is greater incidence among white women. Black women have poor prognostic factors, higher recurrence risk and mortality rates.

STUDY PURPOSEWhat is the purpose of the study?

RESEARCH QUESTIONSWhat are the research question(s)?
What is the experience of being at high risk for breast cancer among African American women
What is the meaning of breast cancer risk for African American Women?
Are the questions stated broadly enough for a qualitative study? Explain WHY.
Qualitative research seeks to draw out the respondents and understand constructs that cannot be easily measured or anticipated at the design stage, which is why the research question or questions are supposed to allow the flexibility to include the unexpected in the study

STUDY DESIGNWhat specific qualitative method is used?

The study used a hermeneutic phenomenological design
Provide a clear description of the qualitative method utilized (utilize your text or another source to do this – provide citation)
The hermeneutic phenomenological is a philosophy of discovering the lived experiences (the meaning of experiences) to the study subjects in the context of their environments. The descriptive design is meant to explore, create a picture of a phenomenon, while an interpretive approach seeks to ensure contextually accurate understating of lived experiences.

In what way is the method used an appropriate one for this study? Clearly justify your answer.

The design choice is appropriate for this study for several reasons. Firstly, the phenomelogical approach tries to understand lived experiences and meaning from perspective of the subject, while also capturing qualities such as angst, throwness, temporality, authenticity and care, which make for a more accurate understanding of a phenomenon. Since the purpose of the study is to identify, describe and interpret the perceptions of black women on breast cancer, these designs help in achieving this purpose with the highest possible accuracy and completeness (Pascal, 2010; Creswell, 1998)
PHILOSOPHICAL/THEORETICAL FRAMEWORK BASIS FOR THE STUDY (DETERMINE FROM LITERATURE – THIS DOES NOT REFER TO THE METHODOLOGY.)Identify the philosophical/theoretical basis of the study.
The researchers did not include a theoretical foundation for the study, but several theoretical possibilities are possible. For instance, the phenomelogical philosophy provides that it is possible to describe and interpret people’s lived experiences in their respective contexts. On the other hand, the reasoned action theory argues that people are aware and thoughtful of their own beliefs and attitudes, which actively shape their decisions and activities. Effectively, it is possible to draw a rational link between their beliefs and attitudes, etc., with their heightened likelihood of dying from breast cancer.

Describe/discuss the references cited to support the philosophical or theoretical approach used.

No theoretical background has been included in the research report, but the implied theories are supported in the form of references to the phonological design.
Is the philosophical or theoretical basis of the study clearly linked with the study assumptions, data collection procedures and analytical and interpretative approach. How? If not, describe what is missing.
The fact that the study sought to understand the perceptions experiences of black women who face a heightened probability of breast cancer that could be linked to the poor prognostic factors, the reasoned action theory and the phenomelogical philosophy that underlies the research design are in line with the assumptions. The data collection methods are also designed in such a way that the subjects’ attitudes, perceptions, biases and contexts are captured as accurately as possible so that they can be used to find a causal link between the results and the outcomes. However, there is not direct reference of the theories or the assumptions for this study, and this makes the report difficult to comprehend, especially for lay users.

How is the framework related to the body of knowledge in nursing?

Nursing is founded on need to provide patients with the best possible environment to recover from disease and infirmary. Grand nursing theories such as Orem’s self-care theory emphasize the need to respect and leverage the patient’s self-care capacity, beliefs and attitudes to achieve the best possible outcomes. Effectively, the attempt to understand the subjects’ perceptions as a basis for developing strategies that would improve their health is in tandem with nursing as a practice. Once again, however, this is far from explicit in this study.

REVIEW OF THE RELATED LITERATUREAre the articles relevant with previous studies and theories described? Justify your response.

There is no formal literature review in this report, but the researchers included a few relevant literature on the research area in the introduction and background area. The included literature include the World Health Organization (2009), ACS (2011) and Yankaskas (2005).
Are the references current? What are the number of sources within past 10 years? What are the number of sources within past five years?
All the references included in this paper are current, with oldest one having been published in the year 2001. The majority of the resources were published after 2006.

Describe the current knowledge about the research problem.

It is apparent that white women have a high incidence of breast cancer but better prognostic factors and less mortality, compared to African American women who have low incidence but poor prognostic factors and high mortality. It is also clear that there are no known preventive measures for breast cancer, but annual mammography, monthly self-examination, annual breast examination, three-yearly mammography and other generally regular contact with physicians as being helpful. Other literature shows that high-risk black women had a heightened risk perception and more inclined to make positive lifestyle changes.

Specify the gap in the literature that justifies the need for the research.

The limited research on breast cancer risk perceptions and the associated behaviours among women of colour who are at a high risk of contracting the disease. Even most specifically, there is no study that explicitly explored the meaning of breast cancer risk for African American women aged 40 and below. Further, very few studies in this research area employed qualitative designs.

SUBJECTS AND SETTINGDescribe the subjects and the setting.

The study involved20 high-risk African American women aged between 23 and 40 draws from families with a personal or family history of breast cancer or have shown genetic mutations that predispose them to breast cancer. The subjects were drawn from major teaching hospitals that specialized in the management of high-risk breast cancer populations. To increase the diversity of experiences, the sample was also drawn directly from women in the community-based settings that were not receiving care.

In what way is the method of obtaining subjects appropriate? Justify your answer.

The sampling design used in this study, but the description of the nature the sample was obtained points to a purposive design. The researchers recruited, screened and interviewed participants arriving the medical centres, while community participants were recruited by phone. A purposive sampling design is best suited for this study because it allows for the selection of samples that offer rich data and information compared to the general population. However, the lack of random sampling hurts the sample’s representativeness.

In what way is the size of the sample used adequate? Justify your answer.

Unlike quantitative studies where the power of a sample lies in the size, doe a qualitative study, the power of the sample lies in the richness the data. The best sample size is reached at the saturation point i.e. when responses are repetitive and no more information can be gathered. Further, in a qualitative study, the interest is far from representation or external validity, but deep understanding of a given sample/population. Effectively, a purposive sample and a sample size of 20 are appropriate.
In what way was the setting in which data were collected an appropriate one for this study? Why? Justify your answer.
Two settings hospital and community are chosen to ensure diversity of experiences and perceptions of the same. It is however, unclear how the sample was divided between the community and the medical centre populations as well as how the general high-risk cancer population is divided between active contact with the health care system and lack thereof.

Indicate the type of consent obtained and Institutional review board approval.

The study was approved by three independent institutional review boards of three medical centres i.e. University of Chicago, University of Nebraska Medical Centre and the University of Illinois. The subjects also provide written, informed consents before they could be included in the study

In what way were the steps taken to protect the rights of subjects adequate?

Written, informed consent was obtained. It is not clear in the report whether any further measures were taken to protect the participants, but it is notable that the research report refers to the participants using pronouns and general nouns such as “one woman” and “another woman”.
DATA COLLECTION PROCEDURE AND APPROPRIATENESS OF DATA ANALYSIS METHODSIdentify the data collection procedures used and provide a description of how the data was collected.
Upon providing consent, the women sampled were requested to share their experiences as a high-risk population group. An African American interviewer conducted the interviews using open-ended questions, with the interviewer letting the subjects to determine the content and direction of the interview. Interviewees were encouraged to fully discuss their experiences and clarify meanings. The two interviews, which lasted between 60 to 90 minutes and 30 to 60 minutes respectively were taped and transcribed with the subject being requested to confirm whether the transcription represented a true reflection of their views and/or make appropriate corrections. Further, the participants completed questionnaires to provide demographic information, before four subjects were requested to review the emergent themes in the study. Participants received $50 for their time.
In what way were the data collection procedures used consistent with the purpose of the qualitative approach selected? Clearly justify your answer.
The need to capture the true reflection of the experiences and perceptions of African American women as a high-risk breast cancer group underlies all the procedures used. To begin with, an African American interviewee was used in order to preclude perceptions on the part of the subjects of racial bias or prejudice. Further, open-ended questions were used to allow the direction of the interview to flow according to the interviewees wishes. Further, after the recording, interviewees were requested to verify the transcripts and a selection of the participants were used to code the data because they are likely to understand the issues raised better than outsiders.

Define data saturation.

Data saturation refers to the point when the researcher is unable to receive any new information because new subjects (or the same subject) tend to give information that has already been given by earlier.

What evidence is there that data saturation was achieved? Describe fully.

Yes. The research report indicates that the interviews were conducted until data saturation was attained i.e. up to the point when the subjects could not raise any new themes. The researcher would thus probe several issues until after they are convinced that no new information is emerging before terminating an interview.

SPECIFIC DATA ANALYSIS PROCEDURES USEDIdentify the qualitative data analysis procedures used to examine the data

This study employed the hermeneutic phenomelogical iterative coding and analysis process through which researchers worked together with the subjects to identify codes or themes from the results. The process draws on reflective awareness, wholesome examination of issues and the dialectical examination of different parts of data in the context of the whole. The researchers also included procedures that ensured theme validation (e.g. using the subjects to identify and confirm themes) and the use of data saturation as the stopping point for interviews and theme creation process.

Define the qualitative data analysis procedures used.

Audio and verbatim transcript verification of the data by the subjects
Phenomelogical analysis
The interviewers and the subjects worked together to identify and verify emergent themes
Themes were compared against those from other interviews
Use of a hermeneutic circle to decipher meanings
In what way(s) are the data analysis procedures appropriate for the data collected? Clearly justify your answer.
The thrust of the analysis is to identify and describe the true picture in the context of the subjects. Effectively, the fact that the researchers emphasized the subjects’ input and that the analytical process was careful to ensure that the researchers remained faithful to what the subjects thought or believed

In what way(s) are the data analysis procedures consistent with the qualitative method used? Clearly justify your answer.

The analysis process is also consistent with qualitative analysis, which seeks to understand a phenomenon as accurately as possible even when it is immeasurable. The intention is to describe and understand as against quantify. The procedure use the common approach of developing themes/codes and applying them to the data gathered.

EVIDENCE OF AUDITABILITY/DECISION TRAIL/MEMBER CHECKSDefine decision trail

It is a documentation of the analytical decisions/choices made in the process of drawing analytical inferences to enhance transparency and consistency

Was a decision trail developed? Was it reported in sufficient detail? Clearly justify your answer.

A procedure was developed through which the researchers worked with the subjects to identify and verify themes as consistently as possible. For instance, passages from the transcripts and theme labels were compared against themes from other interviews to categorize them. Further, a process to reach a consensus was also built into the analysis process.

SPECIFIC RESULTS OBTAINEDIn YOUR OWN WORDS, what are the outcomes of the study? What did the study reveal?

The study shows that African American women thought of breast cancer as a life-changing experience, because it changed the meaning of life and it is a long-term illness. It affected their relationships with close friends and family with some relationships getting stronger, while others struggled for lack of support. Some subjects experienced strained relationships, with family friends failing to appreciate the danger posed by the disease. The overriding themes with regard to relationships were the need for support, concern and fear. Access barriers due to financial constraints, the nature of the health care delivery system and providers characterized the African American women’s experiences with the healthcare system. Insensitivity of providers and poor quality relationships with practitioners contributed to strained relationships. There is, however, increasingly awareness of the incidence of breast cancer among youth African American women, coupled by greater tendency to spirituality.
STRENGTHS AND LIMITATIONSWhat are two major strengths of the scientific merit of this study? (This does NOT refer to outcomes of the study). Address credibility and confirmability.

What are two major limitations of the scientific merit of this study?

While the study was cross-sectional, the subjects were interviewed at different times along the continuum of breast cancer experience and risk perceptions, it would have been more beneficial to use a longitudinal design would have yielded a greater understanding of the subjects’ experiences and how they are related to the risk of developing breast cancer
The study was also carried out among African American women alone, but the study could have benefitted from a comparison with women from different cultures in order to delineate the differences that could explain the differences in prognostic factors and breast cancer mortality
The researchers ensured accuracy of the interpretations by confirming them with the subjects, and using the subjects to identify the codes to ensure that they actually represented what the subjects thought. To this end, the study is internally valid. However, for a qualitative study, external validity is both low and inconsequential, because the objective is not studying the population, but gaining insight into the study phenomenon.

IMPLICATIONS/RECOMMENDATIONSHow did the researcher generalize the findings? Where in nursing can the results be applied?

The researchers argued that women under 40 and at high risk of developing breast cancer exhibited the need for unique support and emotional needs depending on their respective stage of life, primary relationships with family/friends, and interactions with the health care system.

What did the researchers say the relevance of the data was? Describe the researchers’ interpretation of the findings.

The researchers concluded that breast cancer occurred in women under 40, and it is critical that sensitive and timely strategies are taken in order to offer such women with services that would improve their prognostic factors and reduce mortality. Effectively, this study points to the poor prognostic factors and high mortality among African American women to health care inaccessibility, insensitivity of providers and other barriers facing this population group in the US.

What suggestions for further study were identified?

The researchers recommend more research to identify and describe the unique needs of youthful women coping with breast cancer diagnosis. The dearth of research on the perceptions of risk and the associated behaviours among Black women calls for more studies to build on this study. Use of longitudinal research designs would be even more valuable in capturing the long-term experiences, the emotional resources and needs of such women.

Is the description of the study sufficiently clear for replication? Why or why not?

The report does not include a questionnaire and while the procedural descriptions are adequate, they are unclear to allow for accurate replication. For instance, the questions included in the interview could be different and since the interviews are open-ended, they can go in any direction, further from the direction taken by the current study.
REFLECTIONReflect on your newly developed understanding of QUALITATIVE research. What has this experience meant to you? How will this make a difference in your practice of nursing? This is a personal reflection and should have some depth (at least two full paragraphs). Please respond in reference to understanding qualitative methodology and not the specific focus of the research study.
What has the experience of reading and critiquing a qualitative study meant to you? How will understanding and using qualitative research findings make a difference in your practice of nursing?
Reviewing a qualitative research report helped me gain a deeper understanding of the nature and value of this research type, compared to a quantitative study. I have found that qualitative studies are not geared towards describing the population, but providing a close insight into a specific sample or section of the population. Its value lies in the accuracy of its depiction immeasurable constructs. This is more so with the phenomelogical method, which tries to achieve accurate depiction and interpretation of the research phenomenon, while at once constraining the researchers from their own subjective interpretations in deference to the study participants. Effectively, the concepts of reliability are not as important in this kind of study as they are in a quantitative study, which in turn means that the size of the sample and the power of the sample are equally less emphasized.

How will understanding and using qualitative research findings make a difference in your practice of nursing?

Qualitative studies have taught me that people are more than just statistics. They have emotions, cultures, experiences, and other factors that influence their perceptions to life. Many immeasurable, but nonetheless important variables affect their satisfaction with the health care quality. Effectively, as a practitioner, I must pay a close attention to concepts such as culture, social, economic and other factors in determining the nature of care.

References

Creswell, J. (1998). Qualitative inquiry and research design: Choosing among five traditions. Thousand Oaks: Sage Publications.
Fossey, E., Harvey, C., McDermott, F., & Davidson, L. (2002). Understanding and evaluating qualitative research. Australian and New Zealand Journal of Psychiatry 2002; 36, 717–732.
Pascal, J. (2010). Phenomenology as a Research Method for Social Work Contexts: Understanding the Lived Experience of Cancer Survival. Currents: New Scholarship in the Human Services Vol 9, Number 2, 1--23.
Phillips, J., & Cohen, M. (2011). The Meaning of Breast Cancer Risk for African American Women. Journal of Nursing Scholarship , 43(3), 239–247.
Social Research Methods. (2009). Social Research Methods. Retrieved Nov 13, 2014, from http://www.socialresearchmethods.net/kb/convdisc.php
Wills, E., & Kluwer, W. (2010). Theoretical Basis for Nursing 3rd. ed. . New York: Lipincott Williams and Wilkins.