The critical incident technique and nursing care quality research

The critical incident technique, is a highly flexible qualitative research method used in solving practical problems. Although this research method has been extensively used in the service industry to evaluate consumers' expectations and perceptions, applications to the study of health care quality are just beginning. This article describes critical incident methodology, reviews previous applications of the technique to the study of health care quality and provides illustrations from research. This practical research methodology offers the following important advantages to those interested in designing studies of care quality: identifying patients' experiences in health care settings, exploring dimensions of nurse-patient interactions and identifying patients' responses to illness and health care treatment.     

Using the critical incident technique to measure long-term outcomes of interprofessional education

There is a critical need to develop methods that capture long-term trainee outcomes and link these outcomes to interprofessional education (IPE) to establish the value added from IPE. This article describes the use of the critical incident technique (CIT) to evaluate long-term trainee outcomes attributed to IPE. Critical incidents (CIs) are specific examples of behaviours that occurred within the recent past. Trainees of an IPE programme (n = 24) were interviewed using CIT. Across the trainees, 41 CIs were reported, of which 9 were collapsed due to similarity in theme. A final total of 32 CIs were mapped along the Kirkpatrick/Barr Model of Learner Outcomes. The mapping process revealed that all of the CIs reported described incidents at Levels 3, 4a, and 4b, indicating changes in trainees’ own professional behaviour and improvements in patient outcomes related to their IPE experience. Implications for evaluating IPE using the CIT method are discussed.     

The meaning of empowerment for nursing students: a critical incident study

AIM: This paper is a report of a study to explore the meaning of empowerment for nursing students in relation to their clinical practice experiences. BACKGROUND: Empowerment and power are well-researched areas of nursing practice, particularly in relation to Registered Nurses. Furthermore, several studies have considered the experiences of nursing students in terms of nursing culture and socialization. However, few researchers have focused specifically on nursing student empowerment. METHOD: The critical incident technique was used and anonymous data were collected between November 2005 and January 2006. One hundred and nine written critical incidents were provided by 66 nursing students relating to empowering and disempowering experiences in clinical practice. The data were content analysed. FINDINGS: Nursing students experience both empowerment and disempowerment in clinical placements, centring on three issues: learning in practice, team membership and power. Continuity of placement, the presence of a mentor and time underpinned empowering experiences whereas their absence had a disempowering effect. CONCLUSION: The consequences of nursing student empowerment are high self-esteem, motivation for learning and positive regard for placement. Supportive mentors play a pivotal role in the empowerment of nursing students and it is essential for the nursing profession that they are supported to undertake their mentorship role.     

Establishing methodological rigour in international qualitative nursing research: a case study from Ghana

BACKGROUND: Attention to rigour, from the identification of the problem to the dissemination of the findings, is essential in all qualitative research. In this paper, research carried out in Ghana in 1999 is used to highlight methodological issues in relation to rigour in international qualitative nursing research. AIM: The purpose of this paper is to review the literature in relation to rigour in qualitative research, highlight the methodological decisions enhancing rigour during this research project, and describe the criteria used to assess rigour during the research process. DESIGN: A participatory action research design was used to explore the cultural, social, economic, and political factors that influenced Ghanaian women's vulnerability to HIV infection. Collaboration with participants and partnerships with key professionals were integral to the design of the study. FINDINGS: Participatory action research provided a flexible, socially, and culturally adaptable framework to guide this international research project. Prior to the initiation of international research it was essential to establish the relevance and feasibility of the proposed project. This international research project posed additional methodological challenges to the establishment of rigour. Patience, flexibility and sensitivity were required of the researcher to overcome these challenges. CONCLUSION: Collaboration with participants and with culture-specific 'experts' may be key to culturally competent scholarship, particularly in unfamiliar settings.     

The nursing contribution to qualitative research in palliative care 1990-1999: a critical evaluation

BACKGROUND: Qualitative research plays an important part in providing evidence for practice in nursing, and is gaining greater acceptance within medicine. However, questions remain about what criteria are most appropriate for evaluating qualitative research. To date, little systematic evaluation of qualitative research in palliative care has been conducted. AIMS: This paper is based on a larger study in which we conducted a critical review of qualitative research in palliative care from nursing, medicine, specialist palliative care, sociology, death studies, medical anthropology, and gerontology journals published between 1990 and 1999. The aim of this paper is to present an account of the strengths and weaknesses of qualitative palliative care research in nursing, using data from this review. METHODS: In the larger study, 138 papers from 50 journals were reviewed critically using a tool developed to assess both content and quality; in one part of this tool reviewers recorded open-ended comments on the strengths and weaknesses of each paper. In this paper, we present a thematic analysis of reviewers' comments on a subgroup of 67 nursing papers from the main review, together with an analysis of comments on 29 papers from a comparison group of death studies, medical anthropology, and sociology journals. Patterns of positive and negative evaluation are identified and used to generate an account of strengths and weaknesses in qualitative palliative care research in nursing. FINDINGS: Over 40% of the subgroup of papers from nursing journals received positive comments on topic and quality of writing; around 30% received positive comments on contribution to understanding, practical value, and conceptual or theoretical issues. Less than 20% received positive comments on other critical dimensions. Over 40% of nursing papers received negative comments on the link between data, analysis, and findings, other aspects of method and theoretical and conceptual issues. A higher proportion of papers in the comparison group received positive comments on conceptual and theoretical issues and contribution to understanding. CONCLUSIONS: Nearly half the nursing papers reviewed were judged to be well written or to have a well-chosen topic. However, more than 40% of papers drew negative comments about key methods-related issues. Arguably therefore efforts to improve the quality of research evidence should focus on this area.     

Using a synthesised technique for grounded theory in nursing research

Aims. To introduce a synthesised technique for using grounded theory in nursing research. Background. Nursing increasingly uses grounded theory for a broadened perspective on nursing practice and research. Nurse researchers have choices in how to choose and use grounded theory as a research method. These choices come from a deep understanding of the different versions of grounded theory, including Glaser’s classic grounded theory and Strauss and Corbin’s later approach. Design. Grounded theory related literature review was conducted. Methods. This is a methodological review paper. Results. Nursing researchers intent on using a grounded theory methodology should pay attention to the theoretical discussions including theoretical sampling, theoretical sensitivity, constant comparative methods and asking questions, keeping memoranda diagramming, identification of a core category and a resultant explanatory theory. A synthesised approach is developed for use, based on Strauss and Corbin’s style of sampling and memoranda writing, but selecting theoretical coding families, that differ from the paradigm model of Strauss and Corbin, from the wide range suggested by Glaser. This led to the development of a multi‐step synthesised approach to grounded theory data analysis based on the works of Glaser, Charmaz and Strauss and Corbin. Conclusions. The use of this synthesised approach provides a true reflection of Glaser’s idea of ‘emergence of theory from the data’ and Strauss and Corbin’s style of sampling and memoranda writing is employed. This multi‐step synthesised method of data analysis maintains the philosophical perspective of grounded theory. Relevance to clinical practice. This method indicates how grounded theory has developed, where it might go next in nursing research and how it may continue to evolve.     

阻碍护理人员报告护理异常事件因素的质性研究

目的了解护理人员对报告护理异常事件的真实想法和感受,识别阻碍护理人员顺利报告的因素。方法运用质性研究的方法 ,对上海市2所三级甲等医院的12名护理人员进行个别深入访谈。结果通过分析,提炼出3个主题:护理人员的认知、管理人员的负向态度和医院的组织文化因素是阻碍护理人员报告的主要原因。结论应加强护理人员的护理异常事件报告的培训,改变护理管理人员对护理异常事件报告的负向态度,建立健全护理异常事件监测体系,以提高护理人员对护理异常事件的发现能力和报告能力。     

Facilitating best practice in aged care: exploring influential factors through critical incident technique

Aim.  The focus of this study is on the perspective of facilitators of evidence-based aged care in long-term care (LTC) homes about the factors that influence the outcome of their efforts to encourage nursing staff use of best practice knowledge.
Design.  Critical incident technique was used to examine facilitators' experiences.
Methods.  Thirty-four participants submitted critical incident stories about their facilitation experiences through face-to-face interviews, telephone interviews, and/or a web-based written questionnaire. The resultant 123 stories were analysed using an inductive qualitative approach.
Results.  Factors at individual and contextual levels impacted the success of facilitators' work. The approaches and traits of facilitators as well as the emotionality and intellectual capacity of nursing staff were the individual factors of influence. On a contextual level, the inherent leadership, culture, and workload demands within LTC homes, as well as externally imposed standards were influential.
Conclusions.  Primary factors influencing the facilitation of best aged care in LTC homes appear to be largely relational in nature and intimately connected to the emotionality of those who work within these settings. Enhancing the interactional patterns amongst staff and leaders as well as promoting a positive emotional climate may be particularly effective in promoting better aged care nursing practice.     

Identifying cancer nursing research priorities using the Delphi technique

BACKGROUND: Nursing research is an integral component of improving the care of people with cancer. However, for research to be successfully integrated and applied to practice, ownership and identification must come from those in practice. The need for local and national strategies for cancer nursing research and the importance of establishing priorities for cancer nursing research have been repeatedly acknowledged. STUDY AIM: The aim of the study was to facilitate a strategic approach to cancer nursing research by identifying the research priorities of cancer nurses. RESEARCH METHOD: A three-round Delphi survey was administered to nurses (n = 112) attending a cancer nursing research conference in Northern Ireland. Participants were asked to identify five research questions that they considered a high priority for cancer nursing. A response rate of 54% (60 delegates) was obtained for round one and this generated 117 statements. These statements were content analysed. Two subsequent quantitative rounds followed this. RESULTS: The top priority areas identified were psychosocial issues, for example communication and information needs; professional issues relating to nurse burnout, stress and nurse-led care; and context of care issues including continuity of care. LIMITATIONS: A potential limitation of the study is the use of conference delegates. However, it is argued that these are the people we wanted to target as they could be considered as experts who already had an interest and clinical background in both cancer research and practice. CONCLUSION: These priorities have helped to provide both direction and focus for the development of a cancer nursing research strategy for Northern Ireland. It is recommended that future research questions should be focused around the highest ranked priorities.     

基础护理操作技术中护士劳务价值影响因素的质性研究

目的了解影响基础护理操作技术中护士劳务价值的相关因素,为构建科学合理的基础护理操作技术中护士劳务价值评价体系提供借鉴。方法采用现象学研究方法,采取目的抽样法,对16名护士进行深度访谈。结果通过资料分析、整理和提炼,得出影响基础护理操作技术中护士劳务价值因素的4个主题,分别为操作者有多方面的劳动消耗、操作者需具备一定的技术条件、操作者承担着多维的风险和压力、操作者面临复杂的职业环境。结论基础护理操作中的护士劳务价值受多方面因素的影响,护理管理者需在兼顾无形劳动与有形劳动下建立合理的护士劳务价值评价体系,同时完善基础护理服务项目价格形成机制。     

428篇危重病护理论文分析

目的:分析近年我国危重病护理领域护理研究的现况,存在的问题。方法:手工查阅2000～2005年发表于国内4种护理核心期刊的428篇危重病护理论文,就论文研究内容、研究方法等进行分析。结果:目前国内危重病护理研究论文数量呈逐年增长趋势,以经验性论文为主,占60%;机械通气与气道管理为研究的热点问题;实验性研究论文增长较快;需要在科学性和有效性方面进一步提高。结论:危重病护理研究水平有待进一步提高,应发挥学科优势,促进危重病护理研究的发展。     

Clinical supervision in the emergency department: a critical incident study

Objectives

To identify the key features of effective clinical supervision in the emergency department (ED) from the perspectives of enthusiastic consultants and specialist registrars. To highlight the importance of clinical supervision within emergency medicine, and identify obstructions to its occurrence in everyday practice.

Methods

A critical incident study was undertaken consisting of structured interviews, conducted by telephone or in person, with 18 consultants and higher level trainees selected for their interest in supervision.

Results

Direct clinical supervision of key practical skills and patient management steps was considered to be of paramount importance in providing quality patient care and significantly enhancing professional confidence. The adequacy of supervision varied depending upon patient presentation. Trainees were concerned with the competence and skills of their supervisor; consultants were concerned with wider systemic constraints upon the provision of adequate supervision to juniors.

Conclusions

The value of supervision extends to all patient presentations in the ED. The study raised questions concerning the appropriate attitudes and qualifications for supervisors. Protected supervisory time for those with trainees is mandatory, and must be incorporated within ED consultant job planning.     

Mantram repetition for stress management in veterans and employees: a critical incident study

AIM: This paper reports a study assessing the usefulness of a mantram repetition programme. BACKGROUND: Complementary/alternative therapies are becoming commonplace, but more research is needed to assess their benefits. A 5-week programme teaching a 'mind-body-spiritual' technique of silently repeating a mantram - a word or phrase with spiritual meaning - to manage stress was developed. A mantram was chosen by individuals, who were taught to repeat it silently throughout the day or night to interrupt unwanted thoughts and elicit the relaxation response. METHODS: Participants who attended a 5-week course were invited to participate in the study. Of those who consented, a randomly selected subset (n = 66) was contacted approximately 3 months after the course for a telephone interview using the critical incident interviewing technique. Participants were asked whether the intervention was helpful or not, and if helpful, to identify situations where it was applied. Interviews were transcribed and incidents were identified and categorized to create a taxonomy of uses. The data were collected in 2001-2002. RESULTS: Participants included 30 veterans, mostly males (97%), and 36 hospital employees, mostly females (86%). Mean age was 56 years (sd = 12.94). Fifty-five participants (83.3%) practiced the technique and reported 147 incidents where the programme was helpful. Outcomes were organized into a taxonomy of incidents using four major categories that included managing: (a) emotions other than stress (51%); (b) stress (23.8%); (c) insomnia (12.9%); and (d) unwanted thoughts (12.3%). A group of raters reviewed the categories for inter-rater reliability. CONCLUSIONS: The majority of participants from two distinct samples reported that the mantram programme was helpful in a variety of situations. The critical incident interviewing method was found to be practical, efficient, and thorough in collecting and analyzing data. Such qualitative methods contribute to understanding the benefits of mind-body complementary therapies.     

Making words count: the value of qualitative research

In the current climate of evidence‐based practice, physiotherapy is urged to prove its worth via rigorous scientific research. However, there are concerns that limited methodologies are used to explore complex therapeutic issues, and that the profession relies too heavily on quantitative research studies to provide its evidence base. Qualitative research methods are able to explore the complexity of human behaviour and generate deeper understanding of illness behaviours and therapeutic interactions. Nevertheless, there is still a sense of distrust of qualitative research, related to the challenge of evaluating both the quality and usefulness of findings derived through qualitative methods. This discussion paper explores these issues. It examines some of the most frequently used techniques aimed at ensuring quality and value in qualitative research, such as sampling, triangulation, multiple coding, respondent validation and the use of audit trails, as well as addressing reflexivity. Because of the pluralistic and interactive nature of qualitative inquiry, the criteria used to judge quality need to be appropriate to each piece of research and should provide evidence to help readers to evaluate the calibre of the study and its relevance to their own area of work. Copyright © 2004 Whurr Publishers Ltd.