Running head: QUALITATIVE CRITIQUE

A Qualitative Research Critique

Jake Wilcox
Bon Secours Memorial College of Nursing
NUR4122 Nursing Research
October 08, 2015

I pledge that I have neither given nor received aid on this assignment
~Jake Wilcox
A Qualitative Research Critique
Introduction

The qualitative article that is being reviewed was written with the intent of gathering a
further understanding of the care and culture that take place in a trauma unit. Elizabeth Tutton
MSc, PhD, RN, is a senior research fellow at the Kadoorie Center, Oxford Radcliff Hospital as
well as the University of Warwick, UK. She teamed up with Kate Seers BSc, PhD, RN, who is
the director of the RCN Research Institute at the University of Warwick, and Debbie Langstaff
MBA, RN, ONC, who is a matron in the trauma unit at the Oxford Radcliff Hospital NHS Trust,
UK. With their professional degrees and backgrounds in research they are well-qualified for this
task. The article they have written is titled, Professional Nursing Culture on a Trauma Unit:
Experiences of Patients and Staff. The writing is free of grammatical errors and jargon, it is
also very understandable and concise. The authors stated that this is an ethnographic approach.
The title is very clear, explaining the general idea of the article and how it looks into the day to
day experiences had by the staff and the patients that they care for. The abstract provided is a
good summary of the content contained in the article as it includes the title, background,
methods, and findings sections.
Background
The phenomenon that is being looked at is the culture in the trauma unit that is lived by
the patients and staff who create it. The background provided paints a good picture of the way
nursing care has transformed over the years. The nursing process has changed from being goaloriented to being patient-centered. The intention of the transformation was to give the patient the
best care possible. The idea behind this study was to better understand the patients perspective
of the care provided and how it played a role in their outcomes. There was no direct problem
statement addressed in the article. The underlying intention has been to structure and develop
the process of nursing so that the patients can get the best care possible. (Tutton, Seers, &

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Langstaff, 2007, p. 146) The intent was to gain a better understanding of how staff was able to
facilitate or inhibit a positive experience and healing environment for their patients. The purpose
was to gain a better understanding of the role the nurses played in the rehabilitation of the
patients and how the patients perspective of the care they were received. The study showed that
when the nurses included the patients in their own care it provided for a much better outcome.
They provided a literature review of the research they used to gain an understanding of how the
nursing process and how it has changed over the years. There were also articles exploring the
views of patients on the relationship between patients and the providers. The team used the
ethnography as their theoretical framework.
Methodology
Ethnography is often described as a study of culture, or as Ryan put it; The
ethnographic approach attempts to examine the experiences of the person in the context of
his/her natural world and explores the topic of study through the perceptions of the subjects of
study. ( Ryan, Coughlan, &Cronin 2007, p. 740) The study was trying to establish the culture of
the trauma unit, as it seemed that unit had a culture of its own. It was assumed for the study the
meaning of the experiences had by the patients and staff can be known, but a deeper
understanding could only be known by those who lived it (Tutton, et al., 2007). The study was
held in a trauma unit in the United Kingdom between the times of November 2004 and January
2006. A total of 16 periods of observation took place where the researcher was on the unit. The
study group was made up of 40 patients, 19 men, 21 women, and 19 staff members, all of whom
were women, but one. Those chosen for the study had a large range of injuries, however all of
them needed to be able to speak and interact with the research team. Ages of the patients ranged
from 23 to 99 years, with the average being 63 years of age, for the staff members, 22 to 53 years

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of age, with experience working on the unit being from around four months to 19 years. There
were an additional 13 patients that were approached that declined participation due to feeling too
tired or unable to speak.
Interviews and direct observation were used to gather the information needed to complete
the study. The interviews were held in quiet rooms at the patients convenience, or in their
hospital bed if they were not able to get up and move on their own. The interview was based on
one question. What is it like being on a trauma unit? While the staff questions were, What is
it like working on a trauma unit? Additional prompts were also used such as: Tell me more
about that? and how do you feel about that? What was it about that interaction that
helped/hindered you? (Tutton et al., 2007, p. 147) Observations also took place where the
researcher sat on a stool in the corner of the room and listened, but was also active in the
conversation when invited. He/she would also help out with small tasks if asked to do so. This
aided with the social approach that the researcher was aiming for. The sessions of observations
and interviews would run for 7.5 hours in which multiple interviews would be done. These
sessions would be done at a variety of times during the day to encompass the whole 24 hour
period of care.
The study was approved by the local research and ethics committee; it was also supported
by the hospital research and development committee. All of the participants were given written
information inviting them to take part. Participants involved in the interviews were given at least
a 24 hour notice to decide if they wanted to take part. Some of the observations that took place
had less than 24 hours due to the nature of the ever-changing environment in the hospital ward.
Visitors were informed of the study, and if they decided to participate, would first give verbal
consent and also sign written consent after the observation or interview had taken place.

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The data collected from the studies were written out verbatim. The information was then
taken back to the participants to check for any changes or clarifications that may have been
needed. Handwritten notes taken during observations were transcribed as soon as possible,
following the time of occurrence. The data was analyzed using the qualitative software package
QSR NUD*IST N6, as well as Microsoft Office 2003. The information was then compiled and
a thematic analysis was conducted. The data was then broken down into categories and
subcategories grouping all similar meanings. An example being the category of emotional
labor, with a subcategory of attachment/detachment that was driven by the statements made
by the participants of, becoming emotionless, and not having the energy to feel at work.
(Tutton, et al., 2007). The team created rigor, or trustworthiness, by spending ample time in the
field preforming the interviews and the observations. Credibility was maintained by holding
focus groups with the staff to share the findings at the end of the study. The outcomes generally
reflected the culture of the unit. Not all of the feelings discovered were held with the same
regards to all the staff, but these findings added to the thoroughness of the research. A detailed
description of care was established with the data collected from the participants. Saturation of
data was said to be achieved, however a traditional ethnography study would have included more
observations and a longer time period.
Findings
The findings were very well explained and laid out in a manner in which similar topics
were placed together. The findings were discussed by the themes that were discovered. The
themes were: closeness, therapeutic care, and working as a team. It addresses the original topic
of care and culture in a trauma unit and gives examples by the means of direct quotes from the
patients and staff interviewed. The discussion portions talk about the limitations that were faced

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in the study, as it was just one area of care in the hospital and not multidisciplinary in focus. The
results of the study show that as the nurses worked to create a professional culture and work
environment, including of the patients as active participants in their care, greatly improved
patient satisfaction. The staff created an open, sociable, and caring environment that allowed the
patients and nurses a chance to connect. Doing so portrayed a sense of availability and presence
that the patients were comforted by. The trust that can be gained by involving the patients in
their care is crucial for a good outcome and increased satisfaction. There is also a chart that
compared what is already known about this topic to what this paper adds to the subject. The
chart is very easy to read and understand, and does a good job simplifying the information from
the study.
Recommendations
The findings of the research all point to the development of cultures that value the
frontline staff and the impact that they have on the patients perception of care. This point has
been made clear throughout the body of the article. Maintaining an open and professional
atmosphere, as well as embracing a patient-centered care module is pivotal to a healthy patientnurse relationship. The article does recommend that further studies would be beneficial in the
teamwork aspect of frontline staff and its effects on patient-centered care, as well as examining
the emotional strain that is put on the workers in acute care areas.
Conclusion
While this article does not directly apply to permissive hypotension in the trauma patient,
but it is a good portrayal of what the staff, patients, and their family members will go through.
Based on my critique, they did a very good job of explaining why having an environment that is

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open for communication between patient and care provider is a very important part of the healing
process. The effects on the staffs emotions as they are dealing with people in critical times, will
naturally occur in these situations. For some it is a struggle to cope, and for others, they try and
turn off their feelings when they are in the workplace. It can help the nurses realize they are not
just going through the motions, but are actively involved in this persons life. Being fully
involved and available for your patients needs has shown to make a great deal of difference in
that persons life and their recovery. This article did a very good job of describing the culture that
is created and the benefits that come from it.

References
Melnyk, B. M., & Fineout-Overholt, E. (2015). Evidence-based practice in nursing &
health care: A best guide to practice (3rd ed.). Philadelphia, PA: Wolters
Kluwer.

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Ryan, F., Coughlin, M., & Cronin, P. (2007). Step-by-step guide to critiquing research. Part 2:
Qualitative research. British Journal of Nursing, 16(12), 738-744.
http://dx.doi.org/10.12968/bjon.2007.16.12.23726

Tutton, E., Seers, K., & Langstaff, D. (2008). Professional nursing culture on a trauma unit:
Experiences of patients and staff. Journal of Advanced Nursing, 61, 145153.
doi: 10.1111/j.1365-2648.2007.04471.x