Critical Review
This research paper was originally published in the 1st issue of the 14th Volume of the MEDSURG Nursing from pages 51 to 62 of February, 2005. It was then republished in the Dermatology Nursing Magazine in the 17th Volume in Issue 4 of 2005. Both happen to be peer reviewed journals but not current issues.
The study by Beitz and Goldberg was a qualitative research of the phenomenological design which was both apt and in context as the aim of this study involved the investigation into emotional and other feelings and experiences that the patients suffered in the process or lived experiences with a chronic wound. No scope for quantification was present. Interviews with audiotapes for saving information during the study and field notes were used to gather information. Phenomenology is the study of structures of consciousness from the first person point of view. As the experience was a lived one, the phenomenological study which is related to lived experiences was selected.
The study purpose was dual in nature and clearly stated. The intention was to investigate the lived experiences of people with chronic non healing wounds and to sensitize health care professionals and care-givers to the emotional and stressful experiences of the patients. The research questions have been duly noted in the paper.
The researchers appear to have researched sufficiently and have quoted literature from several studies from 1995 to 2004. Current literature is less. The literature covered chronic venous ulcers mainly and had just mentioned one study each for pressure or neuropathic ulcers and one study for diabetic ulcers. However as they were all chronic wounds, the researchers were guided by them. The majority of studies were phenomenological studies. The evolution of the themes from the various feelings of the patients had been mentioned in each study. The review could be described as compelling and clear.
16 participants were selected from a retirement community and a nursing home.
A sampling across a wide socio-economic strata had been done. The retirement community group belonged to a higher strata and the nursing home group, a lower socio economic group. They had chronic non-healing wounds lasting more than 8 weeks, no psychiatric issues or confusion (to facilitate interviewing), with the ability to communicate in English. All were Caucasian and retired. Sampling resumed till a saturation of themes was reached. The sampling method appears appropriate and the participants have been described in fair detail.
Verbal and written communications elaborated the study to the participants.
Interviews were conducted with greatest convenience to the participants, at their living area. Approval for the study was duly obtained from the La Salle’s University Institution Review Board. The participants had also given their consent and were told that they could withdraw at any moment. Their names were not used. Audiotapes were to be destroyed after use for the participants’ anonymity. All ethical considerations were maintained.
Data collection procedures were described in detail. The interviews were done in a quiet area so that the participants could reflect and provide information and the audiotapes could be taken. The questionnaires had 2 open-ended questions which were added to allow the participants to speak freely and bring out their thoughts in the presence of one researcher, frequently prompted by him. Apart from audio taping, the researchers observed the body language and topic avoidance of the participants and made field notes. Interviews lasted 30-45 minutes. The site and participants have therefore been clearly described. The context of the study appeared sufficient for total understanding. The open-ended questions allowed some flexibility for participant reactions. Procedural rigor had been assumed.
The researchers’ assumptions and bias have been noted. The researchers had a few assumptions: that a chronic wound would affect a person’s interpersonal relationship, a chronic wound would affect a person’s thoughts about himself and that it would also affect a person’s experiences on the health services.
Data analysis was done systematically. It is not mentioned but the analysis could be considered inductive as themes evolved from getting answers to questionnaires and open-ended questions. The methods were appropriate as several clusters of themes could be derived. The researchers heard the audio-tapes repeatedly, then checked their questionnaires and the answers to the open-ended questions. The process of analysis was described in detail. An expert qualitative researcher had checked the data for analysis and maintained an audit trail.
The reliability of the data was maintained by the audiotapes and the audit trail. The credibility of the findings was cross-checked with other nursing staff. Biases of the researchers were bracketed. Inter-rater reliability was protected by independent analysis of 2 transcripts by the two researchers. Analyses were shared and discussed for further reliability. An expert in phenomenology was consulted for a comparative analysis for consistency. An emic vs. etic perspective was possible. The participants’ views and researchers’ views could both be incorporated through sheer hard work. The other components of trustworthiness of dependability and confirmability apart from credibility were all achieved in this study. The cluster of themes that evolved pointed to specific wound caring measures which could be transferred to the nursing practice. Thus transferability, the remaining component of trustworthiness, had been achieved in this study. The themes that were singular to this study were the changing eating patterns and the aging and living which were not addressed in earlier studies.
The limitation of this study is that residents in less protective and non supportive surroundings with low income and completely dependent on care-givers may not be served by the findings of this study. However results provide information on how best to care for chronic wounds simultaneously attending to emotional and psychological requirements of the elderly.
The subject of chronic wound therapy especially in the elderly is greatly linked to nursing practice. The large elderly population that is suffering from various types of chronic ulcers like pressure ulcers, extremity ulcers including arterial, venous, neuropathic and pressure related ulcers and have chronic problems like immobility, limited activity, altered mentation, poor nutrition, long operative procedures
incontinence, obesity, hyperlipidemia, and diabetes turn to the nursing profession for relief. Nurses have sufficient work, especially in the community postings, looking after and tending to the chronic problems including non healing wounds of the elderly who cannot attend a clinic or hospital for their chronic complaints due to immobility, no one to take them and similar complaints. Immobility and the impact of pain are the greatest causes of suffering in the old.
References
Beitz J.M. and Goldberg E. (2005). “The Lived Experience of Having a Chronic Wound: A Phenomenologic Study”. Dermatology Nursing, 2005, Vol. 17, No.4, 272:305