Introduction
Qualitative research is a multi-method which involves an attempt to make sense or interpret phenomenon in terms of the meanings that people bring to the researchers (Silverman, 2004). These are meant to describe routine and problematic moments and meanings in individual. In the recent years, qualitative research has achieved status and visibility in the social science and particularly in the health care field (Silverman, 2004). The goal of qualitative research is to give answers which cannot be answered by the quantitative research. Qualitative research helps the researcher to have a more comprehensive understanding of a specific phenomenon of interest (Silverman, 2004). Moreover, it also helps him to understand and explain unusual situations that could not be identified through large scale quantitative methods. This paper analyzes qualitative research issues of liver failure among the adults. It will research the cause of the disease and how to manage it (Silverman, 2004).
Qualitative research methods
The aim of the qualitative research methodology is to find out the cause of liver failure among the adult patients (Silverman, 2004). The research will look at the causes of liver failure among the adults and the possible treatment available. There are different methods of qualitative research which include:
Interpretive grounded theory approach
This approach involves the researcher starting his research by focusing on some area of study (Silverman, 2004). The main aim of this approach is to develop theory from the information gathered, rather than the testing of predetermined theories through a process of experimentation. The researcher uses tools such as observation and interviews to gather relevant data from many sources and the analysis of the data begins with grouping them into categories and assigning codes (Silverman, 2004). By continually comparing data with other categories, the researcher may develop a theory. This approach is advantageous because it has a systematic approach and has the potential for preserving the interpretive properties of the primary data (Silverman, 2004). On the other hand, interpretive grounded theory lacks full transparency because it is an interpretive method. It does not also offer advice on how to appraise studies for inclusion in a review.
Interpretive phenomenon
This approach relies primarily on in depth interviews with the individuals who have experienced the phenomenon of interest and may go beyond the traditional method of gathering and analyzing data (Silverman, 2004). Interpretive researchers sometimes augment their understandings of the phenomenon through an analysis of supplementary text such as novels, poetry or other artistic expressions. Interpretive researchers attempt to understand phenomena through assessing a meaning of a certain phenomenon (Silverman, 2004).
Action research approach
Action research approach is normally associated with hands on small scale projects (Silverman, 2004). It is a type of applied research differing from other varieties in terms of researcher involvement in the action process. It aims to contribute both to the practical concerns of the people in an immediate problematic situation (Silverman, 2004). Action research is concerned with doing developmental work rather than a once off evaluation of routine activities. This method is advantageous because it combines research and application. It also looks at the whole phenomenon and promotes change after knowing the cause of the situation or phenomenon (Silverman, 2004). Being based on collaboration, action research is not something that one party does to another but rather it is a natural evolution. One of the disadvantages of action research is that the methodology requires continuous involvement in planning, taking action, observing the effects and reflecting. Also, if the way that action is undertaken tends to be limited to the pragmatic and commonsense level, it may be difficult to communicate the outcomes of the research (Silverman, 2004).
Research question
In spite of the measures put down to prevent liver failure among the adults, the number has continued to increase. Therefore this research aims at finding out the causes of the disease among the adults, their life experience with the chronic disease and the measures that health care can take to prevent these cases.
Research approach
In order to investigate why liver failure is prevalent among the adults, the researcher will use action research study. The first step in this step is planning which will involve developing an understanding of the problem, planning an action research project and determining the measurement to be used (Silverman, 2004). The researcher will conduct extensive interviews with those suffering from liver problems in order to bring out the perception of the problem and the cause. Gathering this information will require brainstorming with the participants and other researchers, exploring the published professional literature and also observing the group (Silverman, 2004).
The researcher will then review what is known about liver failure which is the research problem. He can gather this from nursing journals, internet and other records. Brainstorming with colleagues to gain ideas about the possible solutions or answers to the question will facilitate the research process. The researcher should also develop a research hypothesis or questions about the problem and plan the research process accordingly (Silverman, 2004). A hypothesis will identify the researcher’s central focus and guide him to investigate the problem. This part of the process also will help the researcher to identify his biases which will influence the questions he will ask and the answers he will get (Silverman, 2004).
The other step in conducting action research is data gathering. The researcher will conduct Interviews on the adults who are suffering from liver disease in order to understand the real cause of the disease and the life experience of the patients suffering (Silverman, 2004). This qualitative research methodology will involve the researcher and the adult patients with liver problems to work together in order to get details about the disease and thus establish the effective ways that the health care can adopt to help the victims and methods of treating the disease (Silverman, 2004). This research methodology will help those participating in the research to get more information about liver failure among the adults and thus come up with an effective plan of action. In addition to interviews, the researcher can also use observation and survey methods. One benefit of using multiple data source is that it will help the researcher to get at the complexity of the problem while one measure or data source will only give a partial view of the whole picture (Silverman, 2004).
The researcher should identify participants of the research process. These will be adult patients with liver problems. In order to achieve the aim of the research, which is to find out the causes of liver failure among the adult patients, the researcher is required to come up with a research team (Silverman, 2004). When the participants have been identified, then the research team should be organized to serve as the governing body of research process to oversee the remedial measures and solutions to liver failure. A time table should be established and given to the research team and the research participants so that the task assigned to them will be accomplished within the stipulated time (Silverman, 2004). The research team and the research participants should cooperate with each other in conducting the action research project in order to find solution to the problem.
The researcher will then analyze the data after gathering it. The initial component of data analysis process will involve describing the data. In order to achieve this, the researcher will look for themes and repetitive concepts that merge. There may be pattern of those with liver failure being alcoholics or having a history of liver failure in their families (Silverman, 2004).
Interpreting the research results, disseminating the findings and recommending an action plan should be done after analyzing the data. The researcher should explain what he found out and what his results mean (Silverman, 2004). The actions to be taken on the problem of liver failure among the adults should also be explained in this stage. Research is most valuable and useful when the outcomes are communicated to audience in which behavior and understanding will be impacted (Silverman, 2004). Therefore, the researcher will communicate his findings to the health practitioners who will use the information to prevent further rise of liver failure problems among the adult patients.
The researcher decided to use action research methodology over other methods because it allows the researcher to determine not only what happened but also why it happened (Silverman, 2004). In addition, this method helps the researcher to place the study in the context of the environment in which it occurs. More over this research approach is also the best compared to other methods because it will help both the researcher and the adult patients with liver problems to gain more information from the research process when it attains greater sensitivity and self awareness of the problem (Silverman, 2004). Good relationship will be developed among research time, research participants and community. This qualitative approach will allow humanistic approach through involvement of everyone in solving the diabetes problem.
On the other hand, this research approach has some drawbacks in that it is sometimes difficult to generalize the results carried out from several people to represent the whole population. It is hard to extrapolate from the result of single case research into a larger context (Silverman, 2004). The other disadvantage is that the reliability of the results is similarly difficult to demonstrate, since the circumstances surrounding the research are so difficult to replicate. Another disadvantage of action research approach is that it requires continuous involvement in planning, taking action, observing the effects and reflecting. Also, if the way that action is undertaken tends to be limited to the pragmatic and commonsense level, it may be difficult to communicate the outcomes of the research (Silverman, 2004).
Compared to other approaches of qualitative research, action research approach method emphasizes the importance of giving attention to various views and opinions from different people (Silverman, 2004). Truth becomes a product of a process in which people come together to share experiences through a dynamic process of action, reflection and collective investigation. At the same time they remain firmly rooted in participants own conceptual world and interactions between them. Interpretive research approach unlike action research does take a lot longer time in the field work and also to analyze the material as well as writing it up (Silverman, 2004). The research method does not also have much breadth as compared to action research approach. It leads to in depth knowledge of particular context and situation. It is also difficult to write up the research for publication for a peer reviewed journal.
Action research approach method is also preferred than interpretive grounded theory because the interpretive grounded theory only looks at a particular situation and so it may not be possible to repeat the study (Silverman, 2004). On the other hand, interpretive grounded theory lacks full transparency because it is an interpretive method. It does not also offer advice on how to appraise studies for inclusion in a review (Silverman, 2004). This method also calls for the need to use careful sampling of items to analyze, for example, if each has it own bias and it consumes a lot of time to come up with a theory (Silverman, 2004).
Literature review
Liver failure is not common in childhood but it is common with adults. In adults, liver disease may come to light either following a clinically apparent episode of acute liver injury with jaundice and deranged liver function tests or more insidious with features of chronic liver disease (Lee & Williams, 1997).
Causes of liver failure in adults
Non-alcoholic liver disease
This includes a range of liver disorders which have similar features to alcoholic liver disorders but they occur in association with diabetes and obesity rather than alcohol (Lee & Williams, 1997). The rising cases of obesity in adults have resulted to increasing cases of non-alcoholic fatty liver disease.
Liver abscess
This is a collection of necrotic and acute inflammatory debris and fluids. It is mostly caused by bacteria and fungi that get to the liver through direct ascent up the billary tree. Liver abscess also occurs mostly to patients who are immune deficient or those on cancer chemotherapy or those patients who are very old or severely debilitated from chronic disease (Lee & Williams, 1997). Diagnosis in most of the time is missed or delayed because the symptoms of the absence are obscured by other serious clinical problems and therefore this may result to liver failure.
Toxic liver injury
Injury from drugs and toxins may result to adult liver failure. Liver metabolizes and excretes most drugs and other exogenous compounds in large amount thus resulting to its damage (Lee & Williams, 1997). There are two types of liver reactions on drugs and toxins. First are those that are dose related, that is, liver damage will occur if enough chemical is present. The second reaction occurs when people cannot metabolize a chemical. The chemical may initiate autoimmune hepatitis. This reaction is attributed to a very long list of drugs like halothane and sulfonamide antibiotics (Lee & Williams, 1997).
Alcohol
Alcoholism is the leading cause of liver failure in industrialized countries. About 20 million Americans abuse alcohol and about 25 percent hospitalized patients have some alcohol related problem (Lee & Williams, 1997). All alcoholics develop fatty livers and the first sign of alcohol injury is degeneration. Patients with fatty liver are usually asymptomatic though they may have mild elevations of liver enzyme levels in blood. Alcohol also causes cirrhosis which is the final and irreversible stage of alcoholic liver disease. It also causes hepatitis which is a chronic form of liver injury and it is characterized by inflammation, hepatocyte necrosis and early fibrosis which can progress to cirrhosis if alcohol abuse continues (Lee & Williams, 1997).
Hemochromatosis
This is a hereditary liver disease which affects the adults (Lee & Williams, 1997). This disease is as a result of defects in the genes which lead to iron accumulation in the liver thus causing cirrhosis. The small intestine absorbs iron but no excretory pathway particularly in men. All body iron reserves are stored in the liver, which is therefore affected directly by iron overload. Fully developed cases of iron deposits in the liver cause cirrhosis and this can lead to liver failure (Lee & Williams, 1997).
Fatty liver disease
This problem is very common with those people who are overweight because it is caused by excess built up fat in the liver. Fatty liver disease leads to liver failure in severe cases (Lee & Williams, 1997).
Treatment of liver diseases
Orthotropic liver transplant may be done which involves surgical procedure to remove the patients diseased native liver and replace it with a new organ in the same location (Lee & Williams, 1997). This procedure is an accepted treatment for most of irreversible liver diseases. The patient goes through donor transplantation which involves removal of the right hepatic lobe from a health individual and transplantation in to an adult recipient. Very small adult patients may be transplanted with the smaller left hepatic lobe which usually has fewer risks to the donor (Lee & Williams, 1997).
The other liver treatment method is cellular therapeutics which is done to help in biological functioning of the destroyed organ. This helps them to survive long enough in order to restore the normal functions of organs and tissues (Lee & Williams, 1997). Organs and tissues treated by this approach can perform their normal function more efficiently than those treated by conventional therapies like transplantation (Lee & Williams, 1997).
Adult haematopoietic stem cell for hepatocyte can also be used to treat liver diseases in adults. Stem cells are in-differentiated and highly clonogenic with self renew capacity and multi-lineage differentiation potential. They are also responsive to environmental cues (Lee & Williams, 1997). Adult bone marrow can give rise to different hepatic epithelial cells which makes it a good source for liver epithelial cell replacement. Human bone marrow cells are able to differentiate in to cells with liver like characteristics (Lee & Williams, 1997).
Conclusion
Qualitative research is meant to describe routine and problematic moments and meanings in individual. It helps the researcher to have a more comprehensive understanding of a specific phenomenon of interest (Silverman, 2004). Moreover, it also helps him to understand and explain unusual situations that could not be identified through large scale quantitative methods. This paper has analyzed qualitative research issues of liver failure among the adults. It has explained the causes of the disease and how to manage it. The research paper has also given the different qualitative research methodologies than can be used. In this research paper the researcher has preferred to use action research approach to investigate his research problem of liver failure among the adults.
Reference list
Lee, W., & Williams, R. (1997). Acute liver failure. Cambridge. Cambridge University Press.
Silverman, D. (2004). Qualitative research: theory, method and practice. Chicago. SAGE.