Abstract
This paper evaluated the qualitative study conducted by Chen and Boore (2009). The study is about the experiences of family carers who took care of people dealing with the impact of spinal cord injury (SCI). The proponents of the study used a cross-sectional, descriptive, and explorative design based on criteria developed by Sandelowski & Barroso (2002). It was an evaluation matrix specifically designed to critique qualitative-type of research.
Chen and Boore (2009) were able to point out the key components of the research that is useful for future study in terms of the effect of care in the treatment of spinal cord injury. The research was also helpful in increasing knowledge with regards to spinal cord injury, specifically when it comes to the use of a family carer in rehabilitation nursing. It is the first qualitative study done in this field, which increases its importance.
Introduction
This paper evaluates the qualitative study conducted by Chen and Boore (2009). The proponents of this study explored the experiences of family carers assigned to people dealing with the impact of spinal cord injury (SCI). Chen and Boore (2009) used a cross-sectional, descriptive, and explorative design based on criteria developed by Sandelowski & Barroso (2002). It was an evaluative matrix used to analyze qualitative-type research.
Purpose of the Study
The proponents of the study made it clear that their goal was to collate information with regards to the interaction of family carers and their patients that are suffering from spinal cord injury. This was done using qualitative research techniques. The secondary purpose is to analyze the data gathered to determine how they can improve treatment and care of SCI. The research aims complemented the goal of family carers and the institutions that support them and it is to provide effective nursing care for the patients and their families whose lives were dramatically altered by the negative impact of SCI.
Literature Review
The researchers cited key studies and made sure to include relevant literature that will shed more light on the research problem. However, they did not provide more background information regarding the effect of the interaction between a family carer and a relative. They went through the process of reviewing literature with this in mind only after the main bulk of the data was collated and interpreted.
This is a significant misstep on their part because, by the principles of utilizing the ground theory approach, researchers need to have thorough knowledge about an aspect of the research problem to minimize bias and not to be influenced by existing theory. Throughout the study, the appropriate citation was made to point out the source of the information. The literature review supported and enhanced the research design.
Methodology
The researchers conducted a qualitative study, based on the grounded theory approach. The goal was to have a deeper understanding of the experience of family carers when it comes to dealing with patients suffering from SCI. The technique used was appropriate because the primary goal of the study was to gather information and make conclusions not based on existing theories and the work of other researchers but only from research data that was observed and recorded throughout the research process.
The method grounded theory approach was used to capture the reality of family carers’ experiences and needs based on what they perceive their situation and not from the opinions of other people who had no idea what it means to deal with people suffering from SCI.
The researchers reviewed different approaches to the grounded theory which resulted in using Strauss and Corbin’s style of sampling and memoranda writing (Strauss & Corbin 1990, 1998). They also utilized theoretical coding as proposed by Glaser (1978). The researchers were able to follow the research design in an orderly and accurate manner.
Sampling Strategy and Techniques
The researchers identified theoretical sampling of participants as a recruitment strategy. Although, the sampling plan they explained fits the overall research design they misused the term “theoretical sampling” when referring to sampling techniques.
According to Glaser and Strauss (1967) “ theoretical sampling is the process of data collection for generating theory whereby the analyst jointly collects, codes, and analyzes his data and decides what data to collect next and where to find them, to develop his theory as it emerges. This process is controlled by the emerging theory” (Glaser and Strauss, 1967, p.45).
Therefore, theoretical sampling is a data collection method, not a sampling technique, and using this term interchangeably under-sampling and data collection confuses the reader. The error made by the researchers may have been the result of their interpretation of Strauss and Corbin’s style of sampling. This is because Strauss and Corbin made a complicated description of the process of theoretical sampling as being open, relational, variational, and discriminate sampling (Strauss & Corbin 1990, 1998).
Combining Strauss and Corbin’s approach with that of Glaser’s was critical to the success of the research because they had different approaches to grounded theory. Glaser grounded theory emphasizes induction, emergence, and creativity within a clear framework (Glaser and Strauss, 1967), while Strauss is interested in a systematic approach and validation criteria (Strauss & Corbin 1990, 1998).
Regardless of the approach used, the sampling plan was described accurately under the data collection section. The demographic data, characteristics of family carers participating in this study, the interviews as well as group discussions were outlined in Tables 1 & 2.
Sample
The sample size consisted of 15 participants. Eight of the said fifteen participants were interviewed one-on-one. The rest of the family carers joined in the group discussions conducted throughout the research process. Those who were part of the group discussion shared their experiences in caring for patients with spinal cord injuries. The recruitment sites were not documented explicitly, it was only mentioned in the abstract section that the study took place in a rehabilitation hospital in Taiwan.
The researchers used comparison methods, asked pertinent questions, kept notes and diagrammatic records, and checked on their review of related literature, which was done at the same time as the interviews and group discussions were conducted. Sample size and configuration fit the purpose and sampling strategy. Additionally, inclusion and exclusion criteria are appropriate and clearly defined to fit the research aims.
Data Collection Techniques and Sources
In qualitative research, it is well established that the researcher is considered the chief data collector. The article pointed out the expertise of one of the researchers in grounded theory. It was also mentioned that the researchers were already experienced when it comes to conducting interviews and facilitating group discussions and this could explain their high competency when it comes to data collection and analysis. They used semi-structured, tape-recorded interviews and observation of a group discussion.
In this study, the researchers conducted their interviews utilizing open-ended questions. The family carers were first asked to share their experience of looking after relatives suffering from SCI. When data gathered corresponded to a particular theory, it was only when the researchers thought of potential categories, their properties, and dimensions. The interview questions were used to reformulate central issues of the interview and helped inform the next interview, the group discussion, and observations.
Table 3 shows sampling at the relational and variational phase, which consisted of re-interviewing one family carer for a patient suffering from tetraplegia and one carer who was dealing with a patient with paraplegia. This was done to clarify the differences between the major categories. The researcher observed religious activities and tried to understand how religious beliefs played a role in the way family carers deal with the patients.
Additionally, issues that were identified through individual interviews, were used to improve group discussions. After the core category ‘living with a relative who has a spinal cord injury’ emerged, theoretical sampling to further develop the core category involved re-interviewing one family carer caring for a patient with paraplegia, along with two newly recruited participants who cared for patients with tetraplegia.
The period for data collection is not explicitly stated, however, they mentioned that the interviews and the observation lasted 50–140 minutes. The data collection techniques fit the purpose of the study and are accurately rendered. The sources of data presented are demonstrably the basis of the findings, however, the data collection techniques, specifically theoretical sampling is the correct method for data collection in grounded theory but not the sampling method as addressed earlier. Researchers should have paid careful attention to the use of critical terms.
Data Management
Data management techniques were not addressed explicitly, however, the researchers pointed out that they spent several months collating data and interpreting them. Data management techniques were not accurately rendered. The researchers did not explain the plan for analytically linking data gleaned from interviews, group discussions, and observation.
Findings
There was a distinct set of results distinguishable from the data researchers collected. The researcher documented the findings that resulted in the core category ‘living with a relative who has a spinal cord injury, and they also identified the experiences of family carers who took care of a relative with spinal cord injury. Additionally, the researchers identified three stages with four conceptual categories to describe the core category of living with a relative who has an SCI.
They said that being a catastrophic event in their lives is stage 1. The need to confront the challenges ahead of them was stage 2. The reality of family resilience and family breakdown was stage 3. Descriptions in each of these categories included direct quotes taken from the interviews and group discussions. The direct quotes from the interviews provided information that served to convey patterns in the participant’s experience when it comes to taking care of a relative with SCI.
This allowed others who study their research design and outcomes to reach a systematic and consistent view of the phenomenon while offering new information about the target phenomenon. Conceptualizations of data are demonstrably credible and data are sufficiently analyzed and interpreted. Additionally, concepts are well developed and there is unity in the whole research design. The interpretation of data and the conclusions made were all relevant in the attempt to use the study to enhance nursing care especially when it comes to patients with SCI.
Discussion
The researchers were able to explain the significance of their findings and how it was linked to related studies conducted in the past. Building on their findings that family care is important and that nursing care must not only be limited to hired help but also assistance and care from family members as well.
Moreover, the researchers explained the result of their study from the perspective of Human Becoming developed by Parse. The researchers documented the rationale for using this approach, as each family with a relative who suffering from SCI has its view of this lived experience. The researchers creatively linked the identified concepts in an explicit sentence that guides the reader for a better understanding of the relationship between related concepts.
In the end, they were able to conclude, “The family carer’s experience of looking after a relative who has SCI moves forward from a catastrophic life event to confronting challenges, to family resilience or breakdown” (Chen and Boore, 2009, p. 181). These three stages were identified from the viewpoint of family carers and were clarified once again in the discussion section. The researcher’s findings were linked to relevant literature and findings in other studies, which were newly introduced in this section. Additionally, recommendations for future studies were identified for each stage in this section.
Recommendations
Recommendations for further studies were identified but not grouped in one section. The recommendations were scattered all over the article. For example under the category of “confronting changes”, they recommended further research on family carers’ intimate needs.
They also recommended further study to explore the concept of ‘family resilience’ related to Taiwanese family carers under the category of family resilience. Finally, under the implications for nursing practice, they recommended further studies that could be guided by Parse’s Human Becoming Theory and her idea on how to investigate the meaning of the lived experiences.
Validity
Limitations of the study were not documented. Techniques for validation are used that fit the purpose, method, sample, data, and findings. The researchers developed a clear method of confirming their data analysis and maintaining trustworthiness throughout this study. It was documented that one of the researchers immersed himself in the study for several months after data collation by listening and transcribing the tapes, reading the transcriptions, interpreting, understanding, and formulating the findings, concepts and categories.
The researchers used specific techniques to enhance credibility, these techniques included prolonged engagement, constant observation, triangulation, member checking, and expert review. The researchers also documented applying absolute honesty to representing the process of data analysis for the efforts of ensuring the validity of the study.
The researchers used audit trail techniques to ensure that findings and conceptualization that will lead others to make the same conclusions which enhances the credibility of the research. It is evident through this study that techniques for validation were used correctly and effectively.
Ethics
The investigators obtained Ethics approval from the University Ethics Committee and also from Institution Review Board (IRB). Additionally, informed consent was obtained from all the participants. Most importantly, the article documented examples of data, which provided evidence to support findings that have analytical value and present subjects fairly. All information provided was treated with strict confidentiality.
Form
The overall literary expertise of the researchers is evident throughout the study and can be seen in the well-crafted research design. Despite this, the researchers were foreigners and this explains the use of the term “carers” instead of caregivers. The term carer is typically used in the United Kingdom, New Zealand, and Australia.
The term caregiver, however, is the term used in the United States and Canada. Nevertheless, the report was written coherently and logically and components of the research report guiding the reader to a better understanding of the study and the core category.
Specifically, data were explained clearly and helped the readers to understand the concepts used and the overall meaning of the research. Furthermore, the three stages including the four categories that emerged from the research were described in detail and easily accessible by the average reader. The researchers were able to visualize the process of how a family carer deals with a relative with SCI.
Conclusions
This study was published in a peer-reviewed journal and as a result, it was a major source of information when it comes to a family-centered approach in clinical care especially when it comes to family carers taking care of a relative with SCI. This article was evaluated using the standards found in the evaluation matrix developed by Sandelowski & Barroso (2002). The researcher was able to meet most of the standards in all categories outlined in the assessment tool.
The researchers have successfully investigated the reality of family carers helping a family member with a spinal cord injury and they were able to have a clear understanding of what it means to be in their shoes. Through data collection, saturation was reached and concepts were developed which provided the reader new insight and emphasized the importance of understanding the experiences and needs of family carers to provide effective rehabilitation.
Although this study was conducted in Taiwan, and findings might not be relevant to family carers living in other countries, just the same, the study made a significant contribution to research in the field of spinal cord injury and the use of a family carer in rehabilitation nursing. This is because it was the first study conducted using the said approach.
References
Chen, H, & Boore, J R. (2009). Living with a relative who has a spinal cord injury: a grounded theory approach. Journal of Clinical Nursing, 18(2), 174-182.
Glaser, B. G. & Strauss, A. L. (1967). The discovery of grounded theory: strategies for qualitative research. Somerset, NJ: Aldine.
Sandelowski, M, & Barroso, J. (2002). Reading qualitative studies. International Journal of Qualitative Methods, 1(1), 1-47.
Strauss, A. & Corbin, J. (1990). Basics of Qualitative Research: Grounded Theory Procedures and Techniques. London: SAGE.
Strauss, A. & Corbin, J. (1998). Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. London: SAGE.