The researcher of the study has a previous history and knowledge in Critical Care Specialist Nursing. The following author is a professor of the Lewis School of Nursing, Georgia. The final author is an associate professor at the same educational establishment. Each person who helped to compose the study are registered nurses who have vast experience and qualifications in this field of nursing. Tarling & Crofts (2002) suggests that when evaluating research that the author(s) place of employment can indicate that the quality and authors suitability of the study is likely to be of a high standard.
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The abstract for this journal is headed clearly and gives a short and simple summary of the study. Firstly the abstract sates the goal of the study and why it has been carried out. The abstract gives the reader a brief account about the history of Chronic Obstructive Pulmonary Disease (COPD) on a worldwide status. It then goes on to suggest that Health Care Professionals have a limited understanding of the potential challenges COPD suffers can face, thus affecting their activities of daily living (ADL). The abstract also gives an indication of the methods and population sample they used to conduct the study. Finally the abstract concludes what the study has found. LoBiondo-Wood & Haber (2006a) state that the abstract is to provide the reader with a brief overview of the research, at the beginning of an article.
The researcher in this study has used a qualitative approach. Qualitative research is the gathering and analysis of information regarding meanings, emotions, experiences and views of the participants (Lanoe, 2002). This method of research is appropriate for this study as the main aim was to gain an understanding of how, severe COPD can affect older people’s lives. Qualitative research is fundamental in nursing as it focuses on previous evidence based practice, this is emphasised in the NMC Code of Conduct (2008a), which states that all nurses must deliver any care based on the best evidence.
The specific research tool used was the Hermeneutic Phenomenological method, which focuses on the meaning and experiences of an individual for a greater understanding of how participants interpret their world within their given context (Polit & Beck, 2004a). The researcher used the Hermeneutics approach in the study to try to gain an understanding of patient’s day-to-day lives at home while living with severe levels of COPD, and by asking the participant to translate their experiences into their own words and ideas. The author states within the article that Hermeneutic Phenomenological method has been selected as the most appropriate tool to use within this study as it is beneficial to gain an understanding of the participant’s general daily life while living with COPD. A negative point is that by Fraser et al (2006) using this type of approach may be that it only focuses on the participant’s present condition which would question whether or not the hermeneutical approach was appropriate to include in their design.
Rigour and validity are important in qualitative health research. Rigour ensures that research has been carried out to high standard and is from a credible, trustworthy source. Morse et al (2002) suggests that research that does not maintain rigour is worthless and loses its utility.
The rigour of this study was maintained by the author as she describes that the data was collected by an interviewing technique. The interviews were conducted within the participants own home or at a COPD clinic, this ensures the participants are within a familiar environment. Fraser et al (2006) also state how the participants were allocated and also gives a brief background of the participants, e.g. marital status and ethnicity. To ensure rigour was maintained the author asked two out of the ten participants to review the findings, each of the participants acknowledged a connection between their own perspective and the researchers.
Hek and Moule (2006) states that the main purpose of a literature review is to understand the research methods undertook by the author and to gain knowledge of the main subject.
Within the research article the author has summarised previous literature about the subject of choice, which is COPD. Fraser et al (2006) also states that qualitative studies have been carried out before into the affects of COPD but the author also maintains that her study is different as it focussed on people suffering from severe COPD whilst living at home. Although, Polit and Beck (2010a) explain that a literature review must critically appraise and compare prior studies and not just summarise the findings, this is apparent within this study. The researcher provides a brief background of the previous studied carried out on the effects of COPD whist living at home. Polit and Beck (2010b) remark on the dispute among researchers, as some researchers believe a prior literature review before undertaking qualitative research may have an influence on the author as well as the outcome of the study, thus making it bias. Other researchers believe that due to the nature of this type of study and the specific questions used within it, it would be somewhat uncommon to find an exact match to the proposed study.
The author has chosen to use a phenomenological method developed by Colaizzi in year of 1978 which involves a 7 step approach which the authors have outlined. Parahoo (2006) states that if a reference is greater than 5 year old, it is essential to consider if there is any literature that may be more up to date. D.D. Fraser may have considered using an alternative and more recent method, which may have been Moustakas (1994) method. Moustaka came up with some very specific techniques for phenomenological data analysis to help ensure validity. The author fails to state why Colazzi’s data analysis method is the most appropriate method to use in this type of research, although, Colaizzi’s methodological interpretation steps are a seminal piece of work which is used throughout nursing research.
There is a need for ethical guidelines within any study. The researcher has outlined ethical issues within the article. She was able to obtain approval from the hospital institutional review and ethics committee and also the university sponsoring the study.
When human beings are being used to conduct the study – just like in D.D. Fraser’s article – it is essential that care is taken to protect the rights of each participant (Polit & Beck, 2004b). This is similar to beneficence, which is, that the researcher has an obligation to benefit the participant and to ensure they come to no harm (LoBiondo-Wood & Haber, 2006b).
The ethical matter of non-malfeasance can be brought to question within this study. This is because Fraser et al (2006) emphasis that each participant has severe COPD, making them very breathless, and that simple task can feel like a chore but the researchers employ very detailed questions which could be very demanding for the participants.
Another ethical issue that has to be considered is confidentiality of the participants. The researcher has used pseudonyms which maintained privacy and anonymity. The article fails to mention how the tapes or transcripts were stored and if they were erased or destroyed upon completion of the study. Polit & Beck (2004c) suggest that all participants should have the right to anonymity and, that any of the data collected should kept confidential.
The researcher does not mention in the study if the participants were informed of their right to withdraw from the study at any time before agreeing to take part.
Fraser has decided to use a purposive sampling strategy for their research. A small sample of 10 participants were used for the study, five males and five females and all within the age range of 59 – 86. All participants where categorised as having severe COPD and all involved with the pulmonary rehabilitation programme and living at home. In general there are no specific rules or guidelines for sample size when conducting qualitative research. The sample size is usually determined by the specific needs of the researcher. Ryan et al (2007a) emphasises that the information gathered from the participants should build upon previous data collected and accumulated, thus providing significant information of the phenomenon. Anyone with a diagnosis of dementia or people cognitively impaired would be excluded from the study.
Data collection is the gathering of relevant information to address a specific research problem (Polit & Beck, 2006a). There are various forms of data collection methods. The type used by Fraser et al (2006) is an interviewing technique by asking opened ended questions. Ryan et al (2007b) suggests that the most common method of data collection used by researchers is an interviewing technique. D.D. Fraser outlines the personal interview questions she conducted within the research article. Polit & Beck (2006b) comment on this method and state a face-to-face interviewing technique is the most respected method of data collection due to the quality of information the researcher can gain. The questions were asked to the participants focussed on the effects that COPD had in their everyday lives as well as the episodes of dyspnoea. The researchers used interview tapes and transcripts to record the data.
The data analysis method used to understand the information gained from the participants was Colaizzi’s (1978) approach. Colazzi’s method requires the researcher to transcribe the interviews, read the transcripts and try and develop an insight and gain an understanding of the participant’s answers. This then allows the researcher to develop common themes that has developed throughout the research. Two independent researchers reviewed the findings and developed the themes using three main headings to represent them. This provides good acceptability and rigour of the research as the findings were analysed by two independent people reducing bias (Todres & Holloway 2006). The first theme identified was named “Knowing what works”, this explained how the participants manage their shortness of breath and what the patients knows and understand about the medication and techniques that works for them. The second theme identified by the researchers was “Hanging on barely”, which explains how the participants react when their usual management of COPD fails to give any relief. The final theme identified was “Losing control-Gaining control”, this gives details of how the participants adapt to their COPD in the general lives.
Fraser et al (2006) states the similarities their research has with the findings from previous studies. The previous studies showed that considerable research has found similar findings on the subject.
The authors outlined the strengths and limitations of the study. Polit & Beck (2010c) suggest that it is necessary for the researcher to understand the limitations and present these to the reader. They acknowledge that in qualitative research that a small sample in generally used. They study was also conducted in the USA and the participants involved had to have a diagnosis of severe COPD. They researchers also realise that the participants involved may have had a better knowledge and understanding of COPD and strategies to cope with it, therefore, this could have resulted in a positive outcome as patients without the same education may manage their condition differently.
The various effects this study could have on the nursing practice will be considered. The main implication for nursing practice is to provide patients with better education and techniques when the patient administers medications themselves e.g. inhalers. Corben (2009) suggests that nurses should demonstrate to the patient the correct methods that should be implemented when using an inhaler to ensure the medication is being administered correctly. Another implication identified is that by the nurse educating the patient on breathing techniques that is specific to the individual this could help to ease and support the patients in episodes of dyspnoea. A vital aspect when nursing for a patient with COPD is education and promoting self-care management (Coyer & Ramsbotham, 2006). This is again emphasised by the NMC Code of Conduct (2008b) which states that all nurses must help to support patients to care for themselves to improve their health.