QualitativeCritical Appraisal Report: Nurses’ Experiences of Patients with Substance UseDisorder in Pain: A Phenomenological Study.

   AjegbileChristianah Oluwabunmi & Mercy OparaUNB-HumberCollege20thDecember 2017    Integrity Pledge We have maintained Academic Integrity in this work by adhering to thevalues of honesty and integrity. We declare that this work respects APArequirements as well as policies within the School of Health Sciences.    Student Name; Ajegbile Oluwabunmi Christianah Student Number:  N01036155  Student Name: Mercy Opara Student Number:  N01060920    Qualitative CriticalAppraisal        Some patients with Substance AbuseDisorder (SUD) and a pain condition do not receive the appropriate painmanagement because their requests for pain medication are perceived as drug-seekingbehavior. This topic is significant for nurses because of their role in painmanagement, and care for patients with SUD. Nurses who provide care forpatients with SUD are challenged when they ask for pain medications becausethey may be unable to identify their request as the legitimate need for painmedications. The purpose of this paper is to present a critical appraisal of aqualitative study investing nurses’ experience of patients with a paincondition and a substance abuse disorder requesting pain medication.  The phenomenon under study in this paper isnurses’ experiences of patients with SUD and in pain.

This paper will include asection on the critical appraisal of the different components of the researchreport and a discussion on the research use and evidence-based application ofthe study findings. Title.         Thetitle of Morley. G., Briggs. E., and Chumbley.

G., (2015) article entitled, Nurses’Experiences of Patients with Substance Use Disorder in Pain: A PhenomenologicalStudy, clearly suggests the key phenomenon and the group that is beingstudied. The phenomenon is Nurses’ Experiences of Patients with Substance UseDisorder in Pain: A Phenomenological Study (Morley et al., 2015). Abstract.         Theabstract concisely summarizes the actual features of the article and theexpected final research report. The purpose of the research which is to explore”Nurses’ experiences of patients with substance use disorder in pain, providingan in-depth insight into their perspectives were included (Morley et al., 2015,p.

701). Furthermore, the study’s background, design and method used incompleting the research findings and investigation as well as conclusions ofthe researchers were also included.IntroductionStatement of theProblem. Morley, Briggs and Chumbley (2015)presented the problem statement in an unambiguous way and made it easy toidentify.

They presented the problem statement in the section with the studypurpose and stated that the research problem as inadequate explanations of whypatients in UK hospitals with SUD receive poor pain management. The phenomenonof interest was clearly identified as nurses’ experience of patients with SUDin pain. There as a good match between the problem and the chosen paradigm ofthe qualitative approach. The qualitative approach is used to explore researchphenomena (Loiselle et al.

, 2011). This approach is appropriate because the aimof this study was to explore the phenomenon of nurses’ experience of patientswith SUD in pain. This problem has significance for nurses because of the roleof nurses in providing pain management for patients with SUD.Literature Review. Morley et al.

(2015) provided a thorough andup-to-date literature review with the majority of their sources publishedwithin the last ten years. The sources consisted mainly of primary sources;however, they included a variety of relevant sources such as textbooks on painmanagement and statistical data on drug abuse from internet governmentdocuments. The literature review provided a good summary of the existing bodyof knowledge on relevant topics such as nurses’ attitudes towards patients withSUD, and their attitudes towards patients with SUD in pain. They used theliterature review to demonstrate a gap in the body of knowledge regarding thetopic of interest laying a solid basis for the new study.Conceptual/TheoreticalUnderpinnings. Morley et al. (2015) did not define all thecomponents of the key phenomena conceptually. They discussed some of thecharacteristics of patients with SUD such as clockwatching and drug-seeking;also, they provided a brief definition of SUD.

They also discussedstigmatization of patients with SUD. Morley et al. used the descriptive phenomenologicalapproach based on Edmund Husserl’s method. The use of descriptive phenomenologyis appropriate for exploring the phenomenon of interest because of the focus onthe experience of the individuals involved in a situation. The descriptive phenomenologicalapproach focuses on a thorough description of situations as people experiencethose (Loiselle et al.

, 2011).Purpose and ResearchQuestions. Morley et al. (2015) explicitly stated andappropriately worded the research purpose by stating that the research purposewas to obtain a deeper understanding of the nurses’ experiences, and thebarriers between them and patients with SUD in pain. They did not present anyexplicit research questions in the report. This research purpose was consistentwith the literature review on the attitude of nurses towards patients with SUD,and the attitude of nurses towards patients with SUD experiencing pain. Theresearch purpose is also consistent with the research tradition of descriptivephenomenology. The outcome of the analysis of descriptive phenomenology is adescription of the meaning of the experiences of the research participants(Loiselle et al.

, 2011). The description of the experiences of the participantsin this study is appropriate because it would provide a deeper understanding oftheir experience.MethodResearch Design andResearch Tradition/Methodology. The research methodology of descriptivephenomenology in this study was congruent with the data collection method ofin-depth interviews. The phenomenological approach involves the use of in-depthconversations to gain access to the lived experiences of the researchparticipants (Loiselle et al., 2011). “Phenomenology”, as defined byMerleau-Ponty “is the study of essences”. In other words, it is the systematicattempt to uncover and describe the internal meaning structures of livedexperience that are intuited or grasped through a study of the particulars orinstances as they are encountered in lived experience (van Manen, M.

, 2017, p.3).  Morley et al. conducted the data analysisby using Giorgi’s five-stage method of data analysis that includes reading thetranscript, re-reading the transcript, expressing the insight from each unit,connecting the units together to understand the phenomenon, and identifying thecommon themes. Giorgi’s method is one of the methods used in descriptivephenomenology (Loiselle et al.). It was difficult to determine the specificamount of time spent with each of the participants. The researcher conducted anin-depth literature search and review, data collection, data analysis andconclusions in one year; however, Morley et al.

did not provide informationabout the time spent with the participants.             The design unfolded in the field because eventhough the researcher’s started with Husserl’s approach to phenomenology, theyused Giorgi’s method to perform the data analysis (Morley et al.).

  They kept a reflective diary throughout datacollection and analysis that provided evidence of reflexivity.  Morley et al. did not provide an adequatedescription of the number of contacts with the study participants making itdifficult to determine the adequacy of the contacts.Sample and Settings. Morley et al. (2015) did not provide anadequate description of the sample.

They described the sample aspost-registration nurses at the King’s College London, and stated that theinclusion criteria permitted nurses with a variety of experiences with patientswith SUD experiencing pain; however, they did not describe the inclusion andexclusion criteria. The use of email to gain access and recruit a conveniencesample of nurses was appropriate. The use of the snowballing sampling method inaddition to the convenience sampling method was not the most appropriate methodfor enhancing information richness. The snowballing sampling method enabledthem to identify additional nurses who were interested in the study and notthose who could provide rich-information about the phenomenon. The purposivesampling method would have been more appropriate. Palinkas et al. (2015) study supported its usein identifying and selecting rich information cases relevant to phenomenon ofinterest.

The purposive sampling method is used by researchers to selectparticipants with expertise on the phenomenon of interest whereas theconvenience sampling method does not provide the most information richparticipants (Loiselle et al., 2011). The small sample size of fiveparticipants was inadequate, and they did not describe attainment ofsaturation.Data Collection. The use of semi-structured interviews forthe data collection was appropriate for the research method of descriptivephenomenology. The data were collected through interviews only, and the use ofone data collection method did not allow them to achieve triangulation.Triangulation is achieved by collecting data from multiple sources such asnurses and patients, using multiple data collection methods and using multipleresearchers to collect data (Loiselle et al.

, 2011). The right questions wereused as probes and prompts.For example, the interview guide had probe questionlike “Can you describe how the experience made you feel” to explore theresponses and a prompt question like “And then what happened” (Morley et al.,2015, p. 711).Procedures.

 The data collection and recordingprocedures were not adequately described. Morley et al. (2015) minimized biasby using bracketing to document the researcher’s preconceived ideas andsuspending them to focus on the participants’ experiences. There was nodescription of training for the data collection staff.  Strategies to safeguard the rights of theparticipants included ethical approval and informed consent. Morley et al. failedto use other measures such as pledges of confidentiality and strategies tomaintain the privacy of stored research data.Rigour.

Morley et al implemented several measures toenhance trustworthiness such as dependability, confirmability, transferabilityand credibility. They provided an adequate description of each measure in thereport.ResultsData Analysis.

Morley et al. (2015) provided an adequatedescription of the data management and analysis methods by describing Giorgi’sfive stage method to data analysis in a table. Giorgi’s method is compatiblewith the research tradition of descriptive phenomenology and interview data.The analysis yielded themes and subthemes from the interview. The identifiedthemes and subthemes are consistent with the research tradition ofphenomenology.Findings. The findings were adequately summarized withnarratives and tables. Morley et al.

(2015) presented the themes and subthemesin a table to illustrate the main findings. They also presented a summary oftheir findings in a narrative in multiple sections with each sectionrepresenting a theme and consisting of multiple subthemes. They included the directquotation from the interviews in the narrative to adequately capture themeaning of the data. The analysis yielded a meaningful picture of the researchphenomenon because it provided a rich description of the main themes in thenurses’ experience of nurses’ experience of patients with SUD in pain such aspatient characteristics, patient management, psychosocial factors, pressuresand targets affecting pain management, and education and support needs, as wellas the related subthemes.TheoreticalIntegration. Morley et al. (2015) did not integrate theidentified themes in a logical pattern.

There were no maps, figure or modelssummarizing or illustrating the conceptions.DiscussionInterpretation ofFindings. All of the major findings were interpreted and discussedwithin the context of prior research. Morley et al. (2015) discussed each ofthe five subthemes in the context of relevant previous research findings. Theinterpretations were all consistent with the results.

Transferability wasattained by including direct quotations of the interviews in the researchreport.Implications. Morley et al. (2015) discussed clinicalimplications such as barrier to pain management from discrepancies betweenphysician and nurse pain management, poor interprofessional communication, theneed for interprofessional communication and the need for trainingcommunication in complex situations.

Furthermore, Morley et al. discussedfuture research exploration on concordance model of care. These barriers canhowever be reduced or eliminated to the barest minimum if nurses developleadership skills.

“Leadership requires self-knowledge (understanding one’sbeliefs and values and being aware of how one’s behaviour affects others),respect, trust, integrity, shared vision, learning, participation, goodcommunication techniques and the ability to be a change facilitator.” (CNO,2002, p. 10).Research Utilizationand Evidence-Based Practice. One of the main findings in this study isthe influence of workloads and staffing levels on the experience of nurses’ inpain management for patients with SUD; however, Morley et al.

(2015) did notdiscuss the implications of this finding. One practical clinical implicationwould be to ensure adequate staffing levels on units with SUD patients in pain. Duffield et al. (2011) study pointed that understaffinggreatly affect the quality of care given to the patient by HCP.  Anticipated barriers to this recommendationwould be resistance from management because of the additional cost ofimplementing this recommendation. I would address the resistance by discussingthe benefits of adequate staffing levels on pain management.Conclusion            A criticalappraisal was performed for a qualitative study investing nurses’ experience ofpatients with a pain condition and a substance abuse disorder requesting painmedication.

  The appraisal revealedstrengths of the study such as a congruence between the research purpose andmethod, a thorough and up-to-date literature review, an appropriate sample dataanalysis and strategies to implement rigour. The weaknesses of the studyinclude failure to integrate the identified themes into a pattern, lack of confidentialityand data privacy measures, and an inadequate description of the sample. The keylearning from the appraisal of the qualitative research study include enhancedknowledge in data collection methods, and data analysis methods congruent withthe qualitative tradition as well as measures for enhancing trustworthiness inqualitative studies.

                                                              ReferencesCollege of Nurses ofOntario. (2002). Practice Standard. ProfessionalStandard. Retrieved from            http://www.cno.

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(2011). Canadianessentials of nursing research (3rd edition). Philadelphia, PA: LippincottWilliams & Wilkins.Morley, G., Briggs, E.

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