Critical Appraisal Report: Nurses’ Experiences of Patients with Substance Use
Disorder in Pain: A Phenomenological Study.




Christianah Oluwabunmi & Mercy Opara

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December 2017





Integrity Pledge


We have maintained Academic Integrity in this work by adhering to the
values of honesty and integrity. We declare that this work respects APA
requirements 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 Critical

        Some patients with Substance Abuse
Disorder (SUD) and a pain condition do not receive the appropriate pain
management because their requests for pain medication are perceived as drug-seeking
behavior. This topic is significant for nurses because of their role in pain
management, and care for patients with SUD. Nurses who provide care for
patients with SUD are challenged when they ask for pain medications because
they may be unable to identify their request as the legitimate need for pain
medications. The purpose of this paper is to present a critical appraisal of a
qualitative study investing nurses’ experience of patients with a pain
condition and a substance abuse disorder requesting pain medication.  The phenomenon under study in this paper is
nurses’ experiences of patients with SUD and in pain. This paper will include a
section on the critical appraisal of the different components of the research
report and a discussion on the research use and evidence-based application of
the study findings.


title of Morley. G., Briggs. E., and Chumbley. G., (2015) article entitled, Nurses’
Experiences of Patients with Substance Use Disorder in Pain: A Phenomenological
Study, clearly suggests the key phenomenon and the group that is being
studied. The phenomenon is Nurses’ Experiences of Patients with Substance Use
Disorder in Pain: A Phenomenological Study (Morley et al., 2015).


abstract concisely summarizes the actual features of the article and the
expected final research report. The purpose of the research which is to explore
“Nurses’ experiences of patients with substance use disorder in pain, providing
an in-depth insight into their perspectives were included (Morley et al., 2015,
p. 701). Furthermore, the study’s background, design and method used in
completing the research findings and investigation as well as conclusions of
the researchers were also included.


Statement of the

 Morley, Briggs and Chumbley (2015)
presented the problem statement in an unambiguous way and made it easy to
identify. They presented the problem statement in the section with the study
purpose and stated that the research problem as inadequate explanations of why
patients in UK hospitals with SUD receive poor pain management. The phenomenon
of interest was clearly identified as nurses’ experience of patients with SUD
in pain. There as a good match between the problem and the chosen paradigm of
the qualitative approach. The qualitative approach is used to explore research
phenomena (Loiselle et al., 2011). This approach is appropriate because the aim
of this study was to explore the phenomenon of nurses’ experience of patients
with SUD in pain. This problem has significance for nurses because of the role
of nurses in providing pain management for patients with SUD.

Literature Review.

Morley et al. (2015) provided a thorough and
up-to-date literature review with the majority of their sources published
within the last ten years. The sources consisted mainly of primary sources;
however, they included a variety of relevant sources such as textbooks on pain
management and statistical data on drug abuse from internet government
documents. The literature review provided a good summary of the existing body
of knowledge on relevant topics such as nurses’ attitudes towards patients with
SUD, and their attitudes towards patients with SUD in pain. They used the
literature review to demonstrate a gap in the body of knowledge regarding the
topic of interest laying a solid basis for the new study.


Morley et al. (2015) did not define all the
components of the key phenomena conceptually. They discussed some of the
characteristics of patients with SUD such as clockwatching and drug-seeking;
also, they provided a brief definition of SUD. They also discussed
stigmatization of patients with SUD. Morley et al. used the descriptive phenomenological
approach based on Edmund Husserl’s method. The use of descriptive phenomenology
is appropriate for exploring the phenomenon of interest because of the focus on
the experience of the individuals involved in a situation. The descriptive phenomenological
approach focuses on a thorough description of situations as people experience
those (Loiselle et al., 2011).

Purpose and Research

Morley et al. (2015) explicitly stated and
appropriately worded the research purpose by stating that the research purpose
was to obtain a deeper understanding of the nurses’ experiences, and the
barriers between them and patients with SUD in pain. They did not present any
explicit research questions in the report. This research purpose was consistent
with the literature review on the attitude of nurses towards patients with SUD,
and the attitude of nurses towards patients with SUD experiencing pain. The
research purpose is also consistent with the research tradition of descriptive
phenomenology. The outcome of the analysis of descriptive phenomenology is a
description of the meaning of the experiences of the research participants
(Loiselle et al., 2011). The description of the experiences of the participants
in this study is appropriate because it would provide a deeper understanding of
their experience.


Research Design and
Research Tradition/Methodology.

 The research methodology of descriptive
phenomenology in this study was congruent with the data collection method of
in-depth interviews. The phenomenological approach involves the use of in-depth
conversations to gain access to the lived experiences of the research
participants (Loiselle et al., 2011). “Phenomenology”, as defined by
Merleau-Ponty “is the study of essences”. In other words, it is the systematic
attempt to uncover and describe the internal meaning structures of lived
experience that are intuited or grasped through a study of the particulars or
instances as they are encountered in lived experience (van Manen, M., 2017, p.
3).  Morley et al. conducted the data analysis
by using Giorgi’s five-stage method of data analysis that includes reading the
transcript, re-reading the transcript, expressing the insight from each unit,
connecting the units together to understand the phenomenon, and identifying the
common themes. Giorgi’s method is one of the methods used in descriptive
phenomenology (Loiselle et al.). It was difficult to determine the specific
amount of time spent with each of the participants. The researcher conducted an
in-depth literature search and review, data collection, data analysis and
conclusions in one year; however, Morley et al. did not provide information
about the time spent with the participants.

             The design unfolded in the field because even
though the researcher’s started with Husserl’s approach to phenomenology, they
used Giorgi’s method to perform the data analysis (Morley et al.).  They kept a reflective diary throughout data
collection and analysis that provided evidence of reflexivity.  Morley et al. did not provide an adequate
description of the number of contacts with the study participants making it
difficult to determine the adequacy of the contacts.

Sample and Settings.

Morley et al. (2015) did not provide an
adequate description of the sample. They described the sample as
post-registration nurses at the King’s College London, and stated that the
inclusion criteria permitted nurses with a variety of experiences with patients
with SUD experiencing pain; however, they did not describe the inclusion and
exclusion criteria. The use of email to gain access and recruit a convenience
sample of nurses was appropriate. The use of the snowballing sampling method in
addition to the convenience sampling method was not the most appropriate method
for enhancing information richness. The snowballing sampling method enabled
them to identify additional nurses who were interested in the study and not
those who could provide rich-information about the phenomenon. The purposive
sampling method would have been more appropriate. Palinkas et al. (2015) study supported its use
in identifying and selecting rich information cases relevant to phenomenon of
interest. The purposive sampling method is used by researchers to select
participants with expertise on the phenomenon of interest whereas the
convenience sampling method does not provide the most information rich
participants (Loiselle et al., 2011). The small sample size of five
participants was inadequate, and they did not describe attainment of

Data Collection.

The use of semi-structured interviews for
the data collection was appropriate for the research method of descriptive
phenomenology. The data were collected through interviews only, and the use of
one data collection method did not allow them to achieve triangulation.
Triangulation is achieved by collecting data from multiple sources such as
nurses and patients, using multiple data collection methods and using multiple
researchers to collect data (Loiselle et al., 2011). The right questions were
used as probes and prompts.For example, the interview guide had probe question
like “Can you describe how the experience made you feel” to explore the
responses and a prompt question like “And then what happened” (Morley et al.,
2015, p. 711).


 The data collection and recording
procedures were not adequately described. Morley et al. (2015) minimized bias
by using bracketing to document the researcher’s preconceived ideas and
suspending them to focus on the participants’ experiences. There was no
description of training for the data collection staff.  Strategies to safeguard the rights of the
participants included ethical approval and informed consent. Morley et al. failed
to use other measures such as pledges of confidentiality and strategies to
maintain the privacy of stored research data.


Morley et al implemented several measures to
enhance trustworthiness such as dependability, confirmability, transferability
and credibility. They provided an adequate description of each measure in the


Data Analysis.

Morley et al. (2015) provided an adequate
description of the data management and analysis methods by describing Giorgi’s
five stage method to data analysis in a table. Giorgi’s method is compatible
with the research tradition of descriptive phenomenology and interview data.
The analysis yielded themes and subthemes from the interview. The identified
themes and subthemes are consistent with the research tradition of


The findings were adequately summarized with
narratives and tables. Morley et al. (2015) presented the themes and subthemes
in a table to illustrate the main findings. They also presented a summary of
their findings in a narrative in multiple sections with each section
representing a theme and consisting of multiple subthemes. They included the direct
quotation from the interviews in the narrative to adequately capture the
meaning of the data. The analysis yielded a meaningful picture of the research
phenomenon because it provided a rich description of the main themes in the
nurses’ experience of nurses’ experience of patients with SUD in pain such as
patient characteristics, patient management, psychosocial factors, pressures
and targets affecting pain management, and education and support needs, as well
as the related subthemes.


 Morley et al. (2015) did not integrate the
identified themes in a logical pattern. There were no maps, figure or models
summarizing or illustrating the conceptions.


Interpretation of

All of the major findings were interpreted and discussed
within the context of prior research. Morley et al. (2015) discussed each of
the five subthemes in the context of relevant previous research findings. The
interpretations were all consistent with the results. Transferability was
attained by including direct quotations of the interviews in the research


 Morley et al. (2015) discussed clinical
implications such as barrier to pain management from discrepancies between
physician and nurse pain management, poor interprofessional communication, the
need for interprofessional communication and the need for training
communication in complex situations. Furthermore, Morley et al. discussed
future research exploration on concordance model of care. These barriers can
however be reduced or eliminated to the barest minimum if nurses develop
leadership skills. “Leadership requires self-knowledge (understanding one’s
beliefs and values and being aware of how one’s behaviour affects others),
respect, trust, integrity, shared vision, learning, participation, good
communication techniques and the ability to be a change facilitator.” (CNO,
2002, p. 10).

Research Utilization
and Evidence-Based Practice.

 One of the main findings in this study is
the influence of workloads and staffing levels on the experience of nurses’ in
pain management for patients with SUD; however, Morley et al. (2015) did not
discuss the implications of this finding. One practical clinical implication
would be to ensure adequate staffing levels on units with SUD patients in pain. Duffield et al. (2011) study pointed that understaffing
greatly affect the quality of care given to the patient by HCP.  Anticipated barriers to this recommendation
would be resistance from management because of the additional cost of
implementing this recommendation. I would address the resistance by discussing
the benefits of adequate staffing levels on pain management.


            A critical
appraisal was performed for a qualitative study investing nurses’ experience of
patients with a pain condition and a substance abuse disorder requesting pain
medication.  The appraisal revealed
strengths of the study such as a congruence between the research purpose and
method, a thorough and up-to-date literature review, an appropriate sample data
analysis and strategies to implement rigour. The weaknesses of the study
include failure to integrate the identified themes into a pattern, lack of confidentiality
and data privacy measures, and an inadequate description of the sample. The key
learning from the appraisal of the qualitative research study include enhanced
knowledge in data collection methods, and data analysis methods congruent with
the qualitative tradition as well as measures for enhancing trustworthiness in
qualitative studies.



College of Nurses of
Ontario. (2002). Practice Standard. Professional
Standard. Retrieved from


Duffield, C., Diers, D., O’Brien-Pallas, L., Aisbett, C., Roche, M.,
King, M., & Aisbett, K. (2011). Nursing staffing, nursing workload, the
work environment and patient outcomes. Applied nursing research, 24(4),

Loiselle, C.G., Profetto-McGrath, J.,
Polit, D. F., & Beck, C. T. (2011). Canadian
essentials of nursing research (3rd edition). Philadelphia, PA: Lippincott
Williams & Wilkins.

Morley, G., Briggs, E., & Chumbley, G.
(2015).  Nurses’ experiences of patients
with substance-use disorder in pain: A phenomenological study. Pain Management, 16(5), 7011-711.

Palinkas, L. A., Horwitz, S. M., Green, C. A., Wisdom, J. P., Duan, N.,
& Hoagwood, K. (2015). Purposeful sampling for qualitative data collection
and analysis in mixed method implementation research. Administration
and Policy in Mental Health and Mental Health Services Research, 42(5),

Van Manen, M., (2017). Phenomenology and
Meaning Attribution. A review of John Paley. (2017). Phenomenology as
Qualitative Research: A Critical Analysis of Meaning Attribution. London &
New York: Routledge.


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