General Descriptions
The title of the article reflects the general focus of the study, which is to evaluate the nurses’ perceptions and experience towards the subject of patient safety and existing protocols to ensure such. The first half of the title highlights the topic of interest, whereas the latter half outlines the target population. It does not give any spoilers as to the result of the study. The abstract presents the study purpose well, stating it in the first few lines of the section. It also features the study design, methods, and results, thus possessing all of the parts required, allowing for quicker and easier navigation at a glance (LoBiondo-Wood & Haber, 2017).
Limitations of the article, as depicted by the researchers, include participation bias (nurses who agreed for the interviews were already interested in the subject of patient safety, as well as a lack of male participants (Skagerstrom, Ericsson, Nilsen, Ekstedt, & Schildmeijer, 2017). Study strengths include a relative heterogeneity of the study sample due to different ages, work experiences, and departments, where nurses served (LoBiondo-Wood & Haber, 2017). The study also features increased levels of rigor due to the independent coding of the extracted data (Patterson & Dawson, 2017).
Descriptive Vividness
The study features adequate levels of factual accuracy in the descriptions of the participants and the setting. Nurse data features their gender, age, years of experience, as well as their current stationing, which are considered to be some of the main independent variables for the research (LoBiondo-Wood & Haber, 2017). To provide rich and varied data, the researchers used a purposeful sampling strategy. They recruited nurses from various facilities, as well as of different age and experience ranges, to provide a heterogeneous picture of nursing attitudes towards patient sampling.
The sampling method is considered adequate, as it allows to achieve a sample of nurses that represented a broad spectrum of perceptions and experiences concerning patient involvement in patient safety (Skagerstrom et al., 2017). The description of the report seems authentic, credible, and trustworthy, as it involves only the important details about the participants and the study itself, avoiding unnecessary details that may distract the reader from the core of the matter (Patterson & Dawson, 2017). Descriptions illustrate individuals that could have potentially been found in the described nursing settings.
Methodological Congruence
Documentation Rigor
The article identifies the need for present research in its problem statement, identifying a knowledge gap in the existing state of affairs as being too focused on the patient perspective, with a lack of input from nurses themselves (Skagerstrom et al., 2017). The purpose of the study is to address the knowledge gap, which is congruent with the problem statement. The research features a robust methodological framework, featuring semi-structured interviews followed by content analysis with separate coding of data, which indicates a sufficient level of documentation rigor (LoBiondo-Wood & Haber, 2017). The steps taken as part of these sections are clear and accurate. The discussion section is based on data as derived from the study as well as information derived from peer-reviewed sources, to gain a broader perspective and ensure that evaluations and conclusions are in line with the general state of research.
Procedural Rigor
The study followed a qualitative design due to the main method of data extraction being semi-structured interviews. The design of the study is considered appropriate for its announced purposes, which were to explore nurse opinions and perceptions of patient safety, which is inherently a qualitative matter (Patterson & Dawson, 2017). Standard sample sizes to ensure data saturation in deep explorative semi-structured interviews is 20-30 participants.
The number of nurses that went through the interviewing process is 19, which is closer to the lower end of the recommended number of participants, but still can be considered enough for data saturation purposes (Patterson & Dawson, 2017). To tap the participants’ experiences and knowledge of the phenomenon, the researchers conducted 1 test interview, which was not recorded. It showed that the questions were generic and open-ended enough to allow the participants to explore both. All of the actual interviews were recorded via a Dictaphone. Researchers did reflect on their own potential biases by noting that their definition of patient safety did not always correlate with the definition actively used by the participants.
Ethical Rigor
The reviewed study was performed by the World Medical Association Declaration of Helsinki’s ethical principles for medical research (Skagerstrom et al., 2017). As such, nurses were required to be informed of their rights before the start of the study. All participants gave their informed consent before undergoing the interviewing process (Skagerstrom et al., 2017). There is no indication of researchers failing to protect the participants’ rights during the conduct of the study.
The identity of the people who took part in the research does not seem to be compromised. The article does not feature any information that could be used for personal identification, such as first names, last names, or hospitals (LoBiondo-Wood & Haber, 2017). All of the data utilized as a part of the study had been properly anonymized. Due to the nature of the research, it did not require mandatory ethical approval from a committee.
Auditability
The data collection process was abundantly described in two separate parts of the article. In the namesake section, the researchers outlined the general trends in how the information was collected (Skagerstrom et al., 2017). In findings, it was elaborated on what kind of data was utilized, with examples of direct answers from the participants (Skagerstrom et al., 2017). Conclusions were formed based on the answers provided as well as the information found in secondary sources, which were used to triangulate the primary data and highlight important similarities and differences. Data was coded separately by three research participants, after which all three managed to independently arrive at similar conclusions, supporting the existing strength and rigor of the study (Patterson & Dawson, 2017).
Each of the researchers approached the task based on their education and experience, allowing for a multidisciplinary approach. The article does not specify what evidence or decision rules were utilized for conclusions, making it impossible to tell what motivated individual decisions. It does mention, however, that all conclusions were based on a consensus between researchers from a multidisciplinary perspective.
Analytical Preciseness
The article features several themes and categories, which were used to group data retrieved after semi-structured interviews. Those groups are as follows (Skagerstrom et al., 2017): dialogue, information, trustful relationship, patient initiatives, responsibility, active communication, interaction, safety, patient benefits, and health professionals’ ambivalent feelings for the subject. These criteria were specified based on a plethora of sources, including literature, initial questions, and nurse answers to such, guiding the researchers to utilize these themes and groupings.
They logically and thematically correspond to the chosen topic of learning about nurse perspectives towards patient safety (LoBiondo-Wood & Haber, 2017). Based on the provided bits and pieces of interviews to highlight important trends in the acquired data, it could be concluded that the inclusion and exclusion criteria for assigning data to themes and categories were consistently followed.
Heuristic Relevance
The article discovered that while nurses were, in general, encouraging and supportive of patient involvement in healthcare. However, they often stated that a nurse could not be held responsible for a lack of interest on the part of the patient to take an active part in their recovery (Skagerstrom et al., 2017). Interviews often showed that many nurses, no matter the levels of experience or the field of practice, encountered patients that were just disinterested in the process. Nurses were powerless to motivate such individuals due to a lack of knowledge or the situation being outside of their control (Skagerstrom et al., 2017).
The limitations of the article were clearly stated in the appropriate section, the primary issues being a lack of male representation and the selection bias. While the lack of male nurses can be explained by the fact that only 14-16% of all nurses in Sweden (where the study took place) are male, the potential for selection bias was a failure of the chosen sampling strategy – participants had to volunteer rather than be randomly selected and asked to join (Skagerstrom et al., 2017). No clear ways of avoiding the second bias were stated in the article.
References
LoBiondo-Wood, G., & Haber, J. (2017). Nursing research-E-book: methods and critical appraisal for evidence-based practice. St. Louis, MO: Elsevier Health Sciences.
Patterson, J., & Dawson, C. (2017). Critical appraisal of qualitative literature. Perspectives of the ASHA Special Interest Groups, 2(13), 122-128.
Skagerström, J., Ericsson, C., Nilsen, P., Ekstedt, M., & Schildmeijer, K. (2017). Patient involvement for improved patient safety: A qualitative study of nurses’ perceptions and experiences. Nursing open, 4(4), 230-239.