Nursing Research Methods Paper Example Essay

Nursing care is provided to people with diverse health and sick care needs in multiple contexts all over the world. The competence and knowledge required to meet the varied care needs may be overwhelming even for experienced registered nurses. However, various nursing programs have been designed to allow the knowledge not only to be accumulated but also assimilated by nurses. This section reviews the literature regarding effective nursing interventions to improve the physical health of people with learning disabilities.Nursing Research Methods Paper Example Essay

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Literature Review of Nursing Research for People with Learning Disabilities
To start with, Hithersay, Strydom, Moulster, and Buszewicz (2014) conducted a review of health interventions in various health settings and populations in order to investigate the potential roles of carers in learning disability healthcare. In the study, the researchers sought to highlight the important role that nurses play in assessing, monitoring, and promoting the health of people with learning disabilities. These intervention strategies are critical in improving the health outcome of the target population.

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The investigators used rapid systematic review methodology with a scale that runs from 1A to 5. 1A provided the highest evidence possible, while 5 had the lowest possible score on interventions based on expert opinion. The results of the scores showed that one of the care-led interventions for the nurses was to work closely with parents in managing childhood obesity and overweight in children with learning disabilities. This health promotion intervention strategy was important because of the serious health problem that obesity poses to the life of people with learning disabilities. To achieve this health intervention objective, nurses should help parents understand the need for behavior change, healthy lifestyle as well as training, especially for parents whose children are overweight. The strategies are more likely to assist in reducing the body mass index (BMI) significantly in children with learning disabilities.Nursing Research Methods Paper Example Essay

During the study, the BMI of the control group without the interventions did not represent positive outcomes. This factor indicates that where the nurses do not intervene through any of the suggested strategies, children with learning disabilities are unlikely to have positive outcomes. From the combined reviews on the topic, it was found that targeting parents was favorable for health improvements in health promotion or the healthier lifestyles of their children. Importantly, parenting and healthy lifestyles skills training had the potential of reducing food consumption in children with learning disabilities and their BMI.Nursing Research Methods Paper Example Essay
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Additionally, caloric food consumption resulted in increasing the risk of weight gain and obesity, which are considered important aspects of learning disability in children. The investigators reported that to deal with the problem of poor parenting and healthy lifestyle skills, nurses needed to provide nursing educational materials focusing on dietary management. Such materials provide vital information that would change the parental perception of the intake of certain classes of food. The parental-care-led interventions were critical in symptom monitoring and management, health promotion, mental as well as physical health screening procedures (Hithersay et al., 2014).Nursing Research Methods Paper Example Essay

Where persons with a learning disability take unhealthy foods, such as the ones that increase weight, nurses could have advised carers to change the diet to more proper ration. Nurses also explained how to exercise as a way of promoting healthy lifestyles. The source is useful in covering the studied topic since it emphasizes the importance of recognizing that nurses, through their training, have the necessary skills and knowledge to conduct screening tests to diagnose both physical and mental challenges, and then advise carers accordingly.

In another research, under the guideline of the Foundation for People with Learning Disabilities, Burke (2014) compiled a report to show how nurses were raising awareness among health care and social service providers, commissioners, and policymakers as an intervention strategy to enhance the wellbeing of people living with learning disabilities. The investigation was conducted after the realization of the inequalities that occur in the way the target audience receives health and social support. However, the services offered to people with learning disabilities need to be person-centered and of a high standard. Although there are many initiatives to reduce the stigma associated with mental health, persons with learning disabilities have continued to face various difficulties in accessing mental health services as compared to other groups.Nursing Research Methods Paper Example Essay

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The Foundation for People with Learning Disabilities, working with an established reference group of people with learning disabilities, identified cognitive behavior therapy as an invention strategy that nurses can use to improve the wellbeing of people with learning disabilities. From the responses of 197 people between the ages of 16 to 65, 8.6% of the respondents recorded physical pain as one of the most common issues that people with learning disabilities are likely to experience (Burke, 2014). Learning disability nurses were identified to be in a good position to provide cognitive behavior therapy.Nursing Research Methods Paper Example Essay

This method of nursing intervention was proposed given it has been applied more successfully in the target group rather than in the general population. Nurses can promote social desirability, ensure acquiescence, and deal with problems of incomprehension and anxiety efficiently in light of this framework (Burke, 2014). Nurses can help carers to identify the problems through pictorial materials as well as through supplementary questions that help to assess comprehension (Burke, 2014).

Therefore, the recommendation is that a nurse as a specialist in learning disability lead could be appointed to advise and assist in addressing the needs of people with learning disabilities. Such nurses can provide health checks and health action plans through regular audits to be shared with local health boards in order to promote the wellbeing of those with learning disabilities (Burke, 2014).Nursing Research Methods Paper Example Essay

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Similarly, Robertson, Roberts and Emerson (2010) conducted a systematic review on health check as an intervention for the analyzed audience. Based on the implementation of annual health checks for learning disabled people in England, the findings allow an opportunity to develop competent health policy responses. To achieve the objective of the research, the researchers were involved in the identification of related peer-reviewed articles. A sum of 38 of such articles was considered from nearly 800 participants, just 5 people less. The samples covered age and range severity of learning disabilities. The studies reviewed by Robertson et al. (2010) had information gathered through the interviews or questionnaires and cross-sectional surveys. The studies used were those that expressed the views of practice nurses, carers, and service users.

The sections covered in the review included health promotion information on weight, blood pressure, height, BMI, urine analysis, cholesterol level cervical screening, and immunization status. The investigation also included chronic illness inquiry on the cardiovascular, respiratory, central nervous, abdominal, gynecological and genitor-urinary systems. The forth content was information on epilepsy along with with behavior information on self-injuries, aggressive, overactive and other challenging behavior. The fifth section was on physical examination information on vision, respiratory systems, cardiovascular system, hearing, abdomen, mobility, communication, breast examination, and dermatology. Finally, there was a section on medication information, such as indicating the dosage, side effects and levels of medication in the blood.Nursing Research Methods Paper Example Essay

The studies used in the review provided data from such countries as the United Kingdom, Australia and the United States (Robertson et al., 2010). In the UK, multidisciplinary clinic checks taken in a learning disability hospital on 35 people with Down’s syndrome identified specific health needs, including pain, vision, hearing suspected dementia, and mental disorder as some of the areas that demanded keen focus (Robertson et al., 2010).

The role of the disability nurse in explaining the effects of these health needs was highlighted as critical in the study. The investigators identified a number of health conditions affecting people with learning disabilities that required nursing interventions to improve physical health. They were overweight or obesity, vision impairment, referral for testing, and undescended testicles (Robertson et al., 2010). The study referred to another research conducted in the US, which provided information on the comprehensive geriatric assessment conducted in 41 elderly people with learning disabilities. The assessments were conducted by a geriatric nurse practitioner, a psychiatric nurse practitioner, a geriatrician, and a geriatric dental fellow.Nursing Research Methods Paper Example Essay

The material highlights an important role of nurses in diagnosing previously undetected conditions, such as anemia, skin cancer, hypothyroidism, and hyperlipidemia, all of which affect the physical wellbeing of people with learning disabilities (Robertson et al., 2010). Importantly, this study showed that an in-home intervention involving a comprehensive geriatric assessment by an advanced practice nurse was notable in improving the health of people with learning disabilities. The significance of the study was particularly fit for learning disability patients with sadness or depression, seizure disorder, sleep, hearing loss, ear wax, pain, and constipation (Robertson et al., 2010).Nursing Research Methods Paper Example Essay

Conclusion
There are a number of other conditions for which the role of advanced practice nurses in providing information and care for patients with disabilities was critical. They are hemophilia, vaginal bleeding, chest pain, diabetes, smoking, as well as being underweight (Robertson et al., 2010). Indeed, the research included the views of professionals involved in the implementation of health needs, specifically nurses and general practitioners. However, the important conclusion made from the study was that the introduction of health checks for people with learning disabilities was crucial for improved lifestyles.Nursing Research Methods Paper Example Essay

This essay will critically compare and evaluate two research articles I identified as
relevant to my practice. The review will consider the research methods, design and
relevance to my practice. I have chosen the topic of pain management as dealing
with patient’s pain is a vital part of my role as a staff nurse.
Pain is a complex and very varied issue dependent on a wide range of different
factors that may present in multifarious ways. The way in which patients cope with
their treatment regime and their life in general can be seriously impacted by their
experience of pain. Therefore, I chose this topic to help inform me more fully on the
subject generally and current views and practices so that I can best assist my
patients.
The two articles I have selected are; “ Patient referred to a pain management clinic;
beliefs, expectations and priorities “ by Allcock et al, (2007) and “ Chronic pain
syndrome associated with heath anxiety: A thematic comparison between pain
patient’s with high and low anxiety” by Tang et al, (2009). For ease of reference, I
shall refer to the article by Allcock et al (2007) as Paper 1 and the article by Tang et
al, (2009) as Paper 2. As indicated this topic is very wide and for the purpose of this
essay I have selected these articles as they are of a similar nature. The review of
the articles will include analysis of the research topic, literature review, design of the
studies, the method of data collection and analysis, findings and conclusions, critical
summaries, appraisal of method and synthesis and findings and reflection on
practice (Burns, 2007). Nursing Research Methods Paper Example Essay In order to deal with these aspects effectively I will use the
critiquing framework for a systematic approach devised by Burnard and Morrison
(1994) as I feel this format is the most effective and simplest to use and dissolve.
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Choosing the articles
I utilised a variety of methods to research and identify appropriate articles. My first
step was to consider which topic would be most beneficial and decided upon pain
management. I gathered literature from past and present in order to engage an indepth discussion thus enabling me to analyse research undertaken into the validity
and reliability of patients with chronic pain. To start off with I used different books
and databases. To find Paper 1, firstly I went through EBSCO host, which gave me a
gateway to the databases MEDLINE with full text. I used the Boolean operators
search terms ‘AND’ and ‘NOT’ were used in order to combine the searches, and to
refine the results. In the field search I selected ‘ TX All TEXT’. Boolean operators are
filters used to join (AND, OR) or exclude (NOT) search terms by instructing
databases to combine the terms (Radbourn 2011); for example a search of journal
article abstracts for the term ‘pain management’ And ‘Clinic’ And ‘Beliefs’ and this
brought up 32 articles. I also refined my search by searching for publication dates
from 2006 to 2011 and this brought the search down to 18 articles.
To find Paper 2, I used British Journal of Clinical Psychology, which had the journal
by British Psychological Society. Hand searches were also carried out at The Royal
College of nursing (RCN) library. I found that there was very limited research in
chosen area, therefore existing literature reviews and systematic reviews were also
sources of data, as they offered the bibliographic references for relevant key articles
that are included in this review. (Aveyard 2010).
Once I had chosen my articles, they had to be signed off by my university supervisor.
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Critical summaries of papers 1 and 2
Overview of the purpose of research and literature review
The purpose of critical reviews of literature is to provide an objective and
comprehensive analysis of the writing. (Cronin, 2008). By using a number of
different sources a researcher can access a range of current data that can be used
for a variety of purposes (Aveyard 2010, Cronin et al 2008). The data can, for
instance, be used to advise on up to date practice or help formulate a further
research question. One key feature is that the analysis must be unbiased and
consider both the strengths and weaknesses of the writings in order to formulate a
complete picture.
Literature reviews should be clear and written in a flowing style to provide for easy
reading. This is characterised by being unbiased and being free from jargon whilst
using any relevant technical terminology correctly and appropriately (Colling, (2003)
cited in Cronin et al 2008).Nursing Research Methods Paper Example Essay
Research is ‘ the attempt to derive generalisable new knowledge by aggressing
clearly-defined questions with a systematic and rigorous method’ (Department of
Health, 2001, section 1.7). However, nursing research involves a systematic
application of scientific methods to the study of phenomena interest within the
nursing profession (Fain,1999). Evidence based research is increasingly becoming
much more important within the medical fields. Research critique is a careful critical
appraisal of the study’s strength and limitations focusing on whether the findings are
accurate, believable and clinically meaningful (Polit and Beck, 2008). Burns and
Grove (2007) assert that if findings cannot be trusted, it makes little sense to
incorporate them into nursing practice (Timmins F, 2005).
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Critical summary paper 1
The aim of this paper is to establish the patients expectations of a pain clinic
together with their beliefs and priorities. This was a very small, self-selected group
of 18 participants at one venue all of whom suffered from chronic pain of non-specific
cause as set out in table 1 of the paper. Invitations with information sheets were
sent out to 42 new referrals to the pain clinic from which the 18 participants were
respondents. The age range was from 27 to 76 although table 1 indicates one
person was aged 85 this may be a typographical error or a demonstration that peer
reviewed articles may not been totally accurate.
The method consisted of the participants being divided into three groups consisting
of 7, 6 and 5 people respectively. These formed focus groups utilising an informal,
and, therefore, non-repeatable, recorded discussion format to encourage debate and
a relaxed situation that was felt to be a productive way of encouraging people to
provide good details of their views, beliefs and feelings. By working in groups
individuals could identify that they were not alone in their situation and may be more
forthcoming in discussion. Participants were asked to rank a number of statements
in order of priority. Statements included such things as ‘to have more pain free
periods’. As this was such a small sample formal statistical methods were
inappropriate and the data was simply ranked in order of numbers of people who
agreed with the statements to obtain the order in which the priorities lay.
The participants were allocated fictional names to ensure anonymity was maintained
and all ethics approvals were obtained.
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The highlighted findings were that people sought a formal diagnosis of the reason for
their pain, that they felt no-one believed them without a diagnosis and that painkillers were a way to ‘fob them off’ because nothing else could be done. Their main
priorities for improvement were to feel less pain, to have more pain free times and to
be able to do more ‘everyday things’.
The researcher has the relevant academic qualification to undertake this research
although there is insufficient evidence to show they also had relevant experience in
the area of chronic pain which may adversely affect the standing of this piece of
research. However, as it was a very small study it could perhaps be used as a pilot
study preparatory to undertaking further more in depth research. Cormack (2000)
recommends the need for researchers to have appropriate qualifications and
experience in the areas they wish to study, nevertheless, Polit and Beck (2008)
comments that being qualified does not guarantee that they are the best
researchers. Nonetheless most journals that publish research reports have a blind
review policy whereby independently and anonymously 2 or more peers who are
experts in the field approve its publication (Polit and Beck (2008).
Burns and Grove (2007) refer to a current source as one published within the last 5
years. Paper 1, has 26 of the 33 references ciited are more than 5 years old this was
out of necessity to the study. Examples include (Eccleston et al 1997, Kleinman,
1998 and Yates et al, 1995). In some cases, particularly where there has been little
or no other research in a particular area, there has to be reliance on less recent or
immediately relevant references. The Harvard system of referencing is used.Nursing Research Methods Paper Example Essay
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Critical summary paper 2
The aim of this paper was to formulate a qualitative thematic comparison between
patients suffering from chronic pain with high and low health anxiety. Sixty
participants were involved as part of a larger ethics approved study. Inclusion criteria
were that participants were; aged 18-70, had non-malignant pain for at least 6
months and a good command of English. Exclusion criteria were an identified
terminal illness/disease, the presence of severe psychopathology or a learning
disability. All participated in semi-structured interviews with a package of questions
include a short form McGill pain questionnaire. In order to evidence the relevance of
using a cognitive-behavioural response the five most and least health anxious
participant’s results were used. This gave two clear groups to compare from either
end of the spectrum providing the information upon which this paper was based.
The short health anxiety inventory (SHAI) scale was used to determine the most and
least health anxious but eliminate those who would be described as suffering from
hypochondriasis. Broadly speaking both groups were similar in nature, gender and
age and none had already received cognitive-behavioural treatment for their pain.
However, the most health anxious group comprised four women and one man which
may be revealing in itself but would take further research to establish. The tape
recorded interviews were conducted on a one to one basis taking approximately two
hours. The interviewers were not aware of the health anxiety status of the
interviewees.
The data was analysed using established conventions of theoretical thematic
analysis. Five themes were established from the data; pain appraisal, pain
preoccupation, coping strategies, self-identity, and suicidal ideation. The two
participant groups also showed marked differences in each theme.
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The researchers for this paper are all appropriately qualified to undertake this study
and have relevant knowledge and experience in the specific topic area. The
reference materials comprise 14 sources which are within the 5 years of publication,
and the Harvard system of referencing is used.
Appraisal of method
Research into pain and pain management can prove to be problematic as the
experience and tolerance to pain in an individual thing. More recent perspectives
suggest that the most appropriate way to treat pain is on a purely individual basis
and not to place all pain sufferers into one category in line with the cognitivebehavioural approach. In order to facilitate this approach it is imperative that the
reasons for non-specific pain are identified and that the needs, beliefs and
understanding of patients are understood and dealt with appropriately.
Paper 1 stated the use of qualitative research in this study. In general the whole
methodology was cleared explained and detailed. The method was using focus
groups which are not generally accepted as good methodology, however, in this
case there was little other literature so this was a valid method. Burns and Grove
(2007) assert that convenient sampling provides a mean of acquiring information in
unexplored areas, whilst Polit and Beck (2008) identify it as a weak form of sampling
arguing that self-selection generally leads to bias. Therefore, it is likely that a view
would have to be taken in individual circumstances as to which of these perspectives
is relevant to the research in question.
This particular paper is investigating the feelings, beliefs and expectations of patients
and as such is an area that has received little attention so any research would be
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ground breaking. Sufficient information was probably obtained to demonstrate the
issue and provide for further more detailed and structured research.
Paper 2 was a much larger study and part of a cross sectional study that was able to
utilise recognised scales such as SHAI and the hospital anxiety and depression
scale (HADS) to measure the data. As there was a great deal more data a more
meaningful result could be obtained. However, there were actually only 10 Nursing Research Methods Paper Example Essay
participants used as the relevant data to take the extremes of the participants i.e. the
most and the least health anxious participants. Whilst there were only a small
number of participants analysed in detail as they were drawn from such a large pool
they could be considered to be a good representation of the two extremes.
The researcher clearly states the methodology, participant selection and purposes of
the research and uses recognised methods to interpret the data obtained. The
interviews were monitored to maintained uniformity and focus throughout.
Both pieces of research experience the same difficulties as they are attempting to
obtain information relating largely to how people feel rather than looking to identify
more concrete demonstrable matters. As such the methods of obtaining the
information need to be such that the participants are relaxed enough to provide good
data. The truthfulness of the participants is also an issue as in cases where a person
is experiencing pain for which no specific cause has been identified there is total
reliance on how they explain their pain and the effects it is having on them. There is
also the contention that a researcher must be able to convince readers of the
importance of the research top and that there is proper and sufficient reason for the
research to be undertaken (Parahoo 2006). Unfortunately that is not always the
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case as there are occasions where students have requirements of their courses to
complete research work and academics too are under pressure to publish.
Synthesis of findings and reflection on practice
The two papers are broadly in alignment with their findings and perspective. It is
clear from both pieces that the question of pain management is a very important but
somewhat under researched topic. There is a disparity between the understanding
and perspective of the medical profession and that of the patient. This clearly shows
that much greater clarity in communication is imperative as is further research to
identify potential causes of non-specific pain. Historically the public have been used
to the medical approach being that of determining a physical cause of a problem and
providing a solution. However, it is evident that there is scope for physical symptoms
to come from other sources such as emotional ones and that education both within
the medical profession and of the public that these are valid. This could begin with
the understanding that psychosomatic actually means conditions affecting body and
mind and not the common perception that it is something that is not real.
It is evident that the approach taken towards a patient suffering from non-specific
pain is very important. Whether or not there is any identified cause in order to make
progress the patient must feel that their medical professionals believe that they are in
pain and are looking for ways to deal with this. There are some salutary lessons that
can be learned from the responses that the participants gave that show their views of
the care they are receiving. Pain management clinics too do not appear to have
been able to promote their work clearly. Where patients are referred to the clinics
and feel that this course of action is simply a ‘fobbing off’ they are unlikely to make
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good progress. The need for a patient to have a diagnosis is also a very important
point which must be addressed either by obtaining a diagnosis or by being able to
reassure the patient properly that their symptoms are not linked to something more
sinister. In my own practice I will now ensure that I elicit as much information as
possible from patients about their pain, how they feel about it and the impact it is
having on them to find the best way for them to be treated (Rosenstiel, 1983).Nursing Research Methods Paper Example Essay
Both these papers too show that there is a major bias in favour of traditional medical
format thinking and treatment. Even moving into the use of cognitive-behavioural
treatment does not appear to be wholeheartedly accepted. There are many different
types of treatment including complementary therapies that can be helpful in pain
management and a much wider research programme would be valuable to assess a
larger number of possible treatments (Harvard Medical School). The view taken by
each of these papers is rather narrow and perhaps a different approach to
understanding pain and pain management is required to identify methods of
treatment that will be more effective (British Pain Society). The effect that the mind
has on pain and perception of pain is not well understood and in the absence of
physical causes (Astin, 2004). The public are also becoming more inclined to wish
to avoid drug treatments unless really necessary and this should be respected. The
researcher in paper 1 clearly does not agree with this view but perhaps should
investigate the reasons why people choose to reduce the amount of medication that
they take. Nursing Research Methods Paper Example Essay

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