A Critique of the Qualitative Research Beatrice J. Kalisch, PhD,

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A Critique of the Qualitative Research
Beatrice J. Kalisch, PhD, RN, FAAN, reports her qualitative study “Missed Nursing Care” on medical-
surgical units in the Journal of Nursing Care Quality. In the article, " Nursing Care: A Qualitative
Study," the researcher helps us understand what nursing care regularly missed on medical-surgical
unit and what are the reasons nursing staff give for not completing these aspects of care. The reader
will examine her use of grounded theory qualitative research method based on the guidelines
provided by Geri LoBiondo-Wood and Judith Haber (2014). This research report will be analyzed
using the criteria found in the Critiquing Criteria box on p. 135-136 in Nursing Research: Methods and
Critical Appraisal for Evidence-Based Practice.
Statement of the Phenomenon of Interest
InResearch:MethodsandCriticalAppraisalforEvidence-BasedPractice,theauthorsdefine
phenomena as those things that are perceived by our senses (LoBiondo-Wood & Haber, 2014). The
research clearly states the phenomenon of internet in the introduction, “...specific aspects of nursing
care missed routinely and nursing staff reasons why these elements of care are prioritized as less
important than others” (Kalisch, 2006, p. 306). Beatrice Kalisch (2006) used the qualitative research
methodbecausetheshehadtodiscoverinformationaboutherphenomenonfromnurses
experiences in their medical-surgical units.
Kalisch (2006) explained, “A literature search revealed a lack of studies...” about “The specific
aspectsofmissednursingcare”andtheassociationbetweenlessstaffingandthenegative
outcomes” (Kalisch, 2006, p. 306). The researcher realizes current relationship between nursing staff
and poor patient outcomes. Kalisch found there was a gap and wanted to discover what "the missing
nursing care" was and why it is missing. Kalisch helps her audience understand the philosophical
underpinnings by explaining the utility of grounded theory in phenomenal sense making. The authors
of Methods and Critical Appraisal for Evidence-Based Practice differentiate ground theory from other
qualitative research methods by stating that ground theory focus on process. The research identifies
the process elements of her phenomenon rather than just describing it (LoBiondo-Wood & Haber,
2014, p.153).
Purpose
Kalisch tells the reader the purpose in her first line of her abstract which is “...to determine nursing
care regularly missed on medical-surgical units and reason for missed care” (Kalisch, 2006, p. 306). ).
Kalisch conveyed to the reader, “Ensuring quality nursing care and patient safety is a major challenge
facing nurses and nurse leaders today” (Kalisch, 2006, p. 306). Thus, this research is done to
discover what can change nursing practice to ensure better patient outcomes.
Method
The authors of Research: Methods and Critical Appraisal for Evidence-Based Practice defines
grounded theory as "different types of qualitative research method in that it goes beyond the
traditional methods of phenomenology and ethnography, which focus on the process that is at the
heart of the inquiry" (LoBiondo-Wood & Haber, 2014, p.154). According to Glaser and Strauss (1967),
grounded theory method was “developed originally as a sociologist’s tool” and Denzin and Lincoln
(1998) add “researchers...use the grounded theory method when they are interested in social
process from the perspective of human interactions...” (LoBiondo-Wood & Haber, 2014, p. 116).
Kalisch analyzed social process among nurses who are divided by job title into focus groups. She
properly use grounded theory method to discover the phenomenon and collect data for the stated
purpose. However, it is unclear if the study followed the guidelines of the grounded theory method.
Sampling
In Methods and Critical Appraisal for Evidence-Based Practice, LoBiondo-Wood and Haber (2014)
explainsInqualitativestudies,theresearchersareusuallylookingforpurposivesampling...a
particular kind of person who can illuminate the phenomenon they want to study” (p. 100). The reader
knows Kalisch (2006) purpose is about the views of nurses on medical-surgical units, and the author
does interviews with “A total of 107 registered nurses, 15 licensed practical nurses, and 51 nursing
assistants, working inmedical-surgical patient care units...” from two different hospitals (Kalisch,
2006, p. 306).
These nurses live the experiences of “missed nursing care” and can shed light on why care is missed
on medical-surgical unit; therefore, they are an appropriate sample for this phenomenon of study.
However, Kalisch could made a stronger sample for the grounded theory method if she included the
words "purposive sample" , explained why this group of nursing staff was chosen, and given details
about the inclusion/exclusion criteria for the sample (LoBiondo-Wood & Haber, 2014, p. 100).
Data Collection
The description of data collection lacks details in Kalisch (2006). The reader knows the author
interviewed “25 focus groups” using “semistructured design and each interview “lasted 90-120
minutes” and the interviewees “were asked to commit to confidentiality” (Kalisch, 2006, p. 306-7). The
data collection did include human experience which was the nursing staff. Though the author states
asking the interviewees to “commit to confidentiality", but this is not enough to protect them from
disclosure. In addition, data saturation isn't confirmed and little known about the data collection
process. The author should have stated during the interviews “nothing new is emerging” (LoBiondo-
Wood & Haber, 2014, p. 101). Furthermore, the author should included clues about questions that
were asked and if anything collected from the interviews focused her study.
Data Analysis
The author used “qualitative analysis software” to apply “a grounded theory approach by which
empirical data are thematically categorized by induction” (Kalisch, 2006, p. 307). There are two
analyses of the “tape-recorded, fully transcribed” interviews, and “to be included as a theme,
supporting data had to be contained... in all of the focus groups” (Kalisch, 2006, p. 307). The reader
identifies the research to be true to data because, as the two analyses “extracted the same issues
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