Evaluating Childbirth Pain Research

Introduction

A critical evaluation of a primary research paper is important for judging the trustworthiness and validity of that research and also, for assessing its applicability to practice (Hosseini et al. 2018). This essay will critically evaluate the primary research article “Assessment of pain associated with childbirth: Women's perspectives, preferences and solutions”(Jones et al. 2015).By critiquing research it is possible to use and process information through which evidence can be systematically evaluated and analysed (Serenko and Bontis, 2018). Acritical appraisal checklist from The Handbook of Midwifery Research (Medforth et al.,2017) will be used to analyse each aspect of primary research study. This allows the evaluation of the individual strengths and limitations which can determine if the evidence is worthy of assimilation into practice (Polit and Beck, 2008), which is important in healthcare for evidence-based practice, where healthcare dissertation help can guide professionals in integrating evidence-based practices (Charlick et al. 2016). According to the Nursing Midwifery Council (NMC) (2018), midwives are required to be up to date in the best methods of practice to ensure patients receive the best care and experience possible. However, to do this, it is important for midwives to acquaint themselves with all available methods and research and to assess the quality of research to be able to carry out their role properly (NMC, 2018). If healthcare professionals assimilate properly researched evidence into their everyday practice it ensures that all care given is appropriate for that woman, which is important for safe and effective health care (Holloway and Galvin, 2016). The objective of this essay is to critically appraise Jones et al. (2015) research study to identify aspects of rigour (Ryen, 2016). The abstract of the article is included in Appendix 1.

Title

The title is the first thing that the reader encounters and it has the power to intrigue or mislead (Bavdekar, 2016). Holloway and Wheeler (2010) argue that an appropriate title should contain certain keywords to allude to the research, intended audience, and methodology used. In Jones et al. (2015) article entitled ‘Assessment of pain associated with childbirth: women’s perspectives, preference and solutions’, it is clear that the title is concise and informs readers clearly of the subject matter. This is by utilising keywords, including the central phenomenon, and detailing the group under investigation(Franzen et al. 2017)Therefore, the title fulfils what a research paper title should include(Ledford and Gast, 2018).

Authors

It would damage the credibility of the research carried out if the individuals did not have necessary skills, experience, or qualifications to do this study (Räsänen and Moore, 2016.). Therefore, it is important to look at the individuals who conducted the research and their background (Ryen, 2016). In the case of Jones et al. (2015), there seems to be adequate experience within the healthcare field, meaning the researchers would have knowledge and practical experience on which to base their research. Therefore, it is clear that the authors of the article have the appropriate skills and experience to work together to compile competent research on this specified topic (Nasheeda et al. 2019).

Journal

When disseminating research articles, there are several avenues that can be taken to ensure that they reach the intended audience, such as publishing them in websites and journals (Harvey and Land, 2017). The most appropriate route disseminate an academic healthcare article, would bein academic journals(Lacey, 2010). This would mean the article would reach the appropriate audience as theyare highly credible and regularly used by professionals and academics alike (Lacey, 2010). Furthermore, it is important that the correct quality of journal is chosen and within the proper academic area, which would be a peer reviewed journal (Räsänen and Moore, 2016). Jones et al. (2015) study was published within the Midwifery journal. This journal is known for distributing up-to-date peer reviewed research worldwide allowing access to evidence-based practices (Räsänen and Moore, 2016). This adds credibility and rigour to the journal as specific standards must be met prior to the publication of the work (Ryen, 2016). Therefore, Jones et al. (2015) chose a publication that was peer reviewed and had a readership that would maximise the dissemination of their study findings to midwives, which was appropriate.

Abstract

A properly presented abstract is important as the reader will judge whether or not to read the article based on that information (Ryen, 2016). For this reason, an abstract should provide a clear but brief overview of the intentions of the research (Hennink et al. 2020.). This includes the methodology and methods (aim, question, population and sample data collection, data analysis, conclusion and recommendation) used throughout the study (Whitehead and Whitehead, 2016). It is advisable to use as many as ten keywords, due to several journals are now online and this would allow for a greater target audience as a result of the article being easily accessed and viewed within any database searches (Moser and Korstjens, 2018). In relation to Jones et al. (2015) study, the abstract was informative and would, therefore, encourage interested parties to continue to peruse the rest of the article.

Introduction and Literature review

A literature review is one of the most important parts in any research paper as researchers use supporting evidence to review the selected literature by comparing and contrasting it with other evidence (Hart, 2018). In the literature review provided by Jones et al. (2015), it is seen that only six updated references are used to support information whereas others were backdated. This acts as weakness for the study as backdated information may have led to include inappropriate information in presenting the topic that are disowned at the present by scientists (Valkonen et al., 2017). Thus, it led to lower validity or credibility of the study to present unbiased and right information. The primary resources in research are referred to original documents such as letters, interviews, eyewitness accounts and others (Druschke et al., 2020). However, the secondary resources are information that are gathered from scholarly books and journals which are presented by researching data through scientific research (Prada-Ramallal et al., 2018). In framing the literature review by Jones et al. (2015) secondary resources are used. This is because it would help the researchers to determine what has been identified regarding the topic of study and what further are to be explored by them in gathering additional information regarding topic of their focus. Therefore, the strength of the literature review presented in the study is that it helped to provide concept regarding the existing information related with the topic and ideas about what further required to be explored. However, the limitation was that the researchers failed to current studies in framing the review that created gap in the study to determine many updated information regarding the study topic (Jones et al., 2015).

Methodological Approach and Research Design

Research perspective is the process of conducting investigation on particular topic for gathering proper knowledge and understanding on it (Hennink et al. 2020). The research methodology is the process that outlines all the steps through which the entire research is going to be conducted (Queirós et al. 2017). There are two types of primary research perspectives such as qualitative and quantitative. As mentioned by Hennink et al. (2020), qualitative research is where the focus is on gathering in-depth detailed data through direct communication with the participants. This is because the qualitative data are gathered through interviewing the participants in natural environment. The benefit of using qualitative research is that it creates openness as it leads to gather expanded responses from participants regarding the topic. Moreover, it is beneficial as it leads to create enriched analysis of data creating opportunity to execute in-depth examining of the feelings, attitudes and behaviour of the participants in interpreting information for presenting the findings (Flick, 2018). Thus, using qualitative research perspective in the study acts as its strength because it leads to gather in-depth and narrative data with openness from the participants regarding pain associated with childbirth.

In the study by Mays and Pope (2020), it is mentioned that the disadvantage of qualitative research is that personal beliefs of the researcher may influence the narration of the gathered data presented in the findings. This would lead to create biased presentation of information. As argued by Park and Park (2016), quantitative research helps to gather statistical information from a wide number of subjects in cost-effective way. This leads it to provide accurate and objective information without biases. In this study, phenomenology is used as the research design. As asserted by Jensen et al. (2020), advantage of phenomenological research is that it helps to effectively understand meaning of the people’s attitude and explanation. This helps to develop effective narration without any confusion of the actual thoughts of participants mentioned in the interview. Moreover, phenomenology design assists gathering natural data rather than artificial information as it collects information from the natural phenomenon created to collect information (Larkin et al., 2019). Thus, the use of phenomenological design as a framework acts as strength for the study to effectively narrate the gathered information in understanding perception and attitudes regarding pain associated with childbirth. However, the researcher failed to identify which of the phenomenological design is used that whether interpretive phenomenology is used or descriptive phenomenology is implemented. This leads to an ineffective audit trail to prove credibility of the study (Jones et al., 2015).

Ethical Considerations

When conducting healthcare research, it is necessary to ensure all ethical areas have been addressed before the research study commences (Thompson and Walsh, 2015). Ethics relates to both the researcher and those participating in the research. This means that both parties are held to the same standards and appropriate behaviours determined based on pre-agreed ethical principles and values (Moreno et al., 2017). With the evolution of Information Technology and research techniques, Bryman (2008) suggests that ethical issues are more central to conducting research than ever before.

Local Research Ethic's Committees (RECs) are utilised to ensure that any research adheres to the national standards of ethics before the research being conducted to safeguard the participant and researcher (Nichols, 2016). The research study received ethical approval from the Human Research Ethics Committees within the healthcare network, as well as approval from La Trobe University. There are also main principles to be upheld in research resulting from the Nuremburg Code (1974), Declaration of Helsinki (1964) and Belmont Report (1978). These basic human rights principles; respect for autonomy, protection from harm and justice which must be upheld when undertaking any research studies(Thompson and Walsh, 2015).

While maintaining research ethics the first principles that researcher would follow is respecting autonomy of respondents (Thompson and Walsh, 2015). In this research, researcher assured, autonomy of each participant is respected in proper manner (Silva et al., 2017) Researcher assures that, no participant has been forced to participate in this research(Jones et al., 2015). The researcher also ensured that participants make their voluntary participation in which researcher respected overall interest and preference of these participants(Jones et al., 2015). Jones et al. (2015) state written consent was obtained from all participating women before any research being carried out, thereby fulfilling this requirement. However, there is no mention of how much information regarding the research was given to the participants to ensure their consent was fully informed. Thus, decreasing rigour to the study (Cosac, 2017).

Other principles to consider are protection from harm (non-maleficence) and the benefits (beneficence) of taking part in the study (Richman, 2019). Johnson and Long (2010) state that although Midwife researchers would not intentionally set out to cause any physical or emotional harm to participants during research, this can inadvertently happen as the harm caused could be the act of participating in the study itself for the participant (Burns and Grove,2009). In order to ensure that all participants have the risk of harm minimised to the fullest extent, the researchers must carry out a risk analysis, determining the risks versus the benefits of participating in the study (Ben Ammar et al., 2016), In the case of Jones et al. (2015), the researchers could cause harm by asking invasive questions regarding childbirth, evoke feelings of failure or guilt in the case of a difficult birth or stillborn. In order to combat this, researchers should take care to warn participants of the potential for emotional upset to occur, and provide appropriate counselling should this occur (Karlsdottir et al., 2018). This is not something which has been noted within the article and therefore does not seem to be something which the researchers offered the participants(Jones et al. 2015). According to research ethics, the confidentiality and data protection of participants in research is important and to be maintained appropriately. This is because it helps them to avoid unnecessary judgement or abuse to be faced in the society due to revelation of their personal opinions regarding sensitive health topics (Petrova et al., 2016). In the study, effective confidentiality of the participants is maintained and they are allowed to leave the study at any point of time if they feel their confidentiality is compromised.

Population and Sample

The population is the collection of individuals that are considered as the focus of the research study (Asiamah et al.,2017). The sample is the subset of population that represents the entire group of population (Boddy, 2016). A small sample size is suitable in qualitative research of primary studies. This is because it allows the researchers to have scope to individually analyse narration of each participant to present in-depth data regarding the topic (Boddy, 2016). In the study by Jones et al. (2015), n=19 participants who are women including both multiparous and primiparous were selected for the study. This is a limited sample size that allowed to researcher have time to interact with each participant in gathering in-depth narrative data regarding the study topic. The sampling method, Jones et al. (2015) used for this study was non-probability purposive. Purposive sampling is where researchers chose a finite sample population based on their understanding and knowledge of the population and study (Ames et al. 2019). Jones et al. (2015) participants were recruited from the same hospital, in the same geographical area, with the shared experience of having experienced childbirth. Non-probability, the purposive sampling process is used in research to enhance the fittingness and transferability of the sample population (Asiamahet al. 2017). Forero et al. (2018), acknowledges that transferability is the qualitative equivalent of quantitative external validity. This is where the research findings gained from this particular research can be applied in other similar context, population, situation and time (Forero et al. 2018.). Therefore, the sampling process used in this research is highly applicable in meeting research objectives and aids fittingness and transferability (Hennink et al. 2020).

Data Collection and Analysis

Jones et al. (2015), conducted semi-structured telephone interviews with post-partum women who had experienced labour in the last month. The advantage of using semi-structured interview is that it helps to create two-way communication that is between the interviewer and interviewee helping the researchers under effective reasons behind the answers of the questions asked. Moreover, the semi-structured interview provides scope for the interviewees to have time and scope for opening up about sensitive issues (Stanyon et al., 2016). Thus, the use of semi-structured interview method acts as strength for the study because it provides opportunity to learn reason behind the answers provided by the participants as well as creating opportunity to gather enhanced data regarding sensitive issues. However, the limitation with performing telephone interviews is that non-verbal cues cannot be understood. This is because in telephonic interview the researchers are unable to determine the facial expression of the participants and this leads to lower credibility of the study (Chrisopoulos et al., 2020). In the audio recording, there is probability of losing information (Chrisopoulos et al., 2020). Thus, adopting it in the study by Jones et al. (2015) would lead to hinder transferability of the research.

Data analysis is the process of transformation, cleaning and examination of the gathered data to discover effective information regarding decision-making in the study (Xu et al., 2018). The use of thematic analysis is strength of the study. This is because it allows the researcher to analyse vast amount of data from different sources to be compiled into respective themes and systematically presented in the study (Hudon et al., 2017). However, the ways themes were derived in the study are not discussed, which lessens the robustness and auditability of the research (REFERENCE).

Findings

Jones et al. (2015) have stated that, the overall findings of this research are that, pain assessment is highly preferable approach in majority of post-partum women. Jones et al. (2015) have discussed how women-centred approaches have favoured the implementation of proper pain management and assessment process in post-partum women to reduce their labour pain during the delivery. Additionally, three multiple dimensions as well as range of labour pain were presented (Jones et al.,2015). Therefore, Jones et al. (2015) have successfully identified that women prefer such pain assessment approach in which there is large scale range to assess the extreme pain during the labour.

In the study by Jones et al. (2015), the findings were presented in narratives and quotes mentioned by the participants. This acts as strength tothe study as the narratives can be referred by the readers to understand reason behind the appropriate discussion mentioned as well as they act as proof that no biased information are presented. However, only quotes of 11 out of 19 participants are presented that reduces the credibility of the researcher as wide representations of the data are not able to be developed (Jones et al., 2015).

Discussion

A discussion section of a paper includes interpretation and description of the significant findings developed under the light of the investigated research problem (Grundströmet al., 2018). Jones et al. (2015) have discussed the research findings and compared and contrasted this successfully against other research evidence.Moreover, the researchers included a comprehensive discussion which is critically supported by previous studies and addressed the key aim of the study.

Conclusions, Recommendations and Limitations

The conclusion and recommendations section of the article allows the researchers to make informed decisions on whether the study aims were met (Velte and Stawinoga, 2017). From analysing the overall findings of research, it can be concluded that an assessment in case of childbirth is highly preferred by women which not only improves their overall physical condition throughout the childbirth but also reduce their labour pain. it can be concluded from the research study that; today's healthcare sector needs to focus so introducing new as well as highly modern pain assessment technique that would reduce the pain of childbirth and improve overall physical and mental status of pregnant women during childbirth. Further, it can be suggested from the findings that additional research is required to gather better results by using large sample size that has failed to be implemented in the current study.

Aspects of rigour

Rigour refers to the identification of strength and quality of the study (Johnson et al., 2020 ). From the overall review of this article, it can be stated that Jones et al. (2015) have successfully considered all the aspects of rigour in terms of assuring credibility and authenticity of the data that are collected from participants. In this research, it is seen that entire data are collected from genuine sources (post-partum women) that assisted the researcher to maintain the accuracy and credibility of database. The dependability is referred to demonstration of information to be accurate by showing an effective audit trail (Korstjens and Moser, 2018). In the study by Jones et al. (2015), the way information are collected to reach the conclusion is not mentioned which lowers the clarity of dependability and overall rigour in the study.

Overall Conclusion

To conclude Jones et al. (2015) have demonstrated some strengths and limitations to their research study. Although midwives constantly strive to make informed choices within their practices, they don’t always make use of available research. This is an issue which needs to be rectified as "care for women will stagnate unless we apply available evidence to practice" Lavender (2010,p.114). Therefore for practice to be evidence-based the research must first be scrutinized for strengths and limitations (Jones et al., 2015). This essay critiqued Jones et al. (2015) research study and would argue that the aim of the research was attained by reflecting on pain assessment in childbirth however failed to provide sufficient solutions to their findings. However, there are no clear references available whether the findings of the study can be applied in practical clinical field to manage pain perception during childbirth among women.

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