Critical Analysis of Atwal et al.'s Study on Older Adults in Acute Care

Introduction

Denscombe (2010) argues that a suboptimal reporting of both qualitative and quantitative studies inhibits readers from judging the validity and reliability of the study findings, or just extracting information from the study itself. Melnyk & Fineout-Ovverholt (2011) also complain that inadequately reported qualitative studies expose the research paper to biased estimates made by the readers, thereby contributing to erroneous interpretation of the study result. Against this background, the present study aims to conduct a critical analysis of a qualitative study by Atwal et al 2012, which was meant to explore the risks associated with older adults when receiving acute care. In doing so, this paper will use the Critical Appraisal Skills Program (CASP). Ideally, the critical CASP will allow for a comprehensive analysis and appraisal of the study to explore the quality with which Atwal and colleagues have reported their study – by evaluating the validity of the results, the results themselves and the usefulness of the results in a local context (Williman, 2011).

Research Critique

Was There A Clear Statement Of Research Aims And Objectives?

Yes, the study had a clear statement of its aims and objectives. Particularly, the researchers clearly state that their main aim is to explore the risks associated with older adults in acute care settings, by identifying the perceptions of various practitioners such as physiotherapists and occupational therapists on the risks associated with such kind of patients. The researchers have also given details of why they think it was important to carry out the research. In doing so, they acknowledge that hospital discharge for adult patients is a complex and multidisciplinary affair and involves effective management of risk by all the practitioners involved. Hence, they indicate that their research is meant to the practitioners’ perception of risk within that healthcare setting so as to have a deeper understanding of the perceived dangers of discharging older patients. This study, therefore, seems to be relevant in addressing the issue of adult outpatient management in the acute care setting, for it seeks to identify the risks associated with such situations.

Methods

Is Qualitative Methodology Appropriate?

Yes, as afore-mentioned, the study sought to explore the perception of different healthcare professionals on the risks associated with older adults in acute care settings, both during practice and at discharge. Plichta & Kelvin (2013) argue that qualitative research methodology is effective in exploring the perceptions and opinions of a particular target population on a certain phenomenon. Besides, according to Eastermy-Smith et al (2012), qualitative research methodology is meant to evaluate what people think about a phenomenon, and why people think so. Hence, qualitative research methodology seems to be the most appropriate methodology that the researcher could have used to identify what different health professionals think as risks associated with acute care for older patients and why they think so. Ideally, the researchers aimed to identify the subjective experiences of the targeted health professionals; hence, qualitative research methodology appears to be the most appropriate for achieving that objective.

Where The Recruitment Strategies Appropriate For The Research Aims?

Yes, the researchers conducted an appropriate selection of study participants through a process that they have clearly explained. For instance, the researchers have noted inclusion criteria that they used to select the participants. They also became clear on how they selected their sample size i.e. by inviting 58 eligible participants, receiving only 8 consents to participate, the re-inviting the 50 remaining participants in a process that yielded four additional participants. Worryingly though, the researchers failed to mention how they developed the inclusion criteria, and why they thought the selected participants were the most appropriate for their research aim. According to Field (2018), this affects the reliability of the study process because it would be difficult for another researcher to repeat the same study and achieve the same results if such information is missing. Moreover, the researchers did not have any detailed discussion on the recruitment process, i.e. why the other 46 potential participants declined to participate. According to Green & Thorogood (2014), this makes it difficult to validate the research process because no reader would know whether the declines were as a result of other weaknesses attributable to the research methodology.

Data Collection

Was the data collected in a manner that addresses the research issue?

Yes, there was an effective collection of data to address the research issue. This is because first, the researchers justified why they selected the neurology, rehabilitation and acute care settings to base their study on, i.e. because the study aimed to identify the risks associated with older adult patient acute care practice and discharge. The researchers have also clearly identified the method of data collection (i.e. semi-structured interviews) conducted by an occupational researcher at the therapy department. However, the researchers failed to justify why they chose the interview method of data collection, yet there are several other methods of collecting qualitative data. Polgar & Thomas (2013) argues that failure to justify data collection methods makes affects the validity of the study i.e. it is difficult to identify whether the researchers are using the right method to measure what they are really trying to measure.

The researchers have also explicitly mentioned details of the interview, including the duration taken for each interview session, and who carried out the interview. Besides, the researcher has explicitly mentioned how they used two sets of questions to gather data i.e. a schedule of questions adapted from another study, and a case vignette to read and later invited to answer questions on their perspective. According to Denscombe (2010), such details are commendable to highlight because they allow any other researcher who would like to repeat the same study to do so and still get similar results. Details of data collection also give readers the opportunity to interrogate the study methodology to a deeper extent, so that they can examine whether the study findings are valid (Denscombe, 2010). Nonetheless, the researcher failed to discuss issues to do with saturation of data and the point at which they decided that the interviews could not yield any additional information.

Procedure

Has the researcher identified the relationship between them and the participants?

Unfortunately, the researchers failed to identify their relationship with the participants. In fact, the researcher failed to identify or explain any role they played in influencing the study outcomes, or whether there was an element of bias within the entire research process. In this regard, according to Melnyk & Fineout-Ovverholt (2011), it is impossible to determine the reliability of the study when such details are missing. More worryingly, the researcher failed to identify or explain their influence in the selection of the research question, sample selection or data collection. We are also not aware of how they selected the location of study. However, it is commendable that the researchers have identified the changes and events that occurred during the study (e.g. participant turn-out) and how they dealt with the changes.

Have Ethical Issues Been Taken Into Consideration

Yes, the researcher has identified and explained various ethical considerations made during the entire study process, including the fact that they got an ethical approval from the local research ethics committee within strict adherence to NHS ethical procedures. According to Denscombe (2010), it is important to gain ethical considerations from the relevant authorities because it contributes to the credibility of the study. Besides, Green & Thorogood (2014) asserts that with the ethical approval from ethics authority makes it easier to approach the authorities at the location of research because they might demand such documents.

Another important ethical consideration made by the researchers is gaining consent from the participants to participate in the study. More importantly, the researchers ensured that the participants were informed of the research aim and objectives. Polgar & Thomas (2013) argued that this not only helps in orienting the participants to the entire study but also serves an important documentation for future references, in case any litigation arises.

Data Analysis

Was The Analysis Sufficient And Rigorous?

Yes, the researchers have clearly identified their process of research analysis. In doing so, they have mentioned how they first transcribed the data verbatim, then adopted both deductive and inductive approaches in analysing the data. Besides, the researchers have demonstrated the use of thematic analysis as the method of data analysis. In doing so, the researchers have clearly explained how they derived themes and categories of data from the interviews (i.e. by listening to the interviews, transcribing the interviews verbatim and reading each set of data for thematic interpretation). The researchers have gone ahead to note how they have conceptualized the data by breaking them down into simpler sentences for easier understanding. Ultimately, the researchers have mentioned in details how they identified latent and manifest themes from the data – as a demonstration of how themes were derived from data.

In an attempt to demonstrate how the presented data was extracted from the original sample, and to further demonstrate the data analysis process, by explaining how they grouped into categories and clustered together to develop themes and subthemes. According to Melnyk & Fineout-Ovverholt (2011), demonstrating the process of thematic analysis in qualitative research not only contributes to the reliability of the study but also promotes the study validity because readers are able to follow up the steps used in analysing data.

Results and Discussions

The researchers have also apparently provided sufficient data to support their findings. For instance, the researchers have demonstrated how they made comparisons between cross-cases and cases; and used a meta-matrix to examine and display all the cases. However, it is unfortunate that the researchers failed to account for any contradictory data that arose from the study. According to Melnyk & Fineout-Ovverholt (2011), this affects the validity of the study because it is difficult to establish the accuracy of analysed data. While the researchers used a third party in the coding process to eliminate bias, they failed to critically examine their influence and role in the data analysis process, as well as any bias involved in the data presentation.

Is there a clear statement of findings?

Yes, the researchers have clearly and explicitly stated their findings. For instance, the researchers identified the elements of risks mentioned by respondents both from the vignette findings and from the interviews. From the respondents on perceptions of risk, the researchers have explicitly reported the participants’ statements that some of the risks include inactivity limitations, poor cognitive function, and impairments of body functions.

Nonetheless, the researchers failed to conduct an analysis of whether the evidence derived from the study are in agreement with, or against their argument, even though there is an attempt to compare the findings with the findings of other scholars. For instance, the researchers have compared their findings with the findings of other studies conducted in Sweden and Canada with similar results that older patients with decision-making problems found it difficult to maintain safety and autonomy. According to Polgar & Thomas (2013), comparing current research findings with the findings of previous pieces of research not only validates the research findings but also proves the significance of the current study because in doing so, the researchers are able to identify how the current study fills the existing research gap. Besides, by comparing the current research findings with previous findings allows for data triangulation, which promotes the credibility of the study findings.

Conclusion

How Valuable Is The Research?

The researchers have clearly identified the contribution of the study to existing knowledge and practice. This is evident in the way the study has been identified as one of the first studies to explore the perception of therapists in regards to the risk of old adults in acute care settings.

References

• Denscombe, M (2010), The Good Research Guide: For Small-Scale Social Research Projects. 4thed. McGraw-Hill House: England
• Easterby-Smith, M., Thorpe, R., Jackson, P.R. (2012) Management research. 4th Ed. London, SAGE
• Field, A. (2018). Discovering statistics using SPSS. 5th ed. London: Sage.
• Green, J. and Thorogood, N. (2014) Qualitative methods for health research. 3rd Ed. London: Sage.
• Melnyk, B & Fineout-Overholt, E (2011) Evidence-Based Practice in Nursing and Healthcare: A Guide to Best Practice. 2nd Ed. Philadelphia: Wolters Kluwers Health / Lippincott Williams and Wilkins
• Plichta,S.B. and Kelvin, E.A. (2013). Munro’s statistical methods for health care research. 6th Ed. Philadelphia: Wolters Kluwers Health / Lippincott Williams and Wilkins
• Polgar, S & Thomas, SA (2013) Introduction to Research in Health Sciences 6th Ed London: Churchill Livingstone
• Walliman, N. (2011) Your Research Project. Sage Publications: London