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Critical Appraisal of a Qualitative Article
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Written by Raymond H. (https://15writers.com/writers/raymond-h/)
Evidence-based practice is a cornerstone of contemporary medical and nursing care (Aveyard & Sharp,
2013) and should be considered the gold standard approach to care. The central tenet of evidencebased practice is that an objective appraisal of published literature can be used to isolate the most
e ective interventions, which may then be applied in practice, while considering the preferences and
considerations of the patient (Hamer & Collinson, 2014). The individual nurse is responsible for ensuring
that they adopt an evidence-based approach to care, appraising research relevant to their professional
duties and responsibilities (Melnyk & Fineout-Overholt, 2011). As such, critiquing is a key skill that should
be developed and practised by all nurses and healthcare professionals alike.
For the purposes of this paper, a critical appraisal was conducted on the paper “Understanding the
experience of patients with chronic obstructive pulmonary disease who access specialist palliative
care: A qualitative study” by Hayle et al., (2013). In order to critique the selected article, the Caldwell et
al., (2005) critiquing framework was employed, to ensure a valid and objective approach to the
appraisal process. The results of this critiquing process, including the identi cations of strengths and
limitations of the article, form the remainder of this paper.
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The title of the paper in question provides a clear insight into the content of the paper, noting the
approach used (qualitative), the population of interest (patients with chronic obstructive pulmonary
disease [COPD])(https://15writers.com/)
and the broad aim of the study. The title of an academic paper should be concise and
should ideally adhere to the format of identifying the population of interest, intervention (if any),
comparisons (if any) and outcomes of interest (O’Brien et al., 2014); this paper follows
this format closely.
(tel:+442039500830)
(https://15writers.com/myThe authors of the paper have a solid publication history
and are members of the nursing or palliative
account/)
care team in a large metropolitan hospital, adding credibility
to the research (Tong et al., 2012).
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The abstract of a paper provides a key summary of the key elements of the paper, including the aim,serv
design, results, and implications of the ndings of the study (Caldwell et al., 2011). This paper utilises a
structured abstract, providing clarity in interpreting the key elements of the paper (Grove et al., 2012).
The authors successfully provide a suitable justi cation for the approach used, summarising the key
processes used to design and conduct the study, as well as the main ndings and their implications.
The rationale for the study is clearly described by the authors, based on a comprehensive and
contemporary literature search. The authors identify the epidemiology of COPD and the consequences
of the condition, including the palliative care needs of patients. Furthermore, they highlight existing UK
policy on palliative care access and service improvement needs for these patients. The literature
review uses up-to-date policy and research to justify the need for the present study and the aim of the
paper is developed accordingly (Grove et al., 2012). The authors explicitly state the aim of the paper as
an in-depth examination of lived experiences of patients with COPD accessing palliative services,
simultaneously justifying the qualitative approach and the holistic nature of patient care (Kisely &
Kendall, 2011).
When conducting research with patients, ethical approval is essential (Denzin & Lincoln, 2011), and the
researchers have sought approval from the local ethics committee. However, a wider discussion of the
ethical issues that arose during the research, or were considered prior to data collection, are not
discussed in detail. The authors do note that the participants had to complete a written consent
document prior to data collection, suggesting that appropriate ethical consideration of capacity and
consent was adopted (Denzin & Lincoln, 2011). The general methodological approach is qualitative in
nature, consistent with the aim of the research (i.e. exploration of lived experiences). Qualitative studies
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often rely on a strong philosophical research background in order to justify the means used to collect
data and then to analyse and interpret the ndings appropriately within the selected paradigm (Marshall
& Rossman, 2014). However, the authors of this paper o er no discussion of their philosophical stance,
a notable limitation. However, it is not uncommon in published manuscripts that these details are
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omitted for brevity, which should be considered a possible explanation for the absence of such
discussion (Rosenfeld, 2010).
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account/)
Despite the absence of a philosophical discussion of the research method, the research design and
associated processes are discussed and justi ed appropriately. The general concepts explored in the
(http
study are de ned in a supplementary appendix and strongly relate to the themes evident in the
serv
background literature search, suggesting an appropriate means of identifying relevant topics for
analysis. The research design is based on the completion of semi-structured interviews, which is not
speci cally justi ed as an approach. However, this is a suitable method, as semi-structured interviews
allow for a detailed narrative to be obtained from each patient, with coverage of key topics but the
opportunity for patients to expand on their own experiences and provide insight into additional
phenomena (Whiting, 2008). Details of the semi-structured interview process are not provided in the
body of the manuscript but are shown in a supplementary appendix, illustrating the length, location, and
processes of the interviews, which is an essential marker of research transparency (Whiting, 2008). The
use of semi-structured interviews, with recorded transcripts, is considered an auditable and therefore
valid means of performing qualitative research (Denzin & Lincoln, 2011).
The participants were selected from a speci c location and their inclusion was based on the ful llment
of key criteria. This is known as purposive sampling and is often used as a means of ensuring that the
researchers are able to obtain data from the group whose experiences are the focus of the research
(Teddlie & Yu, 2007). In this instance, it is an appropriate strategy, as patients with COPD accessing
palliative care services are a distinct group. Both inpatient and outpatient services were considered,
presumably as a means of expanding the available number of patients for participation. Furthermore,
the authors ensured objectivity in the research method by excluding patients known to the researchers
in a clinical capacity, while ensuring that patient capacity to participate was assessed and used to guide
the selection process (Dobson, 2008). Overall, the sampling process may provide limitations on the
generalizability of the ndings to other locations or patient groups (Gibbs et al., 2007), but it is an
appropriate process for the present study aim. However, it should be recognised that the sampling
strategy may have led to bias when selecting patients, as patients with extreme views on service
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quality or their own experiences may have been more likely to share their opinions (Gibbs et al., 2007).
Furthermore, the most unwell patients, who were physically unable to participate, may have di erent
insights into service use, which would not have been explored in this study (Dobson, 2008).
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The data analysis process was guided by hermeneutic phenomenology, as an appropriate approach
for this study based on the need to analyse individual patients’ lived(tel:+442039500830)
experiences, which
(https://15writers.com/myphenomenology is an established approach (Ajjawi & Higgs, 2007). This data analysis method has
account/)
been explored and validated in other research contexts, providing support for the use of the technique
in this paper (Ajjawi & Higgs, 2007). The approach is well-structured and is suitably designed to allow
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for the identi cation and synthesis of the lived experiences of a patient group, consistent with the aim
serv
of the paper. The use of multiple researchers in analysing data also reduces the risk of individual
researchers introducing bias into the analytical process, increasing the reliability of the data analysis
approach (Caldwell et al., 2011).
However, the role of the researcher is important to consider when adopting any qualitative study, as
researchers may in uence the data collected and the analysis process (Caldwell et al., 2005). The
authors fail to provide an overview of the role of the researcher in this study, marking one limitation of
the theoretical basis of the paper. It can be argued that appreciation of the role of the author as a
source of social desirability bias has been presented, which is an important point to note (van de
Mortel, 2008). It must be noted that the authors of the study felt that their in uence would be minimised
as they were not in direct clinical contact with any patient, which may apply to their clinical role but not
necessarily their position as a researcher. Therefore, this point may have required further comment in
the paper to clarify the re ection of the authors.
The results of the paper are based on the analytical approach described and are presented as a series
of key themes or topic areas in which the authors provide a summary of the ndings from all
participants (n=8), supporting these summaries with direct quotations from the interview transcripts. This
is a commonly used approach to presenting qualitative data sets that are thematic in nature and is
therefore justi ed (Bazeley, 2009). The use of quotations allows the reader to relate the assertions of
the researchers back to the original transcripts, thereby increasing the credibility of the research
process (Bazeley, 2009). The main themes identi ed in the literature included: physical impact,
psychosocial impact, spiritual impact and perceptions of palliative care services. All of the themes are
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appropriate and relevant to the research aim, while each theme is explored in su cient detail to
suggest that they are appropriate outcomes of the research process. It may have been useful for the
reader if the themes and sub-themes were identi ed in a tabulated format to supplement the narrative
presentation, while also providing a clear link between themes and the original transcript data (Grbich,
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2012).
(tel:+442039500830)
(https://15writers.com/myThe discussion section provides an overview of the main study ndings and attempts to place these
account/)
ndings within the wider context of patient care and associated literature. The discussion section is
adequately referenced, with contemporary sources used to support he points raised by the authors.
(http
Indeed, the discussion section should be richly referenced to demonstrate that the authors have
serv
considered their ndings in relation to previous studies or knowledge gaps (Caldwell et al., 2011). The
authors achieve this successfully while maintaining their thematic approach to the research question.
The authors of the paper also provide a detailed overview of the strengths and weaknesses of their
paper, which is recommended as a means of self-appraisal in the literature (Caldwell et al., 2005). The
authors rightly re ect that the external validity of the ndings is limited due to the small-scale and
localised geographical nature of the study process (Silverman, 2016). Furthermore, the authors have
generally considered other limitations (noted above), suggesting an honest and re ective account of
the research process (Silverman, 2016).
The conclusion of the paper focuses on the implications of the study for service design and future
research. It is important to note that the authors state that the value of their research lies in providing an
overview of the experiences of patients and therefore may be limited in guiding service design without
future studies being conducted. Indeed, this form of study is often hypothesis-generating, rather than
directly linked to practical measures that may be used to improve services (Daly et al., 2007). However,
the suggestions and conclusions drawn by the authors are reasonable and realistic, relating to their
ndings closely. Finally, the suggested future research directions successfully build on the ndings of
the present study, while exposing knowledge gaps and the need for speci c types of study in this
population.
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Overall, this study adheres to many of the standard requirements of a well-conducted qualitative
research process, including the isolation of a suitable data collection and analysis approach, as well as
interpretation of the ndings in relation to a qualitative perspective. However, the small sample size and
limited geographical location of the study reduce the transferability of the research and the implications
(https://15writers.com/)
for practice. Furthermore, the lack of a philosophical paradigm reduces the theoretical strength of the
research. The implications of the research are considered in light of these limitations and are suitably
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comprehensive to suggest that further studies may integrate these ndings to explore gaps in the
(https://15writers.com/myknowledge base.
account/)
(http
References
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Ajjawi, R., & Higgs, J. (2007). Using Hermeneutic Phenomenology to Investigate How Experienced
Practitioners Learn to Communicate Clinical Reasoning. The Qualitative Report, 12(4), 612-638.
Aveyard, H., & Sharp, P. (2013). A Beginner's Guide to Evidence-based Practice in Health and Social
Care. London: McGraw-Hill Education (UK).
Bazeley, P. (2009). Analysing qualitative data: More than ‘identifying themes’. Malaysian Journal of
Qualitative Research, 2(2), 6-22.
Caldwell, K., Henshaw, L., & Taylor, G. (2005). Developing a framework for critiquing health
research. Journal of Health, Social and Environmental Issues, 6(1), 45-54.
Caldwell, K., Henshaw, L., & Taylor, G. (2011). Developing a framework for critiquing health research: an
early evaluation. Nurse Education Today, 31(8), e1-e7.
Daly, J., Willis, K., Small, R., Green, J., Welch, N., Kealy, M., & Hughes, E. (2007). A hierarchy of evidence
for assessing qualitative health research. Journal of Clinical Epidemiology, 60(1), 43-49.
Denzin, N. K., & Lincoln, Y. S. (2011). The Sage handbook of qualitative research. London: Sage.
Dobson, C. (2008). Conducting research with people not having the capacity to consent to their
participation: A practical guide for researchers. London: British Psychological Society, Professional
Practice Board.
Gibbs, L., Kealy, M., Willis, K., Green, J., Welch, N., & Daly, J. (2007). What have sampling and data
collection got to do with good qualitative research?. Australian and New Zealand Journal of Public
Health, 31(6), 540-544.
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Grbich, C. (2012). Qualitative data analysis: An introduction. London: Sage.
Grove, S. K., Burns, N., & Gray, J. (2012). The practice of nursing research: Appraisal, synthesis, and
generation of evidence. London: Elsevier Health Sciences.
(https://15writers.com/)
Hamer, S., & Collinson,
G. (2014). Achieving evidence-based practice: A handbook for practitioners.
London: Elsevier Health Sciences.
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Hayle, C., Coventry, P. A., Gomm, S., & Caress, A. L. (2013).
Understanding
the
experience
of patients
(https://15writers.com/mywith chronic obstructive pulmonary disease who access
specialist palliative care: A qualitative
account/)
study. Palliative Medicine, 27(9), 861-868.
(http
Kisely, S., & Kendall, E. (2011). Critically appraising qualitative research: A guide for clinicians more
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familiar with quantitative techniques. Australasian Psychiatry, 19(4), 364-367.
Marshall, C., & Rossman, G. B. (2014). Designing qualitative research. London: Sage publications.
Melnyk, B. M., & Fineout-Overholt, E. (Eds.). (2011). Evidence-based practice in nursing & healthcare: A
guide to best practice. London: Lippincott Williams & Wilkins.
O’Brien, B. C., Harris, I. B., Beckman, T. J., Reed, D. A., & Cook, D. A. (2014). Standards for reporting
qualitative research: a synthesis of recommendations. Academic Medicine, 89(9), 1245-1251.
Rosenfeld, R. M. (2010). How to review journal manuscripts. Otolaryngology-Head and Neck
Surgery, 142(4), 472-486.
Silverman, D. (Ed.). (2016). Qualitative research. London: Sage.
Teddlie, C., & Yu, F. (2007). Mixed methods sampling: A typology with examples. Journal of Mixed
Methods Research, 1(1), 77-100.
Tong, A., Flemming, K., McInnes, E., Oliver, S., & Craig, J. (2012). Enhancing transparency in reporting the
synthesis of qualitative research: ENTREQ.BMC Medical Research Methodology, 12(1), 181-188
Van de Mortel, T. F. (2008). Faking it: social desirability response bias in self-report research. Australian
Journal of Advanced Nursing, The, 25(4), 40.
Whiting, L. S. (2008). Semi-structured interviews: guidance for novice researchers. Nursing
Standard, 22(23), 35-40.
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