Patient experiences
Running head: CRITIQUE OF QUALITATIVE STUDY
Patient experiences following cardiothoracic surgery: An interview study
Critique of Qualitative Study
Linda Hansen
Ferris State University
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Patient experiences
Abstract
Using the “Guidelines for Critiquing Qualitative Designs” described in Foundations of Nursing
Research (Nieswiadomy, p.180), this study will critique the journal article Patient Experiences
following cardiothoracic surgery: An interview study that was researched by Gardner, Elliot,
Gill, Griffin, and Crawford (2005). This study used an exploratory style to evaluate patient
memories of their post operative experiences. A total of seven themes were identified from the
responses of the participants to questions from the researchers. Understanding patient
perceptions can lead to nurses being more aware of a patient’s needs in the post operative
recovery period.
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Patient experiences following cardiothoracic surgery: An interview study: Critique of a
Qualitative Research Study
Method
Using the guidelines for critiquing qualitative designs described in Foundations of
Nursing Research (Nieswiadomy, 2008, p. 180) this study will critique the journal article
“Patient Experiences following cardiothoracic surgery: An interview study” exploring patient
experiences (Gardner, Elliott, Gill, Griffin and Crawford, 2005). Because the focus of this study
was patient experiences, it meets the criteria of a qualitative study. A quantitative approach
would focus more on the statistical analysis of data, include a hypothesis, and would not include
personal involvement with the participants (Nieswiadomy, 2008).
Focus
The focus of this study was for patients to relate their post operative cardiothoracic
surgery experiences using a semi-structured interview process with twelve designated prompt
questions that could potentially lead to more probing questions (Gardner, et al, 2005). Other
studies have been done using quantitative methods that focused on morbidity and mortality for
this patient population (Gardner, et al, 2005). This particular study focused on patient
perceptions of quality of life in the six month post operative period (Gardner, et al, 2005). The
questions were specific to patient experiences following an intensive care unit (ICU) and general
ward hospital stay and included questions concerning their convalescence at home. Some
examples of these twelve questions were, “What thoughts did you have about how sick you
were,” “What things did you look for to see if you were getting better or worse,” and “Can you
describe your pain experience since you left the hospital,” (Gardner, et al, 2005, p. 243).
Patient experiences
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Approach
The approach used for this study is described as exploratory qualitative and was part of a
larger triangulated study (Gardner, et al, 2005, p. 243). Nieswiadomy states, “Exploratory
studies are conducted when little is known about the phenomenon of interest” (2008, p.145).
This particular study is qualitative but part of a larger study that used both qualitative and
quantitative approaches. It was similar to the case study style described by Nieswiadomy (2008)
in which information was gathered via questions presented to subjects.
Interviews were conducted in person either at the patient’s own home or when the patient
came in for a clinic appointment and the information was recorded and reviewed. “Interview
transcripts were analyzed for common themes by three members of the research team”
(Gardner, et al, 2005, p. 244). This is comparable to content analysis as described by
Nieswiadomy (2008) when researchers look for common themes as seven common themes were
indentified. This approach used questions that allowed patients to be able to relate their
remembered experiences of the time they spent in the hospital as well as their recovery period up
until the time of the interview.
Significance for Nursing
This study could impact how nurses care for patients by revealing how patients interpret
certain actions. One patient described how much the human touch meant to him when he was in
the ICU and how the presence of a nurse amongst all the machinery helped him to feel secure
(Gardner, et al, 2005). This study also addressed pain issues and how pain is perceived
differently by each person interviewed, as each person related his own pain experiences,
including what worked and didn’t work for pain relief (Gardner, et al, 2005). This information
could lead nurses to be more observant of non-verbal indicators of pain. Several patients noted
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that it was helpful to have a roommate to share experiences, as some that were in private rooms
stated they felt isolated while fewer stated they enjoyed the peace and quiet (Gardner, et al,
2005). Our hospital has mostly private rooms (22 out of 26 rooms) for patients following
cardiothoracic surgery so the patient comments about roommates being helpful to their recovery
were interesting and could lead one to explore how patients can interact in their immediate post
operative period while still in the hospital.
The patient responses about hope versus hopelessness included comments related to
negative feelings about the sometimes lengthy recovery period and included regret about their
decision to have the surgery (Garner, et al, 2005). Learning more about patient feelings in this
area was the main purpose for this critique. Learning about how patients feel in the sometimes
long post operative recovery period will allow nurses to be more sensitive to the long-term needs
that can occur for some patients. Exploring available resources that may be available for patients
after discharge is something that can immediately be incorporated into practice as increased
collaboration between discharge planning team members occurs.
Participant Selection and Sample Size
This study clearly described how patients were selected using purposive sampling.
Patients were chosen based on geographic location, because they spoke English, and based on
how their post operative recovery was progressing. To provide for a “gender balance,” four male
and four female patients were chosen (Gardner, 2005, p. 244). The age range was broad, from
29 to 85 years, although most patients were over the age of 70. Some were married and some
were not. The sample size was determined by data saturation, meaning that a repetitive theme
was developing. The process of informed consent was also obtained from these patients prior to
their discharge from the hospital for permission to contact for the follow-up interviews and again
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obtained once contact was made (Gardner, 2005).
Avoidance of Research Bias
Research bias was avoided as patient quotes were used to support the seven themes that
emerged from the interviews. Interviews were taped to allow for review during the analysis of
data phase. Some patients had differing feelings about a particular situation, even seemingly
opposite experiences, and still their impressions were identified and acknowledged (Gardner, et
al, 2005). However, the research team did summarize the text for coding purposes which could
lead to research bias as a comment could be interpreted differently than it was intended (Gardner,
et al, 2005). Patient selection occurred from a range of clinical experiences and purposive
sampling was used to select these patients (Gardner, et al, 2005). According to Nieswiadomy,
(2008), this method is sometimes called “judgmental sampling” because it involves the
researchers picking their subjects based on who they feel best represent the population that they
are studying, which could lead to research bias.
Data Collection and Analysis
The analysis of the data was consistent with a qualitative approach. Patient responses
were analyzed for a developing theme and the data was presented using direct quotes from the
patients. The purpose of this study was to explore patients’ memories and experiences of their
hospital stay and post operative period, which was achieved through the interview process.
Seven themes were identified from the twelve questions that were asked. These themes
were then discussed in length with patient responses analyzed and then compared to previous
studies that were referenced (Gardner, et al, 2005). The themes were identified as “impressions
of ICU, comfort/discomfort, being sick/getting better, companionship/isolation,
hope/hopelessness, acceptance/apprehension, and life changes” (Gardner, 2005, p. 244-245).
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Some patients had nearly opposite experiences such as some describing the ICU as feeling secure
with people close by while others described their experience as scary (Gardner, 2005).
The interview style approach fit the requirements of a qualitative study while allowing
the researchers to explore for common themes of patient experiences to facilitate changes in
practices for nurses. One conclusion drawn from this study stressed the importance of
psychosocial support in the post operative period as well as in the period after discharge from the
hospital (Gardner, et al, 2005).
Another conclusion was that discomfort experienced by patients in the post operative and
post discharge period could be alleviated by alternative measures and should be explored
(Gardner, et al, 2005). Alternatives for social support should be explored for those lacking the
experience of attending a specific program such as cardiac rehabilitation (Gardner, et al, 2005).
Another area identified was that patients in the ICU needed continual support of the
normalcy of equipment, noises, and recovery time frame (Gardner, et al, 2005). This information
fit the findings of previous studies that have been researched as identified by Gardner (2005).
Limitations of Study and Suggestions for Further Research
This study did offer recommendations for further studies by stating that
“recommendations for further research include further exploration of the experiences and
perceptions of individuals after cardiothoracic surgery, including serial interviews beginning
soon after discharge and continuing until optimal recovery is reached” (Gardner, et al, 2005, p.
249). This particular study was limited as it did not conduct interviews until six months post
hospitalization. Recommendations were also given on screening for depression, following
patients who do not attend cardiac rehabilitation post operatively, and monitoring for continued
post operative complications (Gardner, et al, 2005). Ideas for further study could include follow-
Patient experiences
up calls sooner in the recovery period with the offer of support services for those in need.
Summary
Information gathered in this study could be used for the improvement of nursing care in
the post operative recovery period particularly focusing on the seven themes identified. By
discussing discharge planning and services available in the recovery period, planning can occur
to assist for life changes that may be experienced. Collaborating with my team will allow for
discussion and sharing of information to assist this patient population to have a more positive
post operative experience.
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References
Gardner, G., Elliott, D. Gill, J., Griffin, M., and Crawford, M., (2005). Patient experiences
following cardiothoracic surgery: An interview study. European Journal of Cardiovascular
Nursing. 4 (242-250).
Nieswiadomy, R. M. (2008). Foundations of Nursing Research. Upper Saddle River, New
Jersey: Prentice Hall.