This critique evaluates the research study, by Gibbon and Crane, “The impact of missed care on the professional socialisation of nursing students: A qualitative research study”. This research study was published in “Nurse Education Today” in 2018. A summary of the study along with the key features will be highlighted. Strength and weaknesses of this paper will be described using critical review methodology. Although this study is a new one of its type and it tries to answer the impact of “missed care” on the socialization of new nursing student, it still has some areas that have been ignored.
Overview of the Study
The qualitative research study of Bernard Gibbon and Julie Crane is a beautifully crafted research that tries to identify the impact of missed care nursing in nursing students. Besides discovering the influence of missed care on the professional socialization, this study also tries to cover motivations to attain socialization, awareness against drawbacks of missed care, and strategies to avoid missed care in the career. Qualitative method is used in this research study for the collection of data. The data population is final year students of pre-registration nursing degree from a higher education institute in the United Kingdom. The thematic analysis method is used for the analysis of data, collected by group interviews of the sample population. The results of this study are concluded as the already present acceptance and awareness against missed care. Nursing students are found to be aware that missed care can happen and it has not much to do with their professional socialization.
Problem Statement and Purpose of the Study
The statement of this study is “the impact of missed care on the professional; socialization of nursing students”. The problem statement of this study is self-explanatory. The statement not only defined what is the actual purpose of the study but also outlines the possible relationship in between the missed care and nursing students. Since it is mandatory for students to attain the essential skills along with professional values and behaviors (Lai and Lim, 2012) and students are likely to came in contact with missed care scenarios during their training (Bagnasco et al., 2017), the problem statement is clearly justified to the purpose of the study.
The purpose of this study is to minimize the patient acuity about morbidity and mortality and delivering of incomplete health care by introducing professional nurses into the mainstream. The study will provide ethical as well as the managemental basis for the professional socialization of nursing students. The other main importance of this study is that it is one of the very first kinds of its own. Despite, being having attention (Griffiths et al., 2018), and the presence of large numbers of studies on missed care, no research is so far conducted using nursing students as the sole sample population.
Literature and Theoretical Framework
The literature review of the research study is mixed. Definitions and concepts of particular variables like “missed care”, “impact and influences” are well defined. At the same time, some key variable like the professional socialization is skipped.
The background of the study provides a clear relationship between missed care and its effect and need for nursing students. The background also provides an insight into the environmental background. These explanations are well established using references from other recent research studies available on the topic. The background at the end also provide the purpose of this study as “The UK Health service, is under tension with high levels of patient acuity placing increasing demand on the service”. However, one irritating statement is used in the background that shows a contradiction with respect to the statement and purpose of the study. The words, referring to Bagnasco et al., (2017), does not seem to fit in the context. If it is “reasonable to assume that students” are likely to be involved in missed care during their education then why the study is interrogating directly about the impact, without clearing that whether they are involved or they are not.
The literature review starts with the explanation of the method, and data is counter checked or analyzed. Multiple studies published during the year 2001 and 2007 are searched and read in order to retain the information about the variables. Almost fifty articles are searched for the review and qualitative research purposes, but none of them is searched using the term “nursing students”. Referencing and analyzing the collected data, using only nursing students as the sample, cannot be qualitatively counter checked with the information composed from another sample. Studies related to the effect of poor healthcare practice on nursing students, such as Bagnasco et al., (2017) “Understanding and addressing missed care in clinical placements – Implications for nursing students and nurse educators” are already published, but poor search terms do not make them end up in the result.
Another missing element, in this study report, is the literature review about the detailed explanation of the professional socialization of nursing students. How the professional socialization that is present in nursing students at some extent (Melia, 1987) can be affected by the missed care. Though some of the references, such as “Kalisch, (2006)”, are used so much repeatedly throughout the paper, the references cited by the authors are more primarily in the source, for example missed care aspects that are used for the analysis purpose are directly retrieved form researches where they are first determined. The studies of Kalisch et al., (2013) and Morin and Leblanc, (2005) are a good example of a primary source of references used in this research study.
Selection of Population and Sample
The method used for selection of sample population is qualitatively based. Direct selection of the students, in the last year of the nursing program, is done from a Higher Education Institute in the United Kingdom. Participants are asked to take part in the study using personal communication. About 18 participants are selected and classified into two groups. The population samples are a true match for the study problem as the population selected is the nursing student from the last year of study. The sample size, on the other hand, is questionably small. Since for the analysis purpose the data collected is run against the findings from multiple large-scale researches that utilize different data collection tool, the credibility of the outcomes of the report may be provocative. The results due to the same professional background of the selected population sample can be generalized.
The research design used in this study is a qualitative research methodology. The qualitative method seems to flow in almost every part of the study. The data collected from the qualitative method is then compared to the data collected using the focused group methodology. Group discussion legitimizes the conversation (Papastavrou & Andreou, 2012) hence to bring out the data from a focused group “a simulated clinical scenario” is used. Findings and discussion are well explanatory as usually found in qualitative research methodology (Merriam, 1998). However, the use of “pseudonymization” and transcription of the recorded interviews, raises questions about the correctness and precision of the result outcomes. The selection and stating of the themes for data analysis, by authors as stated in the research paper “Through discussion, the themes were defined and named” also hinders the unbiasedness of the outcomes of the study.
The thematic analysis process is used for the data analyzation. Six phases are extracted from previous studies. The data collected during the audio interview of groups is transcribed and then manually compared by the researchers. The use of transcribed data, though, it is dually checked by both of the authors, “This phase was undertaken independently by each researcher”, give doubtfulness to the accuracy of the interpretation as well as the precision of the data. The manual confirmation of data analysis process, without using any tools and instruments, the significance of the discussion “to ensure credibility”, and the process of validity as described by researches indicate the appropriate measures taken for the reliability of data.
Ethics are very important in researches. They minimize misinterpretations and errors in the final outcomes of the study (Resnik, 2015). In this research study, the authors tried to adhere to the ethical dimensions. Ethical approval is taken prior to the research from the “University Research Ethics Committee”. Research participants are also invited instead of enrolling without their intentions. “Participation Information Leaflet” are distributed to the interested contributors, even an agreement is obtained before the commencement. Use of the pseudonymization system to acquire the confidentiality or anonymity of the participant is another excellent measure taken by the researchers. All these measures seem to be good in context with the ethical dimensions. The “data was however collected by the researcher not known to the participants to avoid a potential conflict of interest” is the turning point for this research study. Without the proper acknowledgment of the participant, the data collection undoubtedly breached the ethical dimension of this research.
Limitations of the Research
The research is very limited in context with the small number of participants (around 18 participants only), single station as the single environment for research, and the comparison between the data collected using focused group methodology and the data set retrieved from search results of multiple research. The themes used in data analysis are also limited to five, and the use of a custom virtual clinical scenario for triggering the group discussion can also be accounted as the limitation of the study, since the participants and researchers, both were bound to remain close to the vignette and five themes respectively, throughout the study.
Findings and Discussions
Findings of this research paper are based on the personal experiences of the participant related to the stimulated ward environment. Since experiences shared were generalized and participants have not individually met the situation, the resulted findings cannot be applicable to other scenarios.
Participants are found to be aware of what missed care is. According to European RN4Cast study, a large number of nurses are found to be aware of missed activities during their work (Ball et al., 2014). This finding from European case study support and strengthens the findings of this research. To what extent they are aware of is, however, undefined and undiscussed.
The basis or causes of missed care, discovered by the study are the scarcity of nursing staff and unproductive teamwork. The scarcity of nursing staff is a universally identified phenomenon for bad healthcare practices (Buerhaus et al., 2007). Even the previous studies, about missed care, found the staff shortage to be the prominent rationale of missed care (Kalisch, 2006); therefore this finding is no contradiction at all. The second rationale, the unproductive teamwork, is found to be another basic cause of missed care. The reasons described by the researchers is the personal opinions of participants on “how they are perceived” in the team. This reason does not justify the claim of teamwork, to be the cause of missed care.
For the impact part of the study, the findings are somewhat ambiguous. The report, itself, accepts that there may be some hidden traits that are not discovered in this study. A part of the research findings stats the ineffectiveness of the missed care on the professional socialization of nursing students, while in the other part of the study, the opposite is described. “The participants themselves reported that missed care negatively impacted”, is a strong indicator of the vague findings of the report. The possible continuity of missed care in nursing student (Bagnasco et al., 2017), as discovered in previous papers, is also discussed correctly.
“The adoption of rounds and routinised care” along with proper teamwork is discussed and describes as basic strategies for the avoiding missed care. To establish this suggestion again personal views, of the participant, have given priority. Strong opinions of students regarding teamwork and their feeling of loneliness during their practice is set as the basic criteria for the identification of the rationales of missed care and are used to propose the strategies. Since the qualitative research method is used to handle people’s way of interacting and organizing the world (Guest, Namey & Mitchell, 2013), it, therefore, cannot be used for suggestions.
Influence of missed care on career ambitions is discussed with no relation to the missed care. The supported point given in support of the influence of missed care i.e. “the participants in this study were more likely to seek to choose to work in very busy environments, … as they saw this as providing them with an enriching experience in a wide range of different patient groups that would enhance their knowledge and long-term career aspirations” has nothing to do with the influence of missed care, instead it only defines the personal urge of students for their career ambitions.
Results or Conclusions
The conclusion of the study is unable to describe the actual impact of missed care on the personal socialization of nursing students. In its place, it highlights the outcomes and personal opinions of participants. “The participants in this study were aware of the impact of missed care”, did not help the result to comply with the problem statement of the study. How participants see missed care and what are the strategies developed by nursing students to tackle with missed care are concluded in the conclusion of the research study. “Missed care is a characteristic of the professional socialization” is the final outcome of the study. In short, the conclusion part does not have a match with the rest of the study.
Presentation and Style
The overall presentation and style of the research are satisfactory. Although some key components like, implications, instruments for data analysis, and recommendations are missing. The other parts are clearly written with a perfect level of details. The conclusion of the study needs to be rewritten due to noncompliance with the actual statement of the research. Little or no use of jargons makes this research easily understandable. Some tables and graph, if added, can help in the better presentation of the research study. References used are recent and related to the content.
The study is written using standard methods and regulations. The main aim of this study is to find out the impact of missed care on nursing students. The literature review and theoretical framework are well defined, but the analysis and result of the study have multiple errors in them. Participant-driven result and strategies of this research are unable to answer the study question properly. Limitations regarding a small number of population sample and a single environment scenario, make the research impossible and inapplicable to the general world. It would be better if the research uses a large population sample for data collection. The presentation and styling of the research study by Gibbon and Crane are beautiful and up to the industry standard. In short, researchers tried their best to make this study perfect but were unable to do so due to the limitations of the study.
Bagnasco, A., Timmins, F., de Vries, J., Aleo, G., Zanini, M., Catania, G., & Sasso, L. (2017). Understanding and addressing missed care in clinical placements — Implications for nursing students and nurse educators. Nurse Education Today, 56, 1-5.
Buerhaus, P., Donelan, K., Ulrich, B., Norman, L., DesRoches, C., & Dittus, R. (2007). Impact Of The Nurse Shortage On Hospital Patient Care: Comparative Perspectives. Health Affairs, 26(3), 853-862.
Griffiths, P., Recio-Saucedo, A., Dall’Ora, C., Briggs, J., Maruotti, A., & Meredith, P. et al. (2018). The association between nurse staffing and omissions in nursing care: A systematic review. Journal of Advanced Nursing, 74(7), 1474-1487.
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Melia, K., 1987. The Occupational Socialisation of Nurses. Tavistock, London.
Merriam, S. (1998). Qualitive Research and Case Study Applications in Education. San Francisco: Jossey-Bass Publishers.
Papastavrou, E., Andreou, P., (2012). Exploring sensitive nursing issues through focus group approaches. Health Science Journal. 6 (2), 185–200.
Resnik, D. (2015). What is Ethics in Research & Why is it Important?. Retrieved from https://www.niehs.nih.gov/research/resources/bioethics/whatis/index.cfm