The article is titled A Qualitative Study of Nurse Observations of Symptoms in Infants at End-Of-Life in the Neonatal Intensive Care Unit and is written by Christine A. Fortney and Deborah K. Steward. The title relates well to the content of the paper since the paper provides information on valuation and managing symptoms presented by infants at the end-of-life and how nurses can manage them in the intensive care unit (Fortney & Steward, 2017). Also, the setting of the study including 14 staff nurses and 20 infants in a hospital setting relates well to the title of the article. The abstract of the article provides the objectives, methodology, primary outcome measures, results and conclusion of the report. The way the abstract has presented the summary of the information included in the sections of the article is concise and to the point. However, the section of limitations was not included in the abstract of the paper. It is an important part that should have been added to provide the reader an overview of the limitations of the study.
The purpose of the study was to explore how nurses observed and managed infant symptoms at the end-of-life in neonatal intensive care (Fortney & Steward, 2017). The study purpose matched the design used since the design was qualitative exploratory design involving face to face interviews and tape recording. These methods of data collection used in the study were necessary as it addressed the purpose of the study and was the best avenue at arriving at the answer to the research question of the study. Also, the research tradition used here was a case study where the staff nurses were recruited to take part in face to face interviews. It, therefore, enhanced the best outcome of primary data collection. Furthermore, the report describes a theoretical framework for the study. The researchers begin by identifying a study area, the problem and its significance in healthcare. It is followed by an extensive literature review of the research problem giving an overview of research findings.
The data of the research especially the interview data received from the semi-structured interviews were analyzed using the framework approach (Fortney & Steward, 2017). This method was appropriate as it involves content analysis of three steps namely data management, descriptive accounts and explanatory accounts hence enhancing rigor. The category scheme presented was used to deduce the coding matrix. The category scheme is appropriately used to show the consistency of the initial themes of the study. In avoiding avoid redundancy in the research, reliability was enhanced by an independent researcher who observed the data to minimize bias. The coding matrix was the method used to index and organize the data by refining the initial themes to form a coding index (Fortney & Steward, 2017). The study safeguarded the rights of nurses in the research by conforming and being in compliance with the ethical standards of hospital Institutional Review Board (IRB) (Fortney & Steward, 2017). Also, al the 14 nurses participating in the study had informed written consent before commencing the research. The design of the research minimized risks to the participants as it only involved interviewing the nurses using appropriate semi-structured questions.
The design of the research was a qualitative exploratory study design (Fortney & Steward, 2017). This design was appropriate as it involved gathering of information using a semi-structured interview from the nurses participating in the study. Given the research question, this method was necessary as it enhanced gathering primary information regarding EOL and an intensive critical care of infants. The setting of the study was in a metropolitan childrens hospital in central Ohio, USA (Fortney & Steward, 2017). The population involved qualified nurses. The subjects of the study, nurses, were obtained through an invitation to a face to face interview. The sample was small since the participants were obtained only from one hospital. Aside from this, the major themes that emerged included uncertainty in the transition of EOL care. The theme apparently captures the meaning of the narrative which is the difficulty in the provision of EOL care to infants in intensive care.
Analysis of data was through content analysis approach by the coding matrix. It included data management where two independent investigators read the data manuscripts to be familiar. Then descriptive accounts step helped to analyze and refine the initial themes (Fortney & Steward, 2017). These steps helped to verify the accuracy and reliability of the results. The presentation of the data was well organized through tabulation helping to validate conclusion reached.
The findings of the study provided difficulties associated with the participants in caring for the infants as uncertainties in infant prognosis, symptom recognition, and treatment, lack of knowledge that is related to the religious and cultural customs of various families. Also, the emotional world of the participants in the study was well outlined. The participants, nurses, felt discomfort with multiple constituents of the EOL care practices.
Trustworthiness and integrity of the data were enhanced through enabling the participants to provide a written consent and also work within the mandate of IRB. The research does not give the specific techniques used to enhance integrity but allowing the nurses to speak freely is one method that could improve transparency and integrity. The limitation of the study include generalizability of the sample due to small sample size, lack of cooperation from some of the participants and use of semi-structured questions in the interview might have precluded essential views of the participants (Fortney & Steward, 2017).
The research is essential in the field of healthcare and nursing and will possibly help in decision making when it comes to infant EOL care. The findings show that necessary EOL care is needed to enhance the process. The study is worth publishing in an academic journal since it provides a framework approach to solving a problem within the healthcare sector. The authors have recommended for further research to ensure improved EOL experiences for the infants at the NICU (Fortney & Steward, 2017).
Fortney, C., & Steward, D. (2017). A qualitative study of nurse observations of symptoms in infants at end-of-life in the neonatal intensive care unit. Intensive And Critical Care Nursing, 40, 57-63. http://dx.doi.org/10.1016/j.iccn.2016.10.004
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