Smallwood ( 2000 ) employed a qualitative attack. The information was expected to uncover common subjects that defined doctors ‘ attitudes. Data was collected utilizing a questionnaire consisting both open-ended and close-ended inquiries. Since this survey was exploratory in focal point, the usage of a qualitative attack was justified. Qualitative research methods are designed to determine the significances and experiences contained in a given information set ( Coolican, 1994 ) . Therefore, whereas a quantitative research worker would seek to mensurate attitudes, and statistically analyze the informations obtained to prove hypotheses, a qualitative research worker explores the readings that underpin people’s attitudes, and identifies repeating subjects or topics in the information. Emerging subjects may back up or belie a hypothesis.
Qualitative methods incorporate a high grade of subjectiveness. The usage of open-ended inquiries allowed the medical advisers to show themselves ‘freely’ , unrestricted by the confines of a pre-determined response graduated table. Furthermore, the survey was conducted in a realistic, specifically the 30-bedded coronary attention unit in a general infirmary, instead than a contrived and therefore unreal environment, such as a research lab. Qualitative surveies incorporate a high grade of ‘construct validity’ , intending that the informations accurately taps the an unobserved concept of involvement ( in this instance ‘attitudes towards nurse appraisal and induction of thrombolysis’ ) , instead than a wholly different concept, such as a personality trait. However, topics responses may be inconsistent over clip ( external dependability ) or across questionnaire points ( internal dependability ) .
One job with qualitative designs is their low grade of control over immaterial influences ( i.e. low internal cogency ) . Although the usage of open-ended inquiries tends to arouse a richer information set, this flexibleness besides introduces systematic or random fluctuations in subjects’ responses. For illustration a respondent may offer an equivocal or complex response that is hard to decode. There are two possible beginnings of mistake ; single differences and facets of the survey design itself, notably measuring and information analysis.
Mistake from single differences can be minimised through random sampling, and/or set uping rigorous standards in order to choose a homogeneous group. However, a sample of convenience was used in the present survey. Nevertheless, all respondents were advisers, bespeaking some grade of sample homogeneousness, an of import factor that reduces unwanted discrepancy in the information.
Measurement mistake frequently consequences from utilizing undependable or invalid instruments. It isn’t clear from this survey what ( if any ) analytic stairss were taken to set up the dependability and cogency of the questionnaire. Flawed methods of analysis may besides present mistake. Data was analysed utilizing thematic analysis, an appropriate method for qualitative informations. However, thematic analysis entails size uping a information set to place repeating subjects, and hence is inherently subjective. Consequently precautions are necessary to understate measurement mistake. These are discussed below.
Research workers recommend several methods for set uping dependability and cogency in qualitative surveies ( Coolican, 1994 ) ; inter-observer dependability ; triangulation, analysis of negative instances, reiterating the research procedure several times, and obtaining feedback from participants. There is no grounds that any of these methods was implemented in the present survey.
Triangulation entails the usage of other methods of informations aggregation and analysis to verify findings obtained. Therefore, for illustration, subjects emerging from unstructured interviews can be crosschecked utilizing structured interviews. However, it is more common to verify qualitative informations utilizing quantitative methods. For illustration, outstanding subjects can corroborate utilizing factor analysis ( Field, 2000 ) .
Analysis of negative instances involves sing why unexpected subjects or forms have emerged. The processs and informations may be reviewed afresh, or some other signifier of reproduction may be attempted. There is some grounds that this method of confirmation was attempted here. Three basic subjects emerged including a dimension labelled ‘conceptual awareness’ . However, the position of one peculiar respondent was out of measure with the remainder of the sample ; whereas other respondents ‘accepted’ the thought of nurses administrating intervention, this person retained the position that nurses could do determinationsbut non really administer intervention. The writer seemed to re-evaluate this negative instance ( p.17 ) .
Finally, participant feedback may be sought, in order to confirm probationary decisions. Where necessary ab initio premises are modified, discarded or replaced. There was no grounds of participant audience in the present survey.It would hold been prudent to inquire several participants their positions about the emerging subjects. Are these subjects concordant with their perceptual experiences?
The British Medical Association ( BMA ) publishes elaborate guidelines on medical moralss ( BMA, 2004 ) which are on a regular basis updated ( BMA, 2005 ) . Key ethical considerations include the doctor-patient relationship, consent, confidentiality, wellness records, ordering and administrating medicine, and relationship with co-workers. This paper was approved by the Nursing Research Committee ( presumptively at New Cross Hospital ) , which would hold ensured rigorous attachment to BMA moralss guidelines. The survey clearly addressed the issues of confidentiality, namelessness, and consent. For illustration participants were informed that they had the option to retreat at any clip and questionnaires were returned to an ‘independent ” aggregation point, instead than straight to the research worker.
The BMA attaches considerable importance to keeping good working dealingss between medical staff, particularly between physicians and nurses. Therefore it is highly of import that personal research information is unbroken private. It is ill-defined what precautions were in topographic point to guarantee privateness. However, it is assumed that the Research Committee would non hold approved the survey if there were serious concerns about this.
Discussion
This survey has several strengths. First, there was a clear principle – the writer identified a spread in the literature, which the survey attempted to turn to. Second, usage of a qualitative design ensured a high grade of pragmatism. Third, an appropriate protocol ( thematic analysis ) was developed and used for analyzing the information. However, it is non clear whether this was done manually or by utilizing a more dependable and flexible computing machine system, such as the Computer-Aided-Thematic Analysis ( CATA ) plan ( CNET Networks, 2001 ) . Use of a computerised system would bring forth greater assurance in the informations and decisions reached, as it minimises human mistake.
The survey has a figure of major failings. First, a qualitative design lacks the construction and numerical preciseness of a quantitative attack. It is extremely subjective. Therefore, showing equal dependability and cogency is overriding. There is really small grounds that any stairss were taken to heighten reliability/validity. The usage of a little sample of convenience rises inquiries about the generalization of the findings. Would similar subjects emerge in other NHS infirmaries? Is the group of advisers recruited representative of the wider population of medical physicians who treat myocardial infarction patients? In position of these restrictions, the findings from this survey must be treated with cautiousness.
Deductions for Clinical Practise
The findings provide a utile resource for rehearsing evidence-based medical specialty ( Thompson et al, 2004 ) . Clinical determinations by physicians, nurses, and other wellness attention staff can hold important deductions for the quality of wellness attention bringing ( Leung et al, 2003 ; Lipman et al, 2000 ) . Consequently, staff are encourage to establish their clinical opinions on published scientific grounds, where possible. Since medical advisers “ keep the cardinal duties in the administrations and bringing of attention ” ( Smallwood, 2000, p.17 ) , it is indispensable that any determinations sing nurse-initiated thrombolysis be based on research grounds. For illustration, if advisers have negative attitudes towards nurse-administered intervention it may be necessary to allow precautions, to guarantee a contributing working environment for nurses.
Recommendations
The present findings suggest that there is a demand to clear up some ambiguities refering nurse-administered thrombolysis. At least one medical adviser did non admit nurse-administered intervention, and a few physicians were diffident about who should take duty for incorrect diagnosing and other negative results. It is recommended that hospital direction issue more specific guidelines on these issues. Furthermore, there is a demand for extra research to set up the generalization of these findings to other NHS infirmaries.
Decision
This survey was selected following a comprehensive literature reappraisal of several bio-medical and psychological databases. The findings highlight the attitudes of medical advisers towards nurse appraisal and disposal of thrombolytic agents. Three major subjects emerged: advisers understanding of what defines nurse-initiated thrombolysis ; medico-legal concerns sing legality, safety, scrutinizing and evidence-based pattern ; and eventually issues of professional duty integrating competency, duty, preparation, and accreditation. Overall, the findings have touchable deductions for clinical scenes, specifically in footings of cut downing door-to-needle times, and supplying valuable research informations for evidence-based pattern. Important recommendations are made including the demand for clear guidelines on intervention duties.
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