Method
Research Design and Research Tradition
Sample and Setting
The researchers employed purposive sampling which is the most appropriate to use in a qualitative study. They considered the family members of elderly patients and chose those who they judged would be best able to relate their experiences in the ED. They made sure that different age groups, gender, and civil status were represented. The authors did not set a sample size beforehand and is also appropriate in a qualitative study because sample representativeness is not based on the size but on how much participant narratives mirror reality (Everest, 2014). As such, purposive sampling in this manner enables researchers to create a rich and accurate description of the chosen phenomenon and thereby fulfill the study purpose (Elo et al., 2014).The sample size of 9 is adequate because saturation was achieved. Redundancy was achieved after 6 interviews but 3 more participants were added to validate the pattern identified. Saturation is the stage in data analysis wherein additional interviews do not anymore create additional information signaling that it is time to end the data collection (Elo et al., 2014). The authors sufficiently described the ED setting, that the study focus was specifically on the family members of elderly internal medicine patients. Participant demographics were further presented in a table. Participant consent was obtained verbally and in writing after verbal and written information about the study was conveyed.
Data Collection
The interview is an appropriate qualitative data collection method (Doody & Noonan, 2013). While it was not specified whether it was a semi-structured or open-ended interview, the authors focused on several topics which makes the former a more appropriate technique. These topics were based on earlier studies and included the ED experience, participation in the care of their elderly loved one, information received, interactions with and attention from the nursing staff. Interviews were tape recorded and this is an appropriate method of documentation that enabled the authors to create transcripts for data analysis (Doody & Noonan, 2013). Sufficient amount, richness, and depth of the data was ensured through saturation and querying the participants at the end of the interview if they thought that all relevant topics in relation to their experiences were covered. While triangulation can further deepen one’s understanding of the phenomenon, it was not performed (Everest, 2014).
Procedures
The description of the data collection procedure focused on how the interview time and venue were decided, the topics covered, and that permission was obtained for tape recording. However, strategies to promote trust and rapport which foster honest and detailed accounts of the experience as well as mechanisms to ensure the anonymity and privacy of the participants were not described (Doody & Noonan, 2013; Polit & Beck, 2012). The authors also did not report on the capability of the data collectors in conducting interviews and in minimizing bias throughout the process.
Enhancement of Rigor
There are several ways to enhance to rigor in a qualitative study. Having at least two authors validate the transcript and member checking, which entails seeking validation from the participant, are two strategies to promote credibility and trustworthiness (Polit & Beck, 2012). The authors did not report on prolonged engagement, whether an audit trail was created, and whether reflexivity was ensured which are also ways to guarantee credibility and trustworthiness.
Results
Data Analysis
A detailed description of how the categories were developed was given which enhances confirmability and rigor. The data analysis method is appropriate considering that the data collected were transcripts of experiences. Subcategories, upper categories, and main categories were derived from participant statements leading to pattern identification in the narratives (Elo et al., 2014; Nikki, Lepisto & Paavilainen, 2012). Themes were thus an appropriate product as these represent the common patterns in the data.
Findings
The themes were illustrated with subthemes and varied examples. The authors also used direct quotes from participants and together created thick descriptions of each theme (Polit & Beck, 2012). However, some of the longer translations were not very clear. The themes and their corresponding descriptions were suitable and demonstrated how the authors effectively captured and synthesized the different participant experiences and perspectives. The analysis was insightful as it showed how family members can have positive or negative experiences in the same clinical setting and staff. The differences in perspectives of different types of family members, e.g. daughter or spouse, were also evident.
Theoretical Integration
Discussion
The results were interpreted from the perspective of patients consistent with the focus of the study. The discussion also related the results to the findings of previous research and showed similarities and some differences. The authors underscored their focus on elderly internal medicine patients who experienced longer waits which limits transferability to other types of patients with shorter wait times.
Summary Assessment
The article was presented in a logical and easy to read manner. The main researcher was a doctorate student and the co-authors were a nurse manager and a doctorate professor which promoted the credibility of the main author. The results are trustworthy when considering the detailed description of the data collection and analysis procedures. However, there was inadequate assurance that biases were addressed. Other elements of rigor such as the audit trail were left out as well. Nevertheless, the findings serve as additional evidence supporting the idea that families in the ED have important needs that must be taken into consideration in the plan of care. Recommendations for improving practice can be drawn based on the experiences and themes described.
References
Doody, O., & Noonan, M. (2013). Preparing and conducting interviews to collect data. Nurse Researcher, 20(5), 28-32. http://dx.doi.org/10.7748/nr2013.05.20.5.28.e327
Elo, S., Kaariainen, M., Kanste, O., Polkki, T., Utriainen, K., & Kyngas, H. (2014). Qualitative content analysis: A focus on trustworthiness. SAGE Open, 2014, 1-10. doi: 10.1177/2158244014522633
Everest, T. (2014). Resolving the qualitative-quantitative debate in healthcare research. Academic Journals, 5(1), 6-15. doi: 10.5897/MPR.2013.0107
Nikki, L., Lepisto, S., & Paavilainen, E. (2012). Experiences of family members of elderly patients in the emergency department: A qualitative study. International Emergency Nursing, 20(4), 193-200. doi:10.1016/j.ienj.2012.08.003
Polit, D.F., & Beck, C.T. (2012). Essentials of nursing research: Generating and assessing evidence for nursing practice (9th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
