Discussing a nursing research article

For this assignment the author will be discussing a nursing research article. The article was published in The Journal of Advanced Nursing which is a quality peer reviewed journal. This means that before an article is published it is reviewed by experts in the relevant field; they look at factors such as clarity, originality, relevance and the evidence base in order to improve the quality of publications, (Journal of Advanced Nursing, 2003a). All articles are double-blind reviewed; medical statisticians also review articles with a statistical content, (Journal of Advanced Nursing, 2003b).

The article, titled ‘The Role of the District Nurse in Bereavement Support’ was published on 4th March 2002; it was developed and written by Birtwistle, a research nurse, Payne, a university professor, Smith, a university lecturer and Kendrick, a professor from a health center, (Birtwistle, Payne, Smith and Kendrick, 2002). Throughout the discussion the author will cover topics such as, the rationale for the research being carried out, the research approach used, the methodology, data analysis, and the impact this research will have on today’s practice. Throughout the assignment the author will be referring to a framework for reviewing and evaluating, the framework is from Cormack, (Cormack, 2000).

Literature Review

One of the first major steps that should be carried out in research is a literature review. This is when a researcher should seek out other research work that has been carried out previously on the same issue. Researchers could benefit from what has been done before and perhaps thereafter they can offer something in return. Sadly this step is sometimes missed out by researchers who are to keen to move on and start their data collection. By reviewing previous literature many ideas and perspectives can be gained, this can aid in the formulation of research questions and will also prevent the exact same research being carried out twice, (Parahoo, 1997).

Birtwistle et al describe how many of today’s district nurses provide follow-up bereavement visits and offer some type of bereavement counselling, advice and support. Their literature search of this area produced very little evidence on which this practice could be based. They carried out a comprehensive literature search using various popular databases such as CINAHL, Medline, Cochrane, Embase and Psychlit.

They also state that previous researches have found evidence to suggest that bereavement can increase mortality and increase the risk of mental and physical health problems. They found conflicting research about whether there is an increased use of health services after bereavement. Their search found no published research articles about district nurses involvement in bereavement support. It was due to this lack of evidence and research that they decided to obtain information from a representative sample of district nurse’s about their beliefs and current practice surrounding bereavement care in the community, (Birtwistle et al, 2002).

Research Approach

The Cormack framework asks us if the study clearly states the research approach used. Although the article does not state whether qualitative or quantitative research is used it does say that a cross-sectional postal survey was carried out using an anonymous self-completed questionnaire. The questionnaire required the nurse to tick a box from a choice of answers based on a five point lickert scale. This would suggest that the approach used is quantitative.

They say this is the best way to obtain a large amount of data in a short period of time at a low cost. This would suggest that Birtwistle et al have predominantly used a quantitative approach, although it is also clear that a small amount of qualitative research has been used. We can tell they also used qualitative research as they mention that nine of the questions provided an opportunity for the respondent to provide additional information, (Birtwistle et al, 2002).

Most studies use either qualitative or quantitative however it is possible to combine both to good effect, this may provide a deeper understanding of the issue in question. Quantitative research used to be known as the traditional research process, regarded as the acceptable method for developing a science. With quantitative research complex information can be systematically broken down into simple components in order to develop an understanding of the research area, (Cormack, 2000). There are various techniques used by researchers to carry out quantitative research. These may be some form of experiment, interview or various survey forms such as attitude measures or questionnaires, (Eachus, 2003).


Various parts of the Cormack framework cover the methodology, it asks if the subjects are clearly identified, if the approach to the sample selection is clearly stated, if the sample size is clearly stated and about the data collection, (Cormack, 2000). For this study Birtwistle et al carried out a cross-sectional postal survey using an anonymous questionnaire. They say this is one of the best ways to gather large amounts of information about a research area when there is a scarcity of information, (Birtwistle et al, 2002).

As this was the first research to be carried out on this subject the authors wanted a large amount of information as a starting block for the future. Their use of a postal questionnaire survey has many benefits, it is usually the cheapest form, anonymous and postal research tends to provide a truer reading as respondents are more likely to report their true feelings of criticism or satisfaction as their anonymity is not compromised, (Crow, Gage, Hampson, Hart, Kimber, Storey, Thomas, 2002). We are told that the survey was carried out in the districts of East Dorset, West Dorset, Isle-of-Wight, Southampton and South-West Hampshire. There is no rationale or explanation offered for why these areas were chosen, (Birtwistle et al, 2002).

As the research title does not specifically say district nurses in the South of England then the whole population of district nurses in Britain should have been given an equal chance at being selected. As only a small section of the country was selected, for whatever reason, then this is a sampling bias, (Eachus, 2003). From the target districts any qualified nurse who worked in the community was put forward for selection but excluded Health Visitors, Community Midwives, Practice Nurses, School Nurses, Community Psychiatric Nurses and Occupational Health Nurses.

Current employment records were used to identify the possible candidates. To maintain confidentiality the questionnaires were not posted directly by the researchers but by the district coordinators. Over a period of eight months throughout 2000 a total of 522 questionnaires were sent out followed up by reminders at four and seven weeks. The method of data collection was through a questionnaire. The questionnaire was based on one that had previously been developed and used by two of the authors, Payne and Kendrick.

This final questionnaire was then pilot tested. It contained sections on demographic information, interest in and education on bereavement, the nurses’ view on bereavement care and their perceived role in this care, the normal care provided to bereaved patients, and information about the general practice the nurse worked from. As briefly mentioned previously the questions asked the nurse to tick a box from a choice of two or more possible answers. The section on the perceived role of the nurse in bereavement care required a response on a five point lickert scale from strongly agree to strongly disagree. Nine of the questions also allowed a section for the nurse to add additional information, (Birtwistle et al, 2002).

Using a Lickert scale is one of the most popular forms of scale measurement, they are named after the psychologist Rensis Lickert, (Polit and Hungler, 1999). Lickert scales are generally based on a five point scale of a person’s opinion; this would normally be set out as ‘strongly agree’, ‘agree’, ‘undecided’, ‘disagree’ and ‘strongly disagree’. However this format is not the only type in use today, other variations are used. For example a scale may be one line with ‘strongly agree’ written at one end and ‘strongly disagree’ written at the other end or a line with -5 written at one end and +5 at the other, (appendix 1), (Cormack, 2000).

There are many advantages in using questionnaires, if as in the case of Birtwistle et al’s study it is a postal questionnaire then large numbers of people can be reached over a larger area at a lower cost than most other methods. Due to the fact that they are structured and predetermined they carry a reasonable degree of reliability and they also allow respondents to answer in their own time at their convenience, (Parahoo, 1997).

Birtwistle et al clearly state that they used the SPSS or Statistical Package for the Social Sciences version 10 for their data entry and analysis. Chi-squared tests were used to identify variables associated with reported roles of the district nurse, levels of interest in bereavement, feeling informed and the likelihood of post bereavement follow-ups. The Chi-square test is used when there are categories of data concerning the proportions of cases falling into the various categories. It is used to test the significance of different proportions, (Polit and Hungler, 1999).

The key variables used for analysis were age, pre and post-registration education, employment status, personal loss, level of academic achievement, district, professional position and general practice activities in relation to death. Ordinal data such as age were analysed using cross-tabulations. Additional comments were grouped into themes with examples. All direct quotes are identified with a code letter to indicate the district and a number to identify the respondent, (Birtwistle et al, 2002).

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