NR 505 Week 4 Qualitative Study Appraisal Paper Example

Appraising a Descriptive Qualitative Study of How Clinicians Feed Critically Ill Children in Two Ghanaian Teaching Hospitals: Focus Groups Split by Profession, a Saturation Claim With No Count, and Two Themes the Question Had Already Named

Student Name

College of Nursing, Chamberlain University

NR 505: Advanced Research Methods: Evidence-Based Practice

Instructor Name

Month Day, Year

Appraising a Descriptive Qualitative Study of How Clinicians Feed Critically Ill Children in Two Ghanaian Teaching Hospitals: Focus Groups Split by Profession, a Saturation Claim With No Count, and Two Themes the Question Had Already Named

Why This Study, and What It Promises

My term question is about gastric residual checks in ventilated adults. The trials tell me what happens when the routine is stopped; they do not tell me how clinicians decide when to feed, hold or stop, which is what any practice change will have to work with. Qualitative research is the design built for that kind of question. I chose Abukari and Acheampong (2021) because it is one of few open-access qualitative studies of feeding decisions in intensive care that describes its methods in enough detail to appraise, and because its setting, two public teaching hospitals in Ghana caring for children from birth to 12 years, is different enough from my adult medical ICU to force me to think about transfer rather than assume it.

The authors describe their approach as a descriptive qualitative design. That promises a close, low-inference account of what participants said about their practice, organized into categories, rather than a theory or an interpretation of lived meaning. The appraisal holds the study to that promise, not to the standards of a trial. A complaint that 42 participants is too few to generalize would be the wrong complaint; descriptive qualitative work does not claim statistical generalization.

Recruitment Read as an Argument

Participants were nurses, midwives and physicians who had worked in the neonatal or pediatric ICU for at least two years, recruited purposively and voluntarily from staff lists with the help of unit heads. The study held six focus groups of five people each and twelve individual interviews, 42 participants in all, across a southern and a northern hospital. About 38% were specialists, and 75% were women.

The recruitment logic is sound in two ways. The two-year rule selects people who actually make feeding decisions, and taking both of Ghana's main pediatric intensive care referral centers, in different regions, gives variation in setting that matters to the question. The focus groups were also, from the participant table, largely grouped by profession: one northern group, for example, was made up entirely of physicians aged 25 to 28 with two to three years' experience. Grouping by profession makes it more likely that junior physicians and nurses speak freely without senior colleagues present.

Two features weaken the logic. Recruitment through unit heads may have favored staff whom managers thought would speak well of the unit's practice. And the study does not say whether it sought out clinicians who disagreed with usual practice, which is the variation that would matter most to anyone planning a change.

The Stopping Rule

The paper states that data saturation was reached when no new information was obtained. It does not say at which interview this happened, how new information was judged, or whether the individual interviews, held after the focus groups, added anything the groups had not. A claim of saturation with no account of how it was reached cannot be checked. It also sits oddly with the design: the numbers, six groups of five and twelve interviews, look planned in advance, which suggests that the stopping point was set before data collection rather than reached through it. That does not make the findings wrong, but it means the reader cannot tell whether a thirteenth interview, perhaps with a dissenting nurse, would have changed them.

A Route a Reader Can Retrace

The analytic route is partly traceable. The authors describe transcribing verbatim, collecting and analyzing data at the same time so that new ideas could be probed in later interviews, manual initial coding by all the researchers, further coding in MAXQDA software, and meetings to agree on themes. Field notes were compared with transcripts, and some participants were contacted afterward to clarify their statements.

Two problems make the route harder to follow. First, the method is called content analysis, but the description of codes and themes cites Braun and Clarke (2006), whose thematic analysis is a different approach with its own steps. The paper does not say which it followed, or how. Second, the two main themes, determinants of feeding and feeding processes, are the two halves of the research question, word for word. Themes that repeat the question suggest that the analysis sorted data into categories set in advance rather than building categories from the data. That can be legitimate in descriptive work, but it should be stated as a deductive step, and the paper describes its coding as inductive.

Findings Relevant to My Question

The findings describe clinicians starting enteral feeding through a nasogastric tube, moving to cup feeding and breastfeeding as children improve, and weighing a child's breathing against the risk of feeding. One pediatrician described respiratory distress as a reason to hold or change feeding. The authors' introduction notes that clinicians commonly measure residual volume before enteral feeding, but the findings do not report whether participants did so or how they used it. For my purposes, that is a gap: the study that could have shown how residual checks enter a feeding decision does not describe them.

The Claim, Held to Its Method

The authors conclude by recommending regular in-service training, logistics and specialized personnel to reduce infant and child mortality from poor feeding. The first part, that clinicians described gaps in training and resources, stays inside what interviews can show. The second part, a link to mortality, does not. A descriptive study of what clinicians say cannot show that training would reduce deaths, and the claim reaches beyond the method.

The authors' own limitations are sample size and interviews held after shifts, when staff were tired. The second is a real concern about data quality. The first, as argued above, is not the main one. The larger limits are the untraceable saturation claim and themes that mirror the question.

What Transfers to My Unit

Little of the content transfers directly. Children in Ghanaian referral ICUs, fed by staff working with scarce equipment and few dietitians, are not ventilated adults in a U.S. medical ICU. What transfers is a lesson about method: if my unit studies how nurses decide to hold feeds, the study should state how it will judge saturation, seek out nurses who disagree with the routine, and build categories from what nurses say rather than from the question's headings. I will carry those three points into the proposal in Week 8.

References

Abukari, A. S., & Acheampong, A. K. (2021). Feeding the critically ill child in intensive care units: A descriptive qualitative study in two tertiary hospitals in Ghana. BMC Pediatrics, 21(1), Article 395. https://doi.org/10.1186/s12887-021-02854-2

Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77-101. https://doi.org/10.1191/1478088706qp063oa