Nursing Critique of a Pediatric Research Article
An abstract is normally a succinct introduction to a qualitative or quantitative article, whose basic intent is to inform the reader of the purpose, methods, and main findings of the study. The abstract should adequately summarize the article. In case of Helvig and Minick (2013), the abstract is succinct, detailed, thoroughly organized, logical, and informative. In other words, the abstract includes the most essential information needed to make the reader interested in reading the article. In Helvig and Minick (2013), the abstract includes the following information: problem statement, background and prior research, methods and research design, results of data coding and analysis, implications for nursing and recommendations for future research.
As such, it is possible to say that the abstract is an abridged version of the article, which includes all relevant information and sets the stage for understanding the method and results of the study. This paper is a critique of a qualitative nursing study that was published in 2013. The paper reviews each and every aspect of the research article, from the introduction to the discussion and conclusions. Implications for the pediatric nursing practices are included and discussed.
Keywords: pediatric, adolescents, qualitative, migraine, phenomenology.
Nursing research is an ever developing dynamic knowledge field. Nurses are constantly exposed to a diversity of knowledge sources, and they are empowered to translate their knowledge, learning, and experiences into research problems and nursing practices. Researchers in nursing apply to a variety of approaches and frameworks, in order to advance their theoretical and practical knowledge. However, the difference between qualitative and quantitative research frameworks cannot be ignored. According to Ryan, Coughlan and Cronin (2007), critical analysis of any qualitative study is impossible without conducting an in-depth review of the research process. Qualitative approaches to nursing research differ considerably from quantitative research models, but they enable nurses to look deeper into patients' and colleagues' experiences, while evaluating their implications for nursing practice.
Title of the Study
The study is titled "Adolescents and Headaches: Maintaining Control". The research was authored by Ashley W. Helvig and Ptlene Minick and published in Pediatric Nursing in 2013. The title does not reflect the nature and essence of the study, since its focus is on migraine headaches facing adolescents, their negative impacts on adolescents' social and mental wellbeing, and the ways in which adolescents try to control their physical pain. Like any qualitative study, the discussed article does not accept truth as being an objective reality and tries to look deeper into adolescents' subjective realities, as they are coping with migraine (Ryan et al., 2007).
The quality of the introduction, as well as the purpose of the study and problem statement presented in the introduction, are the elements, which greatly influence study robustness (Ryan et al., 2007). According to Ryan et al. (2007), many problems and topics explored in qualitative studies are abstract and have the potential to generate different interpretations; at the same time, the qualitative researcher must not only present and validate the importance of the research problem but also communicate the purpose of the study and its expected results (Ryan et al., 2007). The article by Helvig and Minick (2013) begins with a well-developed, well-organized, and logical introductory section, which presents the problem of chronic illness in adolescence, the effects of migraines on adolescents' physical, social, and psychological wellbeing, and the quality of their lives.
Helvig and Minick (2013) lay the background for their study, suggesting that the current knowledge of adolescents with migraines is highly limited. Therefore, the purpose of the discussed phenomenological study is to "investigate the meaning of the lived experience of migraines in the adolescent population" (Helvig & Minick, 2013, p. 19). In addition, the researchers state the importance of the study which, in their view, can inform education and research practices and help future nurses to improve the quality of adolescents' lives (Helvig & Minick, 2013). The only problem with the introduction is that it does not include any research question. However, it does not diminish the significance of the problem described in the introductory section of the paper.
Statement of the Problem
The article does not have any specific section that would discuss the problem of migraines in adolescents and their perceptions of it. The issue of adolescent migraine headaches is addressed in the introduction. Although the evidence provided by is quite compelling to justify the importance of the study, the fact that Helvig and Minick (2013) do not present any research questions makes it difficult to understand the essence of their research. Helvig and Minick (2013) state that understanding adolescents' perceptions of migraine is crucial for the future research, which could also improve the quality of life in adolescence with headaches. This statement, however, is of little value for nurses, since it does not help to understand how the results of the study could benefit practicing nurses and the nursing science, in general.
Review of Literature
Ryan et al. (2007) claim that a literature review is designed to inform the reader of what has been accomplished in research in the given subject. In qualitative research, literature reviews are based on the implicit assumption that there is no single reality, and the phenomenon in question can be better understood, by accepting and describing individual experiences and perspectives (Ryan et al., 2007). The review of literature presented by Helvig and Minick (2013) does not meet these principles. Due to the paucity of qualitative findings in relation to chronic illness and headaches in adolescents, Helvig and Minick (2013) present mostly the results of quantitative studies. Contrary to the qualitative philosophy of the discussed research, the review of literature is full of statistical data, which sound compelling but do not always meet readers' qualitative expectations.
Moreover, the review resembles an annotated bibliography, which includes brief annotations to the studies that were earlier conducted in the field of chronic illness, adolescence, and migraines (Helvig & Minick, 2013). The researchers do not speak about any emerging themes that could potentially inform their conceptual framework (Ryan et al., 2007). The few qualitative studies included in the review of literature either speak of the social impacts of chronic illness or examine the migraine experiences of adult patients, rather than adolescents (Helvig & Minick, 2013). Again, the researchers do not perform any thematic analysis of the earlier findings.
Ryan et al. (2007) recommend conducting a review of literature after the actual study is completed. In phenomenology, Ryan et al. (2007) advise using participants' subjective experiences and reports to interpret the evidence obtained from a review of literature. However, Helvig and Minick (2013) examined research literature before the study data were collected and analyzed. Given that the majority of studies included in the review of literature are quantitative, the researchers may face difficulties with interpreting the results of their interpretive phenomenological study.
Ryan et al. (2007) write that many qualitative studies are either atheoretical or theory-generating. In other words, many qualitative studies either use no theoretical framework or serve as the basis for generating new theories. In the case of Helvig and Minick (2013), the researchers do not use any theory to guide their design and data analysis decisions. However, as Ryan et al. (2007) report, even when a suitable theoretical framework is absent, researchers should indicate this in their study and explain why no theoretical framework was used. Unfortunately, Helvig and Minick (2013) do not include any theoretical information. As a result, the reader is left to guess whether at all any theoretical assumptions could support the design and results of the discussed study.
Qualitative designs encompass a variety of elements that make it sophisticated and, yet, indispensable in the analysis of respondents' personal experiences. "Design in qualitative research incorporates a range of approaches within what is often referred to as the naturalistic, interpretive or constructivist world view" (Ryan et al., 2007, p. 740). In this case, Helvig and Minick (2013) confirm that they used interpretive phenomenology to guide their research decisions. The choice of interpretive phenomenology is justified by the fact that it facilitates a deeper understanding of individual experiences and everyday realities (Helvig & Minick, 2013). Thus, the discussed design approach fits perfectly well into the topic, nature, and scope of the study.
Of particular interest are the sampling approaches and procedures used by Helvig and Minick (2013). As Ryan et al. (2007) report, qualitative samples are usually made of the respondents, who have been exposed to the experiences in question. Such samples are usually small, and most qualitative researchers do not seek to generalize their findings to broader settings (Ryan et al., 2007). Helvig and Minick (2013) created a sample of six participants aged between 12 and 17 years. Purposive convenience sampling was used to recruit the research participants (Helvig & Minick, 2013). The sample is described clearly and comprehensively, from the ways the research participants were recruited to their demographic and chronic illness characteristics.
Apart from sampling, the methods section of the study includes a brief description of the research setting, data collection, and data analysis procedures. The setting is important, as it can potentially influence respondents' subjective perceptions of the problem in question, in this case, migraines. The data collection section specifies the ways, in which Helvig and Minick (2013) sought to answer their research questions. According to the researchers, they conducted and audio-taped interviews with the adolescents, which lasted between 30 and 60 minutes (Helvig & Minick, 2013).
The researchers do not specify whether and how the questions asked during the interviews inform their research problem and help them meet the purpose of their study. However, they do not forget to discuss ethical considerations and their implications for the study design. Since interviews represent one of the most popular tools of data collection in qualitative research, anonymity and confidentiality may not be possible (Ryan et al., 2007). Moreover, all research participants have the legal right to be fully informed of the purpose and possible risks/impacts of the study on their future wellbeing (Ryan et al., 2007). At the same time, the goal of qualitative research is to make the participants reveal and share their most hidden experiences, even though they may not feel comfortable when doing it (Ryan et al., 2007).
In case of Helvig and Minick (2013), the situation is even more complicated by the fact that the study involves vulnerable populations, namely, adolescents. The researchers confirm that their study was approved by the Institutional Review Board, and the parental permission was provided to make the research procedure ethical (Helvig & Minick, 2013). Anonymity was maintained with the help of pseudonyms, and the participating adolescents and their parents had full information about the purpose, importance, and expected results of the study (Helvig & Minick, 2013).
Results and Analysis
It should be noted that the data analysis methods used by Helvig and Minick (2013) were consistent with the methods of data collection and the phenomenological study design. When it comes to qualitative research, the process of data analysis and its consistency have profound implications for the credibility of study results (Ryan et al., 2007). Helvig and Minick (2013) were not very creative in their data analysis procedures, using manual coding to generate and interpret the most prevalent themes. Consistent with the philosophy of the interpretive phenomenological design, three themes were identified and interpreted by the researchers. First, Helvig and Minick (2013) have found the theme of control to be important in the analysis of adolescents' experiences in relation to migraines. Second, all adolescents have reported mind overload to be a solid predictor of migraine (Helvig & Minick, 2013). Third, unsettling manifestations of migraine have been categorized into physical and psychological domains (Helvig & Minick, 2013). The results section is comprehensive, logical, and well-structured. Helvig and Minick (2013) did not present any nursing implications.
In qualitative studies, results should be presented and interpreted in the context of what has already been reported in literature (Ryan et al., 2007). In line with these requirements, Helvig and Minick (2013) discuss and interpret the significance of their results against the findings of the qualitative and quantitative studies referenced in the literature review section. Helvig and Minick (2013) use both quantitative and qualitative results to interpret their findings, which is consistent with their claim that qualitative studies into adolescents' experiences with chronic illness are still lacking.
The article does not have any specific concluding paragraph. However, Helvig and Minick (2013) offer a separate section that includes implications for nursing, research limitations, and recommendations for future research. In this way, they try to separate the most essential findings and themes from the technical information on the benefits and limitations of the study design. Also, they provide the most essential information that could be potentially transformed into a well-developed conclusion. Helvig and Minick (2013) recommend nursing strategies and interventions to alleviate adolescents' physical and emotional sufferings based on their experiences with migraine. Such strategies include relaxation and education, coupled with effective medication scheduling (Helvig & Minick, 2013). At the same time, the researchers emphasize the need to explore the concept of mind overload and its potential effects on adolescents' migraine experiences (Helvig & Minick, 2013). Limitations include: small sample size, purposeful convenience selection, and subjectivity of participants' experiences (Helvig & Minick, 2013).
How the Study Is Applicable to Nursing
The results of the study have far-reaching implications for pediatric nursing. It is no secret that nurses' day-to-day activities bring them in close contact with adolescents and their physical and emotional health problems. Pediatric nurses are in a position to understand what exactly adolescents with chronic illness tend to experience and how they cope with their physical and emotional sufferings. This knowledge should shape the basis for developing various nursing interventions that will reduce the burden of chronic illness on adolescents, while helping them to improve their physical, psychological, and social wellbeing.
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