The Livedqualitative Research : Critique . Experience of Having a Chronic Wound

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In my qualitative evaluation of The Lived Experience of Having a Chronic Wound: A Phenomenologic Study, written by Janice Beitz and Earl Goldberg (2005), I found that the need or rationale for this particular study, as do most qualitative research papers, focused on how or what, as opposed to quantitative studies that focus on asking why?

The problem statement is:             “Approximately 2 million people have venous ulcers. In addition, between 1 and 2 million diabetics have neuropathic foot ulcers. In total, venous, arterial and neuropathic ulcers may affect as many as 5 million older Americans. Consequently, the need to investigate the chronic wound experience has become even more compelling. Given the projected increase in the number of elders, and individuals with diabetes health care provider need to understand the chronic wound experience” (p. 51-52).

Purpose: The primary purpose of this phenomenologic study is to explore and describe the patient’s experience of living with a chronic nonhealing wound. The secondary purpose is to provide knowledge and understanding of the experience for health care providers (Beitz ; Goldberg, 2005). Both purposes of the study were clearly articulated. Research Question(s): The research questions that were explored and investigated by Beitz and Goldberg’s study (2005) included: “What is the experience living with a chronic, nonhealing wound like? ” and “What are the meanings and essences of the phenomenon” (p. 2)? Study Framework: “Phenomenology has been described as the study of essences, a philosophy that puts essences back into existence (Bruns & Grove, 2001). It is also a research method. Phenomenology is the rational investigation of meaning rather than an empirical investigation of things or events. The central focus of phenomenology is to describe or analyze the lived experience of the world of everyday life. The phenomenologic approach in this study is that of Colaizzi (1978) who believed that phenomenology permits researchers to construct a phenomenon as people experience it” (p. 2). In the case of this article the phenomenon is living with a chronic nonhealing wound. It is the focus constructing the study framework. Literature Review: Relatively little research has been conducted concerning individuals’ chronic wound experience related to the high number of patients actually living with chronic wounds. Previous and existing studies have included research on pressure ulcers, venous leg ulcers, lower extremity ulcers, and chronic nonhealing wounds. These studies have described both qualitative and quantitative approaches (Beitz ; Goldberg, 2005).

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Variables: The variables considered in this article researched the effects of gender, age, marital status, type of ulcer/wound, and the experience living with it (Beitz ; Goldberg, 2005, p. 54). The variables or characteristics were clearly articulated in Table 1 in the article. Design: Beitz ; Goldberg’s study used a “phenomenological design to describe living with a chronic wound” (p. 53). Data Collection: Data sources included interviews that were done by the participant observation of the researchers.

Participant-observation is “the active engagement of the researcher in the settings of people being studied” (Melnyk & Fineout-Overholt, 2005, p. 141). Other data sources included field notes, “self-designed observational protocols for recording notes about field observations” from a purposeful sample of participants following specific criteria (Melnyk & Fineout-Overholt, 2005, p. 141). The criteria included; having a chronic wound for over eight weeks, the absence of diagnosed mental health, and finally the ability to communicate in English.

The interviewees were Caucasian, of higher economic status, and retired. Interviews were accurately recorded and participants signed a consent form before the interview. Each participant completed a brief demographic questionnaire. A quiet area was used so that participants could reflect on their experiences and audiotaping could be conducted. “Each interview was conducted by both researchers, with two exceptions when one researcher was present, and consisted of the following semi-structured, open ended requests for information: Please describe your experiences of living with a chronic wound.

Please include anything that you think would help us to understand what it is like to be a person living with a chronic wound” (Beitz & Goldberg, 2005, p. 54). If necessary, reflections or promptings were needed. In addition to taping, the researchers observed body language and topic avoidance, making brief notes. Interviews lasted 30-45 minutes. The researchers met at the conclusion of each interview to discuss their perspective of the interview and their analytical notes that they wrote to record their thoughts, question and ideas (Melnyk & Fineout-Overholt, 2005).

Ethical Considerations: This study was reviewed and approved by La Salle University Institutional Review Board. Furthermore, the researchers clearly specified how informed consent and confidentiality was handled in the field of study. “Participants in the study received a written and verbal explanation before their interview began. Participants were informed that their consent could be withdrawn at any time during the study” (Beitz & Goldberg, 2005, p. 54). Confidentiality was assured by using code numbers instead of names, and at the end of the study, all tapes were destroyed.

Assumptions: From the data collected one can assume that a chronic wound will impact a person’s view of self. One can also assume that a chronic wound will affect a person’s interpersonal relationships. A chronic wound will affect a person’s experience with the health care system (Beitz ; Goldberg, 2005). One can also assume that everyone will react to living with a chronic wound as the elderly participants of higher socioeconomic stratum had reacted. Their reactions are assumed to represent everyone, age, culture etc, with a chronic, nonhealing ulcer.

Data Analysis: The data collected from this study was analyzed at various stages. After each interview and taping the researchers would come together and findings were shared, discussed and compared for interpretive consistency. The study also followed Colaizzi’s (1978) suggestion of phenomenological analysis as the researchers read all of the participants’ descriptions to acquire a feeling for what was being said and a sense of the whole. In this study Colaizzi’s suggestions included watching the audiotape multiple times to sensitize the researchers to concealed meanings.

The researchers also listened to the participants’ description to depict significant statements and phrases pertaining directly to the phenomenon: researcher organized thematic structures with indications. The researchers, throughout the analysis phase, also formulated and identified meaning from each significant statement and phrase. They did this for each participant’s description and organized the aggregate formulated meaning into clusters of themes. The researchers looked for sub themes that fit together under major themes.

They used these clusters to provide an exhaustive description of the experience with many revisions. The description was checked back with the original statement and transcript to ensure accuracy. Finally, researchers validated findings with participants and incorporated any new, relevant data. Investigators returned results to participants, who indicated general agreement with the description (Beitz & Goldberg, 2005). Findings: Common themes present in persons’ experiences of having a chronic wound were organized into theme clusters.

Theme clusters derived from data sources included; “living with pain, losing mobility, receiving care, living and aging, altered sleeping habits, changing eating patterns, explaining causes of wounds, adapting, maladapting, and dealing with wound treatments” (Beitz ; Goldberg, 2005, p. 55). Discussion: While identifying similarities of human experiences living with chronic wounds the study focused on personal, interpersonal, and social aspects of life.

Many theme clusters and themes in this study were identified previously in other research, while others were unique to this study: changing eating patterns, and living and aging. Even though the residents were aging, the loss of personal mobility was critically important. Pain had an enormous impact on the quality of daily living. The model describes pain occurring in noncyclic acute patterns (surgery of the wound), cyclic patterns (repeated sharp debridgment), and chronic wound pain (neuropathic pain). A significant finding was the role of chronic illness.

All identified themes revolved around the fact that important issues were always contextualized by the occurrence of other chronic illness. It was also noted that participants felt support by health care professionals concluding that social isolation was not emphasized (Beitz ; Goldberg, 2005). Descriptive Vividness: “To achieve descriptive vividness, the site, subjects, experience of collecting data, and thinking of the researcher during the data collection process must be described so clearly that the reader has the sense to personally experience the event” (Burns ; Grove, 2003, p. 29). Based on this quote I found this study to achieve descriptive vividness. The article included detailed description of how and why the phenomenologic study was explored. The purpose, process, and findings were all explained in a detailed manner so the reader could visualize the processes of reaching conclusive themes of living with chronic wounds. This article was succinct in descriptive vividness. Methodological Congruence: The research questions of this phenomenologic study were accurate in directing the true findings of this study.

The findings were based on truthful statements and feelings of the interviewees, and in sufficient quantity to provide a valid foundation from which to draw conclusions. Furthermore, the research report is clearly described allowing other researchers adequate information to conduct a similar study, and generate conclusions similar to the original researcher. As mentioned above the participants provided informed consent after receiving a written and verbal explanation before the interview began.

In providing the participants with information about their rights the study was ethical and confidential in its construction. Analytical Preciseness: This article is constructed in such a way that the decision-making process was clearly identified and recorded in data collection. This topic was appropriate for qualitative enquiry; the specific qualitative research method fit the phenomenology. The reviewed literature was consistent with the method chosen. The researchers provided ample description of participants, context, and study. The interview was an appropriate method for gathering information.

Analysis of information was employed and processed to create a sound conclusion and theme from the participants feeling and concerns from the interview. This allows the reader to view the logical organization and the validity of the study’s findings, along with the process of acquiring an accurate relevant conclusion from data results. Theoretical Connectedness: The theoretical representation of this study shows a direct answer to the research question, and the clear purpose of the study to describe the lived experience of having a chronic wound.

There is a positive connection with the developed conclusion and the acquired feeling and experiences of the interviewees. Each of the created themes is clarified and logically by common reflections from the interviews. The data collection and interpretation reflects the conclusion of the study. The results demonstrated the experience of having a chronic wound and the special needs of people living with these wounds. The outcome clearly connects and confronts the knowledge base one should apply to nursing care.

These connections include assuring patients that their social and psychosocial concerns are not unusual, and improving health care workers’ approaches to promote and encourage individual self care and affirmative self-image. Heuristic Relevance: This research article is organized and explained in such a way that the reader is able to recognize what is being studied, the purpose of the study, its theoretical connectedness, and significant application to the health care profession. This was achieved by the inclusion of detailed planning procedures and the data collection and analyses methods.

The study methods demonstrated the required trustworthiness from the perspective of a qualitative research. Conclusion: The studied phenomenon was clearly articulated and delimited as it met the necessities of being applicable and valid in its research and results. This study allows the reader to clearly view not only the physical effect a chronic wound has on a patient, but also the social impact and self image. Applying the results from this valuable study allows the nurse to acquire a holistic approach to direct and focus nursing care towards alleviating problems and providing supportive care when and where needed

References Beitz, J. ; Goldberg, E. (2005). The lived experience of having a chronic wound: A phenomenologic study. Medsurg Nursing, 14 (1), 51-60. Burns, N. ; Grove, S. (2001). The practice of nursing research (4th ed. ). Philadelphia: Saunders. Burns, N. ; Grove, S. (2003). Understanding nursing research (3rd ed. ). Philadelphia: Saunders. Colaizzi, P. (1978). Existential phenomenological alternatives for psychology. New York: Oxford University Press. Melnyk, B. ; Fineout-Overholt, E. (2005). Evidence-based practice in nursing and healthcare. Philadelphia: Lippincott Williams ; Wilkins.