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Qualitative Research Critique Shawna Nietz, Melissa Kurek, Heidi Ertman, Sarah Rousseau, and Molly Bach-Bullen Ferris State UniversityAbstractThis study reviewed the challenges that women and their loved ones face after the birth of a stillborn and how it can affect the mother’s emotional well-being in other aspects of her life. The study consists of 47 women ages 19 to 51. The participants of this study were interviewed using open- ended narrative to collect data. The methodology used for this study is from a phenomenology approach. This approach is used to gain a true insight into the women’s feelings regarding such a profound loss. The data collection consisted of recruiting women through nonprofit agencies that provided bereavement counseling. The instrument used to receive information consisted of three open- ended narrative questions. The data from the questions were assessed for recurring themes. This process provided tremendous insight into revealing the woman's horrific loss. The following paper will critique the qualitative article by comparing it with Rose Nieswiadomy guidelines for critiquing qualitative designs. Qualitative Research Critique The qualitative article titled “The Unique Experiences of Women and Their Families After the Death of a Baby” written by Joanne Cacciatore, was evaluated using specific critiquing guidelines. The critiquing guidelines were put into practice to determine whether the study has provided a clear report of data collected and analyzed. This article focuses on the long lasting effects that women exhibit after a stillbirth and what conditions are present to prolong these effects. Mothers were interviewed using three qualitative questions along with an open-ended narrative. This allowed the study participants to share their thoughts and inner feelings regarding their horrific loss. The majority of the responses concluded that the mothers need to talk and share their feelings about their stillbirth experience. The following paper will be critiqued by group two. Group two will review different areas of the qualitative article by comparing what the textbook by Rose Nieswiadomy explains should be covered in an article that is used versus what the authors of the qualitative article actually wrote. Group two will then analyze the different areas and state if this paper meets the criteria and should be used in nursing practice.Qualitative Versus Quantitative ApproachThe foundation of this study was to determine from the perspective of the mothers their individual experiences regarding the death of their baby. This phenomenological study is beneficial for the women to “construct their interpretation and understanding of a profound event” (Caccitore, 2010, p. 138). Throughout the study, women gave their views and feelings about their child’s death, regrets, and were given an opportunity to express any unsolicited narrative of the events leading up to and after their child’s death. As stated by Nieswiadomy (2008), “qualitative research is concerned with the subjective meaning of an experience to an individual” (p.11). This study meets the expectation required of qualitative research.Subjective Nature of Human ExperienceThe participants were given three qualitative questions and were asked to give an open narrative response. The open narrative responses gave the mothers an opportunity to express their personal experiences surrounding their child’s death. Common phrases and words were found among many of the participants. Some of the personal accounts appeared similar. The psychological trauma involved in delivering a stillborn baby, followed with the physical sequel that naturally occurs after the birth of a child furthers the trauma many women in the study endured. The study also examined the social aspects women experience afterward. The experiences range from immediately after delivery to one year after death. The psychological ramifications continue well past the immediate situation, creating anxiety and uncertainty in planning for future children. Though there were similarities found throughout the women responding, the women’s experience of death was examined and reviewed. Each response reflected how the person felt at the time of the study. The personal experiences, though similar in some instances, were subjective and variable. Specific Qualitative Approach The qualitative methodology used for this study is from a phenomenology approach. “Phenomenological studies examine human experiences through the descriptions provided by the people involved” (Nieswiadomy, 2008, p.172). Cacciatore states “this approach is particularly beneficial when allowing the participants to construct their interpretation and understanding of a profound event” (2010, p.59). Using this method allows the researcher to fully understand the women’s distinctive internal and external emotions regarding this experience. These experiences are considered lived experiences. This is essential in truly gaining insight into the individual’s experience of carrying a baby for nine months that you cannot hold. The phenomenological approach walked the researcher into the mother’s immense and suffocating pain. Significance for NursingThe qualitative research findings within this study show to have great significance for the field of nursing, as health care providers are on the front lines of care when a baby dies. As nurses, we can gain insight through this phenomenological research study with enhanced understanding of the personal experience and loss felt by the mothers and their families. Cacciatore suggests “when confronted with the stillbirth of a baby, women experience some struggles that are unique from other types of losses” (2010, p.142). Furthermore, bereaved mothers often look to nurses and other hospital staff for answers and insight on how to interact with their dead baby. The mothers and family members need unconditional support from the hospital caregivers from admission to discharge. With this in mind caregivers need to separate their personal opinions and viewpoints and instead encourage them to experience the grief process as it takes it natural course. Participant Selection and Sample SizeThe study states that “self-identifying participants were recruited through the newsletters and email lists of two nonprofit organizations that provided aid to families after stillbirth” (Cacciatore, 2010, p.138). The self-identifying participants were enrolled first by the use of purposive and snowball sampling. Purposive sampling “is based on the assumption that the researcher or the chosen expert has enough knowledge about the population of interest to select specific subjects for the study” (Nieswiadomy, 2008, p. 199). Snowball sampling involves “assistance of study subjects to help obtain other potential subjects” (Nieswiadomy, 2008, p. 197). After the participants were recruited they were provided with information regarding the study along with an informed consent. The researcher did not specify when the interview questions were given to the participants. Did the participants receive the interview questions at the same time? These variables were not identified by the researcher. This sample design is a weak part of the research article. The sample size was determined by the number of interview questions that were returned. The total number of participants for this study totaled forty seven women between the ages of nineteen and fifty one. The researcher didn’t illustrate what target population they were trying reach. Data Collection and Recording ProcessThe data collection began after the approval from Arizona State University’s Institutional Review Board. Data was received from the participants that were recruited via purposive and snowball sampling. A majority of the participants gained knowledge of the study through the bereavement nonprofit organizations. All of the participants received the self-administrated questioners through the mail. “Participants were provided general instructions and an informed consent form. They were instructed to respond to the self-administered questionnaire reflecting on their current feelings and emotions. Participants completed the questionnaires and returned them by mail"(Cacciatore, 2010, p.138). All of the questioner questions were disclosed in the article. The researcher used note cards to organize the qualitative data that was returned. The response to the questions were reviewed and analyzed for reoccurring frequent themes. “This process aided in uncovering insights into the uniqueness of the participants experiences of loss, increasing the coherence of the themes revealed in the data” (Cacciatore, 2010, p.139). Researcher BiasData collection for this study involved women that were recruited through the use of purposive sampling. Snowball sampling was also used in addition for data collection. By using this type of methodology, the study may be subject to and increase the risk for biases. “It is evident that bias may enter into the selection of samples through purposive sampling procedures” (Nieswiadomy, 2008, p.199). Bias using purposive sampling occurs because the only women that participated in the study were part of the bereavement support group or were recruited by individuals using snowball sampling. In this case, the study exists of people that have sought out the help of such agencies that have provided aid. Unfortunately, there are many grieving people that haven’t reached out for help that weren’t included in this study. Data Analyses The data analysis method is consistent with the purpose and approach of this study. The idea was to “discover the ways in which the woman’s experience of a baby’s death affects her as an individual and the family system” (Cacciatore, 2010, p. 134). This qualitative study used surveys/questionnaires with open-ended narrative to grasp the emotional aspect of this experience and found many struggles uniquely related to all participants involved. The conclusion of the study recognized the increased understanding of their experiences along with a realization that better psychosocial support must be priority in order to cope with the death of a baby.Clarity of Studies and LimitationsThe study results are obviously presented in detail in this article. The researcher found that “out of 47 participants, 37 cited social support as the most important factor in helping them deal with the baby’s death” (Cacciatore, 2010, p.139). A majority of the women felt comfort in sharing their experiences with other women going through this loss as well as discussions with counselors and therapists. The response to the question regarding regret displayed that “out of the 47 respondents, 46 of them expressed anger and guilt” (Cacciatore, 2010, p.140). The bulk of women in this study exhibited horrendous regret along with intense thoughts of self blame. When asked the question of self harm due to the constant anxiety of trying to cope “almost one-half of the participants (n=21) reported thoughts of self harm. Most of their expressions of self-harm were during the early periods after the death” (Cacciatore, 2010, p.140). The final question consisted of an open-ended narrative. This allowed the mothers to discuss the issues that were of most importance to them. The women were able to share their own experiences. The three most reoccurring themes included the following: Validation of the loss, acknowledgment of the baby’s identity, and the need for social support and interventions. The study findings clearly suggest that after a “stillbirth of a baby, women experience some struggles that are unique from other types of losses” (Cacciatore, 2010, p.142). One of the limitations that were identified in this study is the small sample size. The study consisted of 47 participants. “Generally speaking, large sample sizes are more representative of the population of interest than small samples are” (Nieswiadomy, 2008, p.201). This study recruited individuals using purposive and snowball sampling techniques. This study did not chose participants using a random sampling. The second limitation in this study is the use of self administered surveys. The participants were notified of the study through “nonprofit agencies that provide bereavement care to grieving families” (Cacciatore, 2010, p.138). The use of self administered surveys could lead to inaccurate information. The women could be using caution when answering questions in detail and they may have difficulty recalling certain information. This study is also subjected to selection bias. Only mothers of stillbirth support groups were sampled via purposive and snowball sampling. It is possible that only mothers who had difficult experiences coping with the stillbirths would enroll in the stillbirth bereavement support group and respond to the survey. Despite the limitations presented, “this is an important exploration that could be used to incite important discussions among healthcare social workers” (Cacciatore, 2010, p.145). This study could prove to be beneficial not only to social workers but also to healthcare workers in general. The information obtained “may uncover opportunities to improve psychosocial care in hospital and clinical settings” (Cacciatore, 2010, p.145).Further Research Based on FindingsThe article discusses that “there is a pressing need for research that really describes the particular and unique responses to different types of losses” (Cacciatore, 2010, p.145). The article identified specific suggestions for future research that would be beneficial this included: Studying the differences between a fathers and mothers response of stillbirth, how families can productively move on after loss, and how society views loss especially regarding children.ConclusionAs a group, we feel the study discussed in the article was conducted in qualitative manner. The focus was on subjective data derived from the problem statement which was defined. The purpose question was presented and reiterated throughout the article. However, the body of the study did not focus as much on nursing as it did the women and family members. The study did provide an enhanced understanding of the experience regarding mothers and the long-term effects of the stillbirth. The article fulfilled its specific purpose and provided us with additional tools to help women through their tremendous loss. ReferencesCacciatore. J. (2010). The unique experiences of women and their families after the death of a baby. Social Work in Health Care, 49(2), 134-148. doi: 10.1080/00981380903158078.Nieswiadomy, R.M. (2008). Foundations of nursing research (5th Ed.). Upper Saddle River, New Jersey: Prentice Hall. ................
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