Critical Appraisal in Nursing

Introduction
A nurse’s career is not only professionally challenging but also puts great demand on physical and mental resources to cope up with the continuously changing environment within a healthcare setting. A nurse practitioner is expected to comply with the orders of the physician meticulously and flawlessly as well as take appropriate decisions on her own according to the ever changing situation in a patient care setting. Expectations from a nurse are enormous, especially from the patient’s perspective. This requires discipline, punctuality; evidence based and informed decision making capability, as well as thorough professional competence in terms of theoretical and practical skills. In fact a nurse has to play the role of a physician, counselor, pharmacist, family member and psychologist all rolled into one at the same time while dealing with her patients. No doubt, this requires a high level of competence which can easily break a normal person. Issues such as satisfaction with one’s career, ability to cope up with personal and professional challenges and the question whether the nursing profession allows one to lead a happy, fulfilling life, which is the ultimate human goal, therefore need to be addressed. Nemcek (2007) and Brown (2009) have attempted to address these particular issues precisely in their quantitative and qualitative studies respectively. The former has followed a thorough and well designed approach to evaluate the three facets of life of a nursing practitioner identified by her, which she labels as the ‘ability to promote self nurturance’, ‘satisfaction with life in general’ and ‘career’ in particular. She has conducted a quantitative study to arrive at a statistically significant inference, which might serve to indicate the relationship between the three aspects she has identified as vital in nursing practice. Brown, on the other hand has attempted to conduct an incisive and precise qualitative analysis of the capabilities of established nurse leaders in comprehending the essence of self care and its vital role in allowing them to function effectively in a challenging work environment by obtaining their personal views. The framework for analysis of a research article must identify what problem is being addressed, the purpose for research in the problem area, and a gist of previous and current research on an aspect in order to arrive at a sensible and statistically valid conclusion. The theoretical framework and hypothesis should be clearly stated and the sample size selected for the study should be adequate to provide a valid result. Both studies have satisfied these criteria within the limits imposed by the apparently small sample sizes. Critical Appraisal, Paper 1 Quantitative

Critical Appraisal, Paper 2 Qualitative
The second paper by Brown, 2009 addresses the same issue as the above quantitative study by Nemcek but through a qualitative lens, by assessing the way registered nurse leaders felt about the need for self care after being exposed to a project which introduced and inculcated the importance of the sense of ‘caring-for-self’ in them. The title of the study is self explanatory as it suggests that self renewal can only be established through self care and the author’s attempt at gaining insights from the lived experience of carefully selected nursing practitioners who are themselves leaders in their specific capacities. The abstract briefly introduces the necessity for eliminating stress among nurses due to their overt vulnerability due to the high demands the profession places upon them. The research methodology has been clearly defined as a hermeneutic phenomenology which evaluated the lived experience of 10 carefully selected nurse leaders by intimate interaction with them. The abstract enumerates the findings in the form of four common themes, based on which the author has recommended the use of holistic and creative methods to reinforce self renewal among nurse leaders. The introductory section begins with a quotation highlighting the emphasis on ‘self’ and how everything emanates from it. The author has pointedly explained that though nurses are accustomed to caring for others, they are themselves subject to neglect due to the high demands of the profession. She cites a number of previous studies which have substantially proved the importance of holistic self care practices among nurses and its contribution to their positive image among the patients. Her primary aim in this study was to reinforce the concept of self care in nurse leaders who had been exposed to a caring-for self program in a community hospital setting. A research project lasting ten weeks was initiated at the behest of the chief nursing officer of a private 185 bedded hospital in South Florida within a community setting after the delivery of a seminar on caring for self by the author. During the subsequent sequence of events, the author decided to conduct a personal interview based study on the lived experience of shortlisted participants on an individual basis. This approach seems to be ideal, as getting information directly from the proverbial horse’s mouth is most likely to yield appropriate end points. The author has cited profusely from pertinent literature to highlight the challenges which necessitate the need of caring for self among nurses who might be exposed to the precipitation of physical, emotional and behavioral disorders due to stress factors at work. She has enumerated the various standards accepted and being practiced by appropriate organizations like the American Holistic Nursing Association (AHNA) for holistic nurse self care and its pertinence in actual practice. The author has justified the use of Hermeneutic Phenomenology as the right approach for her study which she has explained to be an ‘interpretive study of being in the world’ (Brown, 2009). She has quoted substantially to explain the nuances related to this phenomenological approach. The author’s experience and qualification are most appropriate for this kind of study as she is an expert in the field and most likely to extract the most appropriate information commensurate with the research methodology employed, in a person to person interaction. The ten nursing leaders chosen as participants were carefully selected based on the vital positions they occupied in the community hospital setting and appropriate environment for the interactions was created after obtaining due approval and sanction of pertinent authority. Care was taken that the interviews and the post interview interactions took place in a quiet, stress free environment with no disturbance. The number of years in nursing which ranged from 18-32 years as well as the number of years in leadership roles which ranged between 8 months to 24 years suggest that the participant selection was most appropriate, as it is likely to yield common viewpoints as well as differences of opinion, if any due to age and experience variations. Moreover the participants were for a wide variety of sub specialties which could allow one to understand whether any variations could occur due to the area of one’s practice. Other variables were educational background and family affiliations such as responsibility towards children or aged parents. All participants were pre-exposed to a 10-week caring-for-self project at the hospital itself and had adequate time to interact with each other and participate in activities designed to enhance self growth and creativity. Although the ten participants were reluctant to being interviewed after the 10 week period in a taped conversation, they continued to meet monthly and agreed for the same after an elapse of one year. The data collection and analysis was in the form of carefully prepared and reviewed transcripts of the one-to-one taped interviews between the researcher and individual participants with due respect to privacy by omitting details of the participants which were mutually decided upon as being too personal. Interviews lasted 45-60 minutes each and began with general questions about self care after which the verbal cues were built upon to pose specific queries about self care. The participants were free to express themselves in the form of anecdotes and stories which explained their personal values and viewpoints. Line by line analysis of the transcripts was carried out by employing special software called ATLAS.ti which has been claimed by the author to provide a consistent decision trail as far as theme analysis was concerned. The primary themes that emerged through analysis of the data were ‘Reflection on the Journey’, ‘Why to Care for Self on the Journey’, ‘How to Care for self on the journey’ and ‘Wisdom Learned along the Path’. These themes have been elaborated by the author one by one with generous excerpts of the interviews which she considered as pertinent for arriving at the inferences which aided her in building the theme categories. Climbing atop to a mountain peak emerged as the primary metaphor for depicting the overall experience of self care along life’s journey. Caring for self increased the ascent atop the mountain as it increased the level of what the nursing practitioners could give to their patients in terms of positivity. Setbacks along the way on this upward journey were referred to as ‘getting caught in a whirlwind’, ‘being pulled away in multiple directions’, ‘a constant hammering’ and ‘being at the bottom of the ladder’ which made the participants realize the gravity of such situations and spurred them on to making efforts to overcome the barriers through self care. All participants had their moments of realization when they felt the need for self care in adverse circumstances as they found that the work pressures had gotten too much or their involvement had been so intense that they failed to recognize that they were not taking care of themselves. Their healing efforts for self included indulging in personal hobbies such as driving or reading books, which gave them adequate diversion from their respective routines, to reestablish their self identities. The discussion in the study focuses on the comprehension of self care by the participants and the ways and means they adopt to overcome the obstacles encountered in their life’s journey which make them wiser along the years. Sharing and assisting other in the profession were considered as vital in promoting the awareness about self care and attain a balance between work and life in general. Holistic self care practices on a shared platform have been recommended by the author in her conclusion which she believes will enable registered nursing leaders to encourage their employees and prevent burnouts as well as promote professional achievement and growth. The limitations in this study include the small number of participants as well as an environment and methodology which might have elicited subdued responses due to privacy concerns. Conclusion
The articles analyzed above stress upon the importance of self care in nursing practitioners which has assumed greater significance in recent years due to reduced workforce and the high attention span required in the workplace. Excess work does not allow a nurse to stop and think about caring for self though she is expected to care for others. This has resulted in situations where some practitioners contemplate withdrawing from the profession altogether or suffer burnouts which are extremely damaging physically as well as emotionally. The first article is a quantitative analysis of the relationship between self nurturance, life and career satisfaction which have been found to be positively correlated with each other (Nemcek, 2007). The second article though philosophical in content, uses an appropriate phenomenological approach to probe the values attributed to self care by established nursing practitioner leaders from various fields through personal interviews (Brown, 2009). Both articles not only suggest further research in this aspect but also offer suggestions to future nursing leaders to incorporate self care and self nurturance into their professional sphere for optimum growth and satisfaction with nursing as a career. References
Brown, C. J. (2009). Self-renewal in nursing leadership: The lived experience of caring for self, Journal of Holistic Nursing, 27(2), 75-84.
Nemcek, M. A. (2007). Registered Nurses’ Self-Nurturance and Life and Career Satisfaction, American Association of Occupational Health Nurses Journal, 55(8), 305-310.

References: Brown, C. J. (2009). Self-renewal in nursing leadership: The lived experience of caring for self, Journal of Holistic Nursing, 27(2), 75-84. Nemcek, M. A. (2007). Registered Nurses’ Self-Nurturance and Life and Career Satisfaction, American Association of Occupational Health Nurses Journal, 55(8), 305-310.