What is your experience with respect to the attention at the “person centered care” during the COVID-19 pandemic?

Journal Club #2—Qualitative Research
Title: Back to the Roots of Nursing: Qualitative Study on the Experience of Nurses in the Front Line During the COVID-19 Pandemic
Purpose of Study: The purpose of this qualitative study was to explore the way nurses felt about their experiences throughout providing care for COVID-19 patients throughout the pandemic. The particular areas of interest were the nurse’s feelings regarding waning professional motivation, willingness to care for those patients afflicted with COVID-19, and the career growth, or lack there of, that they experienced during the pandemic (De Benedicts, Gualandi, Saccoccia, Pensieri, Piredda, De Micco, Marchetti, Facchinetti, Pasquarelli, De Carolis, Di Blasio, Tartaglini, Alloni, 2022.)
Research Design: The design of this study was qualitative in nature and implemented the use of focus groups. This design was appropriate for the topic under review because of its potential to derive genuine answers centered around the way the interviewees feel about the topic. The statistical immeasurability of these types of answers is a large part of how qualitative studies are distinguishable from quantitative studies. The authors of this study also felt that focus groups would be a better form of data collection due to the camaraderie felt amongst nurses who worked together through arguably one of the most difficult times presented to front line workers throughout the 21st century (De Benedicts, Gualandi, Saccoccia, Pensieri, Piredda, De Micco, Marchetti, Facchinetti, Pasquarelli, De Carolis, Di Blasio, Tartaglini, Alloni, 2022).
Sample Selection: the sample selection was derived from a pull of nurses involved in the care of inpatients in a COVID Center of an Italian University Hospital. The researchers enlisted the help of these nurses via mail and through the use of purposive sampling in order to allow the researchers to focus on the specific topics under study. The initial sample was over saturated to account for any potential drop outs and ultimately consisted of a total of 20 nurses with 10 per focus group (De Benedicts, Gualandi, Saccoccia, Pensieri, Piredda, De Micco, Marchetti, Facchinetti, Pasquarelli, De Carolis, Di Blasio, Tartaglini, Alloni, 2022.) This sample size was appropriate for a qualitative study design and was adequate enough to reach saturation.

Data Collection Methods: Each focus group was lead by two research facilitators. One of which asked the proposed questions and was actually the lead investigator of this study and the other whose responsibility it was to ensure the discussions were tape recorded and to observe for non verbal body language throughout the discussions. After the conclusions of these discussions, the tape recordings were transcribed verbatim and the two research facilitators would debrief immediately to note the most important details from the recording session. Afterwards, another moderator and researcher transcribed and analyzed the data. These transcripts were sent back to the participants to allow them to provide feedback or suggest corrections. Throughout data analysis, an inductive content analysis was used and sequestered each focus group transcript as a unit of analysis. The researchers process consisted of open coding and category creation and abstractions (De Benedicts, Gualandi, Saccoccia, Pensieri, Piredda, De Micco, Marchetti, Facchinetti, Pasquarelli, De Carolis, Di Blasio, Tartaglini, Alloni, 2022.) Two researchers then independently read the transcripts and defined codes, categories, and subcategories (De Benedicts, Gualandi, Saccoccia, Pensieri, Piredda, De Micco, Marchetti, Facchinetti, Pasquarelli, De Carolis, Di Blasio, Tartaglini, Alloni, 2022). It could be argued that personal interviews may have elicited a more unregulated response from participants where they didn’t feel limited in what they could respond as they might have felt less willing to speak freely in a group setting. Some people are too shy or reserved to speak freely about personal experiences in a group setting and may have been more forthcoming in a private setting. However, given the traumatizing nature of working on the front lines during the COVID-19 pandemic, the nurses may have been bonded enough for these focus groups to have been preferable regardless of the privacy personal interviews may have provided.
Data Collection Measures/Tools:
Each discussion within the focused groups were guided by the following topic questions:
1. Did your professional and personal motivation and the motivation of your colleagues change during the COVID-19 pandemic? If so, how? If so, what do you think is the reason for the change?
2. What is your experience with respect to the attention at the “person centered care” during the COVID-19 pandemic?
3. Has the experience of the COVID-19 pandemic had an impact on your personal and professional skills? If so, how? If so, why?
4. Can you tell me about your work experience as a nurse in a COVID-19 center?
5. Can you tell me about the main areas for improvement emerging during the COVID-19 pandemic? Could you tell me what you have learned from this experience? (De Benedicts, Gualandi, Saccoccia, Pensieri, Piredda, De Micco, Marchetti, Facchinetti, Pasquarelli, De Carolis, Di Blasio, Tartaglini, Alloni, 2022). These questions were appropriate for the data collection process because they were open ended and focused on the personal feeling behind the experiences prompted by these questions.
Plans for Data Analysis: The answer to these questions were sub categorized into themes which included: motivation and sense of mission; development of professional and personal skill; spirituality, feelings, and emotions; person centered care; uniqueness of the lived experience (De Benedicts, Gualandi, Saccoccia, Pensieri, Piredda, De Micco, Marchetti, Facchinetti, Pasquarelli, De Carolis, Di Blasio, Tartaglini, Alloni, 2022). There were subcategories within these themes that allowed for elaboration on a few points that were brought up consistently amongst the participants. This method of data analysis and organization was appropriate for qualitative research based on the highly subjective nature of the data collected. Due to the individualized and subjectivity of the answers, the qualitative data is often not numerically measurable and is reflected better by being grouped into commonalities within the varied responses.
Strengths: this qualitative study was able to highlight some of the unique experiences and perceptions from front line nurses throughout the COVID-19 pandemic. The results were detailed and were thoroughly reviewed to allow for the spreading of awareness of how front line workers were both positively and negatively affected by all of the events that occurred throughout the pandemic. This was a very well carried out qualitative study that provided the readers with highly subjective responses to open ended questions and effectively grouped and coded these responses into common themes.
Weaknesses: some weaknesses noted throughout this study were not necessarily study specific but rather some of the common protestations aimed at qualitative studies in general. There is no generalizability or replication potential for the data obtained through qualitative methods. The sample studies are normally much smaller and are unable to confidently represent a much larger portion of people. For example, this study focused on 20 nurses solely from a hospital in Italy. When compared to a handful of nurses working on the front lines in Nee York throughout the pandemic, the responses could (and probably would) be wildly different.
Reference:
De Benedictis, A., Gualandi, R., Saccoccia, S., Pensieri, C., Piredda, M., De Micco, F., Marchetti, A., Facchinetti, G., Pasquarelli, A. A., De Carolis, C., Di Blasio, I., Tartaglini, D., & Alloni, R. (2022). Back to the Roots of Nursing: Qualitative Study on the Experience of Nurses in the Front Line During the COVID-19 Pandemic. Frontiers in medicine, 9, 903517. https://doi.org/10.3389/fmed.2022.903517

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