Analysis of ‘Exploring Senior Nurses Understanding of Compassionate Leadership in the Community’

This assignment will undertake a critical analysis of the research study by Ali & Terry (2017), using the Broomfield-Ingham Framework (2014). The Code (NMC 2018) requires nurses to demonstrate an understanding of research methods in order to critically analyse and apply research findings to inform best practice. This structured approach will enable the practitioner to determine the quality of the research, and therefore its value in community nursing practice.

Title

The question was appropriate for what the researcher hoped to understand, using ‘exploring’ and ‘understanding’ imply that the study was qualitative in nature. The title is appropriate for the choice of methodology.

The title was concise, described the phenomenon and informed the reader of the focus.

Author

The researcher’s qualifications are unknown, however the reader can identify their position and place of work. As the study was conducted as part of a Master’s degree the researcher was supported by Associate Professor in the department of Adult Nursing and Midwifery. The senior positions suggest that they would have the ability to understand the concepts to undertake the study, therefore the authors are deemed to be credible giving a positive strength.

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Bias could have been introduced as the researcher worked within the organisation. Bias would be considered as any influence that provides a distortion in results (Polit & Beck 2014). As the study was qualitative, the researcher is naturally an integral part of the process, however the researcher does not consider the impact of this relationship or evidence of any mitigation then this impacts on the transparency and trustworthiness of the results, bringing a weakness.

Date

This is a current piece of research, dated within the last 5 years. The time frame between acceptance and publication is reasonable, suggesting that it was deemed valuable by the publishers. The time scale between the date of the research and submission is omitted, the reader would need to consider if the results were still relevant as lengthy time scales raise concerns over reliability and validity of the research

Journal

The journal is double blind peer reviewed, the experts on the panel were from a range of academic and clinical backgrounds, ensuring the journal is a credible source. The research topic is relevant to the publication due to its target audience of community nurses, ensuring validity.

Abstract

The abstract contains key words, important so that it appears in any literature searches (RCNi 2017), it draws the reader and contains key messages about the phenomenon. The abstract summarises the type of study, influencing theories, data collection methods and analysis and sampling, suggesting trustworthiness and bringing a positive strength.

Some findings are mentioned as expected, however the recommendation is not clear.

 Identifying the problem

The researcher references the problem and contextualises the research using information from the Francis Report (2013) and Keogh Report (2013). The researcher identifies compassion in leadership as an essential part of patient care and outcomes, with further information necessary to inform future service development. This phenomenon is considered to be relevant to current practice and could impact the practitioner. 

Formulation of the research question

The aim was appropriate to the question, as the purpose of exploration is to gain a better understanding of how people think and behave as individuals and as part of a group (Parahoo 2006)

Qualitative studies are inductive and produce concepts, understanding and insite from data, rather than collecting data to assess any preconceived theories (Taylor et al., 2015), therefore there is no need for a hypothesis.

Literature search

The researcher does not evidence how the literature review was undertaken, however the literature cited was relevant, current and from credible sources including peer reviewed journals, think tanks, professional bodies and government sources.

Literature reviews serve to inform projects and put what is already known or not about a subject into context (Parahoo 2006), however the literature review is descriptive bringing a weakness.

The researcher fails to present a balanced evaluation in support and opposition to the question. The researcher believed there to be a gap in the knowledge, however little critical analysis exists and it appears to be a biased discussion, with emphasis being placed on recommendations from Francis (2013) and The Kings Fund (2011). The literature review lists favourable leadership styles and describes why compassion is important in care outcomes, but fails to address literature that opposes this.

Methodology

Design

The research is described as a qualitative, interpretivist phenomenological study. This method seeks to understand the subject’s interpretation of their experiences, in opposition to trying to quantify things in a measurable way per qualitative methods (Andrew and Halcomb 2009). Parahoo (2006) suggest that qualitative exploration seeks to understand human experience, motivations, intentions and behaviour and interpretive phenomenological research studies are concerned with the lived experience of the individual experiencing the phenomenon, then this methodology is justified in relation to the question.

A limitation of this method is that there is limited evidence to show its effectiveness, because of the difficulties in applying findings. However, it remains is a valid methodology as statistical data and quantitative methods would not answer the researcher’s question.

Tools

The researcher does not justify why they have chosen semi-structured face to face interviews over other methods such as focus groups or observation. This choice does allow flexible responses, and additional questions to be asked (Parahoo 2006) that enable the researcher to tailor questions to get richness. Open ended questions were used, which would help the researcher to understand the everyday experiences (Polit & Beck 2014) as feelings and perceptions could be discussed. This is an appropriate tool for use within qualitative methodologies giving strength.

The researcher identified two main questions, these were relevant to the title however the second question is considered to be biased and leading. Le May and Holmes (2012) state that the interviewer may impact on the process and outcome, which can result in unreliable data collection. The researcher imposes a pre conceived idea and this becomes a leading question, suggestive that the participant already feels that compassionate in leadership is important. The participant should have been able to make this decision themselves, this affects the validity and trustworthiness of the research.

The interviews took place on NHS Trust premises, however the researcher did not acknowledge that this may have negatively influenced the participant’s answers.

The researcher sent the interview questions to the participants prior to the interview to allow thoughtful responses and better discussion, this information helps with transparency and shows good methodical rigor.

The interviews lasted an appropriate amount of time, as it is unlikely that any phenomenon could be explored in less than thirty minutes, however lengthy interviews over 2 hours would likely cause the researcher and respondent to become tired (Parahoo 2006), affecting the results.

It is felt that a link between the research question and the research method of data collection can be established, bringing a strength to the study.

Sample

Purposive sampling was used, whereby people from a pre specified group are purposefully sought out (Gerrish & Lathlean 2015), which is acceptable within qualitative research (Parahoo 2006). The sample would be considered to have the experience that can be useful in exploring a phenomenon in depth (Parahoo 2014). The sample strategy is consistent with the aim, however this was a convenience sample as the participants were easily accessible, potentially impacting the data.

The researcher worked within the organisation and may have brought preconceived ideas about the participant’s ideologies to the interview, potentially impacting the interview process and responses. As the researcher was a senior member of staff within the organisation, they would have a duty to report any concerning attitudes or behaviours to the NMC (2018). This may have influenced the participant’s responses potentially over emphasizing the importance of compassionate leadership to ensure their attitudes did not cause concern. This type of research cannot be free of bias, however the research processes are not transparent, and the impact of bias has not been mitigated, meaning the data is unreliable.

As qualitative researchers are not concerned with total populations, researchers should seek out key individuals (Gerrish &Lathlean 2015), making the small sample size appropriate.  The participants are only representative within the area being studied, due to the specific set of circumstances, interviewer impact and selection of sample. This would mean that the results are not transferable to other community settings, however in qualitative research this is not considered to be of concern.

There is no information regarding the demographics of the participants, the only inclusion criteria  known was that compassionate leadership was a key aspect of their role. No exclusion criteria could be identified. The sampling strategy is not transparent as it lacks rich description of the setting and participants (Baille 2015), therefore reducing the rigor.

A snowballing approach, sometimes called network mapping (Gerrish & Lathlean 2015) was used to select the rest of the sample, whereby people are recruited who are known to the other participants. Because the participants are known to each other they are likely to have similar values, attitudes towards compassion in leadership and be of a similar nature to the original participants by definition of the positions they hold as senior leaders, which may be viewed as a limitation but is unlikely to be avoided.

Positively, the researcher stated that saturation occurred, this being the point in data collection when no additional issues or insights emerge (Henick et al 2017).

Ethics

Ethical approval was sought from the University and the NHS Trust, as expected for any study involving human participants.

Written consent was obtained, anonymity was assured and the choice to opt in and out as given, demonstrating good clinical practice in relation to nursing research (Bowray 2014). However, the reader challenges that the identity of the participants was protected. NHS Health Research Authority (2018) states that the confidentiality of individual research participants should remain appropriately protected. The reader suggests that the identities of the participants could be traced, as details of the trust and certain roles are visible. RCN guidance (2009) states that the identity of research participants should not be recognisable, therefore true anonymity of the participants cannot be upheld, bringing a weakness.

It is unclear if the consent was informed, information informing consent should be provided to participants in verbal and written format, with time provided for the participant to consider involvement and to ask questions (RCN 2009).Therefore reader is unable to evaluate if good ethical principles have been followed with regards to consent.

The researcher stated that concerns over safety, bad practice or criminality would be acted upon, as per the Code (NMC 2018), giving credibility to the researcher.

The transcripts were checked for authenticity by the participants, this would negate the issue of them seeing something shared in confidence that may cause distress, which would be contrary to ethical principles of The Declaration of Helsinki (2013), therefore the results could be considered truthful.

Reliability and validity

As previously discussed the reader cannot be confident that the conclusions are dependable due to the issues of bias introduced by the researcher, as the impact of the researcher on the research is not mitigated throughout.

There is a lack of methodological transparency as discussed previously, which questions the reliability and validity. Examples of the probing questions used to follow up on the main questions would have helped with transparency of this part of the research process, and improve rigor, as would details of the consent process and further details of the literature review and analysis of data.

This study was conducted in one community trust, which limits the application to practice as discussed earlier, however the reader acknowledges that qualitative methods do not allow for generalisation to be possible.

Pilot study

A pilot interview was undertaken with one participant, helping to determine the reliability and validity of the instruments used (Pilot & Hungler 2013). It is not clear if any modifications were made following the pilot, therefore the reader cannot assess the process, impacting reliability and validity.

Main Study

Results

The results were offered as text, themes were described under two sub headings. Extracts and direct quotes were followed by an analytic comment, consistent with the IPA process.  According to Smith et al. (2010), a persuasive account that explains to the reader the important experiential things that have been found during the process of analysis should be included. Perceptions and feelings have been included in the results, leading to the conclusions.

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Novice IPA analysis was used and the reader can identify some of the process involved in the development of the themes. There was repeated engagement of the audio recording and transcripts, consistent with interpretive phenomenological analysis.  This would help the researcher to immerse themselves in the data and may provide new insites (Smith et al., 2009) and allowed a deeper level understanding to be achieved by capturing all of the information that was meaningful. This demonstrates methodological rigor.

The emergent themes are not described, however they appear to have sought relationships and clustered themes as they evidenced consistent findings in relation to the understanding that a compassionate leader should lead with their head and their heart (Ali & Terry 2017). No contradictions or surprises were noted.

Formal data was analysed, the transcripts were not included in the study, and the raw dialogue has not been provided, thus affecting the transparency.

It is not clear if the researcher saw everything as data, including the participants tone, body posture, gestures, and clothing. This could have impacted on the data analysis and findings, but is not discussed.

Discussion/Recommendations

The researcher recognises some but not all of the limitations of the study, this affects the validity and dependability of the research.

The implications of the study are discussed, and are understandable to the reader. The discussion relates the themes to existing literature which would be consistent with interpretive phenomenological analysis (Smith et al., 2010). 

The researcher includes a recommendation that further research in relation to identifying how to address the notion that some still lack compassion, they suggest that improved compassionate leadership and employee selection may be areas to consider. This would be acceptable, as research does not necessarily prove a point and may only suggest a relationship or highlight an issue needing further investigation (Ingham –Broomfield 2007).

The researcher suggested that further development is also needed in ways of measuring the impact of compassionate leadership within community settings to support educational development, they do not suggest how this could be achieved or by which method.

Conclusion/s

The importance of compassion in relation to lone working in the community is highlighted, however this does not reflect the research question or relate to leaders, this opening statement does not relate logically to the results. The researcher goes on to discuss the perceptions of the leaders and their understanding of compassion, however the conclusion is short and not all of the major findings were discussed.

The aims were addressed, as the researcher explores the leader’s thoughts, feelings and perceptions regarding the phenomenon. The researcher has not made any reference to any omissions, as identified earlier this has impliactions for the transparency and dependability of the results.

The reader has demonstrated an understanding of research methods, ethics and governance in order to critically analyse and apply research findings to promote and inform nursing practice, in accordance to NMC (2018) requirements.

As discussed the researcher has been deemed credible, the study appears to have follow a suitable methodology, demonstrates appropriate data collection methods and is published in a reputable journal, the data was analysed using an appropriate method and the results are presented as expected. The researcher sought ethical approval and gained consent. These factors all demonstrate good methodological rigor.

Qualitative research cannot be totally free from bias and objective due to its very nature, however the study should be credible, trustworthy and transparent (Gerish and Lathlean 2015). This assignment has identified that this study appears to lack transparency, and there are concerns over the trustworthiness of the results due to bias. The missing information that has been highlighted throughout could be requested from the researcher, as contact details are available. The reader acknowledges that the researcher may have been restricted by their word count, excluding certain details on this basis. Therefore, further information would be necessary for the reader to fully critique the research and establish its value in relation to their practice.

Similar studies could be conducted detailing all of the information of the research process in the future to further explore the same phenomenon and aid knowledge in this area to enhance practice.

References

• Ali, S. & Louise, T. (2017). Exploring senior nurses’ understanding of compassionate leadership in the community. British Journal of Community Nursing,22(2), 77-87. Retrieved from https://www-magonlinelibrary.com.ezproxy.herts.ac.uk/doi/pdf/10.12968/bjcn.2017.22.2.77
• Andrew. S. Halcomb. E. (2009). Mixed methods Research for Nursing and the Health sciences. London. England: Iley- Blackwell
• Baillie, L. (2015). Promoting and evaluating scientific rigour in qualitative research. Nursing Standard. 29 (46), 36-42.
• Bowray, S. (2014). Nursing research: ethics, consent and good practice. Nursing Times.  110(1),20,20- 23.
• Broomfield-Ingham, B. A. (2014). A nurses’ guide to the critical reading of research. The Australian journal of advanced nursing: a quarterly publication of the Royal Australian Nursing Federation, 32(1):37. Retrieved from http://www.ajan.com.au/Vol32/Issue1/5Ingham-Broomfield.pdf.
• Francis, R. (2013). Report of the Mid Staffordshire NHS Foundation Trust public Enquiry. The Stationary Office. London.
• Gerrish, K. & Lathlean, J. (2015). Research process in nursing (7th edition). Retrieved from https://ebookcentral.proquest.com https://www.magonlinelibrary.com/page/bjcn/board
• Hennink, M. M., Kaiser, B. N., & Marconi, V. C. (2017). Code Saturation Versus Meaning Saturation: How Many Interviews Are Enough? Qualitative Health Research, 27(4), 591–608.
• Keogh, B. (2013) Review into the quality of care and treatment provided by 14 hospital trusts in England: overview report. Retrieved from https://www.nhs.uk/nhsengland/bruce-keogh-review/documents/outcomes/keogh-review-final-report.pdf (accessed 17 December 2018).
• Kings Fund. (2011). The future of leadership management on the NHS: no more heroes. In: Report from the Kings Fund Commission on Leadership and Management in the NHS. Kings Fund. London.
• Le, M. A., & Holmes, S. (2012). Introduction to nursing research: developing research awareness. Retrieved from https://ebookcentral.proquest.com
• NHS Health Research Authority. (2018). UK policy framework for health and social care research. Retrieved from https://www.hra.nhs.uk/planning-and-improving-research/policies-standards-legislation/uk-policy-framework-health-social-care-research/
• Nursing and Midwifery Council. (2018). The Code, professional standards of practice and behaviour for nurses, midwives and nursing associates. London: NMC.
• Parahoo, K. (2006). Nursing Research: Principles, Process and Issues. (2nd ed.). Hampshire: Palgrave MacMillan.
• Polit, DF.  Beck, CT. (2014).  Essentials of Nursing Research: Appraising Evidence for Nursing Practice. (7th ed.). Philadelphia PA: Lippincott William and Wilkins.
• Polit, D.F. Hungler, B.P. (2013). Essentials of Nursing Research: Methods, Appraisal, and Utilization (8th ed.). Philadelphia: Wolters Kluwer/Lippincott Williams and Wilkins
• Qualitative Research in Health Care, edited by Catherine Pope, and Nicholas Mays, John Wiley & Sons, Incorporated, 2013. ProQuest Ebook Central, https://ebookcentral.proquest.com/lib/herts/detail.action?docID=284086. https://doi.org/10.1177/1049732316665344
• Qualitative Research Practice, edited by Clive Seale, et al., SAGE Publications, 2004. ProQuest Ebook Central, https://ebookcentral.proquest.com/lib/herts/detail.action?docID=1138447.
• RCNi (2017). Royal College of Nursing. Retrieved from https://rcni.com/write-us/writing-a-great-article/writing-abstract-85391
• Royal College of Nursing. (2009). Research Ethics, RCN guidance for Nurses.
• Smith. J. A. Flowers. P. & Larkin. M. (2009). Interpretative phenomenological analysis: theory, method and research. London: Los Angeles, [Calif.]; SAGE.
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• World Medical Association. (2013). Declaration of Helsinki. Ethical Principles for Medical Research Involving Human Subjects. doi:10.1001/jama.2013.281053.