Critical Review Form - Qualitative Studies

(Version 2.0)
© Letts, L., Wilkins, S., Law, M., Stewart, D., Bosch, J., & Westmorland, M., 2007
McMaster University

CITATION:

Brigitte S. Cypress , 2011. The lived ICU experience of nurses, patients and family members: A
phenomenological study with Merleau-Pontian perspective

Comments
STUDY PURPOSE: Outline the purpose of the study and/or research question.
To describe and understand the lived intensive care unit experience of nurses, patients and
Was the purpose and/or research family members during critical illness.
question stated clearly?
yes
no

LITERATURE : Describe the justification of the need for this study. Was it clear and compelling?
There is a paucity of research studies in the literature conducted on the triad of nurses,
Was relevant background patients and family mem- bers looking at the experience of critical illness and their
literature reviewed? perspective of each from the other. The literature search conducted from 1998 to 2007 did
yes not yield studies conducted on this triad.
no

How does the study apply to your practice and/or to your research question? Is it worth
continuing this review?1
The majority of the studies related to critical illness and the families are also quantitative
with a focus on selected areas of concern and/or selected individuals in the family

STUDY DESIGN: Was the design appropriate for the study question? (i.e., rationale) Explain.
The majority of the studies related to critical illness and the families are also quantitative
What was the design? with a focus on selected areas of concern and/or selected individuals in the family
phenomenology
ethnography
grounded theory
participatory action research
other
_     _____________

1 When doing critical reviews, there are strategic points in the process at which you may decide the research is not applicable to your
practice and question. You may decide then that it is not worthwhile to continue with the review.

© Letts et al., 2007 Qualitative Review Form 1.

 Was a theoretical perspective Describe the theoretical or philosophical perspective for this study e.g., researcher’s
identified? perspective.
yes The nurses providing direct care in the ICU, patients and family members were provided
no with a brief written intro- duction to the study that describes all the information such as
purpose, inclusion criteria, consent, total time needed to participate, remuneration and right
to terminate partic- ipation at any point during the study.

Method(s) used: Describe the method(s) used to answer the research question. Are the methods congruent
participant observation with the philosophical underpinnings and purpose?
interviews The nurses were inter- viewed in different venues of their choice ensuring privacy and
document review confidentiality. The second interview was conducted four days after the first interview. The
focus groups interview for nurses was started with a general lead question — ‘‘Tell me about your
other experience of the patients and family members in the ICU.’’ The patients and family
_     _____________ member’s interviews com- menced with an open-ended question — ‘‘Tell me about your
experience of the nurse in the ICU.’’ These questions put the interview in a context for both
the researcher and the par- ticipant. All participants participated in the two interviews.

SAMPLING: Describe sampling methods used. Was the sampling method appropriate to the study purpose
or research question?
Was the process of purposeful A purposive method of sampling was also used to recruit participants for this study in which
selection described? they were selected for their knowledge and experience of critical illness in the ICU.
yes
no

Was sampling done until Are the participants described in adequate detail? How is the sample applicable to your
redundancy in data was reached?2 practice or research question? Is it worth continuing?
yes Participants were also asked to fully read the informed consent form, encouraged to ask ques-
no tions and to sign prior to their participation in the study.
not addressed

Was informed consent obtained? Eligible participants included five nurses, five patients and five family members who
yes voluntarily signed an informed consent.
no
not addressed

2 Throughout the form, “no” means the authors explicitly state reasons for not doing it; “not addressed” should be ticked if there is
no mention of the issue.

© Letts et al., 2007 Qualitative Review Form 2.

 DATA COLLECTION:
Describe the context of the study. Was it sufficient for understanding of the “whole” picture?
Recruitment continued until data saturation was achieved. No participants approached
Descriptive Clarity refused to be included in the study. No participants dropped-out from the study. Ethical
Clear & complete description of
approval was obtained from the institutional review board of the hospital where the study
site: yes no
took place. This study was conducted in an adult ICU in an urban, nonprofit, nonsectarian
participants: yes no
community hospital
Role of researcher & relationship
with participants:
yes no

Identification of assumptions and

What was missing and how does that influence your understanding of the research?
biases of researcher:
Critical illness is usually characterised by an acute inci- dent that can be triggered by co-

 yes no morbidities that can lead to multiple admissions related to exacerbations and ultimately
chronicity. Patients are sometimes admitted in the ICU mul- tiple times. Overtime, the
critically ill patients either are unable to cope with their illnesses or are able to make sense of
their illness experiences and create meaning schemes
Procedural Rigour
Procedural rigor was used in data Do the researchers provide adequate information about data collection procedures e.g.,
collection strategies? gaining access to the site, field notes, training data gatherers? Describe any flexibility in the
yes design & data collection methods.
no When data collection begins in qualitative research, so, too, data analysis. From the moment
not addressed researchers begin listen- ing to descriptions of a particular phenomenon, analysis is
occurring Thematic anal- ysis was further accomplished using van Manen’s (1990) wholistic,
selective and detailed line-by-line approach. Fol lowing van Manen’s technique, the
researcher listened to the tapes whilst reading the transcriptions for accuracy

DATA ANALYSES: Describe method(s) of data analysis. Were the methods appropriate? What were the findings?
Thematic anal- ysis was further accomplished using van Manen’s (1990) wholistic, selective
and detailed line-by-line approach. Fol- lowing van Manen’s technique, the researcher
Analytical Rigour listened to the tapes whilst reading the transcriptions for accuracy
Data analyses were inductive?
yes no not addressed

Findings were consistent with &

reflective of data?
yes no

© Letts et al., 2007 Qualitative Review Form 3.

 Auditability Describe the decisions of the researcher re: transformation of data to codes/themes. Outline
Decision trail developed? the rationale given for development of themes.
yes no not addressed The research questions that guided this study were: (1) what are the patients’ and their
families’ experiences of the nurse in an intensive care unit environment? (2) what are the
Process of analyzing the data was nurses’ experiences of the patients and families in an intensive care unit environment?
described adequately?
yes no not addressed Five common themes, three specific themes and correspond- ing descriptors emerged from
the thematic analysis of the participant’s narratives and are described below with a
description of the theme and its illustrations in supporting quotes. The quotes used were
selected because they pro- vided a clear illustration of a characteristic of the theme.

Theoretical Connections
Did a meaningful picture of the How were concepts under study clarified & refined, and relationships made clear? Describe
phenomenon under study any conceptual frameworks that emerged.
emerge? The researcher spent 5—6 months with nurses, patients and their families in the ICU to
yes learn the context of the phenomena and become oriented to the situation and to build trust
no and rapport with the par- ticipants. Dependability was achieved by having a doctorally
prepared nursing colleague review the transcribed material to validate the themes and
descriptors identified. Through reflexivity and bracketing, the researcher was always on
guard of her own biases and assumptions that she might bring to the study but was also
aware that complete reduction is not possible (Merleau-Ponty, 1962a,b,c).

OVERALL RIGOUR For each of the components of trustworthiness, identify what the researcher used to ensure
Was there evidence of the four each.
components of trustworthiness?
Credibility yes no Reliability was attained by giving special care to the collection, identification and analysis of
Transferability yes no all data pertinent to the study. The collected and analysed data were presented to the
Dependability yes no participants and they were asked if the narrative is accurate and a true reflection of their
Comfirmability yes no expe- rience and in order to achieve credibility. Credibility, the accurate and truthful
depiction of participants’ lived experience, was achieved through prolonged engagement

What meaning and relevance does this study have for your practice or research question?
The trustworthi- ness of the results of this study is enhanced by the detailed and accurate
descriptions of the patients, their family members, and the nurses’ experiences and by
continuously returning to the texts.

© Letts et al., 2007 Qualitative Review Form 4.

 CONCLUSIONS &
IMPLICATIONS
Conclusions were appropriate
given the study findings?
yes no
The findings contributed to
theory development & future OT
practice/ research?
yes no
© Letts et al., 2007
What did the study conclude? What were the implications of the findings for occupational
therapy (practice & research)? What were the main limitations in the study?
Using phenomenology, Merleau-Ponty’s philosophical per- spective and van Manen’s
method of phenomenological research this study shed light on the phenomenon of the
intensive care unit experience during critical illness in the ICU from the perspectives of
patients, their family mem- bers, and the nurses. Understanding the person’s lived body and
the notion that the experience of critical ill- ness is dependent on the individual’s embodied
temporal, spatial and relational horizons, rather than only the natu- ralistic, biological and
physiological aspects, revealed new conception of critical illness that will provide caregivers
knowledge about effective care. A better understanding and description of these experiences
was revealed towards a more holistic, subjective consideration of the person’s narrative and
life world which opens new ways for cop- ing amongst patients and their families, as well as
care giving possibilities for the nurses. The patient’s experi- ences as it relates to finding
meaning during critical illness, centred on obtaining support from their families and pro-
fessionalism from the nurse. Adaptation in the ICU, as experienced by nurses, patients and
family members inte- grates family as a unit, physical care/comfort, physiological care and
psychosocial support resulting in transforma- tion.
Qualitative Review Form 5.