Free Nursing Dissertations - If This Is The Case, One Could Make A Rational Argument That A Flexible
If this is the case, one could make a rational argument that a flexible approach that could take account of these various and disparate factors, would be likely to be more successful than a rigid, structured approach. This does appear to be at odds with the Vrale paper. Of course, we accept that from a scientific evidence base (Merry 1998) the paper seems to suggest that the converse is true.
If we consider the actual structure of the Vrale investigation, it lacks the scientific rigour that one might expect, as it actually consists of an selective presentation of opinions of five nurses. The authors state that the sample is a selected choice based on the author’s long experience with local psychiatric wards and of expert nurses with highly qualified opinion relating to the subject matter.
It is this matter of selection that poses a problem.(Mohammed et al 2003)
It appears that both the authors and the nurses (in their expert capacity) have selected what they wish to be presented. This is evidenced in the fact that they were encouraged to relate a successful story. If it is viewed as such then there is no problem, but firstly one has to read through more than half the paper to find this out and secondly, because of this structure, no opposing counter argument is presented for balance. (Bartko et al 1976)
This method of data collection is therefore, by definition, highly selective. The authors quote two sources (Mishler 1986 and Banner 1984) to justify the technique. Closer examination of the literature suggests that there is a difference between inviting nurses to share their experiences (Mishler) and asking them to be overtly selective in describing situations that only fit the author’s hypothesis. (Kjaergard et al 2001)
The ethical issues appear to be comparatively straightforward as written consent of participants was obtained, they were not identified in any event and the tapes and transcriptions are said to have now been destroyed. All of this is consistent with the demands of the Helsinki Declaration. (Sugarman J & Sulmasy 2001)
Part of the difficulty in providing a totally valid critique of this paper is the fact that it is read in obvious translation. It is therefore actually possible that some of the criticisms that we have levelled at it may actually be due to inaccurate translations of concept, which is why we have been at pains to contain any comments and criticisms to main elements of structure and content rather than the minutiae. (Pocock SJ 1996).
There is one passage (pg 516 on my copy) which appears seminal to the whole issue:
Two main aspects..emerged from the data: controlling self harm and suicide and creating a therapeutic relation, The two aspects related dynamically.
The whole of the paper is based on this single (rather artificial) premise that these two aspects of control from harm and a therapeutic relationship are discretely different interventions.
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