Professionalism has been described to have five major components in nursing which include “belief in public service, belief in self-regulation, a commitment to the profession beyond economic incentives and a sense of autonomy in practice” (Tanaka et al., 2014). Professionalism in nursing ensures that the nurses are able to provide healthcare services in the best way possible in an environment that is in line with the code of conduct of nursing. Professional development in nursing is both essential and beneficial to patient care, community and healthcare organizations. It positively influences nurses to practice their profession efficiently while providing high-quality healthcare to patients. A critical appraisal tool analytically evaluates the quality of the study with emphasis on assessment of the accuracy of the various steps in the research methodology. These factors have a significant influence on the study results and the interpretations of the findings which are vital to ascertain the validity of the research and application of the findings to the environment in the form of policies, reforms and changes in education or practice. Hence, a critical appraisal tool is a vital constituent of evidence-based practice. The aim of this assessment is to critically appraise the article by Bimray, Jooste and Julie (2019) with the help of CASP (Critical Appraisal Skills Programme) tool (CASP, 2018). The different questions in the CASP tool will be considered as a standard for critical appraisal and it will be supported with references to credible sources.
The aim of a research illustrates an explanation for the purpose of the research and helps the reader understand the rationale behind the research that was conducted. The aim in the article by Bimray et al. (2019) has been clearly identified and demarcated which is to understand and analyse the experiences regarding professionalism of the undergraduate students during their training programme of a 4-year tenure at a Higher Education Institution in the province of Western Cape. On a larger scale, the study was a part of a research project which constructed a conceptual framework for both professional nurses and nurse academicians to promote professionalism at a Higher Education Institution in the Western Cape among the undergraduate students of nursing.
An appropriate qualitative methodology has been used by the authors and a clear presentation of the methodology adopted is given in the paper. A qualitative approach is used by researchers to explore the behaviour, experiences and feelings of individuals (Holloway & Galvin, 2017). Generally, qualitative approaches aid in the exploration of the conflict or changes and illuminate the researcher about an interpretive approach to the social reality along with an insight into the experiences of the individuals. Since the research methodology in the selected article is exploratory and aims to explore and analyse the experiences of the undergraduate students, a qualitative approach is well-suited for this paper.
According to the CASP tool, the researcher in the selected article has distinctly identified the research design to be exploratory, descriptive and qualitative to explore the data from the undergraduate student nurses regarding professionalism in nursing. Since qualitative research which is exploratory and descriptive in nature involves open questions it tends to analyse and understand the subject’s experiences and ideologies (Queiros et al., 2017). This also gives a flexible approach to the research. However, the inherent flexibility of the open questions leads to an extent of uncertainty, can be influenced by the subjectivity of the researcher and gives an open-end character to the qualitative research.
In the selected article, the researcher has defined the participant selection to be purposive sampling through which eight focused group discussions were identified for data collection. The target population has been identified as undergraduate student nurses (1058 in number) for the Bachelor of Nursing Science programme in a nursing school in Western Cape. It was also specified in the article that the students who didn’t give consent for the study or did not match the inclusion criteria were excluded from the study. Purposive sampling was chosen in this study as the aim of the study was to explore and analyse the experience of the nursing students regarding professionalism and it was necessary to take the opinions and experiences of the students enrolled in a nursing programme. However, this method of sampling can lead to bias. Probability random sampling would have been more preferable as it prevents bias and leads to a more valid and accurate collection of data and reduces the risk factor due to assumption which occurs in purposive sampling (Etikan & Bala, 2017). Assumption can lead to inappropriate generalisation of the population.
An adequate method of data collection was chosen by the authors of the selected article as the focused group discussions, that were used as a means of data collection, occurred during the lunch breaks and did not last more than an hour. An interview guide was put to use to pose the questions and “What are your experiences about professionalism in the undergraduate nursing programme at this institution?” was the principal question asked. The focus groups for a focused group discussion generally consist of 6-12 individuals and it benefits from the dynamics of the group to stimulate the discussion (Guest et al., 2017). It has also been asserted that the interactive, interpersonal nature of these groups enables them to assemble information that could not have been accumulated from a solo respondent. Facts about data being transcribed and data saturation have also been mentioned in the research wherein it is reported that data saturation occurred after a total of eight focus group discussions.
The role and influence of the researcher have not been indicated in the selected article. There is also no mention of the relationship between the researcher and the participants and the bias (if any). It is essential to recognise and elaborate on the relationship between the researcher and the participant as it can have a paramount influence on the results. It has been highlighted that the position of the researcher as compared to the participant is that of a privileged one. (Raheim et al., 2016). The innate disparity in the power between the two parties as well as ethical issues regarding these have always been a concern along with the impact and influence on the research results.
Ethical concerns have been acknowledged and approval secured from Research Ethics Community of a university in Western Cape, while the Western Cape Department of Health granted the permission to conduct the research at the accredited healthcare facilities. As mentioned in the article, the ethical considerations that have been acknowledged and addressed include ethical principles and trustworthiness. “The following ethical principles were adhered to; the principles of no harm and beneficence; the principle of respect and justice; and the principle of privacy and confidentiality.” Ethics ensure that the research is scientifically sound along with being respectful to human rights (Ketefian, 2015). It identifies human dignity while preventing their health, privacy and rights from being jeopardized in any manner. Increased vigilance is required on the part of the researchers, interviewers, human subject committees or review boards and also the institutions or settings where the study is conducted, to ensure appropriate precautions and recommendations are levied.
The data analysis for the selected article was found to be moderately rigorous as per the CASP tool. The recorded data was transcribed and the transcriptions were cautiously read and reviewed. Following this, the data was analysed using a procedure to identify the themes in the data. Subsequently, categories were assigned to the themes recognised and the documented observations enlisted during the interview were also reviewed. The missed points as per the data analysis include the absence of details about contradictory data, the role of the researcher and bias. One common hurdle that the qualitative researches come across is that the data is of open-ended nature as compared to the figures found in quantitative research. Textual findings, instead of figures, are more strenuous to deduce and the identification of patterns is much more cumbersome (Castleberry & Nolen, 2018). A data analysis strategy, thematic analysis, is the most frequently applied approach across the various qualitative designs. In this approach, the data is reduced to themes following which conclusion is provided. Thematic analysis recognizes, analyses as well as reports various themes in the data and is a flexible way to interpret the data. It is used widely due to the vast variety of topics and questions of research which can be catered to with this method of analysis.
According to the CASP tool, the findings of the study have been clearly identified and discussed. There is an adequate discussion for and against the topic, the credibility of the findings has been discussed and the findings have been related to the original research question “What are your experiences about professionalism in the undergraduate nursing programme at this institution?”. The results of the study presented that mixed responses exist regarding the views of the student nurses on professionalism even after being supported and trained to develop professionalism by both the academicians and professional nurses. “The dominant themes that emerged from the data were role modelling of unprofessional behaviour; language barriers in the development of professional behaviour; participants’ own understanding of professional behaviour; reasons for students and practitioners’ unprofessional behaviour and suggestions for improvement; prejudice towards degree students; and students’ professional or unprofessional behaviour experienced as contributing to the image of the profession” (Bimray et al., 2019). These themes have also been discussed in-depth by the researchers supported by respondent validation, thus proving the credibility of the findings. The ultimate motive of a qualitative research is to find a contextual understanding of the concept, rationalise beliefs, behaviours and ideologies and understanding the impact of experiences of the individuals (Hennik, Hutter & Bailey, 2020).
The research thoroughly discusses the contribution of the study towards the existing understanding of professionalism by the nursing students. It even identifies the different areas for further research as well as efforts required to overcome the gap in understanding of the nursing students. The research throws light on the facilitation of professionalism in nursing practice and the Provincial Nursing Strategy implementation to overcome the difficulties faced by the profession of nursing in Western Cape. The findings of the research contribute towards training nursing professionals as per the changing times. The authors of the research have even discussed ways to practically approach the cause and put the research findings to use. The authors advocate that the professional nurses should set an example, closely follow the code of conduct and adopt and display expected professional attitude essential for the nursing practice. Also, a need for proper orientation for the nursing students to make them understand what is expected of them has been mentioned by the authors. The basis of qualitative research is to provide understanding and knowledge by exploring, analysing and describing the experiences and feelings within the population of interest (Wu et al., 2016). Qualitative research does not provide results that can be generalised, instead, it focuses on an iterative perspective. Hence, the results of qualitative results are usually fundamental for future researches, both quantitative and qualitative.
All the elements in the CASP tool are sufficiently met with in the selected research article. The aim of the article has been explicitly mentioned to analyse the understanding of professionalism by the undergraduate students of nursing during their training programme at a higher education institute in Western Cape Town. A qualitative methodology has been adopted by the authors of the research article and the research was conducted to explore the feelings and experiences of the students during the 4-year nursing programme. The researcher has identified the research design to be exploratory, descriptive and qualitative which includes open-ended questions to be asked from the participants to understand their comprehension of professionalism in nursing. The sampling method used for the research has been mentioned as purposive sampling and the target population for the research is identified to be the nursing students enrolled for Bachelor Science of Nursing. For data collection, the authors of the research paper undertook focused group discussions and the original research question is highlighted to be “What are your experiences about professionalism in the undergraduate nursing programme at this institution?”. Crucial details about the role and influence of the researcher, researcher-participant relationship and bias are missing from the selected research article. Ethical concerns have been acknowledged, ethical principles adhered to and the research has been approved by the Research Ethics Community of a university in Western Cape and the Western Cape Department of Health. The analysis of data was performed as a thematic analysis, wherein the data collected from the focused group discussion was transcribed and subsequently, themes in the data were identified and then sub-categorized. The contradictory data for data analysis and the role of researcher and bias in the process of data analysis were missing. Hence, the data analysis for the selected article was found to be moderately rigorous as per the CASP tool. The findings of the study are distinctly demarcated by the authors of the research paper and were found to be miscellaneous, that is mixed responses were observed regarding the views of the nursing students on professionalism even after being supported and trained to develop professionalism by both the academicians and professional nurses. The findings were found to be credible as per the respondent validation depicted for each theme recognised in the research data. The findings of the research were found to be conducive for further studies wherein areas for future research were elaborated and the findings were presented with practical approaches to address the issue of lack or minimal understanding of the concept of professionalism by the nursing students.
The research article has been well designed and depicts substantial practical results. The aim and research question have been accurately framed and encompass the essentialities of the purpose of the study. The use of qualitative methodology enabled the researchers to gain perspective of the understanding of the concept of professionalism by the undergraduate nursing students by exploring their subjective views and experiences. A systematic approach for data collection and analysis has been maintained with a well-defined mention of the sampling, target groups, methodologies with the analytic process. The themes recognised in the research mainly include role modelling of unprofessional behaviour, language barriers as a hurdle for practising professionalism and lack of understanding of professional behaviour. The only downfall of the research article is the lack of mention of bias and the researcher-participant relationship. Future research scope and practical ways to address the findings of the research increase the rigour and credibility of the research. A need for professional nurses to model professional behaviour and strictly follow the code of conduct and orienting and explaining the nursing students to enable them to understand the professional behaviour expected from them has been indicated in the recommendations as per the findings of the research.
Bimray, P., Jooste, K. & Julie, H. (2019). Professionalism experiences of undergraduate learner nurses during their 4-year training programme at a higher education institution in the Western Cape, South Africa. Curationis, 42(1), 1-8.
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