Qualitative Data Collection & Ethic

Research Critique: Qualitative Studies

Background of Study

Recent data shows that the incidence and prevalence of End-Stage Renal Disease continue to increase and is high among African America population. As a non-reversible kidney damaging illness, hemostasis in patients diagnosed with ESRD can be maintained in two ways. The ways are either through dialysis or a kidney transplant. Moreover, research shows that blacks and African Americans have an increased risk of developing kidney failure. Therefore, this paper critically appraises two qualitative studies that address the PICO question. The two studies include one by Zazzeroni et al. (2017) on “Comparison of Quality of Life in Patients Undergoing Hemodialysis and Peritoneal Dialysis: a Systematic Review and Meta-Analysis” and the second one by Fox et al. (2020) on “Social Support in the Peritoneal Dialysis Experience: A Qualitative Descriptive Study.” These studies will try to address the PICO question which is: “In African Americans with End-Stage Renal Disease (ESRD), how will peritoneal dialysis make for fewer restrictions and less complication than in-centre hemodialysis? This critique will incorporate the study's background, how the articles support PICO question, the methodology used, results of the two studies, and ethical considerations. 

In the first study by Zazzeroni et al. (2017), the authors noted an increase in the survival rate of patients with chronic renal failure dues to substitution treatment prompting an investigation of their quality of life (QoL), which is a key measure of evaluating the outcomes of chronic disease treatment. The authors embarked on determining whether hemodialysis or peritoneal dialysis provided a better QoL. In doing so, the authors aimed at performing a systematic review and meta-analysis of published studies using KDQOL-SF 1.3 and KDQOL-SF 36 in patients with chronic renal failure to determine which hemodialysis or peritoneal dialysis treatments that lead to a higher QoL. In this study, the problem is increased patients suffering from chronic renal failure and determining the QoL in patients with chronic renal failure best between hemodialysis and peritoneal dialysis treatments.

On the other hand, in the study by Fox et al. (2020), the authors noted that individuals with end-stage kidney disease could decide to go for either conservative (palliative) management or kidney replacement therapy. Again, the authors also noted that most patients prefer kidney transplant. Still, due to the limited number of organs available, most patients are forced to seek some form of dialysis treatment. Moreover, the authors also noted that most patients prefer either hemodialysis or peritoneal dialysis, which are both equivalents concerning clinical outcomes, though peritoneal dialysis is less costly to offer. As a result, peritoneal dialysis is often done in the home by patients or support persons. Peritoneal dialysis is associated with self-care burden on patients and families, even though social support for patients receiving peritoneal dialysis is vital for its sustenance. As a result, the objective of the authors was to explore how patients, family members, and nurses view social support among outpatients undergoing peritoneal dialysis clinic..

How do these two articles support the nurse practice issue you chose?

These two articles support the PICO question and will be used to address the elements of the question to gain a deeper understanding of both hemodialysis and peritoneal dialysis. For instance, the study by Zazzeroni et al. (2017) will be used to determine how hemodialysis and peritoneal dialysis can be used to enhance the quality of life among patients with end-stage renal disease, which are the focus of the PICO question. The systematic meta-analysis will reveal which is the best treatment model is better to enhance the quality of life. Similarly, the article by Fox et al. (2020) will support the PICO question by providing more information on how nurses, family members, and nurses view the social support in helping patients diagnosed with kidney disease under peritoneal dialysis recover.

Moreover, the intervention and comparison groups in the study by Zazzeroni et al. (2017) included patients undergoing hemodialysis and peritoneal dialysis treatment, respectively, exactly as the intervention and comparison group in the PICO question. However, the in the study by Fox et al. (2020), the intervention and comparison groups were patients, family members, and home care–assisted PD program nurse as the intervention group while and PD nurses were the comparison group respectively, which is not the case in the PICO question.

Method of Study

In the article by Zazzeroni et al. (2017), the authors used a systematic review and meta-analysis research design in which data was gathered from the articles searched through various databases and articles that compared peritoneal dialysis and hemodialysis therapy for the treatment of patients with chronic renal failure in relation to the QoL were selected. However, Fox et al. (2020) used a qualitative descriptive research design to comprehensively explore the role of social support as perceived by patients receiving PD, their families, and nurses. The two articles used different research design in which the first study by Zazzeroni et al. (2017) used secondary data while the second by Fox et al. (2020) used primary data. More importantly, the advantage of using a systematic review and meta-analysis is that they seek to reduce bias at all stages of the review process. However, limitation of systematic review and meta-analysis is that the setting of tests used, the expected role of the tests, study design characteristics, and participants' demographics are often left unreported. On the other hand, the advantage of qualitative descriptive research design is that it offers the researchers the opportunity to observe the phenomenon in a completely natural and unaltered natural setting. However, one limitation of qualitative descriptive research design is that I can be difficult to replicate results and is prone to researcher bias.

Results of Study

In the study conducted by Zazzeroni et al. (2017), the authors found that only a few of the seven articles found significant differences between hemodialysis and peritoneal dialysis treatments. The study by Wakeel et al. showed a better QoL for peritoneal dialysis patients than in hemodialysis patients. On the contrary, two other studies support that the best QoL is in patients receiving hemodialysis. Another article displayed a significant difference only for satisfaction in relation to care, better in patients on peritoneal dialysis, and for physical health, better in hemodialysis. These findings imply that the quality of life in patients diagnosed with kidney disease is better in patients undergoing peritoneal dialysis.

On the other hand, in the study by Fox et al. (2020), the authors found that four themes are attributed to social support. They included addressing emotional needs and managing emotion (emotional support); peritoneal dialysis tasks and life tasks (instrumental support); accessing information, receiving information, and learning (informational support); and affirmation/external reassurance and self-confidence (appraisal support). The social support needs of both patients and family members also varied and depended on their existing support networks and individual perspectives of support. This study implies that for health care providers to encourage this treatment route, they need to comprehend how to best support patients and their family members. This knowledge will empower clinicians to focus on these four attributes when providing care to patients and their families.

Ethical Considerations

One important ethical issue in conducting research is ensuring that there if is informed consent, especially where human participants are involved in the research. Informed consent means that an individual knowingly, voluntarily and intelligently, and clearly and manifestly, provides consent to participates in research (Ferreira, Buttell, & Cannon, 2018). Informed consent is one of how the autonomy rights of a patient are protected. Moreover, informed consent seeks to include the rights of autonomous persons through self-determination. The other ethical issue in conducting research is that of Respect for anonymity and confidentiality. According to the American Nurses Association, this ethical issue means that the anonymity is protected when the subjects identify can note be linked with personal responses in research (Ferreira, Buttell, & Cannon, 2018).

However, in Zazzeroni et al. (2017), the authors did not address any of the two ethical concerns because the study was based on other studies other human participants. On the other hand, the study by Fox et al. (2020) followed the ethical principles of confidentiality by where the participants transcribed verbatim by a transcriptionist who signed a confidentiality agreement. Again, this study respected the principle of informed consent by ensuring that patients were reminded that they could withdraw their consent at any point during the qualitative data collection.

References

Ferreira, R. J., Buttell, F., & Cannon, C. (2018). Ethical issues in conducting research with children and families affected by disasters. Current psychiatry reports, 20(6), 1-7.

Fox, D. E., Quinn, R. R., James, M. T., Venturato, L., & King-Shier, K. M. (2020). Social Support in the Peritoneal Dialysis Experience: A Qualitative Descriptive Study. Canadian journal of kidney health and disease, 7, 2054358120946572. https://doi.org/10.1177/2054358120946572  

Zazzeroni, L., Pasquinelli, G., Nanni, E., Cremonini, V., & Rubbi, I. (2017). Comparison of Quality of Life in Patients Undergoing Hemodialysis and Peritoneal Dialysis: a Systematic Review and Meta-Analysis. Kidney & blood pressure research, 42(4), 717–727. https://doi.org/10.1159/000484115