Critical Review of Acute Care Nurses Views on Family Participation and Collaboration in Fundamental Care

Critical Review of Acute Care Nurses Views on Family Participation and Collaboration in Fundamental Care (Mackie, et al., 2018)

In response to the Inquiry into the Mid Staffordshire incident (Francis, 2013) the fundamentals of person-centred care (PCC) in healthcare have been emphasised to ensure patients were treated with respect, dignity and compassion (The Health Foundation, 2014). The Government’s report ‘Patients First and Foremost’ (Department of Health, 2013) highlighted within the Statement of Common Purpose, the commitment towards the full involvement and collaborative working relationships of patients, families and healthcare professionals within in the NHS. However, despite the adaptation and updates to policies and working standards such as the Nursing and Midwifery Council (NMC) code (NMC, 2018), research has indicated that PCC in practice is still lacking, particularly with treatment towards patients with dementia or in elderly care (Manthorpe & Samsi, 2016). Possible reasons that healthcare professionals may struggle in implementing PCC within their practice may be due to the organisational and social constraints of healthcare and the potential risks that may be taken in working in such a way; therefore future research suggestions into PCC should focus on the underpinning values that are held by nursing and clinical teams (McCormack et al., 2017). With suggestions of further research into the practicalities of PCC in healthcare and nursing standards highlighting the importance of patient and family involvement in the delivery of care (NMC, 2018), Mackie et al. (2018) research into the values and attitudes of nurses towards collaborative care is a paper of interest. Throughout this critique the validity of their approach and findings as well as the applicability of their research will be discussed.

Introduction and Background

Mackie et al. (2018) research aimed to understand the role nurses, patients and families play in the participation and collaboration in fundamental care in acute hospital settings. They describe this clinical approach to practice and therapeutic relationships as patient-and family-centred (PFCC), an evidence-based approach that can improve communication, patient involvement and care efficiency (Hsu, et al., 2019). They also investigated reasons that would hinder or enhance the use of PFCC. The aim of this research can be identified as a strength with the International Council of Nursing (ICN) highlighting that quality and cost-effective care as a priority in nursing research (ICN,2012). Mackie et al. (2018) demonstrate an in-depth knowledge of their field of research through the background literature and introduction. The authors use a variety of sources to identify the purpose of their research including journal articles, healthcare standards and government reports. The literature reviewed within the background and introduction has a clear layout and structure throughout as it presents the prior research and potential gaps within the nurses relationships with patients and their family. This improves the credibility of the purpose of the research and the foundation to its applicability to practice (Boswell & Cannon, 2015).

Method and Sample

Mackie et al. (2018) used an exploratory sequential mixed methods approach with a combination of naturalistic observations (observer-as-participant) and semi-structured interviews. Participants were purposefully selected as all were registered or enrolled nurses from the Medical and Assessment Planning Unit in a hospital in Queensland, Australia. During the observer-as-participant phase of the data collection, the lead author, a registered nurse, was the observer in the units for periods of two hours. The use of Mackie as lead observer highlights potential for weakness within Mackie et al. (2018) as research suggests that during participant observations in nursing studies, the researcher is known to have two roles, researcher and a nurse. There is a risk of potential conflict causing a lack of research perspective and loss of credibility of the data (Booth, 2015). Suggestions of cognitive bias and reflexivity in nursing research may be due the interpretative nature of their work and are therefore are susceptible to apophenia, unconsciously finding meaning or patterns between unrelated experiences (Buetow, 2019). With all the researchers of the study being ‘experts in their field’ to healthcare and nursing there is an increased possibility of using previous experience or knowledge in expectations of findings will be (Gonzalez-Garcia, et al., 2015).

Results

From the analysis of the data, Mackie et al. (2018) found two main categories that each contained multiple themes, identifying nurses’ attitudes and beliefs towards PFCC that ‘enact’ family participation and those that ‘hinder’ it. They also identified four factors that can influence a nurse-family relationship and highlighted the importance of these factors upon the uptake of PFCC into fundamental care. In analysing the data collected from the observations and interviews the researchers used data triangulation. Through triangulation the researcher can merge the data allowing for increased confidence in the results and improve the validity and reliability of the data (Carpenter, 2011). Mackie et al. (2018) also stated within their research the use of evidenced based approaches to ensure trustworthiness of the data which included confirmability where the researcher when observing clarified interactions of the participants (Holloway & Galvin, 2016).

The researchers use of the Theoretical Domains Framework to establish the questions for the interviews from the observations and detailed coding of answers to the interviews demonstrate a further strength in Mackie et al (2018) research. It provided an in-depth description of the analysis and clarity in the presentation of the data to support findings suggest a high rigorous level of data analysis (Critical Appraisal Skills Programme, 2018).

Discussion, Conclusion and Relevance to Clinical Practice

From their findings Mackie et al. (2018) believe that their research has implications towards nursing practice including delivery of care, adaptation of communication and information to promote understanding and the importance of clarifying privacy and confidentiality with patients and families on initial meetings. They acknowledge limitations of transferability due to being conducted on one site, however as the study was conducted in Australia, the applicability of findings internationally, especially for NHS, have not been elaborated. Australia’s healthcare system has universal health care system to Australian citizens that covers major health services however may citizens also have private healthcare (Australian Government Department of Health, 2019). To establish the applicability of findings to NHS and use of PFCC in nursing practice additional studies would need to be conducted.

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In conclusion, Mackie et al (2018) research presented findings that were able to provide insight into nurses’ opinions towards healthcare practice and establish where nurses require additional support to ensure patient care. It supports the development of quality healthcare from analysis of interventions to the focus of the experience and effectiveness of quality healthcare (Price & Harrington, 2016). This research also highlighted the importance in changing healthcare practices of the involvement of the patient throughout their care when in acute settings, a change in nursing care that is recognised internationally (World Health Organization, 2015).

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References

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• Department of Health. 2013 Patients First and Foremost The Initial Government Response to the Report of The Mid Staffordshire NHS Foundation Trust Public Inquiry. Available at https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/170701/Patients_First_and_Foremost.pdf (Accessed: 29 October 2019)
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