The problem being researched in the article is significant in nursing since it identifies the process, stressors and adjustment strategies of a novice nurse transforming into an expert nurse. This research could assist in developing new policies on institutional level to allow new graduates adjustment in their roles. The author has linked the significance of the research to increased turnover of new graduates in the hospitals in the general world. No specific turnover rates have been mentioned, however, the author has linked the transition difficulty faced by the novice nurses as the main idea behind the research. The author of this article has explicitly explained the purpose of the study as “the transitional experiences from a student to a staff nurseâ€¦..and generate theory”. The problem statement or the research statement is written as ” the study established the needs of the new graduates and identified strategies to facilitate the process of the role transition’ (pg E1). The theory which has been generated from this research could be used as a framework by institutes to plan out strategies of retention and growth of their new employees. The limitations have been stated in the discussion part last paragraph as forgotten experiences of the participants and feeling of social constraints. The assumptions have not been listed however, it could be inferred that all the participants were present throughout the study and data saturation was also achieved.
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Review of the Literature
The literature review is significant and relevant to the study been conducted. An extensive literature search has been done for categories that have been formulated during the research. The citations documented in the literature review are clear, complete and current as greater part of the references have been taken between the years 1974 – 2001. It can be deduced that the literature review is not within the last five years, however, it can be considered that there was a long time gap between the year of research conduction and the publication of the article. On the contrary, no literature review of previous researches of the same topic and gap analysis has been mentioned in the article. The literature is logical, relevant but the comprehensiveness is lacking. The author has, on many instances, linked the study categories with the previous literature categories, for example, the author has linked the first theme of “Getting on Board” with the a previous research theme by Evans (2001) of “period of uncertainty”. The literature has been paraphrased and no quotes have been mentioned.
The literature review has posed many research questions: what are the coping strategies employed by novice nurses to deal with the transition phase; the strategies are employed by institutions to help new recruits adjustment. Along with this, the author has also mentioned a research aspect of impact of nurse spirituality on patient care in the article.
The article does not mention any usage of a theoretical framework for the research. Theory and research have a reciprocal role towards each other, theory forms the baseline to conduct a research and research is useful to test a theory in different contexts (Polit & Beck, 2001 pg 145). Multiple nursing theoretical frameworks are available; however, the most suitable for this research is the theory of Patricia Benner – which identifies the qualities of nurse undergoing the stages from novice to competent (article). It also recognizes the difficulties that a nurse has to undergo in order to progress from one stage to another; this theory would have been helpful in analyzing the data and identifying the core categories and themes.
Population and Sampling
The target population has been described as the recent graduates from the diploma program of the private hospital with a job experience between 6 – 12 months working in ICU, medical and surgical ward (pg E1). The sampling size has not been mentioned explicitly mentioned in the article, however, in one of the quotes the author mentions ‘Six of the seven staff nurses’ (pg E3), it can be deduced that the study sample size was seven. According to Polit & Beck, a sample size of 20 to 30 participants is required to conduct a grounded theory (pg 358). The author does not significantly mentions the variations in the participants such as age, biological gender, and it does not mention the number of participants selected from each area of the hospital. No method of sample selection has been mentioned but according to Polit and Beck (2001), Glaser (1976) has identified theoretical sampling as a suitable method specifically for grounded theory (pg 356). This sampling technique selects participants on an ongoing basis as the researcher understands the area of interest and develops categories and themes (pg 356 -357). The sampling size could have been increased by including participants from emergency department, oncology ward and clinic areas. The demand characteristics of participants’ namely good participant, the negative participant, faithful participant and apprehensive participant have not been mentioned. Along with this no information of Hawthorne effect which defines the effect on dependant variables due to the participants knowledge of being under study has not been mentioned (Polit & Beck pg 755). The article does not specify the negative or discrepant participant of the study.
A grounded theory approach has been used as a research design for this study. A grounded theory is the evolution of a theory from the data collected and analyzed (polit & beck, 2001). It has indeed played a significant role in developing many nursing theories which are nowadays acting as a framework for many researches. It was developed by Glasser and Strauss in 1960 and functions with the development of categories and themes which are substantive from the original data collected (Polit & Beck, pg 230). The grounded theory approach is appropriate for this study design, however, phenomenological approach could also be used as this study explores the human life experiences and their relation to the environment (Polit & Beck, pg 227). The author has provided immense information in the form of categories and themes for the study replication but no specific permission has been provided.
Formal unstructured interviews of 50 to 90 minutes have been tape recorded and transcribed as a method of data collection. Moreover, separate notes have also been used to record the expressions and behavioral changes of the participants. No rationale have been provided for data collection strategies but in grounded theory, according to Polit & Beck (2001) in depth interviews and observation are important data collection strategies (pg 230) along with documents and other data sources. These methods are congruent with the research question.
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Protection of Human Rights
There is no mention of the study undergoing a ethical review board or committee, however, the article signifies the usage of informed consent (Polit & Beck, pg 176) from the participants. The participation has been based on voluntary basis which denotes the use of the principle of self determination (Polit & Beck pg 171). The author also fails to provide evidence of deception from the participation. Furthermore, there is no mention of appropriate time given by participants for the study data collection. The researcher has provided codes to maintain confidentiality and privacy (Polit & Beck, pg 174) of the participants. The article does not explicitly mentions the implementation of the principal of beneficence (Polit & Beck, pg 170) but it could be assumed that has been minimum risk to the participants.
Data according to the article has been analyzed using comparative analysis which denotes the comparison of one interview with other interviews to identify commonalities (Polit & Beck, pg 523). The researcher has utilized the Glasserian grounded theory approach where the data is conceptualized in substantive codes which are interlinked via theoretical codes (Polit & Beck, pg 523). The author via open coding (Polit & Beck, pg 523) has identified the core category of ‘sailing forward’ as the central concept which has dominated all the themes. Selective coding is the second step where the researcher establishes relationships between the main core category and the sub-categories (Polit & Beck, pg 527). Theoretical codes as per Polit & Beck are very powerful because they provide a lot of abstract meaning – necessary for grounded theory approach (pg 523). According to the article, the separate notes were verified from the participants for the clarification of the meaning. The data analysis strategy utilized by the researcher fits the research problem as it develops a core category which is surrounded by themes or sub-categories. The categories established have been supported by raw data which has been written in the form of quotations in the article – further emphasizing the themes formulated. The explanations provided are reasonable and coherent with the quotes thus increasing the authenticity of the study.
The data collected in the research has been audio taped and individual codes have been provided to each interview. Moreover, separate notes were also used as a strategy for the data collection strategy. Rigor in a qualitative research is based on 4 criterias: credibility, transferability, dependability and neutrality (Krefting, 1990). Though the researcher does not mention that a prolonged time has been spent with the participants but the study participants were re-approached for verification of observation notes and transcribed material indicating that the author has spent a lot of time with the participants – increasing the credibility (Krefting, 1990) of the study. The article has two authors but there has been no mention of the method of division of the data analysis; which denotes that a combined effort was made without any interruptions. The article does not specify authors’ efforts to control the discrepant material and participant thus it could be assumed that the study has the element of neutrality and does not have biasness or socially affected perspectives of the participants and researcher (Krefting, 1990). The researcher does not mention her own perspective which can be taken positively as an aspect to reduce biasness and increase the trustworthiness of the study. The consistency of the study has been strengthened by the narration of quotes and literature support of the emerging themes which clearly shows that if the study is replicated then similar themes would appear.
Conclusion and Recommendations
The author has identified the state of confusion, anxiety and happiness as initial emotions of the new graduates; guidance as the need of the new recruits and use of senior observations, CNI facilitation and peer aid as the major support systems in their initial adjustment phase. Thus the author has been able to analyze the data in accordance to the research question. The conclusions drawn from the study themes are in connection with the results of the study but the conclusion paragraph of the article mostly includes future recommendations for the nursing practice. The recommendations include increasing post conference timings of the students, ongoing assessments of employees via CBOs and ongoing classes for the employees. The results assist these recommendations as they indicate increased need for a strong support system for the preparation of new recruits. This study is transferable is all settings of Pakistan where new graduates are been hired as new recruits in the institution thus this study has increase transferability.
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