Evidence Informed Research Is Vital In Midwifery Nursing Essay

Quantitative and qualitative methods relate to different approaches of research design. They are based on philosophical beliefs and the assumptions of universal laws. Quantitative research is based on the belief that information lies outside the personal views of the individual, it accentuates accuracy and produces numerical value (Rees 1997). I believe it is important when using quantitative approaches to recognise some numerical findings may be down to probability and not universal laws. This is important in midwifery care in understanding that although quantitative findings indicate an assumption, every pregnancy and birth is unique. Statistics may say that a particular treatment is best but not all women will agree just the majority. Fraser and Copper (2009) state that the quantitative method can be used in midwifery care in a non biased way by not reflecting on personal experiences and just as statistics. I however believe that the use of these statistics may make midwives act in a more biased way and disregard woman as individuals and more like a population.

Qualitative research believes knowledge is produced by our subjective experiences and that we need to look at things from our respondents’ point of view (Rees 1997). In this research method we must consider the Hawthorne effect and how the results may vary due to participants be aware of the research taking place (Cluett and Bluff 2006). It has been suggested that qualitative research is ‘soft’ (Fraser and Cooper 2009) I however believe this method is more appropriate in midwifery care, as it shows a deeper understanding of how distinctive and individual the childbearing process and takes this into account.

I am now going to critique the paper Psychological factors that impact on women’s experiences of first-time motherhood: a qualitative study of the transition in relation to research.

The title of a research paper must reveal what the study regards in a clear and concise manner (Cluett and Bluff 2006). I feel that the authors have been precise in the words chosen. It makes clear indications that this paper is concentrating on the psychological factors relating to childbirth and not physiological. The title is also specific on the fact the study is on first time mothers and not multigravidas. Clear use of words is extremely important in research studies, this is to ensure the study is found when searching databases; words are taken from the title and abstract. Inappropriate tittles could cause articles to be unnecessarily missed. I feel the authors have done this in a suitable manner.

Authors of a research paper should have the necessary experiences and skills to accomplish the focus of the study (Cluett and Bluff 2006). Ruth Darvill is a fellow researcher; Heather Skirton is a qualified midwife, registered general nurse and holds a PhD, Paul Farrand also holds a PhD and is a senior lecturer, and his expertise consist of psychology. These are the authors of the study I have already indicated. This gives good knowledge of both the research process as well as the childbearing process; along with the psychological aspect of the study. It has not been indicated why the study was taken, this may suggest it may have been purely for personal interest or for a Masters Project. The different expertise of each researcher assists in stopping bias or hidden agendas. It is important when considering the reliability of a study to consider how funding has been achieved (Cluett and Bluff 2006). The funding has not been mentioned in this paper, this again may signify the paper being created for a Masters Project or due to personal interest. Funding is very important when critiquing a research paper, this is due to possible implications legally or interpreting the results in a way useful. For example a paper regarding smoking in pregnancy funded by a tobacco company, may state smoking is not harmful to the unborn. Reliable evidence has disproved this; however a tobacco company will gain more money by mothers continuing to smoke while pregnant.

This also fits in with how trusting a piece of research actually is. Patton (2007) suggests that validity and reliability are improper terms for qualitative research. It is important to understand how people fit in to meet expectations of others by primary and secondary socialization. We must acknowledge this in the paper as it is possible for participants of the study to say what they thought the researcher wanted to hear. Some women may not want others to know if they are struggling emotionally; they may not like the thought of people sympathising or feeling sorry for them. This may not have happened if questionnaires were used as well as interviews, in which the researcher or person acting on behalf of the researcher during interviews was not present at the time of answering. This is why triangulation is always helpful to gain a consistent result.

Triangulation uses a combination of methods to answer a research question (Cluett and Bluff 2006). It is unusual for a pilot to be used in qualitative research (Cluett and Bluff 2006). I believe this is because qualitative researchers try to be as flexible as possible in collecting data, and are likely to build questions as necessary depending on the answers given. The lack of pilot in Darvill’s paper makes me speculative of the accuracy of the findings. The researchers may have failed to ask vital questions if the conversation was not heading in a certain direction; however they may have asked questions that others had not. A method of grounded theory was used to obtain data in Darvill’s paper, Cluett and Bluff (2007) state grounded theory is able to collect data in an inductive and deductive mode, this is achieved by continuously comparing data’s to one another. I am unsure whether this is accurate in relation to this paper due to the fact there has been no mention of similar studies taking place. However it may have been possible for the participants’ data to have been compared as the study was going along. The paper states grounded theory was used in an inductive manner; this was achieved through the use of semi-structured interviews. I think it is important to consider whether phenomenology would have achieved the outcome in a more appropriate way. This would have revealed what the experience of the transition to motherhood felt like in a more philosophical way and how different people interpret the same situation differently. This may have been able to identify more suitable recommendations for practice. The methods could have been used together to test the validity of the research; this however is my own personal opinion.

When we consider the methods used for data collection we must also consider the participants data has been collected from. There seems to be a population of woman chosen in Darvill’s paper. All women except 2 are educated to college or A level with the majority being degree level or higher. This does not give a clear indication of the transition to all women, but more for educated women. The ages of the women also give indication of inconsistency to the study, all but one of the women are in their late twenties of thirties. Only one lady is 17 years of age. This does not give a general conclusion to the transition of motherhood for first time mums in an overall approach. This may suggest the title is not appropriate as I have previously suggested. It may need to eliminate the 17 year old and signify an age faction, or include more young women to give an overall conclusion. A way in preventing this from happening would have been to introduce randomisation (Cluett and Bluff 2007). Although the researchers suggest this has been used, the fact the midwives handed out the packs to clients gives them some control over who was included. It is randomised in the sense they are unsure of who wish to be concluded and answer. I think a more suitable way of achieving a randomised study would have been to give the midwives 50 packs with only 25 asking to participate in the study. The midwife was then not able to know who she had invited to join the study. This would have prevented a population being formed.

It is important to also reflect on the way in which the data is collected in research papers. Qualitative research is usually collected using unstructured or semi structured interviews (Cluett and Bluff 2007); Darvill et al have used semi structured interviews this allowed the participants to direct the conversation to what was important to them. The participants were able to choose their ideal locations for the interviews. This informal setting would have made the women more comfortable in opening up and saying what they really felt. The researchers did however tape record the interviews. This must be carefully considered when undertaking research. This may cause women to not be 100% truthful through fear of what might happen. For example if a participant claimed to have not felt any love when her baby was born, she may worry what people would think or if any action could have been taken. Darvill et al have been very accommodating by giving each lady a pseudonym. This meant they were unidentifiable and anonymous except by the person attending the interview.

Darvill et al adopted the strategy of asking the women to think back to their pre pregnancy states. It is important in research to determine whether strategies used are appropriate (Cluett and bluff 2007). In this particular research paper I am hesitant whether this was thought through. Not all pregnancies are planned; this could impact on the feelings of the transition period. A more appropriate strategy could have been asking for the feeling when the participant found out she was pregnant, and what they thought they would feel before the pregnancy occurred. The time span in which data is collected after the event it also a considerable aspect in research (Cluett and Bluff 2007) I believe this is particularly important in midwifery and medical care. Darvill et al waited until 6 to 15 weeks after birth to perform the interviews. In my personal opinion this time period is too long. Childbirth itself can make a huge impact on the feelings towards motherhood. The process typically requires drugs or interventions. I believe this use of drugs can hinder a women’s memory on the situation. Simkin (1997) has shown memories relating to childbearing are vivid for many years after the events. I think it may have been useful to hold an interview at 38 weeks of pregnancy to see how the women were coping with the transition to motherhood as well as the one after. The data could then have been cross analysed for a more reliable result.

Analysis in qualitative research is usually assisted with the transcribing of interviews. This could be by means of either tape recording or having a written scribe present (Cluett and Bluff 2007). When analysing data I think it is important to consider who scribed during an interview if it was not tape recorded. It is possible for not everything to have been written down. The scribe may have written down only what they felt was important or necessary; this could result in important information being missed. Darvill et al tape recorded the interviews allowing time for transcribing later. This reduced the probability of such as problem occurring. Data is then the transcripts that are analysed identifying recurrent themes or patterns giving the data meaning. Computer packages such as ethnograph and Atlas are accessible to aid qualitative researchers (Cluett and Bluff 2007); this is to identify core categories’ or themes. It is important to acknowledge the need for authors to include this. It assists in interpreting the findings of the study. Darvill et al have identified how the mothers self concept is a recurrent theme. I believe it is important to also recognise who exactly analysed the data if it was not a computer package. A midwife may perceive a changing self concept in a mother as a normal process of pregnancy while a fellow researcher without midwifery knowledge may see this as a radical change. It had not been stated who or what was used for data analysis. This must also be considered in an ethical option; is it ethical for a midwife to analyse when she is used to seeing self concepts change, or is it ethical for someone with no midwifery background as they are unable to judge what is expected.

Ethics must be considered when undertaking all research studies (Cluett and Bluff 2007); Darvill et al ensured each woman was provided with recruitments packs. These also contained written consent forms. Although contact details were given for support groups it is important to consider how informed these packs were, and if it easy to access someone if any questions arose. The paper also states it had obtained ethical approval through the National Health Service. Confidentiality and anonymity are ethical issues to also consider, as I have already stated pseudonyms’ were provided for transcripts and interview tapes. It has not however stated what the consent was actually obtained for. This many have resulted in the change of research design. Research must have a rationale and cannot be don’t if it is unethical.

Any type of research must be justified and have a purpose (Morse and Field 1996). The key aspects should be defined in the abstract. In Darvill’s paper I don’t feel the purpose has been clearly defined. Although the authors have made us aware they wish to explore the maternal transition to identify any unmet needs for support this is all we know regarding the real purpose of why the study has been undertaken. I do not feel this has been achieved, the conclusion offers recommendations for future practice, although all recommendations are already established; for example the arrangements of early pregnancy meetings, this is done via antenatal classes, and online forums such as cow and gate and net mums.

Darvill et al have indentified 3 predominant findings within their research study; Control, support and forming a family. These all contributed to the core category. Figure 1 on page 8 of the study attempts to show the transition to motherhood, I feel this is not appropriately labelled and is not straightforward to understand. I do however feel the information given by the participants is regarding the themes stated. It does not however state whether the data was member checked or examined by other experts. The findings of the study are accurate to the information given within the paper. This however does not mean it is correct, information could be with held as to not contradict the results of the study. The authors have tried to relate the quotes used to the literature although it may not seem accurate. Elaine speaks of a fear of being knocked over or bumped into, the researcher has interpreted this as feeling a car would mount the pavement and hit her while walking down the road. Elaine may have gone on to voice this worry; however it has not been mentioned in the findings. This indicates the findings may be inaccurate.

It is important when undertaking research to consider the publication needs of your paper. A research paper for midwives is meaningless in a magazine targeted at engineers’. Research itself has no agency, it must be read and understood giving practitioners the ability to use it effectively. Researchers must ensure the correct audience are receiving the paper. Publications are not the only means research is available, conferences, seminars and word of mouth is also very effective. If a student midwife found a useful piece of evidence they are likely to tell their fellow student midwives, friends, family, tutors and mentors. Those people are likely to tell others they feel are necessary, such as pregnant friends or family. This is how research can get out to people and applied to practice.

The conclusion of a research study must be clear and concise and derived from the findings of the study (Cluett and Bluff 2007). The conclusion of the Darvill et al paper fails to include anything concerning the control theme identified although the support theme has been addressed. Although I agree with what the conclusion suggests I fail to see the relationship with the paper. The paper does not speak about preconceptual care so I fail to see why the conclusion mentions it. Nothing new should be included in a conclusion (Rees 2003). I feel the conclusion given is unclear and more research should be undertaken or a more appropriate conclusion written.

Word count 2996