Stress Management for Patients with Rheumatoid Arthritis
A 40-year-old woman diagnosed with Rheumatoid Arthritis (RA) 18 months earlier visited a clinic for a follow-up. The patient had successfully managed the disease for the past 1-year using methotrexate. However, the patient experienced swelling and pain in her hand joints over the past two months before the clinic visit. This coincided with a promotion at work which resulted in increased work-related stress. The rheumatologist prescribed a TNF inhibitor in addition to methotrexate. The patient was concerned that her new demands at work, coupled with financial stress due to the new medication, contributed to the recent flare-ups.
Research shows that minor stress is associated with worsening RA symptoms. Behavioral intervention methods can be a cost-effective method to reduce RA symptoms. Some behavioral intervention methods that have been researched include cognitive behavioral therapy (CBT), Tai Chi, Yoga, and RA patient education programs. Despite conflicting studies on behavioral intervention methods, there is a positive correlation between minor stress and pain. Since behavioral interventions are cost-effective, practitioners in Rheumatology can recommend effective stress management strategies to their patients.
This study used a convenience sampling technique. Convenience sampling is a non-probability form of sampling whereby the participants are selected by the researcher (Stratton, 2021). This form of sampling is common in clinical studies. The main advantages of convenience sampling are that it is cost-effective, less time-consuming, and simplistic (Stratton, 2021). Convenience sampling differs from probability sampling, whereby each member of the target population has an equal chance of being selected for the study.
There are valid concerns about the reliability and validity of this study. Reliability is the consistency of a given method in measuring a phenomenon. A method is considered reliable if the same results are consistently obtained by applying the same method. In the case study under consideration, different results were obtained by using the same method. For instance, one Tai chi study of 15 RA patients reported a significant reduction in the number of swollen joints. In contrast, similar studies reported no significant improvement in RA patients who performed Tai chi. Therefore, the same results cannot be obtained using tai chi to reduce RA symptoms, thus making the study unreliable.
Validity refers to how accurately a scale measures the phenomenon it is intended to measure (Bannigan & Watson, 2009). This study lacks adequate content validity. “Content validity considers whether a scale has included all relevant issues and excluded all irrelevant issues in terms of content” (Bannigan &Watson, 2009, p. 3240). The case study only considers minor stress as a factor that can exacerbate joint pains among RA patients. The study does not consider significant stressors such as the prolonged illness of a family member or the death of a close relative as factors that can increase RA symptoms. The study does not include all the relevant issues, undermining the study’s validity.
This study had some flaws and discrepancies. The study used a convenient sampling method, which is non-probability based. As such, the findings of such a study cannot be used to generalize the results outside the participant group (Stratton, 2021). The use of convenient sampling also introduces motivation bias in the study. It is not clear why the participants were motivated to take part in the survey. Some participants may wish to express their interest in the study, while others may have disgruntled opinions on the study topic. The use of such participants often leads to unreliable information. Furthermore, convenient sampling does not allow statistical scrutiny of the sampling error. The sampling error is critical in establishing the confidence level of the results obtained in a study.
There were some discrepancies in the results obtained from the study. For example, the survey by Sharpe showed that CBT resulted in a significant reduction in joint stiffness and anxiety levels among RA patients. In contrast, other studies show no significant correlation between CBT and RA disease outcomes. The benefits of Yoga, such as reduced levels of disability and pain perception, have been proven to benefit people without Rheumatoid Arthritis. This suggests that patients with RA would also benefit from Yoga.
Young Registered Nurses’ Intention to Leave the Profession and Professional Turnover in Early Career: A Qualitative Case Study
The study’s objective was to explore the factors that led to young nurses’ desire to leave the nursing profession and join other careers. The study used the qualitative case study method, using three participants who were registered nurses in Finland. Specifically, the researchers used an interpretive narrative approach, whereby the nurses narrated their experiences in their nursing careers. After the data was analyzed, the researchers found several common factors that led to young nurses changing careers. The main elements included nursing as a second career choice, demanding work content, a poor working environment, and the inability to identify with typical nursing stereotypes (Flinkman et al., 2013). This study elucidated that professional turnover in nursing is a complex and long-lasting process.
This study achieves dependability by employing a systematic process in identifying the shared themes from the three narratives. Furthermore, the study can be considered dependable since the author provided a detailed account of the procedure and circumstances that led to the chosen data collection method (Daniel, 2019). The author further acknowledges the underlying assumption that people make sense of the world by telling stories, although the narrative approach does not assume objectivity from the narrator (Flinkman et al., 2013). The author gains dependability by acknowledging their prior assumptions.
This study establishes confirmability by demonstrating transference in the research process. Confirmability is established by adopting a systematic data collection, analysis, and interpretation (Daniel, 2019). Such a systematic method has been used in the study. Furthermore, the researcher explained step-by-step the process used to collect, analyze, and interpret the data. The explanation enables other readers to verify the data contained in the study, hence ensuring external auditability. The author also achieves internal auditability by using open-ended questions which are well aligned with the interpretive narrative research design. Using digital recorders in the second interview also increases the confirmability of the research by creating an audit trail. Overall, the researcher achieved confirmability under the TACT framework by describing the entire process that was involved in conducting the research (Daniel, 2019).
Credible qualitative research ensures that appropriate tools, processes, and data are applied (Daniel, 2019). Just like confirmability, credibility can be achieved by carefully describing the data collection process. Furthermore, the author was able to demonstrate that the choice of the research design was appropriate for the questions. The use of open-ended questions in the study ensured that the respondents were able to narrate their experiences in their nursing careers, thus enabling the author to understand why the respondents chose to change their careers. An interpretive narrative approach was the best research design to capture the respondents’ experiences accurately. This study also established credibility by ensuring that the narratives formed by the first author from the interviews were reviewed and discussed by the coauthors (Flinkman et al., 2013). Using appropriate tools and processes and peer debriefing gave the study credibility.
In qualitative research, transferability implies that the findings of one study can be applied to other settings (Daniel, 2019). The study achieved transferability by using vivid descriptions of real-life settings (Daniel, 2019). For example, the overwhelming workload of nurses is not unique to Finland but is shared globally. Many nurses across the world can identify with the three participants when they narrate instances where they encountered overwhelming workloads in their shifts. Therefore, the author achieves transferability by the use of detailed narrations.
Overall, the study’s author achieved trustworthiness by ensuring that credibility, dependability, confirmability, and transferability were implemented. However, some improvements apply to the study. The sample size of three nurses is too small. The author should have included a more significant number of participants in the study. The author also used a convenience sampling method, which is a non-probability sampling method. As such, the study cannot be used to generalize findings and is prone to motivation bias. The author should have used a probability sampling method should have been used to conduct the study.
References
Banningan, K., & Watson, R. (2009). Reliability and validity in a nutshell. Journal of Clinical Nursing, 18, 3237-3243. https://doi.org/ 10.1111/j.1365-2702.2009.02939.x
Daniel, B. K. (2019). Using the TACT framework to learn the principles of rigour in qualitative research. The Electronic Journal of Business Research Methods, 17(3), 118-129. DOI: 10.34190/JBRM.17.3.002
Flinkman, M., Isopahkala-Bouret, U., & Salantera, S. (2013). Young registered nurses’ intention to leave the profession and professional turnover in early career: A qualitative case study. ISRN Nursing, 2013, 1-12. http://dx.doi.org/10.1155/2013/916061
Stratton, S. (2021). Population Research: Convenience Sampling Strategies. Prehospital and Disaster Medicine, 36(4), 373-374. https://doi.org/10.1017/S1049023X21000649
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