Philosophy & quality? TAPUPASM as an approach to rigour in critical realist research

Aims This article discusses an approach to ensuring scientific rigour in post-positivist critical realist research using an enhanced model of TAPUPAS: transferability, accessibility, propriety, utility, purposivity, accuracy and specificity, with the additional criterion, modified objectivity (TAPUPASM). Background Philosophical principles should guide the manner in which research is designed, conducted and appraised. Therefore, the more traditional and commonly employed approaches to positivist (validity and generalisability) or interpretivist (trustworthiness) research do not necessarily complement the philosophical principles of post-positivist critical realism. Methods This is a methodological discussion paper illustrating the strategies for rigorous research using TAPUPASM in a critical realist ethnographic study in nurse education. Results This paper presents examples of strategies to ensure TAPUPASM in the planning, design, conduct and dissemination of a realist research study. These include choices about data collection and analysis and also, the role of a dissemination strategy outside of traditional academic methods. Conclusion This article proposes an enhanced version of the quality criteria framework TAPUPAS(M) for the design of critical realist research. It provides a practical example of how TAPUPASM was used to ensure rigour in a critical realist ethnographic study in pre-registration nurse education. For nurse researchers, this article provides a framework for quality in post-positivist critical realist research. It provides examples of the strategies that can be employed for nurse researchers planning, designing, conducting and disseminating critical realist research

Post Mortem Computed Tomography: An innovative tool for teaching anatomy within pre-registration nursing curricula

The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link.Background There is significant change throughout the world regarding Post Mortem Computed Tomography (PMCT) as an adjunct or a replacement to the traditional invasive autopsy. Of interest, is the ability to demonstrate visually two and three dimensional normal soft tissue, organ and skeletal anatomy, as well as natural disease and trauma pathology. Objectives The objective was to compare formal traditional methods of teaching anatomy and pathology (pictures and diagrams) to pre-registration student nurses with supplementary PMCT 2/3D generated images, videos and printed anatomical models. The specific objective was to determine if these tools would increase the students’ perception of their understanding and learning experience of the subject area. Design A quasi-experimental within-subject design was chosen. Setting A School of Nursing and Midwifery within a Higher Education Institution in the UK. Participants Purposeful sampling of 57 voluntary informed consented pre-registration student nurses. Method Students were initially exposed to teaching of normal anatomy and common fractures using traditional methods. Data was then collected following the teaching session using a questionnaire entailing both quantitative and qualitative elements. The teaching session was then repeated with the same students but with the inclusion of PMCT of all the same normal anatomy and fractures. Data was then collected again using the same questionnaire. Both questionnaires were then compared. Results The quantitative findings proved highly significantly proved (P = < 0.01) that the inclusion of Post Mortem Computed Tomography when teaching normal anatomy and pathology increases preregistration nursing students’ perception of their understanding and learning experience. The qualitative results revealed three positive themes concerning visual learning, realism and patient empathy. Conclusion Including Post Mortem Computed Tomography imagery enables nurse academics to provide students with a virtual tour of the human body and a rich, authentic learning experience of a real individual who experienced a relevant clinical scenario that nurses are likely to encounter in their careers

Decision-making in an emergency department: A nursing accountability model

The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link.Introduction Nurses that work in an emergency department regularly care for acute patients in a fast-paced environment, being at risk of suffering high levels of burnout. This situation makes them especially vulnerable to be accountable for decisions they did not have time to consider or have been pressured into. Research objective The objective of this study was to find which factors influence ethical, legal and professional accountability in nursing practice in an emergency department. Research design Data were analysed, codified and triangulated using qualitative ethnographic content analysis. Participants and research context This research is set in a large emergency department in the Midlands area of England. Data was collected from 186 nurses using participant observation, 34 semi-structured interviews with nurses and ethical analysis of 54 applicable clinical policies Ethical considerations Ethical approval was granted by two research ethics committees and the National Health Service Health Research Authority. Results The main result was the clinical nursing accountability cycle model, which showed accountability as a subjective concept that flows between the nurse and the healthcare institution. Moreover, the relations amongst the clinical nursing accountability factors are also analysed to understand which factors affect decision-making. Discussion The retrospective understanding of the factors that regulate nursing accountability is essential to promote that both the nurse and the healthcare institution take responsibility not only for the direct consequences of their actions but also for the indirect consequences derived from previous decisions. Conclusion The decision-making process and the accountability linked to it are affected by several factors that represent the holistic nature of both entities, which are organised and interconnected in a complex grid. This pragmatic interpretation of nursing accountability allows the nurse to comprehend how their decisions are affected, while the healthcare institution could act proactively to avoid any problems before they happen

The meaning of Being as a nurse involved in the work of death investigation. A North American view and its implications to practice in England.

This research study explored the meaning of ¿Being¿ (i.e. Heidegger¿s four philosophical concepts of Being-in the-world, fore-structures, time and space) as a nurse involved in the work of death investigation in the USA. The objectives were to: reveal the hidden meaning of Being; transfer the findings into an English context by examining what nurses could offer beyond their current role boundaries in an area not currently practised to the extent that nurses make to other medical specialities; and finally put forward developments that would need to take place to ensure such proposals were successful in making an effective difference to health care. In the USA there are two systems of death investigation, the Coronial and Medical Examiner system. The Coroner is an elected county or state position with varied educational and professional requirements. Some Coroner positions have been filled by registered nurses as they have put themselves forward successfully for election. In contrast, the Medical Examiner is an appointed county or state position who must be a licensed physician and a qualified pathologist or forensic pathologist in most cases. Within the Medical Examiner systems death investigators may also be appointed of which some have been filled by registered nurses. It was under the interpretive paradigm that a Heideggerian hermeneutic study was undertaken. Snowball sampling was instigated to reach a hidden population and collect qualitative data by means of unstructured interviews, non-participant observations, interrogation of historical records and the keeping of a personal reflective diary. The seven phase analysis process underpinned by the hermeneutic circle was developed to enable a synopsis of the shared meaning of Being to be revealed through the presentation of paradigm cases that encompass stories and themes. Of the 22 nurses found to be working as either death investigators or Coroners in the USA who fulfilled the inclusion criteria, 17 nurses from 11 States in the USA consented to take part. Fore-structures concerning age (average 37), gender (82% were women) and professional experience (majority came from an adult nursing background with emergency department or critical care experience) are discussed. Overall participants were interviewed for a total of 78 hours in 11 States, five of which were also observed in practice for a total of 142 hours in 3 States, giving a total of 220 hours of interview and observational data. The interpretive analysis revealed the three major paradigms of: the authentic and inauthentic reality of Being (the death investigator nurse in action); the everydayness and averageness of Being (community outreach) and the publicness of Being (mass fatality care). This study reveals knowledge concerning the meaning of Being as a nurse involved in the work of death investigation in the USA. Aspects of this illuminated landscape have propositioned for the advancement of nursing clinical practice to replace and further develop the current coroner¿s officer and soon to be implemented medical examiner officer role in England and Wales. Hence recommendations are made for practice development and further research in England

The use of mid-arm circumference for the estimation of adult body weight: A post mortem computed tomography approach

The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link.Purpose: Cadaver body weight (BW) is to be documented, where possible, in all forensic autopsy examinations.However, it may not always be possible to ascertain an accurate BW if, for example, functioning weighing equipment is unavailable or the body is incomplete. This research aimed to translate an adult clinical prehospital method which uses a mid-arm circumference (MAC) measurement to estimate BW to establish a post mortem computed tomography (PMCT) technique for adult cadaver BW estimation. Method: The clinical method was adapted for PMCT bone and soft tissue methods. Right and left MAC measurements were obtained by four independent observers from sixty-six (45 males and 21 females) consented research adult PMCT scans using the Osirix DICOM viewer. All observers rated MAC quality score on each arm from 0 (very poor) to 3 (good). Results: In the final group of fifty-five with MAC quality score ≥ 1, MAC measurements correlated well with actual BW (r=0.87) and yielded excellent intra- and inter-observer reliability. There were no statistical differences between the two MAC methods, sexes or side of arm. Mean estimated BW by previous study Equation, BW=(4×MAC)-50, was 0.47 kg greater than mean actual BW with limits of agreement of 12.7 kg; this would be reduced to 9.2 kg if an outlier were excluded. Conclusions: The study identifies a quick and easy PMCT technique to estimate adult BW using PMCT. However, the result remains only an estimation and caution should be expressed if a result is applied to medico-legal cases

Ethical, legal and professional accountability in emergency nursing practice: an ethnographic observational study

The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link.Introduction Accountability in nursing practice is a concept that influences quality care, decision-making, safety standards and staff values. Therefore, understanding accountability and how it affects nursing practice could improve patient care and nurses’ working conditions. Aim The aim of this study was to find factors that influenced ethical, legal and professional accountability in emergency nursing practice. Methods A qualitative ethnographic approach using participant observation through convenience sampling was employed as the data collection method, while ethnographic content analysis was used for data analysis. Results The factors linked to nursing accountability found were classified into four main themes: daily dynamics, work environment evolution, customs and routines and bioethics principles’ application. Discussion The long-term effect of chronic high workload and crowding, which affects nursing accountability, could promote burnout in a junior ED workforce. Changes in the nurses’ working conditions need to be implemented to limit the workload to which an ED nurse is subjected to. Conclusion ED nurses have to manage their accountability in difficult situations regularly, which followed patterns of four main themes across the majority of situations. Nonetheless, all those factors were influenced by nursing workload, an ever-present factor that was always considered by ED nurses during decision-making

Accountability issues in an English emergency department: A nursing perspective

University Hospitals of Leicester NHS Trust University of Murcia, Spain The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link.Introduction: Nurses confront doubts about their accountability and how it affects their clinical practice daily in the complex environment of an emergency department. Therefore, nurses’ experiences can provide vital information about the decisions and dilemmas in clinical practice that affect both healthcare professionals and patients alike. Aim: The aim of this study was to explore the perceptions of nursing staff in an English emergency department in relation to their ethical, legal and professional accountability. Methods: Ethnographic content analysis was used to analyse 34 semi-structured interviews from registered nurses working in an emergency department. Results: There were five categories found during the coding process: nursing care, staff interactions, legal and professional accountability, decision-making process and ethics and values. Conclusion: Several issues related to nursing accountability were found, including the effects of nursing shortages and the reasoning behind multidiscipinary team conflicts. Different approaches of individual and institutional accountability, the evolution of Benner’s nursing model and nursing value progression was also identified as key issues. All these phenomena affect nursing accountability in different ways, so their comprehension is paramount to understand and influence them to benefit both patients and nurses