This paper is going to critically appraise the article from Lee et. al (2014) on the ‘Perceived quality of inter-professional interactions between physicians and nurses in oncology outpatient clinics’. The appraisal will check if the steps of the research process were followed including the research design and sample size, ethical issues, methods of data collection, and analysis. It will discuss the study limitations, research findings, and the implication of the study to the nursing practice. The nature of the study is to gain insight of the nature of interactions between the providers in outpatient settings and how this relates to the quality of care that is given to the patients.
The main interest of the authors was to determine the perceived interpersonal interactions in outpatient settings from the physicians and nurses’ perspectives. Interaction is defined by Merriam-Webster (2012) as mutual influences or actions which include the contacts among individuals. Contacts here can be verbal or non-verbal communication, and exchanges in terms of behavior. Oncology refers to the treatment and prevention of cancer tumors. Previous studies which have mainly been in the inpatient setting have always concluded that the patient care was improved with interpersonal interactions between the professionals, however this study is motivated by the fact that outpatient settings have been under less consideration.
The authors of the research article have the relevant qualifications for conducting the research according to UK clinical Research Collaboration (2007) which suggests that the combination of academic and clinical work is vital for nurses for them to be the most knowledgeable researchers. The researchers have vast knowledge of oncology outpatient and therefore can contribute to the knowledge of interpersonal interactions between the outpatients. The researchers work with certified education and research institutes in the field of nursing spread across Toronto, Canada thus giving them credible qualifications to comment about the field.
According to Parahoo (2006) an abstract should summarize the contents of the paper and the major points for the reader, it is meant to create an interest in the reader. The article clearly identifies the objective of the study, methodology that is to be used within the study as the observational and cross-sectional survey, the findings are well articulated and a concise conclusion given at the end.
The methodology used in the study was a quantitative approach using cross-sectional, observational survey. Kanchanaraksa (2008) defines cross-sectional study as an observation study where the exposure is determined at the same point within a given population. The study was conducted for a population of 250 for both nurses and physicians in two regional cancer centers located in Ontario, Canada that deal with oncology outpatient. Questionnaires were used with a relational coordination seven item survey used for quality analysis. The nature of the methodology was appropriate for the study as the authors were holistically looking at the perceived quality of inter-professional interactions between the nurses and physicians.
The authors also conducted a literature review of the previous works done to assess the inter-professional interaction. Although most of the literature they used are valid, some of the articles (Hunt, 1998; Guilford and Fruchter, 1978; Larson 1999; and Baggs et al., 1999) are out of date and thus the authors could have restricted themselves to the ten-year limit (Robinson et al., 2005). The literature had sufficient evidence and backed the motivation with relevance to the study. It clearly showed the lack of much research on the outpatient settings.
Ethical approval was gained from ethical committees such as the sponsoring university community and from the hospital in which the study was conducted. Also the science community at Elsevier checked the standards before publishing the article. Participants and researchers are protected by the ethical committees (Jones and Griffiths, 2006). Consent was sort from the participants though it is not specified whether it was verbal or written. Consent is important prior to a research study. The participants were informed by way of a presentation. Participants can always withdraw from a study at any given time as stipulated by the ethical constraints (Royal College of Nursing, 2006).
the research was approached qualitatively. There are various approaches within qualitative research, this study used the cross-sectional, observational survey approach on how the nurses and physicians perceive their human contact at the professional level. A sample size of 250 was used which is relevant for qualitative studies (Parahoo, 2006). This limited sample size ensured that the data was rich with a power of 80%. The study sample used was based on the proportional ratio of the physicians to nurses at the center. The method used by the researchers was the correct one as stated by McBrien (2008) that qualitative studies in nursing are satisfactory with small sample size.
Data was collected by the use of questionnaires and a seven-item survey of relational coordination. Miller (2005) states that open questions are significant in obtaining more informed discussions from the participants. The questionnaires were sent to the participants and given time to answer with constant reminders. In this way the participants felt that their confidentiality is maintained and thus were even more comfortable. However, the only disadvantage with this method is that it is hard to assess whether the participant answered the questions for themselves. The data analysis was done after data verification and screening and then assessed by the Cronbach’s alpha. The data was then analyzed using descriptive statistics.
The data was based on questions checking the behavior and perceived beliefs of the other professional groups. A sample question was that looking on the respect accorded to the nurse’s role by the physician in patient care. Three levels of findings were yielded from the research.
1. the overall quality of perceived interaction which was high for both professional groups.
2. similar levels of perceived interaction were reported at the two sites as indicated by the MANOVA.
3. there was significant difference in the perceived nurse-physician interaction in the two sites.
Implementation of research in clinical practice should be evidence based. If the research findings are transferable then the data can be replicated. Four main methods are applicable i.e. standards, guidelines, audits, and protocols (Miller, 2005). When improvements have been identified for the clinical practice, the research findings can become protocols. The protocols should be updated regularly through research that is evidenced. Nurses should use evidence based research and information that is up to date and maintained in the nursing practice throughout. the research findings here can be put in practice through educating the nurses and physicians on the importance of interactions at the professional level.
In conclusion, patient care in the outpatient services are equally more complex but significant to the patient health even as facilities dealing with oncology make a move towards it. Therefore, the sharing of professional knowledge is important, but more vital to the quality of care is the interaction. Interactions at the healthcare facility is not only important for the patient, but also creates a harmonious working environment.