Running head: FINDING THE BALANCE 1

Qualitative Research Critique: Finding the Balance: Adolescents with Type I Diabetes and Their Parents Texas A&M University-Corpus Christi College of Nursing and Health Sciences NURS 4318: Nurse as Research Consumer Lakeidre Davis June 18, 2013

FINDING THE BALANCE 2 Introduction Ivey, Wright, and Dashiff (2009) produced qualitative research study involving the interactions of Type I diabetic adolescents and their parents. According to Ivey and colleges (2009), diabetes is emerging as chronic disease epidemic and which there is no way to prevent spread of Type I diabetes. During the adolescent phase of life, teenagers may find difficult to establish independence, be social competent, and adhere to their regimen without conflict. The study conducted chronicles the common themes and barriers to communication that occur between the parent and teenagers. This critique discusses the study determine the researchers adherence to the research process. Legal/ Ethical Issues The research study conducted by Ivey, Wright, and Dashiff (2009) was approved and funded by the National Institute of Nursing Research and National Institute of Health. In order to have a grant approached for research through this agency, the researcher(s)must have human rights protection education training before conducted and be approved through the IRB. No direct evidence from the article suggest that informed consent was obtained. However, it is implied that informed consent was obtained because the study was proved though an IRB. So, it is implied from the obtaining permission from Institutional Review Board that informed consent of the subject must obtained and documented and adequate provisions are provided to protect the privacy of subjects and the confidentiality (LoBiondo-Wood and Haber 2010). Also, it is implied the families participating were informed about the purpose and protected from physical harm since the study was approved by an IRB. Ivey, Wright, and Dashiff (2009) only imply that participants were informed of the potential risk. The researchers maximize the benefits for the human subjects and minimize the risk by allowing for the participants to interact

FINDING THE BALANCE 3 at home with interruption and intervention while being audiotaped. There is no mention of the safeguards possibly implemented to protect the subjects in the article. The reader can imply that subjects participating were not coerced or unduly influenced to participated; for they were recruited from endocrinology clinic in a hospital from the Southeastern United States. 1. Was the Study Approved by IRB or other agency committee members? 2. Is there evidence that informed consent was obtained from all subjects or their representatives? 3. Were the subjects protected from physical or emotional harm? 4. Were the subjects or their representatives informed about the purpose and nature of the study? 5. Were the subjects or their representatives informed about any potential risks that might result from participation in the study? 6. Is the research study designed to maximize the benefit(s) to human subjects and minimize the risks? 7. Were the subjects coerced or unduly influenced to participate in this study? Did they have the right to refuse to participate or withdraw without penalty? Were vulnerable subjects used? 8. Were appropriate steps taken to safeguard the privacy of subjects? How have data been kept anonymous and /or confidential?

Statement of the Phenomena of Interest The phenomenon of interest is explore the unique content of communication about diabetes management between the adolescent and parent (Ivey, Wright, and Dashiff, 2009). A consumer reading this article can only infer that is this phenomenon of interest, for it is not clearly stated in the article itself. The researchers do not state justification for using a qualitative method; however the data collected ( i.e. audiotaped family interactions, questionnaires) were used to detect and measure common themes and behaviors that require in depth emotional and psychosocial thought.

FINDING THE BALANCE 4 Philosophic underpinnings of this research is based on the concept that adolescence is time for transition and establishing independence. As result, communication about disease management can bring additional and unique sources of friction and conflict (Ivey, Wright, and Dashiff, 2009). The main problem for Type I adolescents is fostering independence as social being and managing the disease without encountering long-term complications. 1. What is the phenomenon of interest and is it clearly stated for the reader? 2. What is the justification for using a qualitative method? What are the philosophic underpinnings of the research methods? Purpose The purpose of this study is to describe the ways parents and their teens (11-15 yrs.) communicate about issues related to diabetes management (Ivey, Wright, Dashiff, 2009). This study would allow nurses to utilize effective communication abilities between the parent and teen in order decrease complications and increase autonomy and decision making among the diabetic teen. More importantly, acknowledging the common themes related to this disease will help nurses breakdown communication barriers and psychosocial problems that the family may experience during this time period to produce better outcomes and reduce the emotional stress of the family as a whole. 1. What is the purpose of the study? 2. What is the projected significance of the work to nursing?

Method Ivey, Wright, and Dashiff (2009) used content analysis of interaction transcripts between the adolescent and family. By using the grounded theory based approach, the researchers also conducted questionnaires and interviews within a two-hour period to address the phenomenon of interest. Using these methods is a compatible with the purpose in order to detect and observe

FINDING THE BALANCE 5 communication patterns between the families and adolescents. The researchers imply that this approach was used initiate interactions by letting the teens select a task that was thought to be an important source of disagreement between themselves and their parents (Ivey, Wright, and Dashiff, 2009). 1. Is the method used to collect data compatible with the purpose of the research? 2. Is the method adequate to address the phenomenon of interest? 3. If a particular approach is used to guide the inquiry, does the researcher complete the study according to the processes described?

Sampling Purposive sampling used among with use exclusion and inclusion criteria. The families chosen must have adolescents (ages 11-15), have type I diabetes for one year without any additional psychological problems, learning disabilities, or chronic illness (Ivey, Wright, and Dashiff, 2009). Further exclusion criteria such as parents must not have learning disability in a high school class setting and that adolescents with two parent households (must have both parents must participating) were also used. Purposive sampling is appropriate to use so that families chosen in this study would have experience in exhibiting behaviors and coping mechanisms that were necessary to observe in Type I diabetic families. The researchers do not disclose whether or not the informants were appropriate to inform research. 1. What type of sampling is used? Is it appropriate given the particular method? 2. Are the informants who were chosen appropriate to inform the research ?

Data Collection All of the data collected for the study is focused on the human experience of families living with Type I diabetes. Ivey, Wright, and Dashiff (2009) briefly describe the data collection process of audiotaping of the interactions between the families, conducting interviews, and

FINDING THE BALANCE 6 questionnaires The researchers do not discuss of the protection of subjects, however it can be implied that protection of the subject were given since an IRB was issued. Data saturation is described as a process of reviewing the transcripts line by line noting phrases and interactions until no further themes could be identified (Ivey, Wright, and Dashiff, 2009). 1. Is data collection focused on human experience? 2. Does the researcher describe data-collection strategies (i.e., interview, observation, field notes)? 3. Is protection of human participants addressed? 4. Is saturation of the data described? 5. What are the procedures for collecting data?

Data Analysis According to the researchers, investigators review each transcripts independently and jointly (Ivey, Wright, and Dashiff, 2009). Secondly, the noted and gathered phrases and interactions and noted the common themes and emotions were noted using a template noted from previous literature (Miller and Crabtree, 1992). The process was repeated until data saturation occurred. All emotions and themes were processed and coded into categories onto template. Afterwards, small amount of data was given to experienced researchers to determine the quality and consistency of the findings. Ivey, Wright, and Dashiff (2009) attempts remains to true to the data by having a private investigator review the initial transcripts for accuracy by comparing the transcripts to the audiotaped version. Also, to avoid bias the investigators chose to remain blind until the data analysis was completed. A consumer would be to follow the steps described for the data analysis. In this report, researchers do not make mention concerning how creditability was obtained in the study. It can only be assumed by the reader that the researchers has spent ample

FINDING THE BALANCE 7 time to understand the phenomenon. Auditability in the study can readily be seen. The reader would be able to see the common themes (fear, frustration, discounting, trust, and normalizing) and the information collected regarding each themes in the finding and discussion portion of the article. The findings of the study can be applicable outside the study situation, for these themes are relatively common among many adolescents coping with everyday stresses. The reader is able to follow and comprehend the researchers thinking concerning the communication barriers, and why clinicians must acknowledge this and intervene during negative interactions concerning care. Findings from this qualitative study are more than likely applicable to any teenager with Type I diabetes trying to establish communication and autonomy. Findings from this study can be meaningful to individuals outside of this study such fellow peers and family members by allowing to help families or adolescents cope and communicate effectively as well. 1. 2. 3. 4. What strategies are used to analyze data? Has the researcher remained true to the data? Does the reader follow the steps described for data analysis? Does the researcher address the credibility, audibility, and fittingness of the data? Credibility a. Do the participants recognize the experience as their own? b. Has adequate time been allow to fully understand the phenomenon? Auditability a. Can the reader follow the researchers thinking? b. Does the researcher document the research process Fittingness a. Are the findings applicable outside of the study situation? b. Are the results meaningful to individuals not involved in the research?

FINDING THE BALANCE 8 Findings The findings are presented by explaining the four themes of fear, anger, discounting, normalizing, and frustration in detail. The researchers offered statements from the participants to help the reader comprehend each theme in its entirety. The reader would be able to apprehend the essence of the experience from the findings. The essence of the experiment is that few families were able to negotiate about expectations about their care (Ivey, Wright, and Dashiff, 2009). As result, many parents display did not respect for adolescents thoughts or opinions (Ivey, Wright, and Dashiff, 2009). Nurses must understand that these emotions (themes) are barriers to effective care and influence long term outcomes. Researchers conceptualizations (themes) remain true to data for the findings were congruent with numerous studies done with adolescents with Type I diabetes (Ivey, Wright, and Dashiff, 2009). Also, these concepts were similar among individual interactions with adolescents and their parents. The researchers placed the findings in the context of information of is already known about the relationship between parental involvement and adolescent control and adherence (Anderson et. al, 1997, Anderson et. 2001). Researchers were able to provide existing literature to support their findings. For example, Weiner and colleagues (2001) previously noted that anxiety and other negative emotions lead to ineffective communication and resentment towards parents. This study supported that parental fear of long- term complications may result in lack of trust, confidence, and control of the disease from the adolescents (Weiner and colleagues, 2001). Research previously done by Schilling, Knafl, and Grey (2006) also supports the findings that parents that oversee and participate but allow in the adolescent to manage their own selfcare results in positive outcomes.

FINDING THE BALANCE 9 1. Are the findings presented within a context? 2. Is the reader able to apprehend the essence of the experience from the report of the findings? 3. Are the researcher's conceptualizations true to the data? 4. Does the researcher place the report in the context of what is already known about the phenomenon? 5. Was the existing literature on the topic related to the findings

Conclusions, Implications, and Recommendations Implications in the study give the reader a context to use these findings in a patientprovider or family care setting and found in the discussion section. For example, Ivey, Wright, and Dashiff (2009) notes that nurse should use these findings to allow private opportunities in the clinical setting to address and cope with fears about managing the disease. The conclusions in those study reflect the findings from the data collected reflect the communication barriers between the adolescents and their families. Conclusions in this study support that parental fears heighten adolescents fear and anxiety which adversely effects the adolescents self-confidence and long- term control. Nurses should teach parents to manage these fear and anxiety and negotiate with the adolescents. Researchers do not make any indications or recommendations for future study. However, these recommendations may be found in the limitations discovered in the study. Ivey, Wright, and Dashiff (2009) imply that the significance to current clinical nursing practice is for nurses to utilize opportunities to model effective communication about diabetes management and work directly with parents and adolescents to improve communication about diabetes management. 1. Do the conclusions, implications, and recommendations give the reader a context in which to use the findings? 2. How do the conclusions reflect the study findings?

FINDING THE BALANCE 10 3. What are the recommendations for future study? Do they reflect the findings? 4. How has the researcher made explicit the significance of the study to nursing theory, research, or practice?

References Anderson, B., Ho, J., Brackett, J., Finkelstein, D., & Laffel, L. (1997). Parental involvement in diabetes management tasks: Relationships to blood glucose monitoring adherence and metabolic control in young adolescents with insulin-dependent diabetes mellitus. The Journal of Pediatrics, 130, 257-265. Ivey, J. B., Wright, A., & Dashiff, C. J. (2009). Finding the balance: adolescents with type one diabetes and their parents. Journal of Pediatric Health Care, 23(1), 10-18. Retrieved from http://dx.doi.org.manowar.tamucc.edu/10.1016/j.pedhc.2007.12.008 Miller, W. L., & Crabtree, B. F. (1992). Primary care research: A multi-method typology. In B. F. Crabtree &W. L. Miller (Eds.), Doing qualitative research (pp. 17-21).Newbury Park, CA: Sage. Schilling, L. S., Knafl, K. A., & Grey, M.(2006). Changing patterns of self-management in youth with Type 1 diabetes. Journal of Pediatric Nursing, 21, 412-424. Weinger, K., ODonnell, K. A., & Ritholz, M. D. (2001). Adolescent views of diabetes-related parent conflict and support: A focus group analysis. Journal of Adolescent Health, 29, 330-336.