Discussion

Pressure ulcer is the significant clinical problem in the hospitals and pressure ulcer prevention (PUP) is the significant priority. Pressure ulcers produce severe consequences in patients and cause major economic burden on them. Medical, surgical and rehabilitation wards are associated with large number of pressure ulcer patients and nurses need to play significant role in its prevention. Nurses usually partners with patients in cases of pressure ulcer. Characteristics of the nurses plays major role in the prevention of pressure ulcer. Hence, two research papers are selected and quality of research in these two research studies are elucidated in the systematic manner.

It is necessary to evaluate new process for its further validation and for evidence base. Roberts et al., (2016), identified need to evaluate applicability of pressure ulcer prevention care bundle (PUPCB) in prevention of pressure ulcer. Hence, it is necessary to understand perception of nurse in application of PUPCB. Understanding of nurse’s perception for implementation of PUPCB is important because positive attitude and perception of the nurse would be helpful in effective implementation of PUPCB. However, no study was conducted for understanding patient’s perception in Addis Ababa for PUPCB. Hence, Etafa et al. (2018) undertook study to assess attitude of nurse to pressure ulcer prevention in Public Hospitals in Addis Ababa.

Study design ; Roberts et al., (2016) implemented qualitative descriptive study design using semi-structured interviews. Using this study design, it is possible for the researcher to observe and understand feelings and experience of participants (Ashton, 2014). Observation and understanding of nurse’s experience is an important in this study because it provide information about nurse’s perception. Study design comprising of semi-structured qualitative study is associated with certain limitations. In this study, recruitment of a greater number of samples is not feasible because a greater number of interviewers need to be recruited for interviewing a greater number of participants.

Etafa et al. (2018) implemented cross-sectional multicentre study. Cross-sectional study is useful in the collection of data from the specific population during specific duration of period. Cross-sectional studies give descriptive data (Hanis and Mansori, 2017). Multi-centre study is useful in the obtaining the data of the wider population and comparing the data from the different centres. In this study, data need to be collected for specific population from the different centres; hence, cross-sectional multicentre study design was used in this study. Aim of the study conducted by Roberts et al., (2016) was to explore nurse’s perceptions of PUB which includes its impact and its usefulness into usual practice to provide more insight into the main trial findings, broader PUPCB implementation and translation into routine practice. Objective of the study conducted by Etafa et al. (2018) was to explore nurses’ attitudes towards the prevention of pressure ulcers and to identify staff nurses’ perceived barriers to pressure ulcers prevention in public hospitals in Addis Ababa, Ethiopia.

Research design used in the qualitative research is aimed at obtaining data in the form of verbal narratives; however, research design of quantitative research is aimed at obtaining data in the form of measurable data or statistical observations. Research design used in the qualitative research is exploratory and research design used in quantitative research is conclusive. Approach of research design in qualitative research is subjective and approach of research design is objective. Research design of qualitative research used non-structured technique like in-depth interview and research design of quantitate research used structured technique like questionnaires and observations (Donnelly and Arora, 2015).

Sampling: In study conducted by Roberts et al., (2016), purposive sampling method was used. Purposive sampling method is useful in the recruitment of the participants with identical characteristics (Harreveld et al., 2016). In this study, purposive sampling method is more suitable because recruited participants are with similar characteristics like experience in PUPCB. In this study, nurses with INTroducing A Care bundle To prevent pressure ulcers (INTACT) trial were recruited. Participants were recruited from the different sites and they were recruited till data saturation occur. In data saturation approach, data would not be collected when no further information can be collected. In study conducted by Etafa et al. (2018), six hospitals in Addis Ababa, the capital city of Ethiopia were selected and participants were recruited from these hospitals. In this study, sample size was determined by applying a formula which is useful in estimating a single population proportion for cross sectional study. In this method, population proportionate sampling (PPS) approach was implemented. According to this approach, sampling from the fixed population need to be recruited in which size is measurable for each unit and probability of selecting participants from the specific unit is proportional to its size (Brewer and Hanif, 2013). PPS sampling approach is suitable for this study because in this study participants were selected from the different hospitals and number of participants were selected based on the population of that particular hospital. Purposive sampling method used in the qualitative research is recruit limited number of participants; on the other hand, population proportionate sampling used in the quantitative research recruit more number of participants (Donnelly and Arora, 2015). 

Data collection: In study conducted by Roberts et al., (2016), data was collected by in depth interview. Data collected in this method can be considered as the valid data because it was collected through semi-structured interview guide which was prepared based on published research. Moreover, validity of the semi-structured interview guide was established by piloting the study. Senior members of the multidisciplinary team were involved in the preparation of the interview guide. It is necessary to incorporate professionals from the diverse departments in the preparation of interview guide because views of different professional would be helpful in elucidating varied dimensions of perceptions of nurse. Data collected during this study was based on the self-rating of the subjective characteristics which has probability of potential bias. Association between interviewer and participants could influence outcome of the study because prior association could lead to potential bias (Moser and Korstjens, 2018; Harreveld et al., 2016).

In semi-structured interviews, usually open-ended questions are being used. Hence, participants would be free to express themselves. Semi-structured interviews are useful in obtaining both verbal and non-verbal ques of the participants which could be helpful in understanding perception of the participants. Hence, this method of data collection is useful in meeting aim of the study. Collected data in this study was digitally recorded; which can be useful for future references. Digital recording of the interview process could be useful in providing more insight into the interview process and accurate analysis of the results. After the collection of the data in this study was coded. Coding of the data is useful in reducing bias in the interpretation and measurement of the outcome of the study (Dean et al., 2016). However, validity and credibility of the data could have been improved by performing coding of the data through the researcher who was not directly involved in the study (Morris, 2015).

Research conducted in this study was quality research and it was conducted with correct approach. All the steps involved in this study were aligned with each other. Aim of this study was to explore the perceptions of nurses about implementation of PUP. Sampling and methodology implemented in the study should be selected in such manner that it would fulfil aim of the study. In this study, samples should be nurses who worked in the PUPCB and methodology should be interview of the participants to understand their perception. Both sampling and methodology criteria were met in this study because 18 nurses were recruited from four different hospitals and semi-structured interviews were conducted for collection of the data related to nurse’s perception about PUP.  

In study conducted by Etafa et al. (2018) data was collected in three phases like demographic data, data related to patient’s perception and nurse’s barriers for the implementation of pressure ulcer prevention programme. Demographic data collected in the first phase was not useful in understanding perception of nurses; however, it was useful in understanding characteristics of the nurses. Information related to the characteristics of participants is useful in interpretation of the results. In the phase 2, validated Pressure Ulcer Attitude Test tool was used for the data collection related to the nurse’s attitudes towards prevention of pressure ulcer. Likert scale is most widely used psychometric scale for the assessment of participants based on the interviews. This scale was used because it was useful in full range of attitude about the participants. This scale is based on five points from Strongly disagree, Disagree, neither agree nor disagree, Agree and Strongly agree (Mircioiu and Atkinson, 2017). In this study, Pressure Ulcer Attitude Test tool was used. This tool was developed and validated by Moore and Price, (2004). Hence, it can be considered that collected data was valid. Aim of the research should be aligned with the sampling and research methodology. In this study, both the sampling approach and research methodology were selected in such a manner that it helped in attaining aim of the study. Aim of this study was to explore attitudes of nurses in pressure ulcer prevention and barriers for pressure ulcer prevention. Hence, in sampling stage of the study, 218 nurses working in pressure ulcer were recruited. Research questions for interviews were designed in such a manner that they were useful in obtaining information about the attitude and barriers of nurses.

It is evident that quantitative study ensured construct validity. Construct validity of the research method can be considered as valid when implemented methods and tools in the study are validated in the previous studies. In this study also, tools used to assess the attitude of the nurses in pressure ulcer prevention were validated previously (Donnelly and Arora, 2015). AIn both the studies, data collection was based on the interview process. In interview-based research methods, sampling is most important factor because outcome of the study completely depends on the participants. Moreover, content of the research question are also important factors because these questions need to express feelings and experiences of the participants. In research studies, it is important to mention criteria for the selection of participants. Participants characteristics can be effectively decided by incorporating inclusion and exclusion criteria in the study. Recruitment of the participants with similar characteristics is useful in reducing variability in outcome and improving robustness of the outcome (Brannen, 2017).  Memo-writing is one of the important aspects of the interview-based research studies. However, in both the studies memo-writing was not used. Memo-writing would have been helpful in providing theoretical links and concepts from the collected data. In both the studies, title of the article reflects detailed insight of the study in terms of outcome of the study. In study conducted by Roberts et al., (2016) perceptions of nurses was mentioned in its title. In study conducted by Etafa et al. (2018), attitude and barriers of the nurse were mentioned in its title. However, Etafa et al. (2018), design of the study was not mentioned in the title. Hence, title of the study did not provide comprehensive details of the study.

Quality of the research could be evident by stating credibility and transferability of the research. Study conducted by Etafa et al. (2018), mentioned credibility and transferability of the data obtained from the research study. Credibility of the data was improved by reporting detailed data comprising of its themes and subthemes. However, criteria mentioned for the transferability is not sufficient to prove its transferability. In addition to the purposive sampling method, a greater number of participants also need to be used to ensure the transferability of the data (Creswell and Creswell, 2017).

Conclusion:

Quality in the research study is effectively attainable by following the systematic approach which includes developing research question, setting aims and objectives, selecting appropriate research design, implementing outcome based validated research methodology and carrying out unbiased analysis of the results. Applicability of the research can be effectively augmented by generating valid and robust data. This data can be used as evidence for the future applications of method. Quality data not only provides effective results but also it provides ways to implement effective changes. Hence, studies with diverse research designs like qualitative and quantitative need to be used to assess effectiveness and to bring likely changes. Both qualitative and quantitative research studies discussed to address the research question, were appropriately designed and implemented. Aims and objectives of both the studies were aligned with the study design, research methodology, data collection and analysis. Hence, all the processes implemented in these studies helped to answer the research question. Both the studies used validated methodology and further validated the applicability of the research methods in improving its applicability in diverse clinical settings.

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