NUR 4190 Module 4 Qualitative Study Appraisal Example

More Than a Little Needle Stick: Appraising a Qualitative Study of Children's and Parents' Experiences With Repeated Injections

Student Name

Bachelor of Science in Nursing, Thomas Edison State University

NUR-4190: Exploring Evidence-Based Practice and Research in Nursing

Mentor Name

Month Day, Year

More Than a Little Needle Stick: Appraising a Qualitative Study of Children's and Parents' Experiences With Repeated Injections

The previous module appraised a randomized trial that measured whether cold and vibration reduce venipuncture pain. A trial can show that an intervention lowers a score; it cannot show what repeated needle procedures mean to a child and family, or why some children accept a strategy that others reject. This paper appraises a qualitative study that addresses those questions, in which Sørensen et al. (2021) interviewed Norwegian children with rheumatic diseases and their parents managing regular needle injections at home. Although the study concerns injections rather than venipuncture, it describes the same population my clinic serves and the same experience of repeated, predictable needles. I used the Critical Appraisal Skills Programme (2018) qualitative checklist and the trustworthiness criteria of Lincoln and Guba (1985) to structure the review.

Aim, Design and Fit

The study asked two clear questions: how children and parents experience long-term needle injections at home, and what characterizes their use of coping strategies. These are questions about experience and meaning, so a qualitative design is appropriate; a survey could count how often children were afraid but could not describe how fear changed over months or how families invented routines to manage it. The authors used an explorative design that combined individual semi-structured interviews with focus groups, explaining that the two methods would widen and deepen the data. Combining methods in this way is a recognized strategy for building a fuller picture, and the authors justify it rather than simply using it.

Sampling and Data Collection

Participants were selected purposively for information-rich cases, which is appropriate for qualitative work. The individual interviews included seven children aged six to sixteen and eight parents, interviewed four to six months after injections began; the focus groups included nine children aged eleven to seventeen and eight parents with at least six months of injection experience. The sample is small, but qualitative studies aim for depth rather than statistical representation, and the combination of newer and more experienced families allowed the authors to compare early and settled experiences.

Data collection was thoughtful. Separate interview guides were written for adults and children of different ages, children were offered drawing materials during interviews, and questions were sent to families ahead of time so they could prepare. A user representative, a young adult with long personal experience of the same diseases and injections, helped design the guides and took part in the children's focus groups. That choice probably made children more willing to speak openly. Interviews with children were short, averaging about twenty-three minutes, which is realistic for young participants but may have limited depth for some of them. Parents' interviews ran about twice as long, so the adult voice may carry more weight in the themes than the children's, a point the authors could have weighed more openly. The focus groups helped balance this, since older children could build on each other's comments without an adult family member present.

Reflexivity and Analysis

Reflexivity, the researcher's awareness of how their own position shapes the data, is an important test of qualitative rigor. The first author, an experienced pediatric nurse researcher, conducted all individual interviews and had met the families during an earlier video observation study. The authors state that she was not involved in the children's treatment and that families were told the research was separate from their care. This is a strength, because it reduces the pressure on families to give answers that please their care team. The prior relationship may have built trust; it may also have shaped what families felt comfortable saying, and the paper could have discussed this more.

Analysis followed a thematic approach supported by software. Initial coding of the individual interviews produced sixty-one codes grouped into preliminary themes, which were then applied to the focus group data while staying open to new ideas. All authors met repeatedly to refine the themes until they reached agreement, and a table shows the path from codes to themes. That transparency lets a reader follow how conclusions were reached, which supports what Lincoln and Guba (1985) called dependability and confirmability.

Findings and Trustworthiness

Three main themes emerged: challenges, motivational factors and routines. Many children said that the worst moment was the time immediately before the needle, more than the pain itself. Most parents felt unsure about handling injections and described a lack of follow-up from health care providers. Children's motivation depended on seeing the treatment work and on growing confidence, and families relied on routines and shared responsibility, often discovering useful coping strategies by chance. A notable finding was that distraction, the strategy most often recommended by professionals, was not always preferred. Some children wanted to feel in control of the procedure and disliked being distracted from it.

The authors supported credibility through triangulation across interviews, focus groups and notes, member checking during interviews and review of findings by the user representative, and they reported the study using the COREQ reporting checklist. Quotations from different participants are included, which lets readers judge whether themes are grounded in the data. Transferability is the main limitation for my purposes: the study took place in Norway, concerned injections given at home by parents, and included few younger children. My clinic's children receive venipuncture from nurses in an outpatient setting. The experience of anticipatory fear and the desire for control seem likely to transfer, but the specific coping strategies may differ.

Implications for the Practice Question

This study changes how I will approach the practice change. The trial in Module 3 suggests that cold and vibration reduce pain scores, but this study suggests that fear peaks before the needle and that some children want control rather than distraction. A device that the child can hold, place or switch on themselves may meet both needs: it treats the sensation and gives the child a task and a measure of control. The finding that parents felt unsupported also suggests that any change should include brief guidance for parents, rather than only a new device in the draw room. Qualitative evidence does not prove an intervention works, but it tells me how to introduce one so that children and families will accept it.

References

Critical Appraisal Skills Programme. (2018). CASP qualitative checklist. https://casp-uk.net/casp-tools-checklists/

Lincoln, Y. S., & Guba, E. G. (1985). Naturalistic inquiry. Sage.

Sørensen, K., Skirbekk, H., Kvarstein, G., & Wøien, H. (2021). I don't want to think about it: A qualitative study of children (6-18 years) with rheumatic diseases and parents' experiences with regular needle injections at home. Pediatric Rheumatology, 19(1), 8. https://doi.org/10.1186/s12969-021-00495-4