Article Critique: Meta-Synthesis of Caring in Nursing

Summary of the Article

The article under review is a qualitative meta-synthesis of prior research on the topic of caring in nursing. The researcher employed an adaptation of the meta-synthesis and grounded theory approaches to analyze the results reported in 49 previous qualitative studies of caring in nursing, spanning a spectrum of six concept analyses of caring. The review concluded that caring in nursing is a function of interpersonal processes that are highly context-specific, and that elements of caring are determined by such factors as professional expertise, personal and professional maturity, and the vocational environment in which healthcare services are delivered by nurses.

Sensibility of Research Questions

While it is certainly understandable why caring would be an important concept to investigate in connection with nursing, it is not a topic that is easy to investigate, much less to draw meaningful conclusions about in a nursing context. That difficulty seems to be illustrated by the relative meaninglessness of some of the findings. For example, the reviewer determined that expertise is a relevant factor, yet there is no logical connection between the two concepts, since it is entirely possible to be technically proficient and uncaring, or vice versa.

Likewise, the conclusion that caring depends on interpersonal sensitivity would seem too obvious to require formal study. Furthermore, any analysis of that issue should have also included data from nursing students in order to identify personal attributes among those who select nursing as a profession — attributes that predate professional nursing experience. The implied question about moral foundations would also seem too obvious for formal study, as would the issue of an environment conducive to caring, since vocational frustration would naturally affect attitudes related to caring for others in almost any work environment.

Quality and Breadth of Studies and Methodology

The methodological process used to search the relevant prior literature may have been too narrowly defined. The reviewer searched only for literature containing the word caring. It was appropriate to exclude the word care, as the reviewer did, because including that term would have generated too many irrelevant results given its other contextual uses in connection with delivering nursing care. However, the scope of the literature search probably should have included other relevant terms such as empathy, attitude, and perhaps burnout, since negative changes in vocational satisfaction could conceivably affect caring in nursing. For a broader perspective on empathy as a construct relevant to healthcare, that omission represents a meaningful gap.

It also appears to have been a mistake to exclude data from nursing students, particularly in relation to the potential relevance of attitudinal and motivational factors common to those who select nursing as a profession. Including such data would only have lent greater support to any conclusions about the interpersonal factors associated with caring.

Given those limitations — namely the restriction of data to literature containing the word caring and the exclusion of nursing students — the methodology was otherwise of high quality, as it likely identified all available literature within those defined parameters. The use of coding to transform highly qualitative data into quantifiable terms, however, seems to have been an artificial approach, and it is not necessarily clear that this process increased the data's overall usefulness. Scholars examining qualitative research methods have long debated the trade-offs involved in such conversions.