“The Clients’ Experience of the Community Group” by Harms & Benson

Introduction

Over the past several decades, community or large group meetings have been integrated into the management program of individuals recruited as inpatients in mental health units and are thought to serve a therapeutic purpose. However, there have been conflicting views regarding the role of group sessions in aiding and catalyzing the improvement or recovery of patients suffering from mental health problems, who are parts of such programs. The following paper critically reviews the article ‘The clients’ experience of the community group: implications for nurse facilitators’ by Harms & Benson, published in the ‘Journal of Psychiatric and Mental Health Nursing’ in 2003. The article critique is based on the critique framework proposed by Parahoo (2006) and sequentially provides critique on each section of the article.

Title

This article is entitled “The clients’ experience of the community group: implications for nurse facilitators”. This title is clear and effectively states the purpose of the study conducted. Moreover, it is precise and unambiguous. According to Parahoo (2006), this helps prevent any misconceptions and catches the reader’s attention. However, there is one shortcoming in this title i.e. it does not clearly define the study group or population. Although the title mention that the study population comprises the clients’ recruited in the community group program, it does not specify that these clients’ are inpatients and suffer from a mental health problem. Mentioning the study group clearly prevents the arousal of any doubts regarding the study being performed and the individuals in question. Moreover, it also invokes the reader’s interest in the article.

Abstract

The abstract of an article serves to provide a concise summary and outline of the article. It is one of the most important parts of an article as it determines whether the reader would continue reading the article or not (Parahoo). Therefore, an abstract should be clear and should cover all the aspects of the article efficiently and adequately.

The abstract of this article has the qualities of being precise, yet comprehensive. It starts by providing a background of the problem in question and clearly defines the rationale of and the need for conducting the study in question. The objectives of the study viz. developing an insight about the patient’s perspective and experiences of being involved in a community group while recruited as an inpatient at a mental health facility are clearly defined. The abstract then moves on to describe the methodology and discusses important results. However, it would have been better if the pertinent findings would have been elaborated a bit more. In the end, the implications of the findings in everyday nursing practice are discussed. In totality, the article provides a reasonable overview of the article but lacks in that it does not discuss the recommendations of the author and the potential directions for future research.

Introduction and Background

The introduction section of an article is aimed at identifying the research problem, to determine the magnitude of the problem in the society and to provide the rationale behind carrying out the study, as suggested by Parahoo (2006). In this article, the authors begin by introducing the problem and then present the conflicting views that prevail in the community regarding this problem. They then describe the purpose of the study which was to dispel the confusion which commonly exists regarding the effectiveness of group therapy and hence identify the potential role of nurses in facilitating the community group therapy program.

Although the introduction adequately identifies the problems and describes the purpose that the study is intended to serve, it has certain limitations. For example, it does not throw light on the magnitude of the problem in the society i.e. how many individuals are currently involved in such programs in the society, how many similar programs have been conducted in the past and what percentage of individuals did or did not attain any benefit from such a program.

Literature Review

As suggested by Parahoo (2006), the literature review provided in an article provides an in-depth view of the research done on the topic. It should be based on an extensive review of literature and discuss all aspects of the topic in question. This article provides an adequate theoretical background on the different psychological perspectives of group theory. Most pertinent amongst these were the works of Bion (1961), discussed by Foster and Roberts (1998) in their book “Managing Mental Health in the Community: Chaos and Containment”, which resulted in the postulation of the ‘basic cultures’ and ‘group theories.’ Another important concept is that of ‘group matrix’ as proposed by Foulkes (1975) as highlighted in the book ‘What Works for Whom? A Critical Review of Psychotherapy Research’, by Roth and Fonagi (1998). The article then identifies the issues that arise in community groups and summarizes the purposes identified by various studies that such groups serves. The authors subsequently discuss studies conducted in the past to evaluate the effectiveness of community group such as those conducted by Maratos & Kennedy (1974), Carson & Sharma (1994) and Hafner & Holme (1996), and their pertinent findings.

Moreover, the literature review also identifies the strengths and weaknesses of the studies carried out previously and the gaps in the research literature that exist, viz. conclusive results on the effectiveness of community group program, the patients’ perspective on being involved in such a program and the potential role that nurses can play in the implementation and improvement of the existing program. Thus, in conclusion, the literature review is adequately performed and suffiently describes the research conducted on the topic.

Aims and Objectives

This article states the objectives of the study as gaining an insight into the patient’s experiences and perspectives on being involved in the community group and using this information to define the roles that nurses can play in improving the efficacy of such programs. These objectives are explicit, goal-directed and concise. Moreover, they are designed in such a way that they tend to serve the purpose of overcoming the shortcomings in the existing literature.

Methodology

The methodology section is also an important section of any article as this part guides how the study is being conducted. It has several important components. With regard to this article, the important components of the methodology which are adequately covered in the article include the statement of the study design i.e. descriptive, which in this case, included a phenomenological approach, a description of the study population, the sample size (n=4) and the sample collection method. Ethical approval and informed consent was taken before conducting the study. The data was collected via an interviewer-led questionnaire and was analyzed following the phenomenological method proposed by Colaizzi (1978), who described the six steps of data analysis.

There were certain shortcomings in the methodology section of this article. Firstly, the inclusion and exclusion criteria for study subject selection were not defined. This might have led to several biases such as differences in the baseline demographic characteristics of the participants, for example people belonging to different age groups, genders and ethnicities commonly have different views and perceptions regarding different matters, or other co-morbid conditions which may have influenced the patients perceptions. This was important because the sample size chosen is very small and any bias would lead to considerable skewing of the results and lead to variability.

Moreover, as mentioned before, the sample size was too small and the sample size selection technique used (e.g. via softwares like epiinfo) wasn’t mentioned. In addition, as identified in the article by the authors themselves, the last step in the phenomenological process i.e. the validation of the results was not performed and this can lead to arousal of doubts regarding the variability and reliability of the findings in the minds of the readers. All these limitations contributed towards a weak methodology section.

Results

For qualitative studies, the results need to be extensively discussed and should include actual quotes and statements of the study participants to give a clear view of the outcome of the study to the readers. The results section of this article is very comprehensive and gives a clear overview of the patient’s perceptions regarding the community group program. Another positive aspect of the result section is the organization of the main findings into three broad categories viz. ‘Whose responsibility?’, ‘Me vs. Them’ and ‘What works?.’ This helps to give a clear picture of the main themes around which the perceptions of the participants revolve. Moreover, it also helps in improvising interventions at the level of each sub-category to overcome the factors leading to patient dissatisfaction, where identified. The result section also describes the patients’ experiences and views in their own words, giving the readers a better picture of what the patients actually felt and experienced and how they expressed their feelings regarding the community group program.

Discussion

The discussion section is, in effect, an integration of all the subsections of the article which leads to the generation of a concluding statement. This section is aimed at linking the themes discussed in the introduction and background section of the study, the literature review and the important results generated. In this article, the authors have effectively discussed all their findings and compared them with the previous findings in the discussion section. They have also offered explanations for certain findings based on previously conducted research and offer solutions and the role which nurses can play in overcoming the problems identified via this study. Moreover, they have also identified the limitations in the existing study which include the small sample size, the possibility of bias arising due to researcher bias and the inability to perform the final validation process of the phenomenological approach due to time constraints.

Another important component of the discussion is the identification of issues which require further research. In this article, the authors have sufficiently covered this aspect and have identified arenas which require further exploration. These include the identification, validation and determination of a standard theoretical framework to use in future studies and the need to conduct further studies to validate the findings of this study. Moreover, there is also a pressing need for studies to define the expected benefits and the role that community groups are thought to serve in inpatients recruited in a mental health facility.

Conclusions

All the above discussed sections of a research article lead towards the conclusion section of the article. The conclusions are meant to answer the questions raised and the objectives that were defined prior to conducting the study. They are also meant to summarize the important results generated from the study. This article concludes by identifying the major concerns that are present amongst the participants of a community group program and defines what role the nurses can play in alleviating these concerns. It also proposes a framework which defines how these interventions can be effectively implemented.

References

The reference list provided is sufficiently extensive and includes sources such as articles from peer reviewed journals and books. However, one limitation present is that the sources used are not very recent and some date back to even as early as 1965.

In conclusion, a critical appraisal of this article yields that most sections of this article are well written and this contributes towards the credibility of this article.

References

  1. Carson, J. and T. Sharma. (1994) “In-patient psychiatric care – what helps? Staff and patient perspectives.” Journal of Mental Health: 3:99-104.
  2. Colaizzi, P. (1978) “Psychological research as the phenomenologist views it.” Valle, R. and M King. Existential Phenomenological Alternative for Psychology. New York: Oxford University Press: 48-71.
  3. Foster, A. and V. Roberts. (1998) Managing Mental Health in the Community: Chaos and Containment. London: Routledge.
  4. Hafner, R. and G. Holme. (1996) “The influence of a therapeutic community on psychiatric disorder.” Journal of Clinical Psychology: 52: 461-468.
  5. Harms, S. and A. Benson.(2003) “The clients’ experience of the community group: implications for nurse facilitators.” Journal of Psychiatric and Mental Health Nursing: 10:49-56.
  6. Maratos, J. and M. Kennedy. (1974) “Evaluation of ward group meetings in a psychiatric unit of a general hospital.” British Journal of Psychiatry: 125, 479–482.
  7. Parahoo, K. (2006) Nursing Research: Principles, Process and Issties. London: Palgrave Macmillan. Houndmills Basingstoke.
  8. Roth, A. and P. Fonagy. (1996) What Works for Whom? A Critical Review of Psychotherapy Research. New York: Guilford Press.