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3 Literature Review critique
3.1 The  9 Research Articles Reviewed
Of the nine chosen articles for review, three were single cross-sectional studies (Manthorpe et al. 2015; Bates et al. 2010; Keen et al. 2010), four single in-depth qualitative studies (Manthorpe et al. 2014; Sieminski et al 2011; Bernard et al 2014; Wilson and Kelly 2010), one single perspective cohort study (Plenty and Gower 2013) and one single non-randomised control trial (McDonald, Postle and Dawson 2008). Sieminski et al. (2011) study offered the smallest sample size with nine participants and Keen et al (2010) the largest with 321 participants. Manthorpe et al. (2015) and Bates et al. (2010) offered a sample size across adult and children’s services and Manthorpe et al. (2015) offered the most inclusive response in terms of breadth of participants across the system considering responses from NQSW’s, line managers and Directors. Sieminski and Seden (2011) offered the least with nine tutors across Higher Education Institutes (HEI’s) although it should be noted that they offered the most openly balanced sample group in terms of representation across gender with five female and four male participants. Bates et al. (2010) were the only study to include service users and carers and were unambiguous in terms of their sample age range; from the information provided by the other studies it cannot be determined whether any age group has been under or over represented. Plenty and Gower (2013) study was set across three years of student cohort groups but was not explicit in terms of sample size. McDonald, Postle and Dawson (2008) were the only ones who identified their study solely in an adult context, detailing roles within the setting, e.g. senior practitioner/team manager. Manthorpe et al. (2014) provided the least comprehensive data in terms of identifying their sample group, providing only their single job role and practice setting, as the same size was small it is acknowledged that the findings are no necessarily generalizable to the wider picture of work with adults.


Longitudinal data collection was chosen by two of the nine studies, the benefits of which include the ability to measure individual changes in outcomes and comparisons amongst subgroups. Manthorpe et al. (2015) used this form of data collection to bear comparisons in relation to perceptions of supervision and Bates et al. (2010) chose to measure the learning and development needs of NQSW’s across the course of their first year of employment at three intervals (1 month, 6 months and 9 months). Both used the combined approach of questionnaires and semi-structured interviews although in addition Bates et al. (2010) used telephone interviews and face-to-face semi-structured interviews with two carers and two service users whilst Manthrope et al. (2015) interviews were face-to-face with line managers only. With the exception of Manthorpe et al. (2014) the studies that were identified as single in-depth qualitative studies used focus groups in which to collect qualitative data (Sieminski et al. 2011; Bernard et al 2014; Wilson and Kelly 2010. However, owing to the subjective nature and often small sample size it is rarely used in isolation; Bernard et al. (2011) and Wilson and Kelly (2010) also used interviews and/or surveys to complement it. In the case of Wilson and Kelly (2010) questionnaires mostly contained closed questions that were pre-coded to collect quantitate data alongside students being given the opportunity to add qualitative comments. McDonald, Postle and Dawson (2008) used a series of focus groups in isolation through a non-randomised control trial method in which the researcher defined and managed the group to elicit information for the purpose of collecting data for hypothesis testing in relation to sources of knowledge, value base, employed skills and means of support. Interestingly data was only collected directly from NQSW’s or students in four out of the nine chosen studies although it’s recognised that overall this is still likely to yields the highest number of responses owing to the volume of student intake in comparisons to employed participants. Plenty and Gower (2013) and Keen et al (2010) collected data as part of a larger scale research project which involved collaboration of pilot schemes run by partnership employers, HEI’s (Keen et al 2010) and first to final year students and practice educators (Plenty and Gower 2013); with these exceptions all data from the remaining seven studies was collated by primary means such as face-to-face interviews.
Qualitative data was analysed using a variety of techniques to collate, code, group and organise the information into over-arching themes which were then refined to identify relationships between core categories (Manthorpe et al. 2015; Manthorpe et al. 2014; Bernard at al. 2010; Bates et al. 2010; Keen et al. 2010; Wilson and Kelly 2010; Sieminski and Seden 2011). Manthorpe at al. (2015) and Bernard et al. (2010) used data analysis programme N-Viro 8 to read transcripts and identify key themes and Bernard et al. (2010) used some of the principles and techniques from grounded theory, although it is noted that the study wasn’t a systematic review. Keen et al. (2010) used Richie and Lewis (2003) qualitative analysis framework which is particularly suited to the analysis of cross sectional descriptive data enabling different aspects of the phenomena under investigation to be captured (Ritchie and Lewis 2003).  One of the advantages of the framework approach is that researchers’ interpretations of participants’ experiences are transparent (Ritchie and Lewis 2003). Quantitative data was analysed using a Likert scale (Plenty and Gower 2013) and SPSS computer for statistical analysis (Wilson and Kelly 2010) and Bates et al. (2010) used a combination of both. Manthorpe et al. (2015) went further sharing key themes with Social Care Workforce Research Unit’s User and Carer Advisory Group and Bates et al. (2010) shared initial findings from the questionnaires and telephone interviews to three of the participants at a group meeting with members of the project’s steering group.
3.2 Findings and Conclusion
Overall the studies reported general satisfaction in preparatory teaching between students, NQSWs and line managers (Wilson and Kelly 2010; Bates et al. 2010), although Bernard et al. (2014) study found that minority groups were largely underrepresented on social work programmes. Amongst line managers there was trepidation about how well ‘core’ social work skills such as assessment had been addressed and developed. Findings reiterated the problematic relationship between theory and practice within practice settings as a consequence of lack of confidence, support and inability to recognise and articulate knowledge which could be corroborated at structural, management and practitioner levels ranging, including but not limited to, supervision concentrated on caseloads, gaps in knowledge and lack of value placed on theory (McDonald, Postle and Dawson 2008). However, the implementation of theory in practice seemed to be far more realistic in adult services as there was reported to be a different ethos in relation to nurturing and supporting students and NQSWs (Manthorpe et al. 2015; Manthorpe et al. 2014; Bates et al. 2010; Plenty and Gower 2013). In response to these factors Sieminski and Seden (2011) concluded that agencies must recognise the importance of reflective practice if they want quality social workers which support new changes brought in by the ASYE framework.
3.3 Strengths and limitations of literature
Through data extraction all nine chosen articles were found to be academically credible; majority of the authors were found to be actively working within the field of social work or were affiliated by means of research and/or development positions. Bates et al. (2010) and Wilson and Kelly (2010) both used qualitative and quantitate data collection methods which allowed for triangulation between methods to check the integrity of inferences drawn from findings and also to guard against socially desirable responses, in terms of Wilson and Kelly (2010) this was demonstrated by giving the students the opportunity to introduce new topics based on their practice learning experiences. McDonald, Postle and Dawson (2008) were clear to define the neo-liberal political context and, whilst not directly linked to the ASYE framework highlighted the opportunity for comparisons of the constraints before and after its introduction in terms of managerialism with its focus on limited resources and management of risk. Diversity was sought in terms of participants from across children and adult services (Manthorpe et al. 2015; Manthorpe et al. 2014; Bates et al 2010) which allowed for deeper investigation, understanding and comparisons to be drawn across settings, including, but not limited to the difficulties faced by practitioners and line managers in providing support to NQSW’s. All three studies took their attempts to represent diversity further and were inclusive to NQSW’s, line managers, social work educators and service users and carers which consequently allowed for a broader and as far as possible, non-judgemental approach which also sought to reduce the risk of bias. There is strength in research which offers diversity as it provides information on disparities and the inequalities faced in experiences. Wilson and Kelly (2010) offered comparisons amongst males and females, Sieminkski et al (2011) student group was diverse in terms of ability and experience and also offered a national perspective representing teaching regions across the UK which can be linked to the findings of Bernard et al. (2014) who collated the experiences of students from a range of marginalised groups, highlighting them as more at risk of the identified barriers. Identifying articles within the last seven years gave a significant, but not overwhelming insight into the key changes in social work and encompassed the future drivers in social work teaching, learning and practice (Plenty and Gower 2013).
The studies were not exhaustive in terms of demographics and of the studies that were explicit in terms of race and gender there was a predominance of females although figures weren’t always stated, Bates et al (2010) for example. Studies with NQSW participants weren’t explicitly descriptive in terms of gender, race or age accept in the research of Bernard et al. (2014) in which majority of participants identified themselves as black or ethnic minority but again the proportion of males to females is unknown. Overall sample sizes were small but response rates must also be considered; the low response rate noted in Manthorpe et al. (2015) of 29-44% means the findings must be taken as indicative and this is also true of Wilson and Kelly (2010) study in which only 44 out the 80 enrolled participants completed and returned the questionnaires. In the research of Plenty and Gower (2013) 14 practice educators failed to return the questionnaires but there was no discussions as to the drop-out rate. Funding and time restrictions were noted as limitations of Bates et al. (2010); Sieminski and Seden (2011) and the self-selection/reporting methods used in Wilson and Kelly (2010); Bates et al. (2013); Manthorpe et al. (2015); Manthorpe et al. (2014) meant data collected was necessarily subjective. Building on from this, Manthrope et al. (2014) explores the potential biases created by manager’s personal characteristics around confidence in management styles. In Sieminski and Seden (2011) research course tutors were selected by the University out of those who were delivering the module content as part of the teaching team and these biases further extend to Bates et al. (2010) in which surveyed line managers played a fundamental part in the learning and development of NQSWs. Further limitations of Bates et al. (2010) were that only data from public sector employers was collected due to       no responses being received from requests sent to over 50 voluntary, independent and private sector organisations. Limitations of the participants are highlighted in Bernard et al. (2014) of which there were no comparative studies to analyse the experiences of white counterparts and owing to the small sample sizes overall it’s acknowledged that no generalisations can be made across any of the nine chosen journals; this extends further to representation of geographical area, service user groups or settings (McDonald, Postle and Dawson 2008). Contextual influences both geographically and in relation to current social work developments are also to be considered; Bernard et al (2014) study wasn’t extended beyond the degree, although it’s considered the information is relevant and likely to be transferred to placement and ASYE framework. Those studies that also failed to be explicit about ethical approval need to be given careful consideration in terms of validity (Keen et al. 2010; Plenty and Gower 2013). Plenty and Gower (2013) research also failed to distinguish which research was gathered from year two and year three students respectively.
3.4 Trustworthiness, Validity, Reliability and Ethical Issues
3.4.1Trustworthiness, Validity, Reliability
Department of Health (DoH) funding was sought for three out of the nine studies which carries an information standard quality assurance, making reliable ad trustworthy research easily identifiable (Manthorpe et al. (2015); Manthorpe et al. (2014); Bernard et al. (2013). Bates et al. (2010) collated data from service users and carers which is considered more ethically sound by the Research Ethics Committee (REC) as it incorporates the views of the end user; members were also part of the Universities participation group. Reliability, in the sense of consistency was addressed through peer review of data and an audit trail was created to trace the derivations of findings (McDonald, Postle and Dawson 2010) and all journals were published by reputable sources such as International Bibliogrpahy of the Social Sciences (IBSS). Bernard et al. (2013) research used grounded theory which offers a rigorous set of procedure for ensuring consistency and accuracy. At some level bias is nearly always present in published studies although naturally it’s more easily eliminated in quantitate research. Self-selected study samples, self-reporting, pre-existing relationships between participant and researchers and employer commissioned and/or funded research records potentially heavily biased responses (Bates et al. 2010; McDonald et al 2008; Sieminski and Seden 2011) created by the natural desire to report positive views of individual practices or overtly negative experiences (Bernard et al 2014). In Plenty and Gower (2013) research high biased was present as the University were implementing the framework and interpreting the new PCF framework and subsequent documents whilst teaching the outcomes to their students.
3.4.2 Ethical Issues
Keen et al. (2010); Plenty and Gower (2013) made no specific mention about ethical governance or consent, nevertheless it does mention that the paper reports on formative and final assessment from pilot schemes and previous research. In the case of Keen et al. (2010) research was commissioned by Skills for Care and funded by Social Work development partnership; both studies kept the confidentiality of the participants throughout. Conversely, Manthrope et al. (2015) sought ethical and research governance permissions at National and local levels and in order to respect confidentiality the personal details of survey respondents, interview participants and their locations remained anonymous, all names mentioned in this study and Manthorpe et al. (2014) were pseudonyms. Ethical considerations were obtained on varying degrees; Bates et al. (2010) project was approved by the University’s research committee and endorsed by the research group of the Association of Directors of Social Services and local ethic governance was prior to contacting local authorities to invite sample of NQWS’s to participate. Permission was sought by Manthorpe et al. (2015); McDonald, Postle and Dawson (2008); Wilson and Kelly (2010) to audio record and transcribe although it’s not clear whether this was verbal or written and Bernard et al. (2014); Sieminski and Seden (2011) consent was obtained for use of all material, with Bernard et al (2014) further obtaining approval from the Universities Ethics Committee.
3 Literature Critical Evaluation
3.1 Introduction
The eleven articles have been collated and appear in table format in appendix 5 pg. 53
The data extracted from the 11 articles comprise of the following headings which are the sub sections of this section: findings, strength, limitation, validity and reliability (trustworthiness), conclusion and ethical issues.
3.2 Critical analysis and synthesis: Findings
The factors that influenced parents to circumcise their children varied in the eleven studies. Seven studies talked about the most common factors which included cultural, social, religious purposes and medical reasons (Leung, 2012; Corduk et al., 2013; Sardi and Livingstone, 2015; Skolnik et al., 2014; Atkin et al., 2009; Rediger and Muller, 2013; Bo and Goldman, 2008).  Significantly some parents believed that circumcision could improve cosmetic, growth of the penis, sexual potency and fertility, prevent sexually transmitted diseases and penile cancer (Rediger and Muller, 2013; Bo and Goldman, 2008).  Other parents perceived issues relating to prevention of infection, hygiene, cancer and other health benefits (such as prevention of phimosis and urinary tract infections as influence to circumcise their own children (Leung, 2012; Corduk et al., 2013; Sardi and Livingstone, 2015). There was also a perception among parents that circumcision would enlarge the penis and claims that circumcised penis was cleaner. Three studies mentioned that in some instances peer pressure from friends and family motivated the parents to circumcise their children (Sardi and Livingstone, 2015; Skolnik et al., 2014; Bo and Goldman, 2008). In a study conducted by Skolnik et al. (2014) and Bo and Goldman (2008) some parents believed a circumcised penis had a better shape and would enhance sexual pleasure. However, beliefs about the sexual benefits among others remain controversial. Rediger and Muller (2013) also suggested that personal circumcision status of the male parent is an extremely important factor in the decision to pursue elective circumcision. However, while some parents were concerned about pain, other parents’ desired further information to help them better make the decision before or at the time of childbirth (Waters et al., 2012; Leung, 2012). Circumcision during infancy was considered to heal faster, because it would not be disturbed by scratching or regular erections. In addition, other perceived advantages of circumcising infants were that it would be less painful, and that babies lacked awareness of what was happening, which would prevent shyness and fear (Bo and Goldman, 2008; Waters et al., 2012; Leung, 2012). In two studies where parents had not circumcised their children, parents of uncircumcised sons reported concerns about neonatal male circumcision. They were concerned about the pain and/or risk of the procedure, necessity of circumcision, and concerns about bleeding and infection. Other reasons parents gave for not having their male sons circumcised included the spouse (most often the father) not agreeing to it, the infant’s father not being circumcised, issues of cultural identification, and doubts about the preventive benefits. Some parents suggested a child should be left without being circumcised in order to participate in traditional circumcision ceremony (Waters et al., 2012; Bisono et al., 2012). Two studies highlighted that the fathers made the final decision on whether to circumcise or not.  In other cases, some parents wanted to leave the decision-making up to the son at a later age when a child can decide. Although some parents express difficulties in making decision for their children, the best way for health care providers to impact informed decision-making is not clear (Waters et al., 2012; Bisono et al., 2012). In one study where the decision to circumcise the children was shared by both parents, the parents also emphasised on the procedure being done by a trained personnel (Bo and Goldman 2008). The GMC (1997) cited in Robinson and Wheeler (2009) advised the medical professional to obtain consent of both parents whenever possible. A study conducted by Robinson and Wheeler (2009), indicated where single parental consent had been obtained there was no documentation to suggest any attempt to involve a second parent in the consent process. This illustrates that the guidance set by the GMC are not adhered to. In other instances, when two adults attended with a child for ritual circumcision, there is the general assumption that they were the child’s parents (Robinson and Wheeler, 2009). In addition friends, family members such as mothers, fathers, grandparents, siblings, and children were influential in decision to get circumcised. Similarly, sexual partners, including girlfriends or wives, were also an important influence on men’s decision to seek male circumcision, this was partly due to perception of health benefits in circumcised males (Skolnik et al., 2014). Leung (2012) noted that, in some communities medical opinion was the most important factor guiding parental decisions on circumcision. In this study 82.6% of parents agreed that doctors should make the decision for circumcision, however, the guidelines and involvement of medical personnel in non therapeutic male circumcision is unclear (Robinson and Wheeler, 2009).
The age at which the children were circumcised ranged from neonates to 16 years of age in 8 studies (Bo and Goldman, 2008; Koc et al., 2013; Rediger and Muller, 2013; Atkin et al., 2009; Sardi and Livingstone, 2015; Bisono et al., 2012; Waters et al., 2012 and Corduk et al., 2013). However, Leung (2012), Skolnik et al., (2014) and Robinson and Wheeler (2009) did not mention the age at which the majority of the children were circumcised. On the other hand, there was association between age of circumcision and educational status of parents, occupation, religion, ethnic background, father’s age and satisfaction of his own circumcision. The lower the education level of parents, the higher the age of children at circumcision. In addition, as the educational level of the mothers and fathers increased, the rate of circumcision performed in hospitals also increased (Koc et al., 2013; Bo and Goldman, 2008) Appendix 6 Table 3.1 pg. 93.
3.3 Critical analysis and synthesis: Conclusions
Circumcision, as mentioned earlier, is often performed due to religious, social, cultural, medical and health reasons (Leung, 2012; Corduk et al., 2013; Sardi and  Livingstone, 2015; Skolnik et al., 2014; Atkin et al., 2009; Rediger and Muller,  2013 and  Bo and Goldman, 2008). The findings from Skolnik et al. (2014) and Waters et al. (2012) suggested that circumcision for medical reasons is the predominant motivator for circumcision especially for HIV and STI prevention, and this continues to be an effective message for promoting medical circumcision in some settings.
In Turkey, where the majority of the children are circumcised for cultural reasons, traditional circumcisers are still preferred by the parents.  However, despite the changing trends of evidence on benefits and risk, circumcision continues to decline in many parts of the world (Koc et al., 2013; Corduk et al., 2013). In a study conducted by Atkin et al. (2009) the authors feel that the welfare of any boy undergoing non therapeutic circumcision is paramount and the practice of ritual circumcision outside of the hospital needs close monitoring. Primary Care Trust (PCT) funding withdrawal for non medical circumcision had an impact, in that the medical and non-medical practitioners were being asked to perform a greater number of circumcisions in the community. As a result, they suggested that parents should be informed about the benefits and risks of circumcision and the importance of psychological influences when circumcised at older ages (Atkin et al., 2009). Koc et al. (2013) and Corduk et al. (2013) suggests to parents that it is reasonable to wait up to an age at which the child could understand and participate in the decision of the concept and timing of circumcision. On the other hand, Waters et al. (2012) highlighted that the reasons why parents did not circumcise at neonatal stage was to wait until they are older when they could participate in a traditional ceremony. Therefore, they suggested that education was an important aspect in avoiding unnecessary circumcision. In addition, the AAP (2012) (cited by Koc et al. 2013) circumcision policy statement, suggest that respective medical professionals should give accurate and unbiased information and provide an opportunity to discuss decisions about circumcision with parents (Koc et al., 2013, Leung, 2012). The study conducted by Waters et al. (2012) saw antenatal visits as opportune time to educate expecting mothers on non therapeutic male circumcision, exposure to information during antenatal care might help the parents to make the right decision for their children. Messages given during the antenatal visit should focus on prompting women to consider and discuss the topic with their husbands before giving birth. Bisono et al. (2012) and Koc et al. (2013) in their study showed circumcision decision is often made before the parent has discussion with a healthcare provider. They suggest that the best way to address this issue is to discuss options with parents before the child is born and making sure that they know what they want for the child. Also, suggestion for future research is suggested to address issues on how to ensure health care providers are well informed and have the tools to assist parents in making an informed decision in a culturally sensitive manner. However, the study conducted by Rediger and Muller (2013) noted that despite new medical information and updated stances from various medical associations, the rates of circumcising male children continue to be influenced by the circumcision status of the child’s father. The AAP’s (2012) (cited by Sardi and Livingstone, 2015) stance on male neonatal circumcision states that parents must ultimately decide for themselves based on what they feel is best for their children. The data suggested that parents often do not have the ability to give an informed decision but instead rely on a combination of cultural and culturally informed health information to make the decision (Sardi and Livingstone, 2015). Bo and Goldman (2008) suggest that medical practitioners influence the parents in decision making. Therefore, the doctors are advised to comply with the advice by the BMA (2006) (cited by Robinson and Wheeler, 2009), that is to make every effort to contact the other parent in order to seek consent. The conditional nature of the BMA guidance might give the doctor some latitude to consider that ‘every effort’ would not necessitate refusing to proceed until the absent parent is available (Robinson and Wheeler, 2009; Bo and Goldman, 2008). The two studies suggest that information should be made more readily available in hospitals about circumcision of children. This is attributed to the fact that many parents wished to be provided with further information in the hospital setting, that would guide them make the circumcision decision on whether or not to circumcise their children. If parents lack accurate, up-to-date information regarding the risks of circumcision, this calls into question whether the consent they provide is truly informed (Sardi and Livingstone, 2015; Bo and Goldman, 2008) Appendix 6 table 3.2 pg. 98
3.4 Critical analysis and synthesis: Strengths
The response rate in the majority of the studies was good. These studies included (Koc, et al., 2013; Leung, 2012; Corduk et al., 2013; Bo and Goldman, 2008; Skolnik et al., 2014; Atkin et al., 2009 and Rediger and Muller, 2013). While Koc et al. (2013) used a face to face interview, which is known to obtain in depth data, Leung’s (2012) study used a random selection of sample, which gave each participant an equal opportunity. However, although a study conducted by Sardi and Livingstone (2015) had a small sample, high variance used in the study validated the results. Other studies had a large sample size (Skolnik et al., 2014). The authors were credible and had written other articles, they also declared their respective conflict of interest (Corduk et al. 2013, Waters et al., 2012, Robinson and Wheeler, 2009). Bisono et al. (2012) and Waters et al.’s (2012) findings were in agreement with other similar studies in other parts. Rediger and Muller’s (2013) study in their regression analysis showed that the relationship between the circumcision status of the father and support of elective circumcision was statistically significant (P < .001). In addition the hypothesis was clearly focussed to the aims and objectives of the study. Appendix 6 table 3.3 pg. 100 3.5 Critical analysis and synthesis: Limitations   Koc et al.’s (2013) study was limited to a small sample, hence the results could not be generalised. In addition the parents who have an uncircumcised boy were excluded from the study hence their views were not obtained. However, it acknowledges the main motive of circumcision in Turkey was traditional which was similar to other studies conducted within Turkey.  Similarly, Leung (2012) identified 10 schools among a total of 445. As the number of sampling units from each region was small, they might not reflect the socio-economic status of the true population. On the other hand, no consideration was given for confounding factors since some of the results were descriptive. Bo and Goldman (2008) conducted their study in one centre as a result this was not representative of the entire population. The interviews were for only parents who had brought children for circumcision, excluding views from other parents who did not circumcise their children. Similarly, Skolnik et al.’s (2014) study limited their generalizability to the larger population because the study participants were conveniently sampled among four non-randomly selected sites. A study conducted by Waters et al. (2012) lacked socio-demographic information about participants which made it unclear how the participants compared to the general population. This is also evident in Skolnik et al. (2014) where lack of data variability in demographic variables, such as age, marital status or urban/rural residence, limited the ability to make comparisons and test for statistical differences across groups. Waters et al. (2012) also used a nonprobability sampling, which resulted in selection of a study population that was younger, had a higher level of education, the participants’ in his study were more likely to be married, and may have differed in other ways that were unknown. In the same study, the participants were also given information on the benefits, risks and availability of non-medical circumcision after completing the survey, which meant they had knowledge of the study before answering the questions on whether or not they would choose to circumcise their children and their appropriate age of their choice. Their study was funded by the Centre of Disease Control (CDC), which meant that, CDC could potentially influence in extrapolation of the findings to their favour. Two studies conducted by Bisono et al. (2012) and Skolnik et al. (2014), had to translate their questionnaire to a local language and vice versa. Similarly, in a study conducted by Sardi and Livingstone (2015) all surveys and information forms for parents and expecting parents were translated from English into Spanish then translated back to English. The use of questionnaires, which were translated into English, meant that, some information might have been altered during translation. The nature of the data collection in Bisono et al. (2012) did not allow the authors to explore the role of marital status on the decision-making process. As it was a retrospective study, they were limited to parents’ ability to recall aspects of the decision making process.  In a study conducted by Sardi and Livingstone (2015) the majority of the participants were female parents and, in addition, parents of sons older than 5 years were excluded from the study. However, in Skolnik et al.’s (2014), study the majority of participants recruited were male. Retrospective data collected by Atkin et al. (2009) raises a validity question; this is because they were unable to document a true increase in incidences of community circumcision after funding withdrawal as the actual numbers of ritual circumcisions being performed outside the hospital setting were unknown. However, these data have always been known to be difficult to determine due to lack of proper regulation of circumcision in the community. In the Rediger and Muller (2013) study the questionnaire was not pilot tested, the study was also limited to parents attending prenatal classes therefore, the survey-captured parents’ opinions before the baby was born. The fact that so many respondents were in favour of pursuing circumcision in hospital might have been biased, as some might not be aware of the definite procedures and costs involved in pursuing circumcision. In addition, the circumcision teaching done at the prenatal classes might have influenced parents’ decisions, as parents’ feelings on circumcising their children might have changed after the baby was delivered (Rediger and Muller, 2013). Corduk et al.’s (2013) study did not randomise the thoughts and feelings of the boys circumcised at an early age, therefore their thoughts and feelings may not have been obtained. Although, Robinson and Wheeler (2009) focused their study on informed consent, they did not explore the rationale for circumcision. Appendix 6 Table 3.4 pg. 101   3.6 Critical analysis and synthesis: Validity/Reliability/Trustworthiness Koc et al.’s (2013) face-to-face interviews were conducted while parents waiting for examination. Face to face interviews are known to collect more accurate information, this is because the interviewee can give the interviewer extra information that can be added to the verbal answer of the interviewee on a question. However, Rediger and Muller’s (2013) study used questionnaires to collect data necessary for their study, the questionnaires used were administered prior prenatal classes hence reducing the influence from other parents during antenatal class. Although, Koc et al (2013) used the same approach of questionnaires to collect the data, they failed to clarify the percentage of parents who attended the clinic. Leung (2012); Bo and Goldman, (2008) and Rediger and Muller (2013) studies used self reported questionnaires, therefore, may have validity problems since parents may not provide accurate information about their attitudes on circumcision and socioeconomic status, the use of self-reporting questionnaires also exposes the study to the risk of bias. Similarly, Waters et al.’s (2012) reliance on mothers’ self-reports of the fathers’ demographics and circumcision status may have affected the reliability of data. This is because the findings may not accurately reflect views of all mothers who gave birth in Lusaka during the same period. Generalizability of results is also limited by the fact that the study did not directly assess acceptability among fathers, who appear to have the primary decision-making power. Other issues which raised validity and reliability concerns in the questionnaires used was the lack of pilot testing in Rediger and Muller’s (2013) study as pilot testing identifies crucial procedural difficulties and warning on the tool, protocols and success of the main study. On the other hand, Corduk et al.’s (2013) study sample selection was not randomised; consequently, those children circumcised at a very early age may not be able to express their own emotions on circumcision. Skolnik et al.’s (2014) survey data was double entered into EpiInfo 7.0, compared for inconsistency in data entry, and corrected before export into SAS 9.2 for additional data cleaning, recoding of variables, and statistical analysis. The data collection team reviewed the English and Sesotho transcripts together and annotated each English transcript, including narrative examples and Sesotho phrases, to ensure a culturally appropriate interpretation of the text. Sesotho words that had no equivalent translation in English were kept in their original form. Likewise in a study conducted by Bisono et al. (2012) the questionnaires had to be translated, as all Hispanic cultures are not alike, they did not have the ability to test whether there were different patterns of decision-making based on the country of origin. The use of retrospective data by Atkin et al. (2009) and Robinson and Wheeler (2009) that might have been collected for other purposes, raises the question of validity. Appendix 6 Table 3.5 pg. 103   3.7 Ethical issues In studies where questionnaires were used, confidentiality was maintained by using anonymous questionnaires (Leung, 2012; Bo and Goldman, 2008; Koc et al., 2013 and Corduk et al., 2013). Leung (2012) and Corduk et al. (2013) discussed the issue of a child’s autonomy; they suggested that the child should be left to make their own decision. In the studies, which were sensitive in nature, approval to conduct the study was obtained from the relevant bodies (Waters et al., 2012; Sardi and Livingstone, 2015, Skolnik et al., 2014; Atkin et al., 2009, Rediger and Muller, 2013 and Bison et al., 2012). Likewise all participants provided written informed consent prior to the study and voluntary participation ensured (Bo and Goldman, 2008; Waters et al., 2012; Sardi and Livingstone, 2015; Skolnik et al., 2014; Rediger and Muller, 2013; Bisono et al., 2012; Koc et al., 2013 and Leung, 2012). On the other hand, other studies did not require approval by the regulating body as they used retrospective data (Robinson and Wheeler, 2009). In a study conducted by Bisono et al. (2012) some participants felt discomfort discussing the subject of circumcision, as a result these participants together with those who had problems understanding the question due to a language barrier were eliminated from the study. Appendix 6 Table 3.6 pg. 105 _____________________________________________________________ SECTION 2 LITERATURE REVIEW WRITE UP EXAMPLE 3 3 Critical appraisal of body of literature 3.1   Introduction- Design, Sample size, Data   Collection and Data analysis method of the Ten research papers   Of the ten papers chosen for this literature review two are ‘Single Non Randomised Trials’ and therefore sit near the top of the hierarchy of evidence pyramid (Appendix 1) and one is a ‘Prospective Cohort Study’, sited just below. The final seven are ‘Cross Sectional study designs’, sitting in the lower half of the pyramid. The sample sizes used in the research papers, included in this literature review, ranged from 31,627 in the Griffiths et al. (2014) study, to just 16 participants in Barker and Nussbaum’s (2011) study. Only the studies carried out by Witkoski, Stimpfel and Aiken (2013), Griffiths et al. (2014) and Olds and Clarke (2010) included more than 1600 respondents. Therefore, 94% of participants originated from just 30% of the studies, with each of the remaining studies including responses from under 1599 subjects each, averaging just over 516 per study. The majority of the papers have carried out primary research studies but, Witkoski-Stimpfel and Aiken (2013), Olds and Clarke (2010), and Trinkoff et al. (2011) have carried out secondary analysis of previous works, with Trinkoff et al. (2011) mixing primary and secondary data. Witkoski-Stimpfel and Aiken (2013), Tanaka et al. (2010) and Barker and Nussbaum (2011) papers did not include response rates of participants. However, the response rates from the remaining papers varied from as low as 17% in the Scott, Arslanian-Engoren and Engoren (2014) paper, where a response rate of 40%, based on previous studies, was expected, all the way up to 86% in the Trinkoff et al. (2011) paper which was accomplished by sending follow up reminders to participants, increasing the original response rate from 62%. 70% of the papers reviewed utilised questionnaires, either as stand-alone methods or together with additional approaches, to gather information. 20% of the studies used simulation of nursing tasks to collect data on nursing behaviour and Calhoun et al. (2014) state, in their paper, that ‘simulation enables the reproducible assessment of predefined clinical activities at specific assessment intervals’. Whereas Barker and Nussbaum (2011) believe that their results may not be replicated in qualified nurses as the participants in their study were unspecified university students. The final 10%, Geiger-Brown et al. (2012), used triangulation to collect a variety of data from different sources. All of the papers studied, utilised quantitative research to measure occurrences of variables so, numerical scales were employed to analyse the data collected. The studies by Barker and Nussbaum (2010) and Barker and Nussbaum (2011) both utilised the Swedish Occupational Fatigue Inventory (SOFI) and the Fatigue-Related Symptoms Questionnaire (F-RSQ), along with other scales, as methods to measure and analyse fatigue levels of nurses in particular situations. All ten studies used a number of methods to analyse their data and half, (Barker and Nussbaum, 2010), (Scott, Arslanian-Engoren and Engoren, 2014), (Tanaka et al., 2010), (Geiger-Brown et al. ,2012) and (Barker and Nussbaum, 2011), used t-tests or paired t-tests, to show the similarities of the mean measurements between one or two sets of data, as a form of analysis but, Calhoun et al. (2014) measured their sets of data more than three times with the Analysis of Variance (ANOVA) method.   3.2 Critical appraisal of body of literature: Findings and conclusions   All but two  (Calhoun et al., 2014;Tanaka et al., 2010) of the ten studies reviewed, report that working for longer periods of time has detrimental effects on either patients, nurses or both. Calhoun et al. (2014) however, found that nurses performed tasks, using simulation, in less time after a 12 hour shift than at the beginning, whilst making fewer errors when carrying out more complicated procedures. Tanaka et al. (2010) also reported a higher prevalence of perceived adverse events in nurses working in a three shift system compared to a two shift system. Research carried out by (Barker and Nussbaum, 2010), (Griffiths et al., 2014) and (Barker and Nussbaum, 2011) all link higher levels of fatigue, caused by; extended nurse working hours, lack of rest between shifts and reduced levels of good quality sleep, with a reduction in nurses’ performance.  Despite this, Witkoski-Stimpfel and Aiken’s 2013 study found that a high proportion of nurses were content with extended shifts, although Trinkoff et al., (2011) suggest that nurses suffering with high levels of fatigue are unlikely to remain working in hospitals. Tanaka et al. (2010) reported that nurses working longer shifts benefited from more free time, while hospitals also benefit from the reduced cost of just two staff handovers per 24 hour period (Griffiths et al., 2014). However, both Witkoski-Stimpfel and Aiken (2013) and Griffiths et al. (2014) discovered that longer shifts reduced the quality of care provided, while Olds and Clarke (2010) results indicate an increase in medical errors, which Barker and Nussbaum (2010) calculate as ‘more than three times more likely’ in shifts that exceed 12.5 hours. These results are corroborated by Tanaka et al. (2010) who found that the increased proportion of incidence in the final 2 hours of a 12 hour shift did not occur on an 8 hour shift. Working more than 40 hours per week has also proven to increase the prevalence of chronic fatigue, defined as a ‘long term condition’ as opposed to acute fatigue which is deemed to be transient (Barker and Nussbaum, 2010), the frequency of adverse events, reports of medication errors (Olds and Clarke, 2010) and the increased likelihood of pneumonia deaths (Trinkoff et al., 2011). Consecutive longer shifts, which may come about as a result of the use of overtime to alleviate the strain of a lack of staff (Griffiths et al., 2014), have also been found to reduce sufficient recovery between shifts, increasing fatigue (Barker and Nussbaum, 2010), episodes of daytime sleepiness leading to ‘decision regret’ (Scott, Arslanian-Engoren and Engoren, 2014), and reducing nurses reaction times (Barker and Nussbaum, 2011).  All but the Calhoun et al., (2014) study have concluded that an increase in fatigue impacts on many aspects of nurse performance, often resulting in poor outcomes for patients. After 12 hours shifts, Barker and Nussbaum (2011) found that nurses suffered with increased levels of fatigue. Tanaka et al. (2010) and Geiger-Brown et al. (2012) also discovered that the number of nursing errors rose, while shorter periods of sleep between shifts were associated with the development of decision regret and the occurrence of adverse events (Scott, Arslanian-Engoren and Engoren, 2014).  In order to combat these issues just over half of the studies recommend that further research be carried out to clarify cause and effect. (Witkoski-Stimpfel and Aiken, 2013), (Trinkoff et al., 2011), (Scott, Arslanian-Engoren and Engoren, 2014) and (Tanaka et al., 2010) studies suggest that work schedules for nurses should be reconsidered in an attempt to minimise fatigue, and all but Witkoski -Stimpfel and Aiken (2013), advocate for naps to be encouraged during breaks to curtail sleepiness and maximise the vigilance of nurses. This is especially pertinent for nurses working night shifts (Geiger-Brown et al., 2012).   3.3 Critical appraisal of body of literature: Strengths and limitations   3.3.1 Merits and Limitations of a literature review   According to Holland and Watson (2012) ‘all studies have limitations’. It is extremely difficult to ensure that all papers relevant to a research question have been identified, accessed and read and it is important to note that the ability of the results to be classed as credible, or for the results to be generalizable, can be reduced by its limitations (Burns and Grove, 2010). Particular research methods carry their own specific limitations. For instance; the choice of papers studied during a systematic reviews (Bettany-Saltikov, 2012), possible misinterpretation of questions or answers given on independently completed questionnaires,  the inability of participants to remain anonymous during structured face-to-face interviews and the influence that the researcher’s presence can have on participant’s behaviour during observational research (Parahoo, 2006) can all be considered limitations to research. It is important that each of the limitations are reported and discussed to draw attention to the fact that they have been recognised during the research process (Polit and Beck, 2014).   3.3.2 Strengths of the ten research papers Excluding Geiger-Brown et al. (2012), Barker and Nussbaum (2011) and Calhoun et al. (2014) the number of participants, included in the studies, were high, resulting in the expectation that the findings would be more reliable (Olds and Clarke, 2010). (Barker and Nussbaum, (2011); Scott et al. (2014) and Witkoski-Stimpfel and Aiken, 2013) declare that their results are also representative of some aspects of nursing, as their participants are typical of the wider nursing population. Seven of the ten papers published their rates of response, which ranged from 17%-86%, and the response rates from the Barker and Nussbaum (2010), Witkoski-Stimpfel and Aiken (2013), Griffiths et al. (2014), Olds and Clarke (2010) and Trinkoff et al. (2011) papers are all above 50% which is high considering that Scott, Arslanian-Engoren and Engoren, (2014) state that ‘17% is typical for response rate for non-incentivized, mailed surveys among health care professionals’. 80% of the papers reviewed, used self-reports to collect data which Olds and Clarke (2010) declared as a reliable method of recalling adverse events and, Calhoun et al. (2014) and Barker and Nussbaum (2011) mimicked the nursing environments, as best they could, in order to enhance the reliability of their findings. In an attempt to ensure that the nurse’s responses represented an average work timetable, both (Olds and Clarke, 2010) and (Trinkoff et al., 2011) studies advised participants to report on their typical work hours over a period of time, including any overtime. This was an attempt to reduce bias in recall and, the nurses in the Barker and Nussbaum (2010) study answered the survey questions immediately after their shift had ended, for the same reason. Despite the fact that the Barker and Nussbaum (2011) study was completed in just 2 hours they also found that the level of fatigue experienced by their participants corresponded with that reported by qualified nurses and, Barker and Nussbaum (2010) propose that these levels of fatigue and the numbers of medical errors performed could be diminished by improving the healthcare environment. During the 2014 Calhoun et al., study the components of the simulated tasks and the order in which they were carried out were deliberately modified throughout the day to minimise the possibility of the nurses relying on their previous learned responses. They also report that the assessments of tasks carried out in their simulation environment were given more credibility as the accuracy of the simulation was maintained.             3.3.3 Limitations of the ten research papers     Sample sizes were small in the studies carried out by Geiger-Brown et al. (2012), Barker and Nussbaum (2011) and Calhoun et al. (2014) who document that relatively small changes to performance, driven by fatigue, could easily have been overshadowed by vast variations between the responses of a small number of individual participants. Geiger-Brown et al. (2012) were also one of the eight studies which relied on self-reports in part of their research but they considered the results to be subjective and, collecting data from self-report alone, Trinkoff et al. (2011) suggest, may limit the researcher’s capability to link fatigue to adverse events. Half of the papers document possible elements of bias which may also have an impact on the results collated. While Barker and Nussbaum (2010), Trinkoff et al. (2011) and Tanaka et al. (2010) all cite the inability of the researchers to determine when participants completed their surveys, and the setting of the Geiger-Brown et al. (2012) study prevented the assurance that any errors in measurements were not present. Despite the fact that findings from three of the studies were found to be representative of the wider nursing population there are aspects of two of those studies which were unable to be generalised. For instance Barker and Nussbaum (2011) reveal their participants were younger than the average aged US nurse and Scott, Arslanian-Engoren and Engoren (2014) disclose that their data sources and sample size restrict the ability to make sweeping statements that apply to all hospital based nurses. The remaining eight papers also declare that their findings may not truly reflect the views or abilities of the wider nursing community or those working in different countries (Griffiths et al., 2014). One such study (Trinkoff et al., 2011) brings the reader’s attention to the fact that the study participants were more highly educated than the average nurse and the hospital where the research took place, unlike many others, was a teaching hospital. Barker and Nussbaum (2010) also confirmed that nurse’s roles and duties can considerably differ according to their area of work and their discipline and, Calhoun et al. (2014) evidenced that their research was predominantly undertaken during day shifts, therefore the ability to generalise any of their results, to include night shifts, may be compromised. 100% of the studies reported on associations between the length of shift, fatigue and adverse events however, Barker and Nussbaum (2010), Witkoski-Stimpfel and Aiken (2013) and Griffiths et al. (2014) clearly state that they are unable to conclude the direction of the associations or indeed the causation. In fact, Griffiths et al. (2014) and Tanaka et al. (2010) admit that shift work, actual working hours and the time at which adverse effects occurred were not assessed as part of their research. Even where these measurements were included, the results may not have been considered reliable. Geiger-Brown et al. (2012) requested that data be recorded on the day their participants returned to work following two rest days, however work shifts on the days prior to the rest days, were not recorded. Therefore, high levels of fatigue may have been carried forward, due to inadequate recovery. While Barker and Nussbaum (2011) declare that the levels of mental fatigue recorded in their participants was reduced compared to that of registered nurses, they say this could be caused by the inability to recreate the higher level of mental demand that is present in the true nursing environment. The results collated by Olds and Clarke (2010) were also unable to determine when, during a shift, an increase in reported incidents of adverse events was likely to occur. Nor were they, or Witkoski-Stimpfel and Aiken (2013) able to predict the participant’s interpretation of the Likert type scales, used to dichotomise responses to the occurrence of adverse events, which they believe, may have caused a variation in their responses. Although all of the research findings were published in or after 2010, a few of the papers have utilised data published as early as 2001 (Barker and Nussbaum, 2010) and 1999 (Olds and Clarke, 2010), who recognise that many other research projects have since been undertaken linking the harmful outcomes of adverse events and nursing schedules therefore their results may not be as relevant today.   3.4 Critical appraisal of body of literature -Validity/Reliability/Trustworthiness of the ten research papers   Of the studies reviewed, all but Calhoun et al. (2014), whose assessments were only observed by senior nurses, utilised between 2 and 5 recognised scales in order to ensure their findings were validated. To evaluate measures of scheduling patterns, Trinkoff et al. (2011) presented the participant’s self-reported work schedules to specialists from the ‘National Institute for Occupational Safety and Health’ to scrutinise for content validity, while the ‘Standard Shiftwork Index’ was also applied, they state, to ‘standardise self-report measures used in shiftwork research’. The self-reported staff-to-patient ratio in the Olds and Clarke (2010) paper had also been validated in earlier studies. Similarly, the standard of the practical nursing environment itself with regard to ratios of nurses to patients was previously measured with the use of the authenticated ‘Practice Environment Scale of The Nursing Work Index’ (Witkoski-Stimpfel and Aiken, 2013).                                                                                                                                                                                                            Barker and Nussbaum (2010) and Barker and Nussbaum (2011) each made use of five sets of scales to measure various levels of fatigue, including ‘SOFI’ which measured fatigue associated with labour, over four dimensions, and they reported that it was previously established as ‘reliable and/or valid’. As was the ‘F-RSQ’, which both studies also employed, in order to quantify physical and mental fatigue states. This survey had previously, and successfully, been utilised to measure the levels of mental fatigue, specifically, among the nursing population (Barker and Nussbaum, 2011).                                                                                                                                                                       Nurse levels of chronic/acute fatigue and recovery between shifts was determined by The Occupational Fatigue Exhaustion Recovery (OFER) scale in the Barker and Nussbaum (2010), Barker and Nussbaum (2011) and Scott, Arslanian-Engoren and Engoren (2014) studies, where earlier comprehensive testing in the nursing environment has proved its ability to provide increased levels of validity (Scott, Arslanian-Engoren and Engoren, 2014) and internal reliability, while removing biases based on gender (Barker and Nussbaum, 2010). Visual Analogue Scales (VAS) scores in the Scott, Arslanian-Engoren and Engoren (2014) paper, which allowed nurses to measure aspects of decision regret, have also proved to be reliable and valid when measuring findings from individual self-report surveys.                                                                                                                                                                                Although the use of ‘Actigraphy’ and the ‘Karolinska Sleepiness Scale’ (KSS), which Geiger-Brown et al. (2012) utilised in their research, have both demonstrated validity separately, the practice of inputted KSS scores in the Actiwatch Scores to better determine levels of sleepiness was, at that time, unable to be verified as valid. Likewise neither can the reaction speed of nursing tasks, measured by the ‘Walter Reed Psychomotor Vigilance Test’ (PVT), be validated (Geiger-Brown et al., 2012). However, the Griffiths et al. (2014) survey was derived from ‘International Hospital Outcomes Study’ which was made up of several individual aspects. Each of these aspects were based on the ‘Basel Extent of Rationing of Nursing Care’ (BERNCA) instrument which has previously been certified to produce valid connections between the experience of the patient, care left undone and the outcomes of these. Therefore, the validity of their study, and all items within it, were classed as either ‘good’ or better.   5 Critical appraisal of body of literature -Ethical issues   3.5.1 Ethical issues :- general     The ethical issues which face researchers come about due to the rules put in place to safeguard human rights (Polit and Beck, 2014). To ensure these rights are upheld during experimental models of research, the advice of Ethical Research Committees, which are present within the majority of hospitals (Newell and Burnard, 2006), is sought (Parahoo, 2006). In order to adhere to these ethical principles, which consist of; veracity, justice, beneficence, fidelity and respect (Moule and Hek, 2011), it is imperative that valid consent is gained from all of the participants and that confidentiality and/or anonymity can be assured with regards to the data collected (Polit and Beck, 2014) while the mental and physical well-being of all participants must also be considered (Parahoo, 2006). The quality of quantitative research can be measured by how valid and reliable it is. The reliability of collected data is demonstrated by the constancy and accuracy of the results produced and the ability to repeatedly produce the same results (Newell and Burnard, 2006). The reliability of quantitative research is determined by whether the results are able to be replicated elsewhere and their findings are able to be generalised (Parahoo, 2006). The likelihood that the results obtained can be reproduced using another sample or population of participants, and that those results would imitate the expected results from the wider population, is known as ‘statistical reliability’ (Polit and Beck, 2014). Validity is determined by how effectively the particular data being collected is measured. If the tool or model used measures what it is designed to measure, the results are considered valid. However, this is only true when the tool or model, used to measure the data, are used correctly, as improper use can produce invalid results (Moule and Hek, 2011). In quantitative research, trustworthiness is determined by the ability to generalise the results to other environments or populations and is known as its external validity. However in qualitative research trustworthiness is derived from four components; Credibility, which is determined by whether the conclusion is backed with sufficient evidence and reasoning (Williamson and Whittaker, 2014); Transferability, which is determined by how meaningful the conclusions are in other environments; Dependability, determined by its reliability i.e. the ability to consistently repeat the results; and Confirmability, which is supported by the lack of bias from the researcher and respondents (Lincoln and Guba, 1985, cited in Robert Wood Johnson Foundation, 2008). From the very beginning of the research process and throughout, bias, in one form or another, can affect the results. Bias can influence final results during many parts of the research processes from sampling and researcher bias at the very beginning to systematic bias throughout (Moule and Hek, 2011). 3.5.2 Critical appraisal of body of literature Ethical issues re: Ten research Papers   The precise ethical issues faced by the researchers were not disclosed however, seven of the papers outlined which official bodies approved their research methods. The data from the three remaining papers was gleaned from previous studies and, due to their secondary analysis approach of just one data source each, Olds and Clarke, 2010 and Trinkoff et al. 2011 found that ethical issues were not discovered or did not emerge. Similarly the research carried out by Witkoski-Stimpfel and Aiken, 2013, also used data collected previously however their information came from two sources and as such the authors gained approval from the institutional review board affiliated with their university. This form of approval was also sought and gained by Barker and Nussbaum (2010), Geiger-Brown et al. (2012), Barker and Nussbaum (2011) and Calhoun et al. (2014) for their research papers. Ethical consent in the Griffiths et al. (2014) and Tanaka et al. (2010) papers was awarded from various ethical committees and by the human research review committee in the Scott, Arslanian-Engoren and Engoren (2014) study.                               EXAMPLE OF HIERACHY IN THE APPENDICES YOU HAVE TO COMPLETE YOUR TABLE – USE TEXT BOOKS   IN COLUMN 1 AND WHAT LIST WHAT YOU HAVE FOUND IN COLUMN  2 – 2 COLUMNS Appendices 1   Evidence Hierarchy Level Level explanation/definitions COLUMN 1 USE RESEARCH BOOKS AVEYARD ETC COLUMN 2 9 articles 1  Systematic review A systematic review uses a clear and comprehensive methodology and, following a strict protocol the reviewer(s) ensures explicit and rigorous focus in identifying, critically appraising and synthesizing an exhaustive summary of current literature in order to answer a predefined question. The quality and validity of the selected research is developed using inclusion and exclusion criteria in which two researchers, or more assess, critique, evaluate and analyse the literature before pulling it together and combining it for review in their own study. Due to the time consuming precision and exhaustive nature of systematic reviews they are considered to be the most detailed and robust forms of review that exists. Pearce, C., Swift, J. and Figgett, D. (2015). Post-qualifying learning for social work. British Journal of Social Work, 45(3), pp. 880-895 Trevithick, P. (2008). Revisiting the knowledge base of scial work: A framework for practice. British Journal of Social Work, 38(6), pp. 1212-1237 Parton, N. (2000) Some thoughts on the relationship between theory and practice in and for social work. British Journal of Social Work, 30, pp. 449-463 Martyn, H. (2015) How has the Professional Capabilities Framework changed social work education and practice in England? British Journal of Social Work, pp. 1-16 Taylor, I., and Bogo, M. (2014) Perfect opportunity~perfect storm? Raising the standards of Social Work education in England. British Journal of Social Work, 44, pp. 1402-1418 Burgess, H., Barcham, C., and Kearney, P. (2014) Response to Taylor and Bogo, ‘Perfect opportunity~perfect storm’. British Journal of Social Work, 44(7), pp. 2067-2071 Brigid, D. (2013) Social work: a profession in flux. Journal of workplace learning, 25(6), pp. 394-406 2  Single Randomised Control Trial (RCT) Randomised control trials (RCT’s) are a form to scientific evaluation widely used for showing relations in health and social care because the empirical design of the research is the only one that allows the researcher to control, or completely remove extraneous variables without even having to isolate or be explicitly aware of them. The ability to control variables also enables the researcher to evaluate complex interventions made up of linked parts that act both independently and inter-dependently. Amongst social sciences RCT’s are regarded as the most accurate research method as it almost completely removes any accusations or conscious or subconscious bias and is therefore practically guaranteed external validity, although substantial costs and resources make it a more suited to large study samples.     3  Single Non- Randomised Trial (Quasi- Experiment) A Non-randomised control trial (NRCT’s) is an empirical study in which the research defines and manages the variables and assigns them to the participants whilst monitoring and controlling exposure in order to evaluate and provide evidence on the effectiveness of interventions and/or treatments. Due to researcher manipulation NRCT’s are not considered to be a true scientific experiment and there is great controversy over the validity related to the existence and magnitude of selected biases, sub sequentially NRCT’s are generally only selected when RCT’s are considered unfeasible or unethical. McDonald, A., Postle, K., and Dawson, K. (2008) Barriers to retaining and using professional knowledge in Local Authority social work practice with adults in the UK. British Journal of Social Work, 38, pp. 1370-1387   4 Single Prospective/ Cohort studies A cohort is defined as a group who experience the same variable within a defined period and the study of which refers to an observational study, which amongst other disciplines can be used in social science to accurately observe, measure and compare outcomes without experimental manipulation. Cohort studies can be prospective or retrospective; prospective studies are carried out from the present time into the future and are designed with specific data collection methods offering the advantage of tailoring collection of specific experience data, making it more complete but, because of the nature of observing cohort studies often take long periods to follow up and are susceptible to high withdrawals. Plenty, J., and Gower, D. (2013). The reform of social work practice education and training and supporting practice educators. Journal of Teaching and Learning, 12(2), pp. 48-66 5 Single Cross- Sectional study (Survey) A cross-sectional study is defined as an observational study in which population groups can be compared at a single point in time with the benefit of enabling comparisons of many different variables in the attempt to collect data to answer a predetermined question of research. In social sciences, cross sectional studies are the most commonly used data collection tool for assessing the factors of behaviour, although it is limited in terms of measuring developing change, requiring further surveys in succession to measure variables at two or more points in time. Keen, S., Parker, J., Rutter, L., Williams, S., and Brown, K. (2010). Practice education: where next? Journal of Practice Teaching and Learning, 10(2), pp. 63-88 Bates, N., Immins, T., Parker, J., Keen, S., Rutter, L., Brown, K., and Zsigo, S. (2010) ‘Baptism of Fire’: The First Year in the Life of a Newly Qualified Social Worker. Social Work Education, 29(2), 152-170 Manthorpe, J., Mortiarty, J., Hussein, S., Stevens, M., and Sharpe, E. (2015) Content and Purpose of Supervision in Social Work Practice in England: Views of Newly Qualified Social Workers, Managers and Directors. British Journal of Social Work, 45, 52-68     6Single In- Depth Qualitative Study Qualitative approaches investigate the why and how of outcomes in addition to the what, where, when and who and can contribute in several ways to the development and evaluation of complex interventions, evaluating variables which are interlinked. Additionally interlinking methods are also noted with an increasing qualitative component to RCT’s due to the complimenting methods used, allowing for in-depth and thorough examination with potential to minimise the personal biases and idiosyncrasies synonymous of qualitative methods. Qualitative research studies have a strong basis in understanding government and social agendas in addition to other areas of social science such as social work and education. Manthorpe, J., Mortiarty, J., Stevens, M., Hussein, S., and Sharpe, E. (2014). The ‘making’ of social workers: Findings from interviews with managers of newly-qualified social workers. Practice: Social Work in Action, 26(2), pp. 97-111 Bernard, C., Fairtlough, A., Fletcher, J., and Ahmet, A. (2014) A qualitative study of marginalised social work students’ view of social work education and learning. British Journal of Social Work, 44(7), pp. 1934-1949 Sieminski, S., and Seden, J. (2011) An exploration of how some tutors use learning materials to enable student social workers to link theory to practice while learning in the workplace. Social Work Journal: The International Journal, 30(7), pp. 797-810 Wilson, G., and Kelly, B. (2010) Evaluating the effectiveness of social work education: Preparing students for practice learning. British Journal of Social Work, 40, pp. 2431-2449 7Expert Opinion, Case report Case reports are descriptive analytical research methods based on observation and are often used prospectively to describe and document the potential effectiveness of new interventions. In case report research the researcher does not manipulate the intervention instead allows the natural course of the intervention and provides descriptive opinions and evaluations on the outcomes.   Table 2.0 references Table    Aveyard (2014),  Polit and Beck (2014), Bettany-Saltikov (2012)                                

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