1. Critically reviewing qualitative papers using a CASP critiquing tool
Di Carpenter
How to Write Your Nursing Dissertation, First Edition. Alan Glasper and Colin Rees.
© 2013 John Wiley & Sons, Ltd. Published 2013 by John Wiley & Sons, Ltd.

2. Scenario
Sue, the top‐up degree student, and Sam, the MSc student, have identified a range of qualitative papers that they need to critically appraise to assess the strength of the evidence to determine whether a change in practice is warranted.
They have both been advised by their supervisor to use ‘The Critical Appraisal Skills Programme’ (CASP) appraisal tool suite. Sam is considering using the version for qualitative research. CASP has developed several appraisal tools for different kinds of research.

3. CASP Appraisal Tool
The tool designed to make sense of qualitative evidence has been developed for those who are not very confident or familiar with qualitative research and, as such, provides a starting point. The appraisal tool is copyright protected but it may be used by individuals so long as it is appropriately referenced – the complete tool can be found at: (Public Health Resource Unit, 2006 )
More details about CASP can be found at: (NHS, 2012 ).

4. Shortcuts The CASP tools include two screening questions.
If these can be answered with a ‘Yes’ it is worth continuing with the appraisal.
Sue and Sam were pleased to be saved unnecessary time. They were able to affirm the screening questions for the clown article:
(1) there was a clear statement about the aims of the research and
(2) a qualitative methodology was appropriate.

5. They could have worded it better though – it sounds like a hospital for large children – they’re adults aren’t they?
The focus of the research is definitely qualitative: The perceived effects of clown humour as experienced by children in a large children’s inpatient facility in the South of England

6. 8 Detailed Questions Followed
Was the study design appropriate?
Yes, they described the choice of ‘draw and write / draw and tell’ which are two complementary qualitative research designs.
Did they discuss how they chose their research method?

7. Was the Recruitment Strategy Appropriate?
Children were selected between the ages of four and eleven years as this age group is suitable to engage with the research methods of ‘draw and write / draw and tell’.
It wasn’t really clear why 20 children were chosen though!
The researchers had approached forty-two children but initially sixteen did not consent to participate and a further six were unable to complete the second part of the data collection (they were discharged home early or felt too unwell).

8. Were the Data Collected in a Way That Addressed The Research Issue?
I don’t think that the setting for the data was entirely justified within the article. It was very clear, however, how the data were collected.

9. Reflexivity is the Focus of Questions 6 and 7
Ethical issues and consent were addressed though.
The article makes no reference to the researcher having made a critical examination of her role, potential bias or influence.
Well perhaps some potential for bias or influence was addressed, but it was not sufficiently focussed on the investigator’s own potential for influence and interpretation.

10. Data Analysis
The article provided a reasonably in-depth description of the process of analysis; a thematic analysis was used and an appropriate technique of coding data was utilized to delineate common themes.
There had been no discussion of contradictory data and no critical examination of bias or influence in the selection of data for presentation.

11. Research Findings
The findings were clear and explicit and supported by two tables. Some discussion of the credibility of the findings was included, but there appeared to be no discussion of the evidence for and against the researchers’ arguments although the findings were contextualized with respect to the original research questions.

12. How Valuable is the Research?
The authors had claimed that the study added to the growing literature base for the efficacy of clown humour as experienced by children in hospital.
The limitations of the study were also identified and included that data were collected from children in only one hospital.

13. In Summary
The methodology was suitable for the nature of the enquiry and that the research had been conducted appropriately.
The data collection was consistent with the methodological approach and addressed the research issue.
The data analysis had also been conducted rigorously, but that some important discussion points were missing from the article.

14. And...
One of the study’s weakest areas appeared to Sue and Sam to be in the area of reflexivity. There seemed to have been little consideration of the relationship between researcher and participants and insufficient account made of the ethical considerations.

15. Which the authors also stated.
Finally
Further study is needed before any confidence could be given to the transferability of the findings or any change in practice made.
Which the authors also stated.

16. References
Greenhalgh, T. (2010), How to Read a Paper 4th edn. (London; Blackwell publishing). 
Weaver, K., Prudhoe, G., Battrick, C. And Glasper, E.A. (2007), ‘Sick children’s perceptions of clown doctor humour’, Nursing Times, Vol 1, No. 8, pp
, ‘Critical Appraisal Skills Programme: 10 Questions to help you make sense of Qualitative Research’ consulted on 11/02/2011
, ‘Critcal Appraisal Skills Programme’ consulted on 11/02/2011