“Liminality and Transfer to Adult Services” by Tierney

Research Report Title: Liminality and transfer to adult services: A qualitative investigation involving young people with cystic fibrosis

Critique with rationale



The title of the article introduces a clear picture of what is going to be discussed in the article. The main focus of the study is the introduction of a liminality concept. The central phenomenon is cystic fibrosis and the process of transfer to adult services, and young people (adolescents) are considered to be the study population. A qualitative investigation is chosen as a significant part of research methodology. However, the topic has to be improved upon for clarity as it fails to introduce the context of the research. In the article, it is stated that young people with cystic fibrosis from the north west of England are chosen for the analysis, and the topic fails to underline this particular fact about the chosen location.

Literature Review and Background of the Problem

In the article, there is no particular chapter called “Literature Review”, still, in the introduction, literary analysis as well as problem background is given. The structure of the literature review is well-organized. First, a general evaluation of a transfer process’ importance for patients is offered. Then, young people with cystic fibrosis are chosen as an exemplar for exploring an issue. Adolescents with cystic fibrosis may face a number of problems and should be able to solve them within a short period of time to avoid further complications (Robertson, 2006). Finally, certain attention is paid to liminality and its relevance to adolescents with cystic fibrosis. However, the recentness of the chosen sources (1969 and 1960) proves that certain investigations have to be done immediately. The authors mention that many articles about transfer and cystic fibrosis patients are quantitative by their nature. Though almost all sources (in general, there are 44 sources) are peer reviewed journals, little in-depth exploration on the basis of a qualitative design is given (Tierney, Deaton, Jones, Oxley, Biesty, & Kirk, 2013). The authors use many updated sources (2>10 years), still, the inability to find quality sources within the last five years leads to the use of the investigations of the 1960s. This is the main gap in literature – the definition of ‘liminality’ concept is based on the material of the 1960s, and the transfer process of young people with cystic fibrosis is described on the basis of the sources of the 2000s. The reader should learn how to use modern possibilities and overcome the challenges of the past centuries. All sources are paraphrased, no reliance on quotes is offered.

Sampling & Recruitment

Sampling (the choice of study participants) is one of the most important steps of a qualitative research (Polit & Beck, 2014). The study population of the article is not huge, 19 participants only (12 of them are males). All of them are chosen no more than a year prior to the period when data was gathered. The authors choose adolescents from the north west of England, who have to get their treatment in the same hospital as paediatric clinics (Tierney et al., 2013). The choice of participants undergoes certain norms: 2 people got refused due to psychosocial difficulties, the others were interviewed face-to-face and via e-mail. The choice of participants is explained by the necessity to provide adolescents in need with the required portion of treatment and appropriate conditions for the transfer period. Face-to-face communication allows the researchers observing the attitudes of the patients to the questions posed. Though not all young people with cystic fibrosis agreed to participate, the offered number of people was enough to organize an interesting investigation.

Data Collection (incl. Reliability & Validity for Quantitative Instruments)

The participants choose the most preferable methods of data collection from the interviews via e-mail or face-to-face. Such decision is made considering the age of the group of people chosen for the research. Young people are eager to share information online and spend as much time as they want on questioning. The interviews are transcribed verbatim and saved as Word documents. There are several questions about first impressions about adult clinics, personal preparations for the transfer period, memories about other patients with cystic fibrosis, pieces of advice, etc. The authors also underline that the flexible nature of the chosen qualitative research provided them with a chance to change questions in accordance with the data collected outside from the interviews. Still, the data collection methods remain to be interesting and appropriate for the chosen form of research. Trustworthiness of the study is enhanced due to the attention to patients’ desire to stay anonymous: on the one hand, there are no transcribed sources of information, and on the other hand, patients’ identities may be defined by the interviewer if necessary. Data triangulation (LoBiondo-Wood, & Haber, 2014) has been achieved due to the fact that the research is based on the analysis of literature and interviews taken from different times and people. Finally, the results of the research are introduced on the basis of the interviews, observations, and literary analysis and prove that the chosen research question concerning liminality importance is a burning issue and has to be discussed from different perspectives to improve the conditions under which young people with cystic fibrosis have to overcome transfer challenges.

Ethical considerations

The main strategy to protect participants’ rights is based on the presentation of information about the peculiarities of the research and time provision to discuss possible outcomes of participation with other people beforehand. The local research ethics committee approve the research and prove that all issues concerning anonymity and confidentiality are met. All possible risks are minimized due to the possibility to stop collecting information at any stage without giving any explanations and further investigations. Meetings are organized on a regular basis, so the participants can easily address the investigators and ask questions any time to clarify some point. The diary created by one of the writers provides patients with a kind of insurance about what kind of information could be used in the article.

Data Analysis

Data interpretation is combined with the analysis of the interviews’ answers. The authors use a systematic thematic analysis known as framework that consisted of the following stages: data familiarisation, development, indexing, charts’ development, and data interpretation. As soon as an indexing scheme is developed, the authors summarize the interviews and conclude that their results resonated with the liminality concept (Tierney et al., 2013). They prove that liminality may be used to help young people with cystic fibrosis to succeed in a transitional programme in case various stakeholders like nurses, family members, friends, etc. invest the process. Data analysis’ steps are specific to phenomenological study of the article (Beck, 2009): some bias possibilities are not identified, and the interviews with 19 patients show that liminality could be used as a powerful tool for patients with cystic fibrosis to rely on.


Beck, C.T. (2009). Critiquing qualitative research. AORN Journal, 90(4), 543-554.

LoBiondo-Wood, G. & Haber, J. (2014). Nursing research: Methods and critical appraisal for evidence-based practice. St. Louis, Missouri: Elsevier Health Sciences.

Polit, D.F. & Beck, C.T. (2014). Essentials of nursing research: Appraising evidence for nursing practice. Philadelphia, PA: Lippincott Williams & Wilkins.

Robertson, L. (2006). When should young people with chronic rheumatic disease move from paediatric to adult-centred care? Best Practice and Research: Clinical Rheumatology, 20(2), 387-397.

Tierney, S., Deaton, C., Jones, A., Oxley, H., Biesty, J., & Kirk, S. (2013). Liminality and transfer to adult services: A qualitative investigation involving young people with cystic fibrosis. International Journal of Nursing Studies, 50(6), 738-746.

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