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An overview of research theory and process
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This article examines several methodological issues associated with combining qualitative and quantitative methods by comparing the increasing interest in this topic with the earlier renewal of interest in qualitative research during the 1980s. The first section argues for the value of Kuhn’s concept of paradigm shifts as a tool for examining changes in research fields such as social science research methodology. The next two sections consider the initial rise of the “metaphysical paradigm” that justified the renewed interest in qualitative research and the subsequent problems that have encouraged efforts to replace that paradigm. The final section of the paper advocates a “pragmatic approach” as a new guiding paradigm in social science research methods, both as a basis for supporting work that combines qualitative and quantitative methods and as a way to redirect our attention to methodological rather than metaphysical concerns.
‘Best research practice’: in pursuit of methodological rigour
Rationale. This paper is based on the rationale that misuse of methodological notions in research publications lays research studies open to criticism and dismissal.
Aim. In search of ‘best research practice’, this paper aims to examine the different qualities of four major qualitative methodologies: ethnography, descriptive phenomenology, interpretative phenomenology/hermeneutics and critical social theory.
Design. The study presents a critical overview of methodological decision-making, illustrating the sorts of issues researchers must consider in order to justify to the readership and to themselves the employment of a particular methodology. This is presented alongside a general overview of qualitative research and a précis of each of the major qualitative methodologies. The paper describes the methodologies, salient features, and examines methodological similarities and differences. The paper concludes by examining the need for methodological rigour within the framework of the National Health Service (NHS) Executive’s drive for evidence-based practice in health care.
Recommendations. It is hoped that the paper will stimulate a deeper exploration of methodological rigour in future research publications.
This paper is a report of an analysis of the use of theory in qualitative approaches to research as exemplified in qualitative end-of-life studies.
Nurses researchers turn to theory to conceptualize research problems and guide investigations. However, researchers using qualitative approaches do not consistently articulate how theory has been applied, and no clear consensus exists regarding the appropriate application of theory in qualitative studies. A review of qualitative, end-of-life studies is used to illustrate application of theory to study design and findings.
A review of theoretical literature was carried out, focusing on definitions and use of theory in qualitative end-of-life studies published in English between 1990 and 2008.
The term 'theory' continues to be used in a variety of ways by theorists and researchers. Within the reviewed end-of-life studies, the use of theory included theory creation or provision of a comparative framework for data analysis and interpretation. Implications for nursing. Nurses who conduct qualitative studies should examine the philosophical and theoretical bases of their selected methodological approach, articulate a theoretical framework that fits the phenomenon being studied, and adopt a critical, flexible and creative attitude when applying theory to a study.
Theory can be put to several uses in qualitative inquiry and should guide nurse researchers as they develop and implement their studies. Nurse educators who teach qualitative approaches to research should emphasize a variety of ways to incorporate theory in qualitative designs.
Although evidence indicates that women who suffer a myocardial infarction (MI) are less likely than men to be diagnosed based on their presenting symptoms, to receive aggressive treatment, and to survive an acute cardiac event, most studies conducted to date are retrospective chart reviews that examine the triage decision-making practices of physicians.
This study examined whether emergency department (ED) nurses' triage decisions were different when the nurse was presented with similar cues for MI, but different patient gender.
A nonexperimental, descriptive study was conducted. Five hundred ED nurses were randomly selected to receive a mailed clinical vignette questionnaire. Data analysis included descriptive, bivariate, and multivariate analyses.
ED nurses perceived the middle-aged male vignette patient to be in need of more urgent triage (t = 2.58; df = 207; p = 0.01) and an admission to an intensive care unit bed (chi2 = 10.43; df = 1; p = 0.001) and were more likely to consider a cardiac diagnosis in the male than the age-matched female (chi2= 37.49; df = 1; p < 0.0001) with identical presentation. However, no such differences were noted in the elderly vignette patients.
The findings of this study suggest that gender bias and ageism may account for the disparities in triage decisions for middle-aged women with complaints suggestive of coronary artery disease. Although middle-aged women may have a lower incidence of MIs than middle-aged men, their increased morbidity and mortality warrants its consideration.
To examine Chinese women's satisfaction with and the perceived effect of childbirth education class on their labour experience.
Attending childbirth education classes is a common activity for pregnant women. Nonetheless, evidence reveals that evaluation of the effects of childbirth education classes is inconsistent. Moreover, women's perceived effect of these classes has not been systematically examined.
This two-phase study adopted a mixed-method design with Donadedian's model as the theoretical framework. In Phase One, a random sample of 40 Chinese women was invited to complete a questionnaire after attending a childbirth education class. The questionnaire was focused on their satisfaction with specific aspects of the class. Descriptive statistics were performed to summarize participants' response. In Phase Two, six of the original 40 women were purposely selected for a semi-structured interview pertaining to the perceived effect of the childbirth education class on their labour experience. Thematic analysis was conducted on the interview data.
The participants expressed overall satisfaction with the class. The area that satisfied them the most was the performance of the midwife. The areas that satisfied them the least were the date, length, size and time of the class. Three themes emerged from the interview data, namely, 'learning about labour', 'contributing to a smooth labour process' and 'coping with uncertainty and handling anxiety.
This study supports using a mixed-method approach to evaluate client education activity, and highlights the importance of cultivating positive coping measures among the Chinese women after attending childbirth education class when facing childbirth-related anxiety.
To test the effectiveness of an efficacy-enhancing educational intervention to promote women's self-efficacy for childbirth and coping ability in reducing anxiety and pain during labour.
The evidence of the effective application of the self-efficacy theory in health-promoting interventions has been well established. Little effort has been made by health professionals to integrate self-efficacy theory into childbirth care.
Randomised controlled trial.
An efficacy-enhancing educational intervention based on Bandura's self-efficacy theory was evaluated. The eligible Chinese first-time pregnant women were randomly assigned to either an experimental group (n = 60) or a control group (n = 73). The experimental group received two 90-minute sessions of the educational programme in between the 33rd-35th weeks of pregnancy. Follow-up assessments on outcome measures were conducted within 48 hours after delivery. The short form of the Chinese Childbirth Self-Efficacy Inventory was used to measure maternal self-efficacy prior to labour. Evaluation of pain and anxiety during the three stages of labour and performance of coping behaviour during labour were measured by the Visual Analogue Scale and Childbirth Coping Behaviour Scale respectively.
The experimental group was significantly more likely than the control group to demonstrate higher levels of self-efficacy for childbirth (p < 0.0001), lower perceived anxiety (p < 0.001, early stage and p = 0.02, middle stage) and pain (p < 0.01, early stage and p = 0.01, middle stage) and greater performance of coping behaviour during labour (p < 0.01).
The educational intervention based on Bandura's self-efficacy theory is effective in promoting pregnant women's self-efficacy for childbirth and reducing their perceived pain and anxiety in the first two stages of labour.
Relief of pain and anxiety is an important issue for both women and childbirth health professionals. The efficacy-enhancing educational intervention should be further developed and integrated into childbirth educational interventions for promoting women's coping ability during childbirth.
A plethora of studies describe helping professionals' responses to and actions directed toward battered women in the emergency department. However, research that yields data regarding the clients' perceptions about their actual experiences in the ED setting is sorely needed. The aim of this study was to describe battered women's perceptions of their ED experience.
A qualitative design, namely a phenomenologic approach, was used for this inquiry to enable the women to express themselves in their own voices. Informants were recruited from shelters for battered women. Women who had sought help for abuse-related injuries at a hospital emergency department within the past 12 months were asked to participate. Methods used to collect data were in-depth, individual, audiotaped interviews and demographic data sheets. Data analysis was conducted using Colaizzi's (1978) procedural steps.
Several categories emerged as being descriptive of the women's perceptions of their ED experience. Themes identified included the women's feelings during the visit, such as fear of their partner, concern for children, and loneliness; the women's belief that the ED staff do not understand abuse; satisfaction with treatment of physical injuries but dissatisfaction with how the issue of abuse is managed; the difficulty of disclosing the abuse because of fear, embarrassment, and a lack of resources; and a request that health care professionals display compassion, provide referrals, and offer options.
The women's narratives explicate their feelings during the ED visit and sensitize nurses to their experience. The reports of dissatisfaction with the care they received in the emergency department add to the validity of findings from previous studies that have documented similar results and point to the need to examine and reshape the delivery of care to abused women in the emergency department.
The focus of the study tour to several research and nursing units in Australia and New Zealand (NZ) was to investigate what has influenced the way nurses implement research into practice. The key areas examined were strategic policy influences, activities within leading academic units and responses in practice areas. The main themes to emerge were that the strategies developed by health policy makers in Australia and New Zealand have been profoundly influenced by the global clinical effectiveness and evidence-based practice movements. Nursing needs to position itself firmly in the centre of such developments and leading nursing initiatives need to be mainstreamed into the wider evidence-based movement. While activity around clinical/practice guideline development moves on, more work needs to be done to understand how best to actually implement research in practice. Issues of organizational context, ownership, practice, culture and identifying local champions are emerging as key challenges for the next stage of implementation. Much can be learnt from ongoing dialogue.