The qualitative-quantitative debate: moving from positivism and confrontation to post-positivism and reconciliation

The intersection between logical empiricism and qualitative nursing research: a post-structuralist analysis

PURPOSE

To shed light on and analyse the intersection between logical empiricism and qualitative nursing research, and to emphasize a post-structuralist critique to traditional methodological constraints.

METHODS

In this study, a critical examination is conducted through a post-structuralist lens, evaluating entrenched methodologies within nursing research. This approach facilitates a nuanced exploration of the intersection between logical empiricism and qualitative nursing research, challenging traditional methodological paradigms.

RESULTS

The article focusing on the "what abouts" of sample size, analytic framework, data source, data analysis, and rigour and methodological considerations, challenging the predominance of semi-structured interviews and the reliance on spoken voice as primary data sources, and re-evaluating the conventional notion of "rigour".

CONCLUSIONS

I advocate for a shift from qualitative positivism towards more interpretive and post-qualitative inquiries, this work proposes new trajectories through interpretive, critical, post-qualitative, and artistic turns in nursing research, aiming to transcend positivist limitations and foster a plurality of perspectives and research as praxis. Implications emphasize the need for nursing researchers to expand methodological horizons, incorporating visual and artistic methods to enrich understanding and representation of health experiences, moving beyond positivist norms towards a more inclusive and ethically sound research paradigm.

Non-pharmacological management of osteoporotic vertebral fractures: health-care professional perspectives and experiences

PURPOSE

To understand experiences and perceptions on non-pharmacological treatment of vertebral fractures and virtual-care from the perspective of care professionals' (HCPs).

DESIGN AND SETTING

We conducted semi-structured interviews with 13 HCPs within Canada (7 F, 6 M, aged 46 ± 12 years) and performed a thematic and content analysis from a post-positivism perspective.

RESULTS

Two themes were identified: acuity matters when selecting appropriate interventions; and roadblocks to receiving non-pharmacological interventions. We found that treatment options were dependent on the acuity/stability of fracture and were individualized accordingly. Pain medication was perceived as important, but non-pharmacological strategies were also considered helpful in supporting recovery. Participants discussed barriers related to the timely identification of fracture, referral to physiotherapy, and lack of knowledge among HCPs on how to manage osteoporosis and vertebral fractures. HCPs reported positive use of virtual-care, but had concerns related to patient access, cost, and comprehensive assessments.

CONCLUSION

HCPs used and perceived non-pharmacological interventions as helpful and selected specific treatments based on the recency of fracture and patient symptoms. HCPs' also believed that virtual-care that included an educational component, an assessment by a physiotherapist, and an exercise group was a feasible alternative, but concerns exist and may require further evaluation.

"I just can't go back": Challenging Places for Older Americans since the COVID-19 Pandemic Onset

During the pandemic, many older adults felt 'out of place' in their home, work, and community spaces with potentially long-term consequences for health and wellbeing. Using national data from the COVID-19 Coping Study, thematic analysis of online long-answer responses (n = 1171; mean age 68 years; 71% female; 93% non-Hispanic White; 86% with at least a 4-year college degree; data collected April-June 2022) identified four themes regarding why particular places are challenging since the pandemic onset: (1) viral exposure fears, (2) frustrating regulations, (3) uncomfortable and hostile social dynamics, and (4) 'out of place' negative emotions. Participants also shared how they continuously address or adapt to place-based challenges through lifestyle adjustments and coping strategies. Novel findings may inform multi-scalar policymaking and interventions to support wellbeing in later life in times of stress and instability.

How to communicate with children, according to Health Play Specialists in the United Kingdom: A qualitative study

Child-focused anthropologists have described how sick-children utilise 'Play' and 'imagination' as a tool to cope and make-meaning of their illness-experiences. Health Play Specialists (HPS) are professional healthcare-workers who advocate for children and use 'playful' methods to improve communication with, and the lived-experience of, children in hospital. The research aim of this study was to identify strategies and methods employed by HPS to effectively communicate with children. The research methodology comprises interviews conducted with HPS and utilises a qualitative data-analysis model. The main findings include: the importance of 'Play' for chronically ill children; how HPS utilise material-resources to explain illnesses and procedures to children; structural challenges HPS face as a profession; and applicable advice for paediatric-healthcare-workers. This research highlights the importance of introducing a 'pro-play' mindset to healthcare-workers, in order to facilitate children's basic human-rights in hospital. It seeks to advocate for the potential of 'Play' and the value of HPS within paediatric-healthcare-settings, as well as the need for further recognition and multidisciplinary research in this area.

Functions of disordered eating behaviors: a qualitative analysis of the lived experience and clinician perspectives

BACKGROUND

One method to improve treatment outcomes for individuals with eating disorders (EDs) may be understanding and targeting individuals' motives for engaging in DE behaviors-or the functions of DE behaviors. The goal of this study was to investigate and categorize the various functions of DE behaviors from the perspectives of adults who engage in DE behaviors and clinicians who treat EDs.

METHODS

Individuals who engage in DE behaviors (n = 16) and clinicians who treat EDs (n = 14) were interviewed, and a thematic analysis was conducted to determine key functions of DE behaviors.

RESULTS

Four main functions of DE behaviors were identified by the authors: (1) alleviating shape, weight, and eating concerns; (2) regulating emotions; (3) regulating one's self-concept; and (4) regulating interpersonal relationships/communicating with others.

CONCLUSIONS

Differences in participant responses, particularly regarding the relevance of alleviating shape and weight concerns as an DE behavior function, highlight the importance of individualized conceptualizations of DE behavior functions for any given client.

Patient- and Team-Level Characteristics Associated with Handoff Protocol Fidelity in a Hybrid Implementation Study: Results from a Qualitative Comparative Analysis

BACKGROUND

Standardization is an evidence-based approach to improve handoffs. The factors underpinning fidelity (that is, adherence) to standardized handoff protocols are not well specified, which hampers implementation and sustainability efforts.

METHODS

The Handoffs and Transitions in Critical Care (HATRICC) study (2014-2017) involved the creation and implementation of a standardized protocol for operating room (OR)-to-ICU handoffs in two mixed surgical ICUs. The present study used fuzzy-set qualitative comparative analysis (fsQCA) to characterize combinations of conditions associated with fidelity to the HATRICC protocol. Conditions were derived from postintervention handoff observations yielding quantitative and qualitative data.

RESULTS

Sixty handoffs had complete fidelity data. Four conditions from the SEIPS 2.0 model were used to explain fidelity: (1) whether the patient was newly admitted to the ICU; (2) presence of an ICU provider; (3) observer ratings of attention-paying by the handoff team; and (4) whether the handoff took place in a quiet environment. None of the conditions were singly necessary or sufficient for high fidelity. Three combinations of conditions were sufficient for fidelity: (1) presence of the ICU provider and high attention ratings; (2) a newly admitted patient, presence of the ICU provider, and quiet environment; and (3) a newly admitted patient, high attention ratings, and quiet environment. These three combinations explained 93.5% of the cases demonstrating high fidelity.

CONCLUSION

In a study of OR-to-ICU handoff standardization, multiple combinations of contextual factors were associated with handoff protocol fidelity. Handoff implementation efforts should consider multiple fidelity-promoting strategies that support these combinations of conditions.

Factors Influencing Participation in Physical Activity, Sports, and Exercise in Children and Adolescents with Spinal Pain or Spinal Conditions: A Systematic Review and Meta-Ethnography

BACKGROUND

Physical activity is an effective treatment for paediatric spinal pain. However, participation rates remain low and review evidence is needed to establish why. This review identifies factors influencing participation in sports, exercise, and physical activity in those aged 18 or under with spinal pain or spinal conditions. Trends or differences between discrete sub-populations are identified.

METHODS

A meta-ethnographic review was undertaken. Qualitative papers were identified and appraised using the JBI checklist. Thematic trends were mapped onto the biopsychosocial model and subthemes identified. Uniqueness was calculated and the confidence in the evidence was evaluated using the GRADE-CERQual tool.

RESULTS

Data were gathered from nine qualitative papers (384 participants). Three themes were identified: (1) biological: physical challenges and bladder and bowel care; (2) psychological: perceptions of differences to peers, struggle, anger, sadness, adjustment, and acceptance; and (3) sociological: influence of friends, social acceptance, negative attitudes from others, and the influence of their disability on family routine.

CONCLUSIONS

Sociological factors were most influential on exercise participation alongside related psychological and biological factors. Adolescents over 14 years offered greater critical insight compared to the younger children. Results are best applied to neuromuscular conditions with further robust evidence required in paediatric musculoskeletal spinal pain.

Non-pharmacological management of osteoporotic vertebral fractures: Patient perspectives and experiences

OBJECTIVE

To understand perceptions on rehabilitation after vertebral fracture, non-pharmacological strategies, and virtual care from the perspective of individuals living with vertebral fractures.

DESIGN AND SETTING

We conducted semi-structured interviews online and performed a thematic and content analysis from a post-positivism perspective.

PARTICIPANTS

Ten individuals living with osteoporotic vertebral fractures (9F, 1 M, aged 71  ±  8 years).

RESULTS

Five themes emerged: pain is the defining limitation of vertebral fracture recovery; delayed diagnosis impacts recovery trajectory; living with fear; being dissatisfied with fracture management; and "getting back into the game of life" using non-pharmacological strategies.

CONCLUSION

Participants reported back pain and an inability to perform activities of daily living, affecting psychological and social well-being. Physiotherapy, education, and exercise were considered helpful and important to patients; however, issues with fracture identification and referral limited the use of these options. Participants believed that virtual rehabilitation was a feasible and effective alternative to in-person care, but perceived experience with technology, cost, and individualization of programs as barriers.

Patients' and therapists' experience and perception of exoskeleton-based physiotherapy during subacute stroke rehabilitation: a qualitative analysis

PURPOSE

To explore the experience and acceptability of an exoskeleton-based physiotherapy program for non-ambulatory patients during subacute stroke rehabilitation from the perspective of patients and therapists.

MATERIALS AND METHODS

This was a qualitative descriptive study using semi-structured interviews and thematic analysis. Fourteen patients with stroke who participated in the experimental arm of a randomized controlled trial investigating the efficacy of exoskeleton-based physiotherapy were recruited. Six physiotherapists who provided the intervention were also recruited.

RESULTS

Three themes were identified relating to the experience and acceptability of an exoskeleton-based physiotherapy program: (1) A matter of getting into the swing of things depicted the initial and ongoing learning process of using an exoskeleton; (2) More of a positive experience than anything else described the participants' mostly favorable attitude toward exoskeleton-based gait training; and (3) The best step forward captured participant-identified recommendations and considerations for the future integration of exoskeleton training into stroke rehabilitation.

CONCLUSIONS

Patients with stroke were even more optimistic than therapists toward the experience and benefits of exoskeleton-based gait training during subacute stroke rehabilitation. Future clinical practice should consider the balance between actual and perceived benefits, as well as the potential barriers to integrating an exoskeleton into stroke rehabilitation.IMPLICATIONS FOR REHABILITATIONPowered robotic exoskeletons can be used to provide higher duration and more repetitious walking practice for non-ambulatory patients with stroke.Patients with stroke view exoskeleton-based physiotherapy highly favorably, attributing greater opportunity and benefit to using the device during subacute rehabilitation.Physiotherapists should consider learning challenges, patient characteristics, and implementation barriers when integrating exoskeleton-based training within a treatment program.

Conceptualizing Context and Intervention as a System in Implementation Science: Learning From Complexity Theory Comment on "Stakeholder Perspectives of Attributes and Features of Context Relevant to Knowledge Translation in Health Settings: A Multi-country Analysis"

In implementation science, implementation has been widely theorized and assessed. Context, on the other hand, usually played a minor role in the field and was usually conceptualized in a rather positivist way. Despite some promising efforts, there is a strong need to continue building theory on context and operationalizing the concept in implementation practice. I argue for the benefit of integrating complexity theory into our understanding of context in order to further our thinking about context and intervention as a system. This should be reflected by the way in which we build theory as well as apply this theory by employing methods that adequately account for complexity in systems.

Exploring the Experiences of Co-morbid Pain and Depression in Older African American Women and Their Preferred Management Strategies

The intersection of race, gender, and age places older African American women at an increased risk for untreated physical pain and depression that can significantly diminish their quality of life. The objectives of this study were to (1) explore older African American women's perceptions of pain and depressive symptoms and how these symptoms influence each other, and (2) explore effective pain and depression alleviation strategies used by the women. We conducted five focus groups with older African American women (N = 18). We used deductive coding to analyze focus group transcripts and qualitative description to summarize themes. We identified five major themes: (1) Spiritual Suffering from Linked Pain and Depression, (2) Lack of Understanding from Healthcare Providers, (3) Push Through and Live Through, (4) Medications Not Worth the Risk and, (5) Strategies for Pain and Depression. This study offers insight into the experiences of pain and depression in older African American women, and alleviation strategies they perceive as effective. These qualitative findings may be used to inform interventions for older African American women who experience pain and depressive symptoms.

Perceptions of the caregiver-pediatric physical therapist relationship1

PURPOSE

Collaboration between physical therapists and caregivers of children who receive physical therapy is integral to providing family-centered care. Successful collaboration depends upon the therapeutic relationship built within the caregiver-therapist dyad. However, the nature of these relationships is not well understood. The purpose of this study was to explore the caregiver-pediatric physical therapist relationship from the perspectives of the caregiver and pediatric physical therapist.

METHODS

A qualitative multiple case study methodology was used; a caregiver and pediatric physical therapist represented a bounded case. Each caregiver and therapist engaged in separate, semi-structured, in-depth interviews.

RESULTS

Through within- and cross-case coding, three themes were identified: physical therapist as a guide, the caregiver-pediatric physical therapist connection, and professional qualities and performance.

CONCLUSION

These themes help to provide an understanding of the therapeutic relationships that can occur between caregivers and pediatric physical therapists, which can help support effective collaboration as part of providing family-centered care.

The Organic Turn: Coping With Pandemic and Non-pandemic Challenges by Integrating Evidence-, Theory-, Experience-, and Context-Based Knowledge in Advising Health Policy

The COVID-19 pandemic has posed an extraordinary challenge for public health and health policy. Questions have arisen concerning the main strategies to cope with this situation and the lessons to be learned from the pandemic. This conceptual paper aims to clarify these questions via sociological concepts. Regarding coping strategies used during the pandemic, there is a strong tendency for health policymakers to rely on expert knowledge rather than on evidence-based knowledge. This has caused the evidence-based healthcare community to respond to urgent demands for advice by rapidly processing new knowledge. Nonetheless, health policymakers still mainly rely on experts in making policy decisions. Our sociological analysis of this situation identified three lessons for coping with pandemic and non-pandemic health challenges: (1) the phenomenon of accelerating knowledge processing could be interpreted from the organizational innovation perspective as a shift from traditional mechanistic knowledge processing to more organic forms of knowledge processing. This can be described as an "organic turn." (2) The return of experts is part of this organic turn and shows that experts provide both evidence-based knowledge as well as theoretical, experiential, and contextual knowledge. (3) Experts can use theory to expeditiously provide advice at times when there is limited evidence available and to provide complexity-reducing orientation for decisionmakers at times where knowledge production leads to an overload of knowledge; thus, evidence-based knowledge should be complemented by theory-based knowledge in a structured two-way interaction to obtain the most comprehensive and valid recommendations for health policy.

An evaluation of Lean and Six Sigma methodologies in the national health service

Purpose

The purpose of this paper is to conduct an empirical study derived from the previous literature from the perspective of benefits, tools and techniques, continuous improvement (CI) and quality improvement (QI) methodologies and critical failure factors (CFFs) of Lean and Six Sigma (SS) in the national health service (NHS).

Design/methodology/approach

A literature review was carried out to identify previous findings, empirical data and critical variables concerning Lean and SS in healthcare for over ten years. Second, primary research in quantitative surveys and qualitative interviews was carried out with 110 participants who have experience using Lean and SS in the NHS.

Findings

Lean and SS have evolved into common practices within the NHS and now have an established list of tools and techniques frequently employed by staff. Lean and SS are considered robust CI methodologies capable of effectively delivering extensive benefits across many different categories. The NHS must overcome a sizable amount of highly important CFFs and divided organizational culture.

Originality/value

This paper has developed the most extensive empirical study ever produced on Lean and SS in the NHS and has expanded on previous works to create new and updated research. The findings produced in this paper will assist NHS medical directors and practitioners in obtaining up-to-date insight into Lean and SS status in the NHS. The paper will also guide the NHS to critically evaluate their current CI strategy to ensure long-term sustainability and deliver improved levels of service to patients.

Using naturalistic inquiry to inform qualitative description

BACKGROUND

Choosing how to answer a research question requires an understanding of philosophical and theoretical assumptions and how these inform a study's methodology and methods. This can be a challenge for all researchers, but for novice researchers, such as doctoral candidates, this can feel like an overwhelming task. Ensuring there is clear alignment between philosophy, theory, methodology and methods is an essential part of the research process, that enables research to be undertaken with clarity and integrity. This alignment must be a good fit for the research aim, and to ensure the researcher's intrinsic values and beliefs do not affect the analysis undertaken.

AIM

To describe the alignment between qualitative description and naturalistic inquiry and how it was applied to a doctoral candidate's exploration of the meaning of safety for people with experience of admission to an acute mental health unit.

DISCUSSION

Understanding the alignment between qualitative descriptive methodology and naturalistic inquiry provided a clear pathway for the doctoral candidate.

CONCLUSION

The assumptions that underpin a methodological approach need to be unpacked to understand how to answer a research question effectively.

IMPLICATIONS FOR PRACTICE

Qualitative description, informed by naturalistic inquiry, offers a practical way to explore and answer research questions.

What do people post on social media relative to low back pain? A content analysis of Australian data

OBJECTIVE

Low back pain is the leading contributor to the global disability burden. The Global Spine Care Initiative (GSCI) recommend patient-centred care to stem the cost of low back pain. One way to enhance patient-centred care is by better understanding what is relevant for people with low back pain. Exploring social media posts about low back pain could offer this insight and provide valuable information for health care professionals to facilitate active participation in patient-centred care.

METHODS

We used an inductive content analysis method. In the form of social media posts, data on Twitter and Instagram were collected from June to August 2018. The posts were geo-targeted to Australia. We recorded the number of status broadcasts that contained a low back pain keyword and responses. We developed a codebook to describe the data and applied it to identify low back pain themes.

RESULTS

We analysed 768 posts containing 457 status broadcasts and 311 responses. Almost half (49%) of status broadcasts about low back pain seemed to seek validation. Expressing sympathy (31%) was the most common response to a status broadcast about low back pain. There were no public responses to 76% of status broadcasts about low back pain. Our analysis yielded two core themes, "hear my pain" and "I feel for you".

CONCLUSIONS

Posts about low back pain on social media often seem to suggest that the person posting is seeking validation. Responses typically express sympathy or a shared experience; yet, there is no response to most social media posts about low back pain.

Stagewise Overview of Issues Influencing Organizational Technology Adoption and Use

This paper provides a stagewise overview of the important issues that play a role in technology adoption and use in organizations. In the current literature, there is a lack of consistency and clarity about the different stages of the technology adoption process, the important issues at each stage, and the differentiation between antecedents, after-effects, enablers, and barriers to technology adoption. This paper collected the relevant issues in technology adoption and use, mentioned dispersedly and under various terminologies, in the recent literature. The qualitative literature review was followed by thematic analysis of the data. The resulting themes were organized into a thematic map depicting three stages of the technology adoption process: pre-change, change, and post-change. The relevant themes and subthemes at each stage were identified and their significance discussed. The themes at each stage are antecedents to the next stage. All the themes of the pre-change and change stages are neutral, but the way they are managed and executed makes them enablers or barriers in effect. The thematic map is a continuous cycle where every round of technology adoption provides input for the subsequent rounds. Based on how themes have been addressed and executed in practice, they can either enhance or impair the subsequent technology adoption. This thematic map can be used as a qualitative framework by academics and practitioners in the field to evaluate technological changes.

Attrition From a National Surgical Training Program: A Qualitative Analysis

OBJECTIVE

The objective of this study was to examine the trainee experience to identify some of the factors which contribute to attrition from surgical training.

SUMMARY BACKGROUND

Not all trainees who commence a surgical training program continue and complete it. Surgical training can be personally and professionally demanding and trainees may, for a multitude of reasons, change career direction. Attrition from surgical training impacts upon multiple stakeholders: A decision to leave may be difficult and time consuming for the individual and can generate unanticipated inefficiency at a systems level. This project examined attrition from a national surgical training program to deepen understanding of some of the causes of the phenomenon.

METHODS

A qualitative study was performed. A purposeful sampling strategy was used to identify representative participants. Semistructured interviews were conducted with eleven trainees who withdrew or considered doing so. A thematic analysis was performed to examine the experiences of trainees and explore the factors which influenced a decision to withdraw.

FINDINGS

Five major themes emerged from the interview data: delivery of training, the training atmosphere, influence of seniors, concerns regarding progression, and the perception of the future role with respect to lifestyle.

CONCLUSIONS

The personal experience of surgical training is crucial in informing a decision to withdraw from a program. Voluntary attrition is appropriate where doctors, after experiencing some time in surgical training, recognize that a surgical career does not meet their expectation. However, improving the delivery of training by addressing the concerns identified in this study may serve to enhance the personal training experience and hence maximize retention.

What can be done to reduce the prevalence of teen pregnancy in rural Eastern Uganda?: multi-stakeholder perceptions

Introduction

The teenage pregnancy rate of 25% in Uganda is worrying though it may seem low compared to 28% in Sub-Saharan countries and West and Central Africa. Young mothers in Uganda risk poor maternal and child health, being isolated, attempting unsafe abortions, failure to continue with school, and poverty. This paper describes perceptions and recommendations of young mothers, family and community members on why the high rate of teenage pregnancies in Uganda and how these can be reduced.

Methods

This qualitative research was conducted from March to May 2016 in six communities within Budondo sub-county (Jinja district), Eastern Uganda. In-depth oral interviews were conducted with 101 purposively sampled adolescent mothers, family members, and workers of government and non-government organizations. Thematic analysis framed around levels of influence within a social cognitive framework was conducted using Atlas-ti (version 7.5.4).

Results

Perceived determinants of teenage pregnancies include: lack of life and social survival skills, lack of knowledge on how to avoid pregnancy, low acceptance/use of contraceptives, neglect by parents, sexual abuse, pressure to contribute to family welfare through early marriage or sexual transactions, lack of community responsibility, media influence, peer pressure, cultural beliefs that promote early marriage/childbearing and lack of role models. Other contributing factors include drug use among boys, poverty, late work hours, long travel distances, e.g., to school, and unsupervised locations like sugarcane plantation thickets. Recommendations participants offered include: sensitization seminars and counselling for parents and girls, closing pornography outlets that accept entrance of minors, using the law to punish rapists, involvement of the President to campaign against early pregnancies, school dismissal before dark, locally accessible schools and job creation for parents to earn money to support the girls financially. Areas for capacity building are: training teachers and community members in transferring empowerment and vocational skills to girls, and construction of homes with separate rooms to support parents’ privacy.

Conclusion

The factors associated with adolescent pregnancy in Uganda fall under individual, economic, social and physical environmental determinants. Recommendations spanning family, community and government involvement can ultimately empower girls, their families and community members, and support collective action to reduce teenage pregnancies.

Understanding student radiographer attrition: Risk factors and strategies

INTRODUCTION

Diagnostic student radiographer attrition is reported at 14%, 6% higher than the average for higher education, however, little research has been undertaken on this subject. This study explored risk factors for attrition and strategies that enabled these to be overcome.

METHODS

A two-phase study was undertaken. Phase one: data for 579 former student diagnostic radiographers (468 completers and 111 non-completers) from 3 English universities were analysed. Logistic regression was used to estimate odds ratios and 95% confidence intervals for completion based on individual characteristics. Phase two: content analysis of data from an online survey of 186 current UK student diagnostic radiographers exploring their experiences was undertaken.

RESULTS

Phase one: Attrition was 19%. Increased age, non A-level entry qualifications and poor academic performance were predictors of attrition (p < 0.005). Phase two: Challenges reported by groups identified as 'at risk' showed that for mature students and those with non-traditional entry qualifications, external responsibilities/pressures and financial pressures were likely to be the greatest cause of attrition and for younger students with traditional qualifications, academic difficulty and excessive workload were most significant. Scientific learning and academic writing were identified as the most common academic difficulties by all groups. Poor mental health may also be a risk factor.

CONCLUSION

Although characteristics were identified that increased the chance of attrition, the study concluded that attrition is most likely to be multi-factorial. Academic and personal support were identified as key in students continuing their studies when they considered leaving. Clinical placement experience is likely to influence continuation decisions.

IMPLICATIONS FOR PRACTICE

Transparency around course expectations and academic requirements together with ensuring high quality clinical placements may assist in reducing attrition.

The effect of a family intervention on primary caregivers psychological outcomes: Findings from the integrative literature review

AIMS

This literature review examines the effectiveness of the family interventions (FIs) targeted at the primary caregivers of people diagnosed with schizophrenia on improving the knowledge level of schizophrenia and health-related outcomes.

METHODS

A total of nine studies were reviewed from December 1999 to May 2017. The methods described by the Center for Reviews and Dissemination were used to guide this review.

RESULTS

The FIs showed consistent improvement in the knowledge level of schizophrenia among participants for various follow-up intervals. In addition, FIs were found to be superior to treatment as usual in influencing health-related outcomes.

CONCLUSIONS

Implications of the findings for mental healthcare practice to include primary caregivers with the patient in the treatment process.

Needs and Barriers of Teen Mothers in Rural Eastern Uganda: Stakeholders' Perceptions Regarding Maternal/Child Nutrition and Health

For adolescent mothers in rural Eastern Uganda, nutrition and health may be compromised by many factors. Identifying individual and environmental needs and barriers at local levels is important to inform community-based interventions. This qualitative study used interviews based on constructs from social cognitive theory. 101 adolescent mothers, family members, health-related personnel and community workers in Budondo sub-county (Jinja district), eastern Uganda were interviewed. Young mothers had needs, related to going back to school, home-based small businesses; social needs, care support and belonging to their families, employment, shelter, clothing, personal land and animals, medical care and delivery materials. Barriers to meeting their needs included: lack of skills in income generation and food preparation, harsh treatment, pregnancy and childcare costs, lack of academic qualifications, lack of adequate shelter and land, lack of foods to make complementary feeds for infants, insufficient access to medicines, tailored health care and appropriate communications. Using the social cognitive framework, this study identified myriad needs of young mothers and barriers to improving maternal/child nutrition and health. Adolescent-mother-and-child-friendly environments are needed at local levels while continuing to reduce broader socio-cultural and economic barriers to health equity. Findings may help direct future interventions for improved adolescent maternal/child nutrition and health.

The value of measurement for development of nursing knowledge: Underlying philosophy, contributions and critiques

AIM

A philosophical discussion of constructive realism and measurement in the development of nursing knowledge is presented.

BACKGROUND

Through Carper's four patterns of knowing, nurses come to know a person holistically. However, measurement as a source for nursing knowledge has been criticized for underlying positivism and reductionist approach to exploring reality. Which seems mal-alignment with person-centred care.

DESIGN

Discussion paper.

DISCUSSION

Constructive realism bridges positivism and constructivism, facilitating the measurement of physical and psychological phenomena. Reduction of complex phenomena and theoretical constructs into measurable properties is essential to building nursing's empiric knowledge and facilitates (rather than inhibits) person-knowing.

IMPLICATIONS FOR NURSING

Nurses should consider constructive realism as a philosophy to underpin their practice. This philosophy supports measurement as a primary method of inquiry in nursing research and clinical practice. Nurses can carefully select, and purposefully integrate, measurement tools with other methods of inquiry (such as qualitative research methods) to demonstrate the usefulness of nursing interventions and highlight nursing as a science.

Exploring Imagery as a Technique for Promoting Physical Activity in Older Adults

Exercise imagery can be beneficial for insufficiently active people as a means to promote physical activity (PA) engagement and positive psychological states. The present study explored imagery use in physically active and insufficiently active older adults. The revised applied model of deliberate imagery use (RAMDIU) was used as a framework to explain When, Where, Why, What, and How older adults image and explored whether the Who component of the model (older adults/PA status) interacts with these different components; 37 ( Mage = 64, SD = 5.2; 17 females) participants representing a range of PA levels took part in one of seven focus groups. Thematic analysis provided support for RAMDIU, with motivation, memory, and planning identified as the most common imagery functions, and scenery and reward images as the most commonly reported imagery content. Although some similarities exist, older adults tend to use imagery for unique functions compared with younger counterparts (e.g., to improve memory). Understanding the use of imagery in older adults will help to tailor PA interventions for promoting healthy aging in this population.

Interprofessional Collaboration: A Qualitative Study of Non-Physician Perspectives on Resident Competency

BACKGROUND

The Association of American Medical Colleges (AAMC) includes the ability to collaborate in an interprofessional team as a core professional activity that trainees should be able to complete on day 1 of residency (Med Sci Educ. 26:797-800, 2016). The training that medical students require in order to achieve this competency, however, is not well established (Med Sci Educ. 26:457-61, 2016), and few studies have examined non-physician healthcare professionals' perspectives regarding resident physicians' interprofessional skills.

OBJECTIVE

This study aims to describe non-physicians' views on barriers to collaboration with physicians, as well as factors that contribute to good collaborative relationships.

PARTICIPANTS

Nurses, social workers, case managers, dietitians, rehabilitation therapists, and pharmacists at one academic medical center, largely working in the inpatient setting.

APPROACH

A qualitative study design was employed. Data were collected from individual interviews and focus groups comprising non-physician healthcare professionals.

KEY RESULTS

Knowledge gaps identified as impeding interprofessional collaboration included inadequate understanding of current roles, potential roles, and processes for non-physician healthcare professionals. Specific physician behaviors that were identified as contributing to good collaborative relationships included mutual support such as backing up other team members and prioritizing multidisciplinary rounds, and communication including keeping team members informed, asking for their input, physicians explaining their rationale, and practicing joint problem-solving with non-physicians.

CONCLUSIONS

Discussion of how physician trainees can best learn to collaborate as members of an interprofessional team must include non-physician perspectives. Training designed to provide medical students and residents with a better understanding of non-physician roles and to enhance mutual support and communication skills may be critical in achieving the AAMC's goals of making physicians effective members of interprofessional teams, and thus improving patient-centered care. We hope that medical educators will include these areas identified as important by non-physicians in targeted team training for their learners.

The Value of Developing a Mixed-Methods Program of Research

This article contributes to the discussion of the value of utilizing mixed methodological approaches to conduct nursing research. To this end, the author of this article proposes creating a mixed-methods program of research over time, where both quantitative and qualitative data are collected and analyzed simultaneously, rather than focusing efforts on designing singular mixed-methods studies. A mixed-methods program of research would allow for the best of both worlds: precision through focus on one method at a time, and the benefits of creating a robust understanding of a phenomenon over the trajectory of one's career through examination from various methodological approaches.

Adult patients' experiences of NHS specialist services for chronic fatigue syndrome (CFS/ME): a qualitative study in England

BACKGROUND

Few studies have explored patients' experiences of treatment for CFS/ME. This study aims to fill this gap by capturing the perspective of patients who have been treated by NHS specialist CFS/ME services in England.

METHODS

Semi-structured interviews were conducted during the period June-September 2014 with 16 adults who were completing treatment at one of three outpatient NHS specialist CFS/ME services. Interviews were analysed thematically using constant comparison techniques, with particular attention paid to contrasting views.

RESULTS

Three themes were identified: 'Journey to specialist services'; 'Things that help or hinder treatment'; and 'Support systems'. Within these themes nine sub-themes were identified. A wide range of factors was evident in forming participants' experiences, including personal characteristics such as perseverance and optimism, and service factors such as flexibility and positive, supportive relationships with clinicians. Participants described how specialist services played a unique role, which was related to the contested nature of the condition. Many participants had experienced a lack of validation and medical and social support before attending a specialist service. Patients' experiences of life before referral, and the concerns that they expressed about being discharged, highlighted the hardship and obstacles which people living with CFS/ME continue to experience in our society.

CONCLUSIONS

The experiences of CFS/ME patients in our study showed that NHS specialist CFS/ME services played a vital role in patients' journeys towards an improved quality of life. This improvement came about through a process which included validation of patients' experiences, acceptance of change, practical advice and support, and therapeutic outcomes.

Using Qualitative Methods to Validate and Contextualize Quantitative Findings: A Case Study of Research on Sexual Behavior and Gender-Based Violence Among Young Swazi Women

Nesting qualitative data collection methods within quantitative studies improves results by assessing validity and providing depth and context. Using data from 3 sources from Swaziland, we triangulate qualitative and quantitative findings to highlight how different methodologies produce discrepant data regarding risky sexual behaviors among young women. We found that women reported similar numbers of lifetime sex partners in all sources, but the proportion reporting multiple and concurrent partnerships was several times higher in qualitative interviews. In addition, qualitative data can provide deeper understanding of how participants, such as those experiencing gender-based violence, understood the experiences behind the quantitative statistics.

The strengths and weaknesses of research designs involving quantitative measures

This paper presents a critical review of the strengths and weaknesses of research designs involving quantitative measures and, in particular, experimental research. The review evolved during the planning stage of a PhD project that sought to determine the effects of witnessed resuscitation on bereaved relatives. The discussion is therefore supported throughout by reference to bereavement research. Three levels of quantitative research are presented: descriptive, correlational and experimental. The findings suggest that experimental research is subject to a number of methodological limitations that may jeopardise internal and external validity of the research results and, consequently, limit their applicability for practice. Nurses are therefore encouraged to carefully consider the virtues of experimental designs, in their quest for evidence-based practice and in the planning of future research.

The Impact of Health Scares on Parents’ Information Needs and Preferred Information Sources: A Case Study of the MMR Vaccine Scare

Health scares are characterized by mass media reporting that generates panic about a particular health issue or intervention, and those involved often require information. This article describes a study that aimed to examine the measles, mumps and rubella (MMR) vaccination scare, its impact on parents of young children, and its effect on their need for information. Seventeen semi-structured interviews were carried out with parents in Sheffield, UK. Analysis of the interview transcripts revealed several categories including the one presented in this article, ‘Information and the MMR vaccine’. The health scare increased parents’ information needs in relation to their decision whether to have their child vaccinated. Parents viewed traditional sources of information critically as they did not consider them to be trustworthy. Parents considered trustworthiness of the information source to be an important factor. Ongoing work in this area is investigating these issues through a large-scale, quantitative study.

Sex life and role identity in Taiwanese women during menopause: a qualitative study

AIM

Our goal was to examine Taiwanese women's perspectives on the way menopause affected their sexual behaviour to gain an in-depth understanding of their experiences during this transition.

BACKGROUND

Physical symptoms associated with menopause may affect women's sexual experiences. Little is known about how menopause-related changes in sexual behaviour may affect role identity of women living in a modernizing urban culture that is still strongly rooted in traditional beliefs and attitudes.

DESIGN

This was a qualitative study involving face-to-face interviews using open-ended questions.

METHODS

During 2011-2012, eighteen peri or postmenopausal women visiting a medical clinic for gynaecological examinations or treatment were interviewed about their sexual experiences. Responses were analysed for common themes.

FINDINGS

Four themes were identified about the effects of menopause on women's sex life: (1) changes in physical responses during sex; (2) the acceptance/non-acceptance of the current situation; (3) sexual pressure related to their marital role; (4) efforts to improve sexual interest or activity. Menopause-related physical changes often (but not always) made sexual interactions difficult. But women's responses to the changes varied. Some used sexual discomfort as a reason to avoid sexual intercourse. Others sought to improve their sexual encounters through behavioural modifications or hormone therapy.

CONCLUSIONS

Given the variety of reactions to the impact of menopause on sexual behaviour/relationships seen here, it is clear that health professionals need to assess of each woman's specific situation and be prepared to recommend a variety of behavioural or hormonal treatment options.

The health perspectives of Australian adolescents from same-sex parent families: a mixed methods study

BACKGROUND

Research involving adolescents from same-sex parent families provides an important contribution to the evidence base on their health, well-being and the impact of stigma. To date reports on the perspectives of adolescents with same-sex attracted parents have been limited. This study aimed to describe the multidimensional experiences of physical, mental and social well-being of adolescents living in this context.

METHODS

A mixed methods study of adolescents with same-sex attracted parents comprising of an adolescent-report survey of 10- to 17-year-olds and family interviews with adolescents and their parents. Data were collected in 2012 and 2013 as part of the Australian Study of Child Health in Same-Sex Families.

RESULTS

The findings from qualitative interviews with seven adolescents and responses to an open-ended survey question (n = 16) suggest four themes: perceptions of normality, positive concepts of health, spheres of life (including family, friends and community) and avoiding negativity. The quantitative sample of adolescents with same-sex attracted parents (n = 35) reported higher scores than population normative data on the dimensions general health and family activities within the Child Health Questionnaire (CHQ) as well as higher on the peer problems scale on the Strengths and Difficulties Questionnaire (SDQ). Perceived stigma correlates with lower health and well-being overall.

CONCLUSIONS

Positive health outcomes are informed by the ways adolescents conceptualize health and how they construct their spheres of life. Peer relationships, and community perspectives of same-sex families, inform perceived stigma and its correlation with poorer health and well-being. Although adolescents see their families as essentially normal they are negatively affected by external societal stigma.

Development of an Instrument to Measure the Unintended Consequences of EHRs

This article augments the existing body of literature through examining the creation and design of an instrument measuring unintended consequences (UCs) of electronic health records (EHRs). Data from a previous qualitative study that explored nurses' perceptions of EHR effectiveness as a communication system were analyzed using a theoretical model focused on decision making. The qualitative data, informed by the model, were then organized into an instrument seeking to quantitatively measure nurses' experiences with UCs of EHRs. The model assisted in revealing patterns in nurses' perceptions of the effectiveness of the EHR as a communication system that ultimately strengthened the development of the instrument. Instrumentation from qualitative data has long been considered an acceptable and positive approach to scale development. The process for accomplishing this goal has often been omitted from the literature. We contend that other researchers will find this methods article informative for similar undertakings.

Viewing the art and the science of pediatric nursing through the lens of paradigms: the impact on hope for the future

PURPOSE

The purpose of this study was to examine the strengths and limitations of common research paradigms used in the study of the hope of parents who have children with a variety of illnesses.

CONCLUSIONS

Research findings on parental hope extracted from only one paradigm present limitations to related knowledge development. To take into account the contributions from each paradigm and to allow for a multidimensional understanding of parental hope, a multiparadigmatic approach is needed.

PRACTICE IMPLICATIONS

The complementary findings from multiple research paradigms can lead to a comprehensive base of knowledge that can guide future research and develop effective, family-centered pediatric nursing care.

Positioning positivism, critical realism and social constructionism in the health sciences: a philosophical orientation

Positioning positivism, critical realism and social constructionism in the health sciences: a philosophical orientation This article starts by considering the differences within the positivist tradition and then it moves on to compare two of the most prominent schools of postpositivism, namely critical realism and social constructionism. Critical realists hold, with positivism, that knowledge should be positively applied, but reject the positivist method for doing this, arguing that causal explanations have to be based not on empirical regularities but on references to unobservable structures. Social constructionists take a different approach to postpositivism and endorse a relativist rejection of truth and hold that the task of research is to foster a scepticism that undermines any positive truth claim made. It is argued that social constructionism is a contradictory position.

Complex critical realism: tenets and application in nursing research

AIM

To outline the main tenets of critical realism (CR), its use, and future application in nursing.

BACKGROUND

Little work has been done to discuss how CR can be applied to nursing research.

FINDINGS

The tenets of CR include recognition of reality independent of human perceptions, a generative view of causation in open systems, and a focus on explanations and methodological eclecticism using a postdisciplinary approach. Critical realism is useful for (1) understanding complex outcomes, (2) optimizing interventions, and (3) researching biopsychosocial pathways. Such questions are central to evidence-based practice, chronic disease management, and population health.

CONCLUSIONS

Critical realism is philosophically strong and potentially useful for nursing research.

A critical realist approach to understanding and evaluating heart health programmes

Secondary prevention programmes for Coronary Heart Disease (CHD) aim to reduce cardiovascular risks and promote health in people with heart disease. Though programmes have been associated with health improvements in study populations, access to programmes remains low, and quality and effectiveness is highly variable. Current guidelines propose significant modifications to programmes, but existing research provides little insight into why programme effectiveness varies so much. Drawing on a critical realist approach, this article argues that current research has been based on an impoverished ontology, which has elements of positivism, does not explore the social determinants of health or the effects on outcomes of salient contextual factors, and thereby fails to account for programme variations. Alternative constructivist approaches are also weak and lacking in clinical credibility. An alternative critical realist approach is proposed that draws on the merits of subjectivist and objectivist approaches but also reflects the complex interplay between individual, programme-related, socio-cultural and organizational factors that influence health outcomes in open systems. This approach embraces measurement of objective effectiveness but also examines the mechanisms, organizational and contextual-related factors causing these outcomes. Finally, a practical example of how a critical realist approach can guide research into secondary prevention programmes is provided.

Phenomenology: an exploration

Investigators who use phenomenological approaches to understand experiences of human healing, caring, and wholeness need to consider the differences that exist between descriptive and hermeneutic phenomenology. In this article, these two approaches are compared and contrasted with respect to roots, similarities, and differences. Guidelines are offered to assist prospective investigators in selecting the approach most suitable to personal cognitive style and beliefs about the ways humans experience and find meanings during transitions through wellness and illness to advance nursing knowledge in a holistic view.

A guide and glossary on post-positivist theory building for population health

This guide and glossary focuses on the role of theory and conceptual models within population health research. Upon discussing the critical need for theory in conducting interdisciplinary research, it provides strategies for crafting theories that can be empirically tested and a glossary of theory building terms that are useful for guiding research. In addition to general concepts, the glossary includes some terminology commonly found in the social sciences, whose well established traditions and practices of formal theory building may be particularly informative for epidemiologists and other population health researchers who have minimal formal social science training, but study social factors in their research.

A birth centre's encounters with discourses of childbirth: how resistance led to innovation

An ethnographic study of a free-standing birth centre uncovered a site of intense contestation. Two prominent childbirth discourses attempting to inscribe their orthodoxies on staff and women users encountered stern and persistent resistance. Using postmodern theory, this resistance is conceptualised as nomadic activity, as space is made at the margins of discourse for a difference and diversity to manifest. The relationship between discourse and women's agency is layered and non-linear as the presence of dissonant data indicates. The birth centre, however, actualises a number of contrasting ways of 'being' and 'doing' that appear to serve the interests of staff and women well. In particular, 'nomadic' midwifery practice and a 'care as gift' orientation challenges the biomedical model that defines the parameters of normal and the 'vigil of care' discourse that regulates the professional/patient relationship. Birth centres may encourage novel and eclectic ways of providing childbirth care.