Time-series designs in clinical nursing research: human issues

Once a clinician, always a clinician: a systematic review to develop a typology of clinician-researcher dual-role experiences in health research with patient-participants

Background

Many health researchers are clinicians. Dual-role experiences are common for clinician-researchers in research involving patient-participants, even if not their own patients. To extend the existing body of literature on why dual-role is experienced, we aimed to develop a typology of common catalysts for dual-role experiences to help clinician-researchers plan and implement methodologically and ethically sound research.

Methods

Systematic searching of Medline, CINAHL, PsycINFO, Embase and Scopus (inception to 28.07.2014) for primary studies or first-person reflexive reports of clinician-researchers’ dual-role experiences, supplemented by reference list checking and Google Scholar scoping searches. Included articles were loaded in NVivo for analysis. The coding was focused on how dual-role was evidenced for the clinician-researchers in research involving patients. Procedures were completed by one researcher (MB) and independently cross-checked by another (JHS). All authors contributed to extensive discussions to resolve all disagreements about initial coding and verify the final themes.

Results

Database searching located 7135 records, resulting in 29 included studies, with the addition of 7 studies through reference checks and scoping searches. Two overarching themes described the most common catalysts for dual-role experiences – ways a research role can involve patterns of behaviour typical of a clinical role, and the developing connection that starts to resemble a clinician-patient relationship. Five subthemes encapsulated the clinical patterns commonly repeated in research settings (clinical queries, perceived agenda, helping hands, uninvited clinical expert, and research or therapy) and five subthemes described concerns about the researcher-participant relationship (clinical assumptions, suspicion and holding back, revelations, over-identification, and manipulation). Clinician-researchers use their clinical skills in health research in ways that set up a relationship resembling that of clinician-patient. Clinicians’ ingrained orientation to patients’ needs can be in tension with their research role, and can set up ethical and methodological challenges.

Conclusion

The typology we developed outlines the common ways dual-role is experienced in research involving clinician-researchers and patient-participants, and perhaps the inevitability of the experience given the primacy accorded to patient well-being. The typology offers clinician-researchers a framework for grappling with the ethical and methodological implications of dual-role throughout the research process, including planning, implementation, monitoring and reporting.

Analysis of data over time: a difficult statistical issue

The aim of this paper was to review the literature on time-series analysis and describe its use within the context of a nursing research project. The author utilized the method to investigate the symptoms of somnolence and fatigue that patients experienced following cranial irradiation for cancer. The need for longitudinal research in all areas of health care is a current concern. This is especially true in clinical areas where small patient numbers and palliative settings make large quantitative studies difficult. There are few studies or texts that help the practising researcher to explore data analysis over time in a way that reflects the time-series nature of these data. This raises questions of how to analyse such data. The study indicated that symptoms following radiotherapy were different from that previously described in the literature. Time-series analysis indicated a cyclical pattern that gave valuable information for planning supportive services. This paper explores some of the issues of time-series analysis and illustrates the process of analysis, exploring the benefits and disadvantages of this approach for research.

Physical and emotional responses of expectant fathers throughout pregnancy and the early postpartum period

A comparative, repeated measures survey design was used to monitor the physical and emotional health of 81 expectant fathers and 66 non-expectant men over the course of a year at monthly intervals. A total of 877 monthly data collection episodes were completed. Compared to non-expectant men, expectant fathers were found to experience relatively similar patterns of both physical and emotional symptoms throughout the three trimesters of pregnancy. However, expectant fathers' health was found to differ significantly from that of non-expectant men during the immediate postpartum period with a greater incidence of emotional discomforts as well as total number of symptoms, their duration and perceived seriousness. Included are recommendations for anticipatory health counseling to promote health in expectant fathers.