Historical and epistemological perspectives on research and nursing

Qualitative research ethics: enhancing evidence-based practice in physical therapy

BACKGROUND

Increasing challenges to health care systems and the prominence of patient-centered care and evidence-based practice have fostered the application of qualitative approaches in health care settings, prompting discussions of associated ethical issues in a range of disciplines.

OBJECTIVES

The purposes of this work were to identify and describe the application and value of qualitative health research for physical therapy and to identify ethical considerations in a qualitative research study.

DESIGN

This was a qualitative interview study with telephone follow-ups.

METHODS

Forty-six participants were interviewed about their early experiences with rheumatoid arthritis. They also were asked what motivated them to volunteer for the study. To inform the discussion of ethics in qualitative health research, this study drew on the in-depth interviews, took a descriptive approach to the data, and applied the traditional ethical principles of autonomy, justice, and beneficence to the study process.

RESULTS

Ethical issues emerged in this qualitative health research study that were both similar to and different from those that exist in a positivist paradigm (eg, clinical research). With flexibility and latitude, the traditional principle approach can be applied usefully to qualitative health research.

CONCLUSIONS

These findings build on previous research and discussion in physical therapy and other disciplines that urge a flexible approach to qualitative research ethics and recognize that ethics are embedded in an unfolding research process involving the role of the subjective researcher and an active participant. We suggest reflexivity as a way to recognize ethical moments throughout qualitative research and to help build methodological and ethical rigor in research relevant to physical therapist practice.

Why nursing has not embraced the clinician--scientist role

Reasons for the limited uptake of the clinician-scientist role within nursing are examined, specifically: the lack of consensus about the nature of nursing science; the varying approaches to epistemology; and the influence of post-modern thought on knowledge development in nursing. It is suggested that under-development of this role may be remedied by achieving agreement that science is a necessary, worthy pursuit for nursing, and that rigorous science conducted from a clinical perspective serves nursing well. Straddling practice and research is a powerful strategy for ensuring relevant research while forging strong links with practice. The clinician-scientist role, typically requiring a 75:25 ratio between research and clinical activities, is well established in medicine. Nursing, however, has been slow to institute the role; it is rare within North America, Australia, and western European countries, and almost non-existent outside those areas. Beyond structural obstacles, philosophical issues may explain nursing's reluctance to implement the role. Following a survey of clinician-scientist roles throughout the world, the nature of nursing science and epistemology, and the influence of post-modern thought on nursing attitudes to research are examined with respect to their influence on this role. The nurse clinician-scientist role holds promise for making strides in clinically relevant research, and for accelerating the knowledge cycle from clinical problem to research question to change in clinical practice.

Ethical components of researcher researched relationships in qualitative interviewing

Qualitative interviews are widely and often uncritically adopted for health care research, with little justification of therapeutic value. Although they might provide valuable insights into the perspectives of participants, they represent only a version of reality, rather than "truth" per se. Qualitative research is vulnerable to bias through the attitudes and qualities of the researcher, social desirability factors, and conditions of worth. Exploitation, through role confusion, therapeutic misconception, and misrepresentation are particular risks for health care-related research. Ethical codes, biomedical principles and care philosophies provide little contextual guidance on the moral dilemmas encountered in the practice of research. If nurse researchers are to navigate the moral complexities of research relationships, then sensitivity to risk to participants must be of continual concern, from conception of the study to the reporting of outcomes. Examination of the self through critical reflection and supervision are therefore necessary components of ethical research.

Qualitative meta-synthesis: a question of dialoguing with texts

AIMS

This paper discusses whether useful synthesis of research reports across different qualitative methodologies is possible, and whether qualitative meta-synthesis violates the tenets of the interpretive paradigm.

BACKGROUND

Qualitative meta-synthesis is a recent development in qualitative inquiry that offers a means of enhancing the contribution of qualitative findings to the development of more formalized knowledge. However, there are a number of unanswered questions and areas that require debate.

DISCUSSION

A brief overview of qualitative meta-synthesis as a method of inquiry is presented. The assumptions of phenomenology, ethnography and grounded theory are explored for their amenability to meta-synthesis and the possibility of coherent synthesis of findings across these methodologies. In addition, a summary of major philosophical commitments common to the interpretive paradigm is presented. Qualitative meta-synthesis as a methodology is then explored for its fit within this paradigm. An argument is made, with some caveats, for synthesis across qualitative methodologies. Gadamer's concepts of the hermeneutic circle, the fusion of horizons, and dialogue with the text are explored for the insight they provide into the place of qualitative meta-synthesis in inquiry.

CONCLUSION

It is important for researchers to bring hermeneutic skill to the process of meta-synthesis in order to develop a comprehensive understanding of the various philosophical assumptions in which qualitative approaches are based. The particular challenge of combining analysis and interpretation from studies with markedly different approaches and intentions may prompt synthesists to create new and innovative approaches to the presentation of meta-synthesis.

A historical perspective on the contrasting experiences of nurses as research subjects and research activists

According to the spectrum of opinion, nursing research appears to be alive but vulnerable, poised for further growth but still liable to wither if starved of funding. By using a historical approach to provide an understanding of the present, this paper hopes to offer some guidance for the healthy future of nursing research. Documentary and oral evidence has been cited to compare the experiences of nurses as the subjects of research and as researchers themselves. Investigations on recruitment and retention in nursing undertaken prior to World War II tended to give monocausal explanations for complex problems. As a result, pioneer nurse researchers had to work in an atmosphere of suspicion from sections of the profession and little regard from more established professions. The paper demonstrates that in order to make progress they used formal and informal support networks. Contemporary practitioners could identify similar networks.

A philosophical analysis of evidence-based practice in mental health nursing

Mental health nurses need to be aware that their knowledge base does not exist in isolation from other cultural practices. They/I/we must become more willing to engage in theoretical problem solving that directly affects clinical practice issues such as the introduction of evidence-based practice. Critical discussion of evidence-based practice should be informed by the complex issues that permeate all our socio-cultural and linguistic practices. This paper examines some of the major philosophical problems in the debate over the use of evidence-based practice in mental health nursing using both Foucault's formulation of discourse analysis and Derrida's construal of deconstruction. The conclusion reached is that postmodern philosophy offers a way to rid nursing of incessant naiive attacks on either quantitative or qualitative research methods which underpin the debate over evidence-based practice in mental health nursing.

The case for researching the history of community nursing practice

Despite a flurry of interest in the 1980s, the adoption of a positivist, objective, scientific paradigm for nursing research has led to a rejection of the study of nursing history as a valid pursuit in recent years. In this article, it is argued that this is a precarious situation. By not examining the history of the profession, nursing -- and in particular community nursing -- undermines its efforts to validate itself within the wider health-care arena. Nursing must learn from the mistakes of the past, as well as the successes, but do so in a critical way that does not romanticize its history.

Hermeneutic-phenomenology: providing living knowledge for nursing practice

The phenomenological approach has gained popularity among nurse researchers as an alternative investigative method to those used in the natural sciences. As more nurse scholars and nurse researchers utilize phenomenology as a research approach, it becomes critical to examine the implications this may have for nursing knowledge development and for the utilization of that knowledge in practice. In this paper, an examination of the results of phenomenological inquiry is presented and compared with the types of knowledge considered important for nursing by Carper and White. It is clear that phenomenology contributes to empirical, moral, aesthetic, personal, and socio-political knowledge development. Its contribution is not in developing predictive and prescriptive theory, but in revealing the nature of human experience. Although interpretive inquiry, such as hermeneutic phenomenology, does not prescribe action for use in clinical practice, it does influence a thoughtful reflective attentive practice by its revealing of the meanings of human experience.

The impact of knowing your child is critically ill: a qualitative study of mothers' experiences

Discussion in this paper is drawn from an exploratory study designed to elicit mothers' lived experiences of crisis and coping, and their experiences of nursing following the unexpected emergency admission of their child to the paediatric intensive care unit (PICU). An in-depth critique of literature supporting this study has been published. Two theoretical perspectives serve as a basis for this exploratory study: firstly, the idea that in a crisis situation, a mother's ability to cope and function is influenced by therapeutic interventions of nurses by meeting her needs in a holistic way; and secondly, symbolic interactionism, that focuses on the meaning of events to mothers. Data were elicited through focused interviews with 10 mothers of children aged between 3 months and 15 years who had been admitted unexpectedly to the PICU with a life threatening condition. Findings reveal the major impact of crisis on mothers immediately following their child's critical illness and admission to PICU, and this specific aspect therefore warrants in-depth discussion and analysis. The study did not generate a theory; however, important recommendations are made for nursing practice and research in relation to the impact of crisis experienced by mothers. Nursing practice issues include meeting the psychosocial needs of parents prior to and immediately after admission, and the importance of family-centred nursing care. Issues for nursing research include exploring how families cope with the impact of crisis and critical illness.

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

Critiques of logical positivism form the foundation for a significant number of nursing research papers, with the philosophy being inappropriately deemed synonymous with empirical method. Frequently, proposing an alternative method to those identified with the quantitative paradigm, these critiques are based on a poor foundation. This paper highlights an alternative philosophy to positivism which can also underpin empirical inquiry, that of post-positivism. Post-positivism is contrasted with positivism, which is presented as an outmoded and rejected philosophy which should cease to significantly shape inquiry. Though some acknowledgement of post-positivism has occurred in the nursing literature, this has yet to permeate into mainstream nursing research. Many still base their arguments on a positivistic view of science. Through achievement of a better understanding of post-positivism and greater focus on explicating the philosophical assumptions underpinning all research methods, the distinctions that have long been perceived to exist between qualitative and quantitative methodologies can be confined to the past. Rather methods will be selected solely on the nature of research questions.

Seeking balance to dialectic tensions in teaching through philosophic inquiry

PURPOSE

To propose a plausible means of cultural criticism of nursing's educational environment for preparing new nurses by exploring epistemological tensions and their consequences from the perspective of educators.

DESIGN

Naturalistic, qualitative, philosophic.

METHOD

Six nurse educators teaching in a university-based traditional BSN program were interviewed in one southeastern state of the United States about their experience as creative, innovative teachers during 1991.

FINDINGS

Three major themes were reflections of the positivist work culture of teaching, reconciliation of tensions, and repercussions from personal choices. Educators reconcile dialectic tension by suppression, subordination, or equilibrium and are influenced by their sense of tension and willingness to be risk takers.

CONCLUSIONS

Philosophical conflicts are inherent in nursing when commitments to empirical knowledge and personal meaning are both valued. A plausible means for moving beyond this tension is to increase awareness of the dynamics and consequences that occur when perspectives seem contradictory. Schools of nursing socialize future nurses. Calling into question the context in which the professional nursing culture is transmitted and reproduced is necessary if nurses of the future are to be in the forefront of changing health care.

Using a phenomenological research technique to examine student nurses' understandings of experiential teaching and learning: a critical review of methodological issues

This paper provides a report of the usage of a phenomenological research methodology to investigate the influence on clinical practice of pre- and post-registration nurse education which makes explicit use of experiential teaching and learning approaches. The primary aim of the research was to explore the use of a phenomenological research methodology to examine the students' understanding of experiential teaching and learning. The claims made for the use of experiential teaching and learning approaches in both pre- and post-registration nurse courses and how clinical practice is influenced by the experiential learning elements of pre- and post-registration nurse education were also examined. The first stage of the enquiry involved focused non-directive interviews with members of BSc Nursing Studies and MSc Mental Health Branch programmes. Both programmes claim to make use of experiential teaching and learning. The data were analysed using a technique developed by Giorgi. Previous experiences of experiential teaching and learning were probed, student interpretations differentiated, and the relationship between course-based learning using experiential approaches and the implications for it's influence on practice were examined. The second stage of the enquiry has followed up the initial findings, exploring the students' experience of experiential approaches on their courses both in the classroom and in work-based learning situations. The findings are presented and discussed in the context of other studies from both nurse and higher education. Throughout the paper methodological concerns arising are discussed. The paper concludes with the identification of methodological problems arising from the research strategy: the implications of the power nexus created when teachers research students, and issues relating to the use of a phenomenological methodology in a longitudinal study.

Preliminary testing of a proposition from the Roy Adaptation Model

OBJECTIVE

To test a framework based on a proposition of the Roy Adaptation Model predicting the relationships of severity of illness, perceived control over visitation (PCV), hardiness, state anxiety, and length of stay in an intensive care unit (ICU).

DESIGN

Descriptive-correlational.

POPULATION, SAMPLE, SETTING

Convenience sample was 60 general medical-surgical ICU patients admitted to one regional medical center in the Southeastern U.S.A. Patients completed data collection instruments after a minimum of 20 hours in the ICU during January-March 1994.

METHODS

Instruments included the PCV Scale, the State Anxiety Inventory, the Health Related Hardiness Scale, and the Acute Physiologic and Chronic Health Evaluation II. Model testing and path analysis were done.

FINDINGS

The study variables explained 18% of the variance in length of stay in the ICU, with anxiety and hardiness being the major contributing variables. The path between hardiness and PCV was the only path in the model supported by the data.

CONCLUSIONS

The proposed model had inadequate support in this preliminary testing. However, interventions that increase a patient's feelings of control and hardiness could decrease length of stay in ICU's.

Eco-wellness nursing: getting serious about innovation and change

Eco-wellness nursing represents a creative, challenging and empowering approach for facilitating a sustainable future for people and their environments, focusing beyond positivistic explanations and solutions, towards a more emancipating eco-centric praxis. Underlying this approach are the principles of 'wellness', 'holism', and a 'reflexive and sustainable eco-culture'. The goal is helping people understand how to sustain their wellness, including their environments. Negotiating or brokering change from a traditional nursing model will require a revision of focus in roles, attitudes, contexts and actions of nurses. Crucial in this transformation is greater nursing independence in the private marketplace, which may involve consultancies, collaborative ventures, utilization of new technologies such as multimedia communications, and targeted nursing oriented research and development.

A pesquisa em enfermagem: notas de ordem histórica e metodológica

O artigo se propõe a algumas considerações sobre a pesquisa em enfermagem no que se refere ao referencial teórico e caminhos metodológicos. Com esse intuito, seus autores resgatam o momento em que a enfermagem passa por um redirecionamento do método clássico de investigação para novas propostas metodológicas, contemplando outros objetos de estudo, possibilitando, assim, novos horizontes epistemológicos para a geração do conhecimento. Discutem questões relacionadas à coerência interna da pesquisa qualitativa, à observância de seus pressupostos filosóficos, ressaltando a importância da produção de conhecimentos que respondam às indagações do assistir e do cuidar em enfermagem.