Category Archives: Qualitative research

Is History “Bunk”? We report. You Decide.

History?  Really?  Fascinating!  Ever thought about all the stories behind your own present life?

Check out this youtube dramatized documentary about Nurse Mary Seacole.  I promise – you’ll enjoy: https://www.youtube.com/watch?v=RIrim4r-LbY   

You can be a part of documenting such stories, including your own.  Can I pique your interest with these examples about historical research?

1. Artifacts: Example = http://acif.org/ The American Collectors of Infant Feeders:

Infant feeder
CREDIT http://acif.org/

The American Collectors of Infant Feeders is a non-profit organization whose primary purpose is to gather and publish information pertaining to the feeding of infants throughout history. The collecting of infant feeders and related items is promoted.

2. Interviews: Example = http://www.oralhistory.org/  Want to do interviews of interesting faculty, students, leaders, “ordinary” nurses?  Check out the Oral History Association    In addition to fostering communication among its members, the OHA encourages standards of excellence in the collection, preservation, dissemination and uses of oral testimony.

scrapbook
CREDIT https://archives.mc.duke.edu/blog/nursing-materials-displa

3. Stories from the “ordinary: Example: http://www.murphsplace.com/mother/main.html My Mother’s War – “Helen T.Burrey was an American nurse who served as a Red Cross Nurse during World War I. She documented her experience in both a journal and a scrapbook which has been treasured by her daughter, Mary Murphy. Ms Murphy has placed many of these items on the Internet for people to access and it provides a first-hand account of that experience. Additionally she has a variety of links to other WWI resources.” (quoted from AAHN Resources online)

Army history
CREDIT http://e-anca.org/

4. Ethnic studies: Example=https://libguides.rowan.edu/blacknurses  Black Nurses in History “This is a ‘bibliography and guide to web resources’ from the UMDNJ and Coriell Research Library. Included are Mamie O. Hail, Mary Eliza Mahoney, Jessie Sleet Scales, Mary Seacole, Mabel Keaton Staupers, Susie King Taylor, Sojourner Truth, Harriet Tubman.” (quoted from AAHN Resources online)

Want more?  

Critical thinking:  Don’t forget to save your own materials.  Your life is history!  What in your life is most interesting?  Have you written it down or dictated it into your iphone voice memo? There is GREAT interest in “ordinary” men and women.  Many times items are tossed because they are “just letters” or “only old records,” or “stuff.” Just Don’t Do It.

 

Advertisements

Missing in Action: The Pyramid foundation

Last post I commented on the potentially misleading terms of Filtered & Unfiltered Filtered Unfiltered jpgresearch.  My key point?  Much so-called “unfiltered research” has been screened (filtered) carefully through peer-review before publication; while some “filtered research”  may have been ‘filtered’ only by a single expert & be out of date. If we use the terms filtered and unfiltered we should not be naive about their meanings. (Pyramid source:  Wikimedia Commons )

This week, I address what I see as a 2nd problem with this evidence based medicine pyramid.  That is, missing in action from it are descriptive, correlation, & in-depth qualitative research are not mentioned.  Where are they?  This undercuts the EBM pyramid as a teaching tool and also (intentionally or not) denigrates the necessary basic type of research on which stronger levels of evidence are built.  That foundation of the pyramid, called loosely “background information,” includes such basic, essential research.

Ask an ExpertYou may have heard of Benner’s Novice to Expert  theory.  Benner used in-depth, qualitative interview descriptions as data to generate her theory.  Yet that type of research evidence is missing from medicine’s pyramid!  Without a clear foundation the pyramid will just topple over.  Better be clear!

I recommend substituting (or at least adding to your repertoire) an Evidence Based NURSING (EBN) pyramid.  Several versions exist & one is below that includes some of the previously missing research!  This one includes EBP & QI projects, too! Notice the explicit addition of detail to the below pyramid as described at https://www.youtube.com/watch?v=MfRbuzzKjcM.EBN

Critical thinking:  #1List some EBM & EBN pyramid differences.  #2 Figure out where on the hierarchy this project would go: Crowell, J., OʼNeil, K., & Drager, L. (2017). Project HANDS: A bundled approach to increase short peripheral catheter dwell time. Journal of Infusion Nursing, 40(5), 274-280. doi: 10.1097/NAN.0000000000000237.   1st use medicine’s EBM pyramid; & then 2nd use nursing’s EBN pyramid.  #3 Label Crowell et al.’s study as filtered or unfiltered and explain what you mean by that.

For more info:  Watch the YouTube video at the link above.

Want to change the world? Make a list

For new graduate RNs (& those who help them) entering the workforce, Dr. Pat Benner PhD RN FAAN, who wrote Novice to Expert, has some great, very practical advice: Changehttps://www.youtube.com/watch?v=yxsBVPxS_zg  (1:56)  (hint: Remember the only behavior you can control is your own!)

And…it’s pretty good advice for any who assume a new job, too!

For More Information: If you want to know what it feels like sometimes to be a new growing plantgrad RN, check out the 2 main themes and the subthemes voiced by new graduates in the free full-text: Hussein et al., (2017). New graduate nurses‘ experiences in a clinical specialty: a follow up study of newcomer perceptions of transitional support. BMC Nursing, 16(42). doi: 10.1186/s12912-017-0236-0. eCollection 2017.

Critical Thinking:   Whether or not you are a new grad, did you have experiences similar to those in Hussein’s study?   Can you use Benner’s suggestions to deal with the issues?

 

Words vs. Numbers: What does it all mean?

There are several ways to classify types of research.   One way is qualitative versus quantitative–in other words, WORD  vs. NUMBER data, methods, & analysis.

  1. Qualitative research focuses on words (or sometimes images) and their meanings.
  2. Quantitative research focuses on numbers or counting things and statistical analysis that yields probable meaning.

If you watch this short, easy-to-understand youtube clip, you’ll have all the basics that you need to understand these!   Enjoy!

Critical thinking:  Go to PubMed for this QUANTitative study on spiritual issues in care (https://www.ncbi.nlm.nih.gov/pubmed/28403299) and compare it to this PubMed QUALitative study (https://www.ncbi.nlm.nih.gov/pubmed/27853263) in terms of data, methods, & analysis)

For more information: See earlier posts

Listen up! Don’t interrupt!

Researchers collect two types of data in their studiescounting-sheetword-art

  1. Numbers (called quantitative data)
  2. Words & narratives (called qualitative data)

StorytellerOne source of rich word or narrative (qualitative) data for answering nursing questions is nurses’ stories.  Dr. Pat Benner RN, author of Novice to Expert explains two things we can do to help nurses fully tell their stories so we can learn the most from their practice.

  1. Listen well without interrupting
  2. Help nurses ‘unpack’ their stories 

Check out this excellent 2:59 video of Dr. Benner’s and revolutionize how you learn about nursing from nursing stories:  Preview: The use of Narratives 

Critical thinking:  For a study using narratives in research see  Leboul et al. (2017).  Palliative sedation challenging the professional competency of health care providers and staff: A qualitative focus group and personal written narrative study.  [full text available thru PubMed at https://www.ncbi.nlm.nih.gov/pubmed/28399846].    1) Do you think the authors listened and unpacked information from the focus groups & written narratives; 2)  Do you think there might be a difference in the way people write narratives and verbally tell narratives?   3) How might that difference if any affect the research findings?

For more information:  Check out The Power of Story  by Wang & Geale (2015) at http://www.sciencedirect.com/science/article/pii/S2352013215000496

 

DATA COLLECTION SECTION! (Methods in the Madness)

Key point! The data collection section of a research article includes: who collects what data when, where & how.

In previous blogs we’ve looked at title, introduction, and other elements of methods section (design, sample, & setting). In this one let’s take a look at data collection.

Data are a collection of measurements. For example, student scores on a classroom test might be 97, 90, 88, 85, & so on. Each single score is a datum; collectively they are data.

What data are collected is answered in this section. The data (or measurements) can be counting-hashmarksnumbers OR words. For example, numbers data might include patient ratings of their pain on a 0-10 scale. An example of word data would asking participants to describe something in words without counting the words or anything else.  For example, word data might include patient descriptions pain in words, like word-art“stabbing,”  “achy,” and so on.  Sometimes a researcher collects both number and word data in the same study to give a more complete description.  You can see how knowing the patient’s pain rating and hearing a description would give you a much clearer picture of pain.

  • Studies reporting data in numbers are called quantitative studies
  • Studies reporting data in words/descriptions are called qualitative studies
  • Studies reporting number & word data are called mixed methods studies

How the data are collected includes what instrument or tool was used to gather data (e.g., observation, biophysical measure, or self-report) and how consistently & accurately that tool measures what it is supposed to measure (e.g., reliability & validity). Also included is who collected the data and the procedures that they followed—how did they obtain consent, interaction with subjects, timing of data collection and so on.

Now you know!

Critical thinking question: Did these authors use qualitative or quantitative data collection methods?  Coelho, A., Parola, V., Escobar-Bravo, M., & Apostolo, J. (2016). Comfort experience in palliative care, BMD Palliative care, 15(71). doi: 10.1186/s12904-016-0145-0.  Explain your answer.

Afraid to Relieve Pain? You may have Opiophobia

fear5In pain management are you afraid to give comfort to your patients with appropriate medications?   Are you afraid to be comforted when in pain?  Have you encountered families or care partners, who are afraid to comfort their loved one in pain by giving pain medications?

In a classic 2002 qualitative study, “Fearing to Comfort,” Zerwekh, Riddell, & Richard identified that RNs, physicians, patients, families, and health systems were afraid to relieve pain with appropriate use of pain medications.  They were Not doing evidence-based practice, but fear-based practice. barrier

Fear barriers include, but are not limited to 1) patients’ fear of addiction, fear of distracting the MD from the main treatment plan, and loss of control; 2) MDs’ avoiding the needs of the dying, fear of rewarding drug-seekers, or equating pain management with euthanasia; 3) RNs’ avoiding pain, failing to switch to palliative goals at end of life,  and fear of killing the patient; 4) families’ fears of addiction, side effects, & killing their loved one; and 5) health facilities’ not giving unique consideration to those at end of life, inadequate staffing, & time constraints (Zerwekh et al., 2002).

This is an issue because irrational problems cannot be simply solved by giving rational Pain fistinformation.   We have to find evidence-based practices that can create a change of heart, if you will.  As Zerwekh et al wrote: “Because fear is so influential in decisions to keep pain under control, palliative educational approaches must go beyond providing information to fill deficits in palliative knowledge.”
We must learn evidence-based ways to overcome fear and control pain.  Why?  Because pain interferes with living life.  Who are we protecting when we fear appropriate pain medications?  Not the patient.

FearRemedy?  Palliative care education must confront the fears and remove them through cognitive restructuring that includes learning to question beliefs about addiction etc.  Role playing, role modeling, and an expert walking through this with the provider or family who is afraid.  Beyond this helping people to recognize their own fears of pain & death, and providing the very best available information on pain management (Zerwekh et al).

CRITICAL THINKING:  Have you been afraid?  Or seen others afraid?  How can you solve this problem using evidence-based practice that = BEST available evidence + Clinical judgment + Patient/family preferences & values? Be specific because if you haven’t yet encountered the problem of fearing to comfort, be assured that you will.fear4

FOR MORE INFORMATION:   Read full text Zerwekh et al (2002) online.   It could change your life & the life of those for whom you care!!