Developing a model of collaborative research: the complexities and challenges of implementation

While the benefits of collaborative research have been well documented, fewer publications exist regarding the complex, problematic issues involved in these undertakings. This paper offers an integrated collaborative research model to depict the complexities and challenges of initiation and implementation of a 2 1/2 year joint research project between a community hospital and a university school of nursing in Southern Ontario, Canada. A sampling of the experiences of the researchers are analyzed to clarify the dynamic and often competing issues and interactions involved in encouraging hospital-wide research involvement during periods of organizational growth and change. The model reflects the simultaneous interaction of organizational, change and collaborative processes while maintaining the rigor of the research (RCT), and ensuring minimal disruption to the service agency. Quantitative outcomes of this collaboration are presented through an analysis of participant involvement on multiple organizational levels. Recommendations for future collaborative research, including design and methodological issues and collaborative and change strategies are offered. The complexity of balancing the necessary trade-offs required of successful collaborative research are highlighted and will be useful to those considering and planning future collaborations.     

Comprehensive therapeutic benefits of Taiji: a critical review

This literature review offers physical rehabilitation professionals an update on the current breadth and strength of research evidence regarding comprehensive therapeutic benefits of Taiji practice. A critical analysis distinguishes between what is known from controlled clinical research and what is suggested in preliminary research. Of >200 published reports examined, 17 controlled clinical trials were judged to meet a high standard of methodological rigor. Controlled research evidence was found to confirm therapeutic benefits of Taiji practice with regard to improving quality of life, physical function including activity tolerance and cardiovascular function, pain management, balance and risk of falls reduction, enhancing immune response, and improving flexibility, strength, and kinesthetic sense. Preliminary research on implementation feasibility of Taiji programming exists for a variety of clinical populations. Further controlled clinical study is justified for a wide variety of clinical contexts.     

Addressing the threat of evidence-based practice to qualitative inquiry through increasing attention to quality: a discussion paper

The current evidence-based practice (EBP) movement in healthcare emphasizes that clinical decision making should be based on the "best evidence" available, preferably the findings of randomized clinical trials. Within this context qualitative research findings are considered to have little value and the old debate in nursing has been re-ignited related to whether qualitative versus quantitative research findings provides the best empirical evidence for nursing practice. In response to this crisis qualitative scholars have been called upon by leaders in the field to clarify for outsiders what qualitative research is and to be more explicit in pointing out the utility of qualitative research findings. In addition, attention to "quality" in qualitative research has been identified as an area worthy of renewed focus. Within this paper two key problems related to addressing these issues are reviewed: disagreement not only among "outsiders" but also some nursing scholars related to the definition of "qualitative research", and a lack of consensus related how to best address "rigor" in this type of inquiry. Based on this review a set of standard requirements for qualitative research published in nursing journals is proposed that reflects a uniform definition of qualitative research and an enlarged yet clearly articulated conceptualization of quality. The approach suggested provides a framework for developing and evaluating qualitative research that would have both defensible scholarly merit and heuristic value. This will help solidify the argument in favor of incorporating qualitative research findings as part of the empirical "evidence" upon which evidence-based nursing is founded.     

The problem of rigor in qualitative research

There are few explicit discussions in nursing literature of how qualitative research can be made as rigorous as it is relevant to the perspective and goals of nursing. Four factors complicate the debate about the scientific merits of qualitative research: the varieties of qualitative methods, the lack of clear boundaries between quantitative and qualitative research, the tendency to evaluate qualitative research against conventional scientific criteria of rigor, and the artistic features of qualitative inquiry. A framework for understanding the similarities and differences in research approaches and a summary of strategies to achieve rigor in qualitative research are presented.     

Using quantitative and qualitative approaches in knowledge production

The debate over the differences between quantitative and qualitative methods is frequent, holding favorable and opposite positions concerning their integration. Outlining a research that contemplates both approaches generates doubts and restlessness about how to use them without damaging the methods' rigor, specificity, as well as the methodological and reflective sophistication of each. The purpose isto report and discuss using the quantitative (randomized controlled clinical trial) and the qualitative approach to analyze and understand the practice of including a companion chosen by the woman during her labor and childbirth, performing the role of support provider. Using both methods allowed for approximating the multiple facets involved in this practice and evaluating both the explicative dimension and the comprehension, since it could be performed with complementary views.     

Ethical issues in health‐care inquiry: A discussion paper

This paper is a discussion of the possible ethical dilemmas that may arise in both qualitative and quantitative research despite stringent methodological protocols. Three categories of ethical issues will be elaborated on, namely, researcher–participant relations, informed consent and confidentiality and privacy. These are of note because ethical dilemmas most often arise in these areas. Both qualitative and quantitative research types may thus present with problems associated with any, or a combination, of these categories. Methodological rigour will also be discussed as a vital component of any research study. Critics of the qualitative approach have often suggested that the innate lack of methodological rigour has resulted in the preponderance of ethical issues in qualitative studies. Qualitative studies, similar to quantitative studies, have mechanisms that guarantee rigour, quality and trustworthiness. These checks are at par with those of quantitative research but based on different criteria. Both types of research, then, can be considered equal in terms of methodological rigour, regardless of the nature. As no research approach can be perfectly free from threats of ethical issues, it is the researcher's responsibility to address these in ways that will be less harmful to the participants, bearing in mind ethical problems can arise at any time during the research endeavour.     

Improving the effectiveness of interventions in palliative care: the potential role of qualitative research in enhancing evidence from randomized controlled trials

Evaluating interventions in palliative care using randomized controlled trials (RCTs) has helped advance the specialty and create an evidence base for the delivery of care. RCTs, however, are notoriously difficult to conduct in palliative care, raising a variety of practical, ethical and moral dilemmas. Mixed-methods research, which combines qualitative research and RCTs, offers a potential solution to these problems. This paper begins by examining the theoretical basis for combining the two approaches, before reviewing the specific role qualitative research could play in planning, conducting and implementing trials. The paper then goes on to explore how palliative care research currently uses the mixed-methods approach, by searching the trials included in six Cochrane Systematic Reviews (n = 146) on the incorporation of qualitative research. Only one trial undertook qualitative research. These findings reflect some of the challenges facing mixed-methods research, which include lack of experience in a research team, the problems of obtaining funding and difficulties in publishing. The paper concludes that while combining qualitative and quantitative research is not a panacea for methodological problems in palliative care research, with careful planning and integration, the approach may enhance the clinical and ethical utility of trial findings, which in turn will improve patient care.     

基于中国护理科技核心期刊的质性研究抽样报告现状分析

目的了解护理类期刊中质性研究抽样报告存在的问题并提出建议,为未来规范质性研究抽样的实施提供参考。方法检索EQURTOR、国际指南协作网、Cochrane library中的质性研究报告规范,根据专家建议选取书籍,制定抽样报告条目。检索2017-2020年中国护理科技核心期刊的质性研究文章,审查抽样过程。结果共产生抽样报告条目10条,纳入文献729篇,在“选择此种抽样方法的理由(1.51%)”“招募时与研究对象接触的方式(2.47%)”“为何选择这些研究对象(24.97%)”“拒绝或中途退出的情况(1.37%)”等方面存在问题。结论质性研究抽样报告中应注意阐明抽样理由、招募时的接触方式、研究对象拒绝或中途退出等情况,根据研究方法学确定停止抽样的标准,从而提高质性研究抽样报告的透明度和严谨度。     

Combining evidence in nursing research: methods and implications

BACKGROUND: The knowledge explosion in health care coupled with recent evidence-based practice initiatives has increased both the need for and the production of reviews of past research. The proliferation of such reviews has contributed to inconsistency in methods and terminology. Differing methods for integrative reviews, systematic reviews, meta-analyses, and qualitative reviews have been proposed, yet are not clearly differentiated in published reports. Although there are common features to these methods, each method has a distinct purpose, sampling frame, definition, and type of analysis. APPROACH: The literature on research review methods was analyzed and synthesized. Specific attention was directed toward the issues specific to combining primary nursing research studies. RESULTS: The defining characteristics of different research review methods, the common stages of all research reviews, and criteria for evaluating quality are described. DISCUSSION: Greater clarity regarding research review methods has the potential to enhance methodological rigor and subsequently the applicability of findings of all review methods to practice and policy.     

A Trojan horse for positivism?: a critique of mixed methods research

Mixed methods research is captured by a pragmatically inflected form of postpositivism. Although it passes for an alternative methodological movement that purports to breach the divide between qualitative and quantitative research, most mixed methods studies favor the forms of analysis and truth finding associated with positivism. We anticipate a move away from exploring more philosophical questions or undertaking modes of enquiry that challenge the status quo. At the same time, we recognize that mixed methods research offers particular strengths and that, although it serves as a Trojan Horse for positivism, it may productively carry other paradigmatic passengers.     

Rigor in cross-cultural nursing research

With the increasing number of cross-cultural nursing studies, many scholars have suggested methods for conducting cross-cultural research. However, rigor in cross-cultural research has rarely been addressed. In this paper, five evaluation criteria for rigor in cross-cultural nursing research are proposed based on a review of the literature related to cross-cultural research published from 1965 to 2003. The proposed evaluation criteria include: (a) cultural relevance; (b) contextuality; (c) appropriateness; (d) mutual respect; and (e) flexibility. We advocate that these evaluation criteria be used to ensure rigor of cross-cultural nursing research, whether quantitative or qualitative work.     

Methodological and ethical issues in conducting qualitative research with children and young people: a literature review

BACKGROUND: There is an increasing interest in involving children in research that has been influenced by the recognition of children's rights and by the reconceptualisation of children within the social sciences as active agents rather than as the objects of research. OBJECTIVES: To review the methodological and ethical issues involved in conducting qualitative research with children and to consider the implications for nursing research in light of recent debates within the social sciences. DESIGN: Narrative literature review using a systematic search of computerized databases. DATA SOURCES: Published papers, key texts, reports and policy documents that relate to the methodological and ethical issues in conducting qualitative research with children. RESULTS: There are three ethical issues in relation to conducting research with children: power relations, informed consent and confidentiality. Two key methodological issues are identifiable in relation to conducting research with children. One is epistemological and relates to the different cultures of childhood and adulthood and the second relates to the heterogenous nature of childhood itself. Novel techniques and task-based activities are being increasingly used to establish rapport and as a method of data collection. CONCLUSION: There are both differences and similarities in conducting qualitative research with children and with adults but often the similarities have been overlooked and the differences overstated. Nursing and other health-related researchers conducting research with adults could learn much from children's researchers, particularly in terms of sensitivity to ethical issues. Nursing research need to consider the methodological issues that have been debated in the social sciences and to critically reflect on the use of novel techniques in qualitative research.     

Impact of training on work-related assault

Although training is often recommended as a part of a comprehensive approach to address occupational violence, little empirical literature exists to support this recommendation. Over 40% of nurses responding to the Minnesota Nurses Study reported being trained about occupational violence, involving seven different training topics. Although at the univariate level, an increased risk was identified for nurses trained in managing assaultive/violent patients, no statistically significant results remained at the multivariate level. This lack of protection from training is consistent with previous research, although the explanations for this lack of effect remain unclear. Additional research is necessary to obtain more specific details on occupational violence training, including training content and methods, to understand more thoroughly the impact of training on occupational violence.     

Teaching qualitative research through participatory coursework and mentorship.

Many doctoral programs in nursing now offer at least one course in qualitative research. Yet it remains a challenge to adequately prepare new qualitative researchers due to lack of faculty expertise and mentorship, student unfamiliarity with qualitative research when entering the doctoral program, and uncertainty as to appropriate teaching methods. The authors describe how they addressed these issues historically and in their current two-course qualitative research sequence. Accompanying reports of four studies conducted by students who completed the two-course sequence during academic year 1996 to 1997 provide evidence of the viability of the authors' approach and serve as the basis for recommendations to others who use a similar strategy for teaching qualitative research.     

Generic qualitative research: a design for qualitative research in emergency care?

The frequency of qualitative studies in the Emergency Medicine Journal, while still low, has increased over the last few years. All take a generic approach and rarely conform to established qualitative approaches such as phenomenology, ethnography and grounded theory. This generic approach is no doubt selected for pragmatic reasons but can be weakened by a lack of rigor and understanding of qualitative research. This paper explores qualitative approaches and then focuses on "best practice" for generic qualitative research.     

Acupuncture in headache: a critical review

Twenty-seven clinical trials that evaluated the efficacy of acupuncture in the treat ment of primary headaches (migraine headache, tension-type headache, and mixed forms) were reviewed. In the majority of the trials (23 of the 27 trials), it was concluded that acupuncture offers benefits in the treatment of headaches. Conversely, the evaluation of physical forms of treatment, including acupuncture, has special difficulties, and certain parameters in the study design need consideration. Acupuncture methods need individualization, a carefully selected placebo ("minimal acupuncture" seems to be best), and the crossover design must have adequate time between the two treatment periods. Clinical trials that evaluate acupuncture frequently are characterized by several inadequacies (including some from these evaluating headaches), but it seems that additional clinical research is necessary to confirm its efficacy and to clarify its indications.