examples of qualitative and quantitative research questions in nursing

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A Good Question...

• Focuses your information needs
• Identifies key seach concepts
• Points you in the direction of potential resources

Background Questions

These questions are general in nature and provide foundational information on a single concept.  Background questions cover:

• Terminology
• General Pathology
• Patient Education Resources
• General Drug Information
• Examination/Assessment Procedures

What is the pathology of asthma ?

What drugs are used to treat hypertension ?

How do I perform a psychological assessment ?

What education resources exist for patients with gestational diabetes ?

How is hepatitis b diagnosed?

What does a normal heartbeat sound like?

These questions are best answered using the resources found in the Background Info page of this guide.

Foreground Questions

These questions bring together multiple concepts related to a specific clinical situation or research topic.  They may be divided into two  broad categories:

• Qualitative Questions  aim to discover meaning or gain an understanding of a phenomena or experience.  They ask about an individual's or population's experience of certain situations or circumstances
• Quantitative Questions  aim to discover cause and effect relationships, often through comparison. Comparison may occur between two or more individuals or groups based on outcomes associated with differences in exposures or interventions. Comparison may also be made to 'no intervention', standard care or standard practice, 'no exposure'.

These questions are best answered using the resources found in the 6S/Foreground Info page of this guide.

Forming Foreground Questions

Building an effective foreground question can be challenging.  The following models will help:

Qualitative Questions: The PS Model

P - Patient/Population

S - Situation

How do/does ___ [P] ____ experience _____ [S] _____?

What is the experience of ____ [P] ___ [S] ____?

Ex. How do  caregiver- spouses of Alzheimer patients  experience  placing their spouse in a nursing home ?

___________________________________________________________________________

Quantitative Questions: The PICO(T) Model

A quantitative approach can answer many different types of questions, but all can be formatted by following the  PICO(T) Model  outlined below:     

PICO(T) Templates

In ___ [ P ]___,  do/does ___[ I ]___ result in ___[ O ]____ when compared with ___[ C ]___ over ___[ T ]____?

E.g.) In nursing home residents with osteoporosis , do hip protectors result in fewer injuries from slips, trips, and falls when compared with standard osteoporosis drug therapy over the course of their stay ?

Are ___[ P ]___  with  ___[ I ]___  over ____[ T ]____ more likely to ___[ O ]____ when compared with ___[ C ]___ ?

E.g.) Are   female non-smokers   with  daily exposure to second-hand smoke  over  a period of ten years or greater  more likely to  develop breast cancer  when compared with  female non-smokers without daily exposure to second-hand smoke ?

Is/are ___[ I ]___ performed on ___[ P ]___   more effective than ___[ C ]___  over ___[ T ]____in ___[ O ]____?

E.g.) Are   self-reporting interviews and parent reports  performed on   children aged 5-10   more effective than  parent reports alone  over a  four-week consultation process  in  diagnosing depression ?

In ___[ P ]___,  do/does ___[ I ]___ result in ___[ O ]____ when compared with ___[ C ]___ over ___[ T ]____?

E.g.) In  emergency room visitors , do   hand sanitizing stations  result in   fewer in-hospital infections  when compared  with no hand sanitizing stations  over  a year-long pilot period ?

Do/does ___[ I ]___ performed on ___[ P ]___   lead to  ___[ O ]___  over ___[ T ]____compared with ___[ C ]____?

E.g.) Do  regular text message reminders  performed on  patients recently diagnosed with diabetes  lead to  a lower occurrence of forgotten insulin doses  over  the first six months of treatment  compared with  no reminders ?

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Nursing Resources : Qualitative vs Quantitative

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Differences between Qualitative & Quantitative Research

" Quantitative research ," also called " empirical research ," refers to any research based on something that can be accurately and precisely measured.  For example, it is possible to discover exactly how many times per second a hummingbird's wings beat and measure the corresponding effects on its physiology (heart rate, temperature, etc.).

" Qualitative research " refers to any research based on something that is impossible to accurately and precisely measure.  For example, although you certainly can conduct a survey on job satisfaction and afterwards say that such-and-such percent of your respondents were very satisfied with their jobs, it is not possible to come up with an accurate, standard numerical scale to measure the level of job satisfaction precisely.

It is so easy to confuse the words "quantitative" and "qualitative," it's best to use "empirical" and "qualitative" instead.

Hint: An excellent clue that a scholarly journal article contains empirical research is the presence of some sort of statistical analysis

See "Examples of Qualitative and Quantitative" page under "Nursing Research" for more information.

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Examples of Qualitative vs Quantitiative

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Introduction to qualitative nursing research

This type of research can reveal important information that quantitative research can’t.

• Qualitative research is valuable because it approaches a phenomenon, such as a clinical problem, about which little is known by trying to understand its many facets.
• Most qualitative research is emergent, holistic, detailed, and uses many strategies to collect data.
• Qualitative research generates evidence and helps nurses determine patient preferences.

Research 101: Descriptive statistics

Differentiating research, evidence-based practice, and quality improvement

How to appraise quantitative research articles

All nurses are expected to understand and apply evidence to their professional practice. Some of the evidence should be in the form of research, which fills gaps in knowledge, developing and expanding on current understanding. Both quantitative and qualitative research methods inform nursing practice, but quantitative research tends to be more emphasized. In addition, many nurses don’t feel comfortable conducting or evaluating qualitative research. But once you understand qualitative research, you can more easily apply it to your nursing practice.

What is qualitative research?

Defining qualitative research can be challenging. In fact, some authors suggest that providing a simple definition is contrary to the method’s philosophy. Qualitative research approaches a phenomenon, such as a clinical problem, from a place of unknowing and attempts to understand its many facets. This makes qualitative research particularly useful when little is known about a phenomenon because the research helps identify key concepts and constructs. Qualitative research sets the foundation for future quantitative or qualitative research. Qualitative research also can stand alone without quantitative research.

Although qualitative research is diverse, certain characteristics—holism, subjectivity, intersubjectivity, and situated contexts—guide its methodology. This type of research stresses the importance of studying each individual as a holistic system (holism) influenced by surroundings (situated contexts); each person develops his or her own subjective world (subjectivity) that’s influenced by interactions with others (intersubjectivity) and surroundings (situated contexts). Think of it this way: Each person experiences and interprets the world differently based on many factors, including his or her history and interactions. The truth is a composite of realities.

Qualitative research designs

Because qualitative research explores diverse topics and examines phenomena where little is known, designs and methodologies vary. Despite this variation, most qualitative research designs are emergent and holistic. In addition, they require merging data collection strategies and an intensely involved researcher. (See Research design characteristics .)

Although qualitative research designs are emergent, advanced planning and careful consideration should include identifying a phenomenon of interest, selecting a research design, indicating broad data collection strategies and opportunities to enhance study quality, and considering and/or setting aside (bracketing) personal biases, views, and assumptions.

Many qualitative research designs are used in nursing. Most originated in other disciplines, while some claim no link to a particular disciplinary tradition. Designs that aren’t linked to a discipline, such as descriptive designs, may borrow techniques from other methodologies; some authors don’t consider them to be rigorous (high-quality and trustworthy). (See Common qualitative research designs .)

Sampling approaches

Sampling approaches depend on the qualitative research design selected. However, in general, qualitative samples are small, nonrandom, emergently selected, and intensely studied. Qualitative research sampling is concerned with accurately representing and discovering meaning in experience, rather than generalizability. For this reason, researchers tend to look for participants or informants who are considered “information rich” because they maximize understanding by representing varying demographics and/or ranges of experiences. As a study progresses, researchers look for participants who confirm, challenge, modify, or enrich understanding of the phenomenon of interest. Many authors argue that the concepts and constructs discovered in qualitative research transcend a particular study, however, and find applicability to others. For example, consider a qualitative study about the lived experience of minority nursing faculty and the incivility they endure. The concepts learned in this study may transcend nursing or minority faculty members and also apply to other populations, such as foreign-born students, nurses, or faculty.

Qualitative nursing research can take many forms. The design you choose will depend on the question you’re trying to answer.

A sample size is estimated before a qualitative study begins, but the final sample size depends on the study scope, data quality, sensitivity of the research topic or phenomenon of interest, and researchers’ skills. For example, a study with a narrow scope, skilled researchers, and a nonsensitive topic likely will require a smaller sample. Data saturation frequently is a key consideration in final sample size. When no new insights or information are obtained, data saturation is attained and sampling stops, although researchers may analyze one or two more cases to be certain. (See Sampling types .)

Some controversy exists around the concept of saturation in qualitative nursing research. Thorne argues that saturation is a concept appropriate for grounded theory studies and not other study types. She suggests that “information power” is perhaps more appropriate terminology for qualitative nursing research sampling and sample size.

Data collection and analysis

Researchers are guided by their study design when choosing data collection and analysis methods. Common types of data collection include interviews (unstructured, semistructured, focus groups); observations of people, environments, or contexts; documents; records; artifacts; photographs; or journals. When collecting data, researchers must be mindful of gaining participant trust while also guarding against too much emotional involvement, ensuring comprehensive data collection and analysis, conducting appropriate data management, and engaging in reflexivity.

Data usually are recorded in detailed notes, memos, and audio or visual recordings, which frequently are transcribed verbatim and analyzed manually or using software programs, such as ATLAS.ti, HyperRESEARCH, MAXQDA, or NVivo. Analyzing qualitative data is complex work. Researchers act as reductionists, distilling enormous amounts of data into concise yet rich and valuable knowledge. They code or identify themes, translating abstract ideas into meaningful information. The good news is that qualitative research typically is easy to understand because it’s reported in stories told in everyday language.

Evaluating a qualitative study

Evaluating qualitative research studies can be challenging. Many terms—rigor, validity, integrity, and trustworthiness—can describe study quality, but in the end you want to know whether the study’s findings accurately and comprehensively represent the phenomenon of interest. Many researchers identify a quality framework when discussing quality-enhancement strategies. Example frameworks include:

• Trustworthiness criteria framework, which enhances credibility, dependability, confirmability, transferability, and authenticity
• Validity in qualitative research framework, which enhances credibility, authenticity, criticality, integrity, explicitness, vividness, creativity, thoroughness, congruence, and sensitivity.

With all frameworks, many strategies can be used to help meet identified criteria and enhance quality. (See Research quality enhancement ). And considering the study as a whole is important to evaluating its quality and rigor. For example, when looking for evidence of rigor, look for a clear and concise report title that describes the research topic and design and an abstract that summarizes key points (background, purpose, methods, results, conclusions).

Application to nursing practice

Qualitative research not only generates evidence but also can help nurses determine patient preferences. Without qualitative research, we can’t truly understand others, including their interpretations, meanings, needs, and wants. Qualitative research isn’t generalizable in the traditional sense, but it helps nurses open their minds to others’ experiences. For example, nurses can protect patient autonomy by understanding them and not reducing them to universal protocols or plans. As Munhall states, “Each person we encounter help[s] us discover what is best for [him or her]. The other person, not us, is truly the expert knower of [him- or herself].” Qualitative nursing research helps us understand the complexity and many facets of a problem and gives us insights as we encourage others’ voices and searches for meaning.

When paired with clinical judgment and other evidence, qualitative research helps us implement evidence-based practice successfully. For example, a phenomenological inquiry into the lived experience of disaster workers might help expose strengths and weaknesses of individuals, populations, and systems, providing areas of focused intervention. Or a phenomenological study of the lived experience of critical-care patients might expose factors (such dark rooms or no visible clocks) that contribute to delirium.

Successful implementation

Qualitative nursing research guides understanding in practice and sets the foundation for future quantitative and qualitative research. Knowing how to conduct and evaluate qualitative research can help nurses implement evidence-based practice successfully.

When evaluating a qualitative study, you should consider it as a whole. The following questions to consider when examining study quality and evidence of rigor are adapted from the Standards for Reporting Qualitative Research.

Jennifer Chicca is a PhD candidate at the Indiana University of Pennsylvania in Indiana, Pennsylvania, and a part-time faculty member at the University of North Carolina Wilmington.

Amankwaa L. Creating protocols for trustworthiness in qualitative research. J Cult Divers. 2016;23(3):121-7.

Cuthbert CA, Moules N. The application of qualitative research findings to oncology nursing practice. Oncol Nurs Forum . 2014;41(6):683-5.

Guba E, Lincoln Y. Competing paradigms in qualitative research . In: Denzin NK, Lincoln YS, eds. Handbook of Qualitative Research. Thousand Oaks, CA: SAGE Publications, Inc.;1994: 105-17.

Lincoln YS, Guba EG. Naturalistic Inquiry . Thousand Oaks, CA: SAGE Publications, Inc.; 1985.

Munhall PL. Nursing Research: A Qualitative Perspective . 5th ed. Sudbury, MA: Jones & Bartlett Learning; 2012.

Nicholls D. Qualitative research. Part 1: Philosophies. Int J Ther Rehabil . 2017;24(1):26-33.

Nicholls D. Qualitative research. Part 2: Methodology. Int J Ther Rehabil . 2017;24(2):71-7.

Nicholls D. Qualitative research. Part 3: Methods. Int J Ther Rehabil . 2017;24(3):114-21.

O’Brien BC, Harris IB, Beckman TJ, Reed DA, Cook DA. Standards for reporting qualitative research: A synthesis of recommendations. Acad Med . 2014;89(9):1245-51.

Polit DF, Beck CT. Nursing Research: Generating and Assessing Evidence for Nursing Practice . 10th ed. Philadelphia, PA: Wolters Kluwer; 2017.

Thorne S. Saturation in qualitative nursing studies: Untangling the misleading message around saturation in qualitative nursing studies. Nurse Auth Ed. 2020;30(1):5. naepub.com/reporting-research/2020-30-1-5

Whittemore R, Chase SK, Mandle CL. Validity in qualitative research. Qual Health Res . 2001;11(4):522-37.

Williams B. Understanding qualitative research. Am Nurse Today . 2015;10(7):40-2.

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• Quantitative
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Quantitative research articles will tackle research questions that can be measured numerically and described using statistics. An example of quantitative research would be a randomized controlled trial.

• contains statistical analysis
• large sample size
• objective - little room to argue with the numbers
• types of research: descriptive studies, exploratory studies, experimental studies, explanatory studies, predictive studies, clinical trials

Finding Quantitative Studies

• “chronic pain” AND quantitative
• “chronic pain” AND “clinical trial*”
• Explore the advanced search options in the database you are using. Some databases (like PsycINFO, CINAHL, and PubMed) have limiters by study type or research design. See the example below from the CINAHL database advanced search.

Qualitative research articles will attempt to answer questions that cannot be strictly measured by numbers but rather by perceived meaning. Qualitative research will likely include interviews, case studies, ethnography, or focus groups.

• includes interviews or focus groups
• small sample size
• subjective - researchers are often interpreting meaning
• methods used: phenomenology, ethnography, grounded theory, historical method, case study

Finding Qualitative Studies

• “chronic pain” AND qualitative
• “chronic pain” AND ("grounded theory" OR ethnography OR phenomenology)
• "chronic pain" AND (focus group OR interview)
• High Sensitivity - the broadest search to include ALL relevant material. It may include less relevant materials
• High Specificity - the most targeted search to include only the most relevant result set, may miss some relevant materials
• Best Balance - retrieves the best balance between Sensitivity and Specificity

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• Overview of Quantitative vs. Qualitative Research
• Steps for Conducting a Literature Review
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In general, quantitative research seeks to understand the causal or correlational relationship between variables through testing hypotheses, whereas qualitative research seeks to understand a phenomenon within a real-world context through the use of interviews and observation. Both types of research are valid, and certain research topics are better suited to one approach or the other. However, it is important to understand the differences between qualitative and quantitative research so that you will be able to conduct an informed critique and analysis of any articles that you read, because you will understand the different advantages, disadvantages, and influencing factors for each approach. 

The table below illustrates the main differences between qualitative and quantitative research. Be aware that these are generalizations, and that not every research study or article will fit neatly into these categories. 

Systematic reviews, meta-analyses, and integrative reviews are not exactly designs, but they synthesize, analyze, and compare the results from many research studies and are somewhat quantitative in nature. However, they are not truly quantitative or qualitative studies.

References:

LoBiondo-Wood, G., & Haber, J. (2010). Nursing research: Methods and critical appraisal for evidence-based practice (7 th ed.). St. Louis, MO: Mosby Elsevier

Mertens, D. M. (2010). Research and evaluation in education and psychology (3 rd ed.). Los Angeles: SAGE

This 2-minute video provides a simplified overview of the primary distinctions between quantitative and qualitative research.

It's important to keep in mind that research studies and articles are not always 100% qualitative or 100% quantitative. A mixed methods study involves both qualitative and quantitative approaches. If you need to find articles that are purely qualitative or purely quanititative, be sure to look carefully at the methodology sections to make sure the studies did not utilize both methods. 

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Understanding Nursing Research

• Primary Research

What is Quantitative Research?

How do i tell if my article has quantitative research, qualitative research.

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There are two kinds of research: Quantitative and Qualitative

Quantitative is research that generates numerical data. If it helps, think of the root of the word "Quantitative." The word "Quantity" is at its core, and quantity just means "amount" or "how many." Heart rates, blood cell counts, how many people fainted at the jazz festival-- these are all examples of quantitative measures.

Qualitative , on the other hand, is a more subjective measurement. Think of the root of the word again, this time it's "Quality." If someone is called a quality person or someone's selling a high quality product, they're being measured in subjective terms, rather than concrete, objective terms (like numbers.) Qualitative research includes things like interviews or focus groups.

Just like when we examine whether or not our article is an example of Primary Research, the best way to examine what kind of data your article uses is by reading the article's Abstract, Methodologies, and Results sections. That will tell you how the research was conducted and what kind of data (qualitative or quantitative) was collected.

An example of what to look for in the Abstract can be seen here:

You can see that data was evaluated (66% of students were in compliance with school immunization requirements), a strategy was implemented (letters and emails were sent to student's parents/guardians), and at the end of the study, new quantitative data is reported (99.6% of students were in compliance with vaccination requirements).

Finding qualitative research can be trickier, since it can often take more time to collect. Examples of qualitative data include things like interview transcripts, focus group feedback, and journal entries detailing people's experiences and feelings. The easiest way to search for a qualitative study is to include the word "qualitative" as a keyword in your database search along with the search terms about the topic you're interested in.

Check out the video below to see an example of searching for qualitative research in CINAHL.

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Evidence Based Nursing

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Difference between Qualitative vs. Quantitative Research

Qualitative research allows you to discover the why and how of people and activities. The abstract from this dissertation shows  the study: 

• Asks open-ended questions
• Examines people's activities
• Gives a narrative conclusion 
• Observations and Interviews 
• Understanding and interpreting social interactions and behaviors 
• Uses a small group of subjects 
• Uses words 

Quantitative research is based on things that can be accurately and precisely measured. The abstract shows that this dissertation:

• Describes with statistics
• Gives a statistical result 
• Makes predictions 
• Objective 
• Studies a randomly selected group 
• Tests a theory 
• Uses numbers
• Uses a survey 

Identifying Quantitative Research- Example

This abstract has several indications that this is a  quantitative  study:

• the goal of the study was examining relationships between several variables
• the researchers used statistical methods (logistic regression models)
• subjects completed questionnaires
• the study included a large number of subjects

Based on Eastern Michigan University Library Libguide Quantitative and Qualitative Research 

Identifying Qualitative Research-Example

This abstract has several indications that this is a qualitative study: 

• the goal of the study was to explore the subjects' experiences. 
• the researchers conducted open-ended interviews. 
• the researchers used thematic analysis when reviewing the interviews. 

Based on Eastern Michigan University Library Libguide  Quantitative and Qualitative Research 

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Nursing Research - Undergraduate: Quantitative vs. Qualitative

• Primary vs. Secondary
• Peer-Reviewed
• Quantitative vs. Qualitative
• Evidence-Based Practice
• Hiearchy of Evidence

What is the difference?

Quantitative research and qualitative research are two types of original research that you will come across when you are researching for original nursing research. 

While both contain useful data to use, you may be required to use one particular type of data for a paper or presentation. 

Definitions

Quantitative research : A traditional approach to research in which variables are identified and measured in a reliable and valid way (Houser, 2018, p. 34)

Qualitative research : A naturalistic approach to research in which the focus is on understanding the meaning of an experience from the individual's perspective (Houser, 2018, p. 35)

Houser, J. (2018). Nursing research: Reading, using, and creating evidence  (4th ed.).  Jones & Bartlett Learning. 

Quantitative Research

Think of quantitative research as a scientific experiment. You have your hypothesis, an item you want to change, an item you are comparing the change against, and then the results of your experiment.

At its core, quantitative research involves a control variable and an independent variable. Typically with nursing research, the independent variable will be the proposed change or intervention that you are looking to implement in your practice . Results of a quantitative research study should be something that can be replicated. Data results for quantitative research typically involve hard data, such as blood pressure, temperature, oxygen levels, etc. 

Types of Research Used for Evidence-Based Practice

Ovid. [OvidWoltersKluwer]. (2015, October 6). Types of research used for evidence- based practice [Video file]. YouTube.  https://youtu.be/jwOu24btBVk

Qualitative Research

Qualitative research focuses more on soft data, meaning it observes an individual's experience and cannot be replicated (Houser, 2018). Types of research studies that are qualitative include: "observations, in-depth interviews or focus-groups, case studies, and social interaction studies" (Houser, 2018). 

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150 Qualitative and Quantitative Nursing Research Topics for Students

Do not be lazy to spend some time researching and brainstorming. You can either lookup for the popular nursing research topics on social media networks or news or ask a professional writer online to take care of your assignment. What you should not do for sure is refuse to complete any of your course projects. You need every single task to be done if you wish to earn the highest score by the end of a semester.

In this article, we will share 150 excellent nursing research topics with you. Choose one of them or come up with your own idea based on our tips, and you’ll succeed for sure!

Table of Contents

Selecting the Top Ideas for Your Essays in Healthcare & Medicine

Would you like to learn how to write a research paper topic for nursing students? We will share some tips before offering lists of ideas.

Start with the preliminary research. You can get inspired on various websites offering ideas for students as well as academic help. Gather with your classmates and brainstorm by putting down different themes that you can cover. You should take your interests into consideration, but still, remember that ideas must relate to your lessons recently covered in class. You have to highlight keywords and main phrases to use in your text.

Before deciding on one of the numerous nursing school research topics, you should consult your tutor. Make sure that he or she approves the idea. Start writing only after that.

50 Popular Nursing Research Topics

Are you here to find the most popular research topics? They change with each new year as the innovations and technologies move on. We have collected the top discussed themes in healthcare for you.

• Problems Encountered by the Spouses of the Patients with Dyslexia
• Ethics in Geriatrics
• Checklist for the Delivery Room Behavior
• Parkinson Disease: Causes and Development
• Exercises Used to Improve Mental Health
• Effective Tips for Antenatal Treatment
• Syndrome of the Restless Legs: How to Treat It
• Behavior Assessment in Pediatric Primary Care
• Why Can Mother’s Health Be under the Threat During the Child Birth?
• Recommendations for Creating Strong Nursing Communities
• Alzheimer’s Disease and Proper Treatment
• Pre-Term Labor Threats
• Music Therapy and Lactation
• Influence of Ageism on Mental Health
• Newborn Resuscitation Practices
• Effective Therapy for Bladder Cancer
• Approaches to Improving Emotional Health of Nurses
• Skin-to-skin Contact by mothers and Its Consequences
• Does a Nurse Have a Right to Prescribe Drugs?
• Research on Atrial Fibrillation
• Pros & Cons of Water Birth
• Prevention Measures for Those Who Have to Contact Infectious Diseases
• Stroke Disease and Ways to Cure It
• The Role of Governmental Policies on the Hiring of Healthcare Professionals
• Demands for the Critical Care
• Joint Issue Research in Elderly Population
• Why Should Nurses and Healthcare Workers Cooperate?
• The Role of Good Leadership Skills in Nursing Profession
• How to Minimize the Threat of Cardiovascular Problems
• What Should a Nurse Do When an Elderly Refuses to Eat?
• Main Reasons for the Depression to Occur
• Methods Used to Detect an Abused Elderly Patient
• Treatment and Prevention of Acne and Other Skin Problems
• Consequences of the So-Called “Cold Therapy”
• End-of-Life Care Interventions That Work
• Risk factors for Osteoporosis in Female Population
• Alcohol Addiction and How to Get Rid of It
• Emerging Ethical Problems in Pain Management
• Psychiatric Patient Ethics
• How to Teach Female Population about Menopause Management
• Reasons for Aged Patients to Use Alcohol in Nursing Homes
• Family Engagement in Primary Healthcare
• Do the Race and Gender of a Patient Play a Role in Pain Management?
• PTSD in the Veterans of the United States Army
• How to Prepare a Nurse for Primary Healthcare
• The Correlation between Teen Aggression and Video Games
• Outcomes of Abdominal Massage in Critically Sick Population
• Developing an Effective Weight Loss Program: Case Study
• Comparing and Contrasting Public Health Nursing Models in Various Regions
• Mirror Therapy for Stroke Patients Who Are Partially Paralyzed

50 Interesting Nursing Research Topics

Do you wish to impress the target audience? Are you looking for the most interesting nursing research topics? It is important to consider time and recently covered themes. People tend to consider a topic an interesting one only if it is relevant. We have prepared the list of curious ideas for your project.

• Reasons for Hypertensive Diseases
• Self-Care Management and Sickle Cell Grown-Up Patients
• Schizophrenia Symptoms, Treatment, and Diagnostics
• Acute Coronary Syndrome Care
• Getting Ready with Caesarean Section
• What Are Some of the Cold and Cough Medicines?
• Why Do Patients Suffer from Anxiety Disorders?
• Use of the Forbidden Substances in Medicine
• How to Make Wise and Safe Medical Decisions
• CV Imaging Procedure
• Complementary vs. Alternative Therapy
• Can Some Types of Grains Prevent Cardiovascular Diseases?
• Restrictions of Medical Contracts
• How to Cope with High Levels of Stress
• Legal Threats with Non-English Patients
• The Basics of Palliative Care
• Clinical Cardiology Innovations
• How to Reduce Body Temperature in Household Conditions
• What Causes Type II Diabetes?
• Ways to Control Blood Pressure at Home
• Dental/Oral Health in the US
• Is There a Gender Bias in Nursing Profession?
• Gyno Education for the Young Girls
• Bipolar Disorder and Its Main Symptoms
• Methods Used to Recover after Physical Traumas
• The Principles of Sports Medicine
• The Gap between Female and Male Healthcare Professionals
• Increasing the Efficiency of Asthma Management in Educational Establishments
• Different Roles of Clinical Nurses
• Case Study: Successful Treatment of Migraine
• In-depth Analysis of the Ovarian Disorder
• Distant Intensive Treatment Until Questions
• Proper Treatment of Sleep Disorders
• How to Overcome Stressful Situations during Night Shifts
• Effective Methods to Prevent Breast Cancer
• Future of Healthcare & Medicine (Based on Modern Innovations)
• Approaches to Treating Insomnia
• Reproductive Endocrinology
• Diversity in the Field of Medicine
• Issues Associated with Menopause
• Causes and Effects of the Vaginal Atrophy
• Is Child’s Health Insurance a Right or a Privilege?
• Best Practices for Nursing Practitioners
• What Does the Phenomenon of Phantom Pains Stand for?
• Ethical Aspects of Infertility
• Protocol for Headache Treatment
• Moral Aspects of Euthanasia
• Treatment of Homeless People
• Why Should Healthcare System Be Made Free Everywhere in the World?
• Pain Restrictions Evaluation

50 Good Nursing Research Topics

Here is one more list of the nursing topics for research paper. We hope that at least one of these ideas will inspire you or give a clue.

• Advantages of Pet Therapy in Kids with the Autism Disorder
• Contemporary Approaches to Vaccinating Teenagers
• eHealth: The Effectiveness of Telecare and eCare
• Burn-Out in the Nursing Profession: Effective Ways to Handle Stress
• Healing of Bone Injuries
• Providing Spiritual Care: Does It Make Sense?
• Rheumatoid Arthritis: Opioid Usage
• Symptoms in ER That Cannot Be Explained by Medicine
• Contemporary Neonatal Practices
• Disorders with the Sexual Heath of an Average Woman
• Typical Causes of Headache
• Top Measures Used to Prevent Pregnancy
• Strategies Used by Government to Finance Healthcare System
• The Possible Consequences of Abortion for Women
• Evaluation of Childbirth Efficacy
• Quality Evaluation Techniques in Healthcare & Medicine
• Maternal Practices in Urban Areas
• Childcare Services Integration in Primary Medicine
• Rules for Pregnant Women Who Suffer from Obesity
• Mental Causes of Anorexia Nervosa
• Self-Instruction Kits
• Post-Natal Period Recommendations
• Midwifery Continuous Treatment & Care
• Case Study: Analyzing Positive Birth Experience
• Issues Related to the Gestational Weight Gain
• The Importance of Healthy Nutrition and Hydration
• What Are the Obligations of Every Nurse in Any Situation?
• Causes, Symptoms, and Treatment of ADHD
• Management of Disease and Prevention Methods
• The Importance of Kid and Teen Vaccination
• Termination of Pregnancy: Risks for Female Health
• Obligations of Every Pharmacist
• How to Prevent Child Obesity
• How to Stick to the Safe Sex Culture
• What Are the Main Symptoms of Autism?
• Ethics of the Healthcare Sales Promotion Campaigns
• Pros and Cons of Telemedicine
• Ethics in Pediatric Care
• Therapies Used to Treat Speech Disorders
• Medical Uniform Code Principles
• Psychological Sides of Infant Treatment
• Reasons for Seizures to Happen in Young Adolescents
• Healthcare Home Service and Self-Medicine
• How to Deal with Various Types of Eating Disorders
• Treatment of Patients in Prison
• Patient Security and Human Factors
• Bad Habits and Illnesses Impacted by Social Media and Pop Culture
• Apology Legislation and Regulations
• Antibiotic Resistance in Small Kids
• Nursing Marijuana Management & Control

You should also know that there are qualitative and quantitative nursing research topics. If you decide to base your study on numbers and figures, you should think about the second category. In quantitative research papers, writers must provide statistical data and interpret it to defend a thesis statement or find a solution to the existing problem.

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Mixed Methods in Nursing Research : An Overview and Practical Examples

Ardith z. doorenbos.

School of Nursing, University of Washington, USA, Box 357266, Seattle, WA 98177

Mixed methods research methodologies are increasingly applied in nursing research to strengthen the depth and breadth of understanding of nursing phenomena. This article describes the background and benefits of using mixed methods research methodologies, and provides two examples of nursing research that used mixed methods. Mixed methods research produces several benefits. The examples provided demonstrate specific benefits in the creation of a culturally congruent picture of chronic pain management for American Indians, and the determination of a way to assess cost for providing chronic pain care.

Introduction

Mixed methods is one of the three major research paradigms: quantitative research, qualitative research, and mixed methods research. Mixed methods research combines elements of qualitative and quantitative research approaches for the broad purpose of increasing the breadth and depth of understanding. The definition of mixed methods, from the first issue of the Journal of Mixed Methods Research, is “research in which the investigator collects and analyzes data, integrates the findings, and draws inferences using both qualitative and quantitative approaches or methods in a single study or program of inquiry” ( Tashakkori & Creswell, 2007 , p.4).

Mixed methods research began among anthropologists and sociologists in the early 1960s. In the late 1970s, the term “triangulation” began to enter methodology conversations. Triangulation was identified as a combination of methodologies in the study of the same phenomenon to decrease the bias inherent in using one particular method ( Morse, 1991 ). Two types of sequencing for mixed methods design have been proposed: simultaneous and sequential. Type of sequencing is one of the key decisions in mixed methods study design. Simultaneous sequencing is postulated to be simultaneous use of qualitative and quantitative methods, where there is limited interaction between the two sources of data during data collection, but the data obtained is used in the data interpretation stage to support each method's findings and to reach a final understanding. Sequential sequencing is postulated to be the use of one method before the other, as when the results of one method are necessary for planning the next method.

Since the 1960s, the use of mixed methods has continued to grow in popularity ( O'Cathain, 2009 ). Currently, although there are numerous designs to consider for mixed methods research, the four major types of mixed methods designs are triangulation design, embedded design, explanatory design, and exploratory design ( Creswell & Plano Clark, 2007 ). The most common and well-known approach to mixed methods research continues to be triangulation design.

There are many benefits to using mixed methods. Quantitative data can support qualitative research components by identifying representative patients or outlying cases, while qualitative data can shed light on quantitative components by helping with development of the conceptual model or instrument. During data collection, quantitative data can provide baseline information to help researchers select patients to interview, while qualitative data can help researchers understand the barriers and facilitators to patient recruitment and retention. During data analysis, qualitative data can assist with interpreting, clarifying, describing, and validating quantitative results.

Four broad types of research situations have been reported as benefiting particularly from mixed methods research. The first situation is when concepts are new and not well understood. Thus, there is a need for qualitative exploration before quantitative methods can be used. The second situation is when findings from one approach can be better understood with a second source of data. The third situation is when neither a qualitative nor a quantitative approach, by itself, is adequate to understanding the concept being studied. Lastly, the fourth situation is when the quantitative results are difficult to interpret, and qualitative data can assist with understanding the results ( Creswell & Plano Clark, 2007 ).

The purpose of this article is to illustrate mixed methods methodology by using examples of research into the chronic pain management experience among American Indians. These examples demonstrate the methodology used to provide (a) a detailed multilevel understanding of the chronic pain care experience for American Indians using triangulation design (multilevel model), and (b) a comparison of cost for two different chronic pain care delivery models, also using triangulation design (data transformation model).

An Example : Understanding the Pain Management Experience Among American Indians

Chronic pain poses unique challenges to the American health care system, including ever-escalating costs, unintentional poisonings and deaths from overdoses of painkillers, and incalculable suffering for patients as well as their families. Approximately 100 million adults in the United States are affected by chronic pain, with treatment costs and losses in productivity totaling $635 billion annually ( Institute of Medicine, 2011 ). Symptoms of pain are the leading reason patients visit health care providers ( Hing, Cherry, & Woodwell, 2006 ).

At the level of the community-based primary care provider, especially in tribal areas of the United States, there is often not enough capacity to manage complex chronic pain cases, and this is often due to lack of access to specialty pain care ( Momper, Delva, Tauiliili, Mueller-Williams, & Goral, 2013 ). The American Indian population in particular is underserved by health care and the most vulnerable to the impact of chronic pain, with high rates of drug poisoning due to opioid analgesics ( Warner, Chen, Makuc, Anderson, & Minino, 2011 ). There are 2.9 million people who report exclusive and an additional 1.6 million who report partial American Indian ancestry in the United States. They are a diverse group, residing in 35 states and organized into 564 federally recognized tribes ( U.S. Census Bureau, 2010 ). However, there is a scarcity of published literature exploring the experience, epidemiology, and management of pain among American Indians ( Haozous, Knobf, & Brant, 2010 ; Haozous & Knobf, 2013 ; Jimenez, Garroutte, Kundu, Morales, & Buchwald, 2011 ).

Using Mixed Methods to Overcome Barriers to Research

Barriers to effective research into chronic pain management among American Indians include the relatively small number of American Indian patients in any circumscribed area or tribe, the limitations of individual databases, and widespread racial misclassification. A mixed methods research approach is needed to understand the complex experience, epidemiology, and management of chronic pain among American Indians and to address the strengths and weaknesses of quantitative methodologies (large sample size, trends, generalizable) with those of qualitative methodologies (small sample size, details, in-depth).

This first example is from an ongoing study that uses triangulation design to provide a better understanding of the phenomenon of chronic pain management among American Indians. The study uses a multilevel model in which quantitative data collected at the national and state levels will be analyzed in parallel with the collection and analysis of the qualitative data at the patient level (see Figure 1 ). This allows the weakness of one approach to be offset by the strengths of the other. The results of the separate level analyses will be compared, contrasted, and blended leading to an overall interpretation of results.

Role of quantitative data

Previous examination of U.S. national databases has reported a higher prevalence of lower back pain in American Indians than in the general population (35% compared to 26% ; Deyo, Mirza, & Martin, 2002 ). Thus, at level 1, quantitative administrative data sets representing health care received by American Indians, both across the United States and in broad regions, will be used to evaluate macro-level trends in utilization of health care and in basic outcomes, such as opioid-related deaths.

At level 2, more detailed quantitative Washington state tribal clinic data will be used to identify American Indian populations, evaluate breakdowns in the delivery of care, and identify processes that lead to unsuccessful outcomes. For example, in a study conducted with community health practitioners in Alaska, participants reported low levels of knowledge and comfort around discussing cancer pain ( Cueva, Lanier, Dignan, Kuhnley, & Jenkins, 2005 ).

Role of qualitative data

At level 3, qualitative research through focus groups and key informant interviews will provide even more refined information about perceptions of recommended and received care. These interviews will provide insight into selected immediate and proximal factors. These factors include patients' choice and use of services; attitudes, motivations, and perceptions that influence their decisions; interpersonal factors, such as social support; and perceived discrimination. This qualitative data will shed light on potential barriers to care that are not easily recognized in administrative or clinical records, and thereby will provide greater detail about patient views of chronic pain care.

Role of (qualitative) indigenous methodologies

Since the focus of this study is on the chronic pain experience among American Indian patients, it is important that the qualitative work in level 3 be guided by indigenous methodologies, in both data collection and analysis. The phrase “indigenous methodologies” refers to an evolving framework for creating research that places the epistemologies of indigenous participants and communities at the center of the work, while building an equitable and respectful setting for bidirectional learning ( Evans, Hole, Berg, Hutchinson, & Sookraj, 2009 ; Louis, 2007 .; Smith, 2004 ). Although the tenets of indigenous methodologies vary according to the source, there is agreement among sources that research with indigenous populations should be wellness-oriented, holistic, community-oriented, and focused on indigenous knowledge, and should incorporate bidirectional learning ( Louis, 2007 ; Smith, 2004 ).

The ongoing project aligns with these guidelines by building knowledge about the chronic pain experience from the perspective of American Indian patients. The data is being interpreted with the goal of designing a usable and relevant model that will resonate at the American Indian community level. The researchers have conducted focus groups with the needs and priorities of the participants placed at the forefront, to best achieve the goals of learning and building knowledge that reflects the participants' experiences. Specifically, the focus groups were scheduled within three tribes, ensuring high familiarity and social support among group members. These focus groups met either at a tribal community center or in a nearby tribally owned casino in the evening. Each focus group started with a dinner, followed by discussion.

The focus group facilitator was well-known to the community, and although not American Indian, had been an active participant in community events and had provided expert knowledge and consultation to the tribes. Additionally, each focus group was co-facilitated by a tribal elder. The high familiarity among the participants and the research team was an important component of the bidirectional learning: it helped reduce much of the mistrust that has historically prevented medical researchers from obtaining high-quality data in similarly vulnerable populations ( Guadagnolo, Cina, & Helbig, 2009 ).

Benefits of Triangulation Design: Multilevel Model

In summary, only a mixed methods study that included quantitative and qualitative methods could provide the data required for a comprehensive multilevel assessment of the chronic pain experience among American Indians. Although this study is ongoing, the plan is for a nationwide analysis of variations in chronic pain outcomes among American Indians to examine the structure of service delivery and organization. Analysis of the state tribal clinic data will address intermediate factors and will examine community-level variation in pain management and local access to pain specialists. Preliminary analysis of the focus group data has already demonstrated that there is insufficient pain management among American Indians, due in part to lack of knowledge about pain management among providers and lack of access to pain specialists.

An Example; Comparing the Costs of Two Models for Providing Chronic Pain Care to American Indians

Telehealth is one innovative approach to providing access to high-quality interdisciplinary pain care for American Indians. A telehealth model with a unique approach based on provider-to-provider videoconference consultations allows community-based providers to present complex chronic pain cases to a panel of pain specialists through a videoconferencing infrastructure that also incorporates longitudinal outcomes tracking to monitor patient progress. Telehealth is an innovative model of health care delivery, and its use among American Indians has been expanding over the past several years ( Doorenbos et al., 2010 ; Doorenbos et al., 2011a ; 2011b ). Although the use of telehealth for providing chronic pain consultation is still in early stages, the long-term effectiveness of this approach and its impact on increasing capacity for pain management among community providers is being investigated ( Haozous et al., 2012 ; Tauben, Towle, Gordon, Theodore, & Doorenbos, 2013 ). The mixed methods approach for this transaction cost analysis used a unique triangulation design with a data transformation model to build a body of evidence for telehealth pain management.

With ever increasing mandates to reduce the cost and increase the quality of pain management, health care institutions are faced with the challenge of demonstrating that new technologies provide value while maintaining or even improving the quality of care ( Harries & Yellowlees, 2013 ). Transaction cost analysis can provide this evidence by using mixed methods research methodologies to provide comparative evaluation of the costs and consequences of using alternative technologies and the accompanying organizational arrangements for delivering care ( Williamson, 2000 ).

The theory of transaction cost developed from the observation that our structures for governing transactions—the ways in which we organize, manage, support, and carry out exchange — have economic consequences ( Williamson, 1991 ). Though prices matter, this theory recognizes that prices can and do deviate from the cost of production and do not include the cost of transacting ( Coase, 1960 ). Setting aside neoclassical economic conceptions of price, output, demand, and supply, the transaction becomes the unit of analysis ( Williamson, 1985 ).

In transactions, there are typically two parties engaging in the exchange of goods or services, and both exert effort to carry out the transaction, incurring costs in the hope or with the expectation of realizing benefits. Some ways of structuring or supporting a given transaction, such as consultation or treatment for a patient from a health care provider, may be more efficient than others. The analysis examines the actual costs incurred and the related consequences experienced by the parties over time, with the hypothesis that efficiency results from the discriminating alignment of transactions with alternative, more efficient structures of governance ( Williamson, 2002 ).

Specialty health care services participating in the study described here included the University of Washington (UW) Center for Pain Relief and the UW TelePain program. The UW Center for Pain Relief is an outpatient multispecialty consultation and treatment clinic that uses the assembled expertise and skills of physicians and other medical team providers to assist in diagnosis and care for chronic pain, for example for people with painful disorders that have persisted beyond expected duration, or for people who have persistent uncontrolled pain despite appropriate treatment for the underlying medical condition. The clinic also offers pain consultation and treatment for a variety of new-onset or acute problems that may benefit from selective anesthetic procedures, such as nerve blocks or spinal nerve root compression.

The UW TelePain program serves tribal providers in the Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI) region. These tribal providers include primary care physicians, physician assistants, and nurse practitioners. The tribal providers have access to weekly videoconferences both with other community providers and with university-based pain and symptom management experts. During videoconferences, providers manage cases, engage in evidence-based practice activities, and receive peer support. Throughout the process, these community providers are responsible for direct patient care, and they act on recommendations of the consulting pain specialists.

The two care delivery models discussed above — traditional in-clinic consultation at the Center for Pain Relief and telehealth case consultation through TelePain — provided this mixed methods study using triangulation design and a data transformation model with two comparative arrangements for delivering the same transaction: delivery of pain care to patients (see Figure 2 ).

Qualitative and Quantitative Data Collection Procedures

Participant observation and structured interviews were used to identify and describe two comparable completed transactions for patients with chronic pain. Members of the clinical care teams selected one transaction from each service for which the care could be said to represent the routines and norms of their health care organization. The chosen transactions were carried out with patients of the same gender, similar age, and similar health characteristics. For the study, clinical care teams from each service provided two qualitative on-site interviews documenting clinical work flow and processes (i.e., the steps in the transaction). For the in-clinic transaction, members of the clinical care team interviewed included a nurse care coordinator, pain specialist, medical assistant, patient outcomes assessment coordinator, nurse triage manager, patient support services supervisor, and financial authorization specialist. For the Tele-Pain transaction, team members interviewed included the TelePain nurse care coordinator, two pain specialists, an information technology specialist, and the clinic provider.

The following details the process of the mixed methods analysis. First, individual steps, or discrete tasks, within each transaction (in-clinic versus TelePain) were identified using qualitative interviews and itemized in detail. Details from the qualitative data included a description of each task, the person (s) engaged, the duration of engagement of each person in minutes, the information accrued to the patient's medical record, the technologies employed, and the locations where tasks were conducted and information was transmitted or stored.

The quantitative data collected included date and time, and therefore duration in business days, that accumulated with each step in the transaction. Finally, the costs of each step collected from the qualitative data were identified and transformed into quantitatively estimated data for each transaction. Analysis focused on the primary costs in health care: the value of people's time. These values were limited to labor costs for the in-clinic and telehealth personnel; proxies for the value of time were used with estimates of time for the patient. Costs were estimated as a function of time spent per task and per patient, and the actual wage, including benefits, of personnel engaged in the transaction.

Qualitative and Quantitative Data Analysis

Personal identifiable information was redacted from each patient's medical record, and the records were reviewed for comparability as well as for norms and routines of care for the in-clinic and telehealth organizations. The characteristics of the two patients were similar. Both were first-time patients to their respective organizations, and were referred by their primary care providers for specialized care. The reasons for seeking care and report of conditions potentially related to chronic pain were similar. Both transactions resulted in a consultation recommending referral for additional specialized care or treatment.

Two work flows, one in-clinic and one telehealth, were developed by documenting actual tasks undertaken during the transactions. In follow-up interviews, these work flows were presented to participants for review and comment. These interviews resulted in a complete itemized list of dates, personnel, and time spent per person on discrete steps or tasks. Tables and graphs expressing the steps, with cost accrual over time and in sum, were developed and compared for each transaction, to each other, and with respect to participants' rationales for the tasks in each transaction.

The equation expressing the cost per transaction is as follows, where the total cost of the transaction ( C T ) is the sum of the costs of each discrete task ( k i ) in the transaction, measured per participant ( x, y, z …) on the task, as the product of time ( t ) and wage rate ( w ), or in the case of the patient ( x, y, z …), a proxy for the value of time ( w ) and estimated time ( t ).

In total, 46 discrete steps were taken for the typical in-clinic transaction at the UW Center for Pain Relief (one patient case, reviewed by two pain specialists) versus 27 steps for the typical TelePain transaction (three patient cases, reviewed by six pain specialists). The greater number and types of administrative steps taken to schedule, execute, and follow up the in-clinic consultation resulted in greater duration of time between receipt of initial referral request and completion of the initial consultation with the pain specialists. A total of 153 business days (213 calendar days) elapsed between referral and the completion of the entire in-clinic transaction, versus 4 business days (4 calendar, days) for the TelePain transaction. Importantly, for the transaction at the UW Center for Pain Relief, 72 business days transpired before consultation concluded with a referral for the patient's record; the same conclusion was reached in 4 days in the TelePain transaction. These methods used to determine transaction costs provide an excellent example of mixed methods research, where both qualitative and quantitative data and analysis are needed to provide the transaction cost results.

Mixed methods are increasingly being used in nursing research. We have detailed two studies in which mixed methods research with triangulation design brought a richness to the examination of the phenomenon that a single methodology would not In the two examples described, a major advantage of the triangulation design is its efficiency, because both types of data are collected simultaneously. Each type of data can be collected and analyzed separately and independently, using the techniques traditionally associated with each data type. Both simultaneous and sequential data collection lend themselves to team research, in which the team includes researchers with both quantitative and qualitative expertise.

Challenges include the effort and expertise required due to the simultaneous data collection, and the fact that equal weight is usually given to each data type. Thus this research requires a team, or extensive training in both quantitative and qualitative methodologies, and careful adherence to the methodological rigor required for both methodologies. Nursing researchers may face the possibility of inconsistency in research findings arising from the objectivity of quantitative methods and the subjectivity of qualitative methods. In these cases, additional data collection may be required.

The first example, regarding the pain management experience among American Indians, used triangulation design in a multilevel model format. The multilevel model was useful in designing this study as different methods were needed at different levels to fully understand the complex health care system. In this example, quantitative data is being collected and analyzed at the national and state levels, and qualitative data is being collected at the patient level. Both qualitative and quantitative data are being collected simultaneously. The findings from each level will then be blended into one overall interpretation.

The second example, a transaction cost analysis, also used triangulation design, but the model used was that of data transformation. As in the multilevel model used in the first example, the data transformation model involved the separate but concurrent collection of qualitative and quantitative data. A novel step in this model involves transforming the qualitative data into quantitative data, and then comparing and interrelating the data sets. This required the development of procedures for transforming the qualitative data, related to, time spent on a step and salary of the provider, into quantitative cost data.

The two studies presented as examples demonstrate mixed methods research resulting in the creation of (a) a rich description of the American Indian chronic pain experience, and (b) a way to assess cost for providing chronic pain care via tribal clinics. In both examples, the quantitative data and their subsequent analysis provide a general understanding of the research problem. The qualitative data and their analysis refine and explain the results by exploring participants' views in more depth. Research using a single methodology would not have been able to achieve the same results.

Acknowledgments

Research reported in this paper was supported by the National Institute of Nursing Research of the National Institutes of Health under award number #R01NR012450 and the National Cancer Institute of the National Institutes of Health under award number #R42 CA141875. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

• Coase R. The problem of social cost. Journal of Law and Economics. 1960; 3 :1–44. [ Google Scholar ]
• Creswell JW, Plano Clark VL. Designing and conducting mixed methods research. Thousand Oaks, CA: Sage; 2007. [ Google Scholar ]
• Cueva M, Lanier A, Dignan M, Kuhnley R, Jenkins C. Cancer education for community health aides/practitioners (CHA/Ps) in Alaska assessing comfort with cancer. Journal of Cancer Education. 2005; 20 :85–88. [ PubMed ] [ Google Scholar ]
• Deyo RA, Mirza SK, Martin BI. Back pain prevalence and visit rates : Estimates from U.S. national surveys. Spine. 2002; 31 :2724–2727. [ PubMed ] [ Google Scholar ]
• Doorenbos AZ, Demiris G, Towle C, Kundu A, Revels L, Colven R, Norris TE, Buchwald D. Developing the Native People for Cancer Control Telehealth Network. Telemedicine and E-Health. 2011; 17 :30–34. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Doorenbos AZ, Eaton LH, Haozous E, Towle C, Revels L, Buchwald D. Satisfaction with telehealth for cancer support groups in rural American Indian/Alaska Native communities. Clinical Journal of Oncology Nursing. 2010; 14 :765–770. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Doorenbos AZ, Kundu A, Eaton LH, Demiris G, Haozous EA, Towle C, Buchwald D. Enhancing access to cancer education for rural health care providers via Telehealth. Journal of Cancer Education. 2011; 26 :682–686. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Evans M, Hole R, Berg L, Hutchinson P, Sookraj D. Common insights, differing methodologies : Toward a fusion of indigenous methodologies, participatory action research, and White studies in an urban Aboriginal research agenda. Qualitative Inquiry. 2009; 15 (5):893–910. [ Google Scholar ]
• Guadagnolo BA, Cina K, Helbig P. Medical mistrust and less satisfaction with health care among Native Americans presenting for cancer treatment. Journal of Health Care for the Poor and Underserved. 2009; 20 (1):210–226. doi: 10.1353/hpu.0.0108. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Haozous E, Doorenbos AZ, Demiris G, Eaton LH, Towle C, Kundu A, Buchwald D. Role of Telehealth/videoconferencing in managing cancer pain in rural American Indian communities. Psycho-Oncology. 2012; 21 :219–223. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Haozous EA, Knobf MT. ‘All My Tears Were Gone’: Suffering and cancer pain in Southwest American Indians. Journal of Pain and Symptom Management. 2013; 45 :1050–1060. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Haozous EA, Knobf MT, Brant J. Understanding the cancer pain experience in American Indians of the Northern Plains. Psycho Oncology. 2010; 20 (4):404–410. doi: 10.1002/pon.l741. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Harries D, Yellowlees PM. Cyberterrorism: Is the U.S. healthcare system safe? Telemedicine Journal and e-Health. 2013; 19 (1):61–66. [ PubMed ] [ Google Scholar ]
• Hing E, Cherry DK, Woodwell DA. National Ambulatory Medical Care Survey : 2004 Summary. Hyattsville, MD: National Center of Health Statistics; 2006. [ PubMed ] [ Google Scholar ]
• Institute of Medicine, Committee on Advancing Pain Research Care, and Education. Relieving pain in America : A blueprint for transforming prevention, care, education, and research. Washington, DC: Institute of Medicine; 2011. [ PubMed ] [ Google Scholar ]
• Jimenez N, Garroutte E, Kundu A, Morales L, Buchwald D. A review of the experience, epidemiology, and management of pain among American Indian, Alaska Native, and Aboriginal Canadian peoples. Journal of Pain. 2011; 12 :511–522. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Louis R. Can you hear us now? Voices from the margin: Using indigenous methodologies in geographic research. Geographic Research. 2007; 45 (2):130–139. [ Google Scholar ]
• Momper SL, Delva J, Tauiliili D, Mueller-Williams AC, Goral P. OxyContin use on a rural Midwest American Indian reservation : Demographic correlates and reasons for using. American Journal of Public Health. 2013; 103 :1997–1999. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Morse JM. Approaches to qualitative-quantitative methodological triangulation. Nursing Research. 1991; 40 :120–123. [ PubMed ] [ Google Scholar ]
• O'Cathain A. Mixed methods research in the health sciences : A quiet revolution. Journal of Mixed Methods Research. 2009; 3 :3–6. [ Google Scholar ]
• Smith L. Decolonizing methodologies: Research and indigenous peoples. London: Zed Books; 2004. [ Google Scholar ]
• Tashakkori A, Creswell J. The new era of mixed methods. Journal of Mixed Methods Research. 2007; 1 :3–7. [ Google Scholar ]
• Tauben D, Towle C, Gordon DB, Theodore BR, Doorenbos AZ. TelePain : A platform for concurrent education, clinical care, and research. Pain Medicine. 2013; 14 (4):560. [ Google Scholar ]
• U.S. Census Bureau. Statistical Abstract of the United States. Washington, DC, U.S: Bureau of the Census; 2010. [ Google Scholar ]
• Warner M, Chen LH, Makuc DM, Anderson RN, Minino AM. Drug poisoning deaths in the United States, 1980-2008. NCHS Data Brief. 2011; 81 :1–8. [ PubMed ] [ Google Scholar ]
• Williamson OE. The Economic Institutions of Capitalism. New York: The Free Press; 1985. [ Google Scholar ]
• Williamson OE. Comparative economic organization : The analysis of discrete structural alternatives. Administrative Science Quarterly. 1991; 36 (2):269–296. [ Google Scholar ]
• Williamson OE. The new institutional economics : Taking stock, looking ahead. Journal of Economic Literature. 2000; 38 (3):595–613. [ Google Scholar ]
• Williamson OE. The theory of the firm as governance structure : From choice to contract. Journal of Economic Perspectives. 2002; 16 (3):171–195. [ Google Scholar ]

Understanding Qualitative and Quantitative Research in Nursing: Qualitative Research Information

• Qualitative Research Information
• Quantiative Research Information

About Qualitative Research

The goal of qualitative research is to generate new insight or knowledge, or to validate existing knowledge. Qualitative research data are usually driven by the participants' thoughts, reactions, perceptions, and experiences. This type of research focuses on systems, steps, rituals, processes, best practices, observations, or personal experiences, and may or may not have an outcome. Qualitative research can be used to gain a better understanding of a topic, inform the reader about how to perform a task, or gain a new perspective on a topic. It's helpful to explain sensitive, unique, and difficult-to-understand information that can't be conveyed quantitatively.

Below you will find helpful resources on qualitative research

• Understanding the value of qualitative research in nursing
• Qualitative research and its role in nursing knowledge
• Understanding qualitative research
• The Role of Qualitative Research in Evidence Based Practice (Article)

Qualitative Data

"The Qualitative Data Repository (QDR) is a dedicated archive for storing and sharing digital data (and accompanying documentation) generated or collected through qualitative and multi-method research in the social sciences. QDR provides search tools to facilitate the discovery of data, and also serves as a portal to material beyond its own holdings, with links to U.S. and international archives. The repository’s initial emphasis is on political science."

What qualitative research consist of

a hypothesis or theory

• an observation through experience or interactive stud
• practice-based interventions
• implementation strategies
• casual or formal approaches
• approaches to adaptation or variation
•  how-to guidance
• unanticipated adverse reactions if applicable
• relevant background or circumstantial factors.

To find articles in    ERIC    and  Education Source  use the phrase "Qualitative Research"  as one of your search terms.

Related terms:

Case Studies; Ethnography; Evaluation Methods; Field Studies; Focus Groups; Grounded Theory; Interviews; Naturalistic Observation; Participant Observation; Research Methodology; Social Science Research; Transcripts (Written Records);

5 types of qualitative research

Ethnography involves the analysis or observation of a culture or social group's customs, rituals, and behaviors, and their understanding of disease and illness within that culture. It requires methodical collection, detailed descriptions, and analysis of the information to help refine or develop cultural theories. Ethnographic studies allow the reader to understand a subject group's way of life and the cultural forces that shape the group's rituals, behaviors, thoughts, or feelings. The research may have a specific or global focus; for example, the group's interaction among themselves or with others, or social norms or taboos.

Grounded theory is often referred to as "theory building" because concepts, problems, and theories are continuously reevaluated. It's designed to discover what problems exist in a specific social environment and how these problems are resolved. It involves devising a theory, testing the theory, and refining the theory until the core problem or solution is identified. This type of research often includes personal or professional first-hand experiences. A common core question within grounded theory is, "What's the basic problem and how are we going to resolve or improve it?" An example is a patient describing how he or she copes with existing or new health conditions. Another example: A nurse describes the methodical steps that have improved a patient's experience or health, or resolves the knowledge deficits of other healthcare personnel.

  Symbolic interactionism focuses on patterns of communication, interpretation of that communication, and understanding how this communication forces adjustments between individuals who react to their interpretation of their world or social group. This type of research reflects the theory that people behave or react in response to what they believe is true or correct, and not just based on what's objectively true. Teenagers who are overwhelmed with information on the health risks of smoking are one example: Despite this information, they may still smoke because they believe it will help them fit in with their peer group.

  Historical research involves understanding and gathering information on the history of a topic, group, or culture. This type of research allows the reader to systematically evaluate historical information via a detailed analysis of past occurrences and guides the reader to what's been proven to be beneficial or ineffective in certain situations in the past. Armed with this knowledge, nurses can develop a plan to improve results or outcomes for their patients, work environment, or clinical practice. An example of this type of research is Florence Nightingale's discovery that unsanitary wound care and infrequent hand washing led to poor patient outcomes and that sanitary wound care with good hand washing improved patient outcomes.

  Phenomenology utilizes personal experiences to gain insight, empathy, or knowledge about a specific topic, situation, or "phenomenon." With this type of research, the investigator attempts to describe or understand a person's or group's perception, perspective, and understanding of a phenomenon and tries to answer the question, "What's it like to experience a given situation?" By understanding how patients view or experience events, nurses can formulate new treatment plans to enhance the healthcare experience or resolve knowledge deficits. By looking at multiple perspectives on the same situation, a researcher can make generalizations about what something is like from an insider's point of view. This research is typically focused on specific topics, such as a patient's response to illness, physical disability, healthcare procedures, or healthcare work environments.

Qualitative Research eBooks

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Evidence Based Nursing Practice

• PICO(T) and Clinical Questions
• Literature Review
• Study Design and Methodology
• Documenting EBP
• Additional Sources & Assistance
• MUHC Evidence Based Practice Model

PICO Templates

For an intervention/therapy:

In _______(P), what is the effect of _______(I) on ______(O) compared with _______(C) within ________ (T)?

For etiology:

Are ____ (P) who have _______ (I) at ___ (increased/decreased) risk for/of_______ (O) compared with ______ (P) with/without ______ (C) over _____ (T)?

Diagnosis or diagnostic test:

Are (is) _________ (I) more accurate in diagnosing ________ (P) compared with ______ (C) for _______ (O)?

Prevention:

For ________ (P) does the use of ______ (I) reduce the future risk of ________ (O) compared with _________ (C)?

Prognosis/Predictions

Does __________ (I) influence ________ (O) in patients who have _______ (P) over ______ (T)?

How do ________ (P) diagnosed with _______ (I) perceive ______ (O) during _____ (T)?

Based on Melnyk B., & Fineout-Overholt E. (2010). Evidence-based practice in nursing & healthcare. New York: Lippincott Williams & Wilkins .

Using PICO to Formulate Clinical Questions

PICO  (alternately known as PICOT ) is a mnemonic used to describe the four elements of a good clinical question. It stands for:

P --Patient/Problem I --Intervention C --Comparison O --Outcome

Many people find that it helps them clarify their question, which in turn makes it easier to find an answer. 

Use PICO to generate terms - these you'll use in your literature search for the current best evidence.   Once you have your PICO terms, you can then use them to re-write your question.  (Note, you can do this in reverse order if that works for you.)

Often we start with a vague question such as, "How effective is CPR, really?"  But, what do we mean by CPR?  And how do we define effective?  PICO is a technique to help us - or force us - to answer these questions.   Note that you may not end up with a description for each element of PICO. 

P -  our question above doesn't address a specific problem other than the assumption of a person who is not breathing. So, ask yourself questions such as, am I interested in a specific age cohort? (Adults, children, aged); a specific population (hospitalized, community dwelling); health cohort (healthy, diabetic, etc.)   

I - our question above doesn't have a stated intervention, but we might have one in mind such as 'hands-only'

C - Is there another method of CPR that we want to compare the hands-only to?  Many research studies do not go head to head with a comparison.  In this example we might want to compare to the standard, hands plus breathing

O - Again, we need to ask, what do we mean by 'effective'?  Mortality is one option with the benefit that it's easily measured. 

Our PICO statement would look like:

From our PICO, we can write up a clearer and more specific question, such as:

 In community dwelling adults, how effective is hands-only CPR versus hands plus breathing CPR at preventing mortality?

More information on formulating PICO questions

Now that we've clarified what we want to know, it will be much easier to find an answer.

Breaking Down Your PICO into a Search Strategy

We can use our PICO statement to list terms to search on.  Under each letter, we'll list all the possible terms we might use in our search. 

P - Community Dwelling:  It is much easier to search on 'hospitalized' than non-hospitalized subjects.  So I would leave these terms for last. It might turn out that I don't need to use them as my other terms from the I, C, or O of PICO might be enough.

community dwelling  OR out-of-hospital

P - adults: I would use the limits in MEDLINE or CINAHL for All Adults.  Could also consider the following depending upon the population you need:

adult OR adults OR aged OR elderly OR young adult

CPR  -  cardiopulmonary resuscitation

I - Hands-only

 hands-only OR compression-only OR chest compression OR compression OR Heart Massage

C - Hands plus breathing Breathing is a tougher term to match.

breathing OR mouth to mouth OR conventional OR traditional

O - Mortality:  If your outcomes terms are general, they may not as useful in the literature search.  They will still be useful in your evaluation of the studies.

mortality OR death OR Survival

Putting it together - a search statement from the above might look like this:

cardiopulmonary resuscitation AND (hands-only OR compression-only OR chest compression OR compression OR Heart Massage) AND (breathing OR mouth to mouth OR conventional OR traditional)

Note that the above strategy is only using terms from the I and the C of PICO.  Depending upon the results, you may need to narrow your search by adding in terms from the P or the O.  

An easy way to keep track of your search strategy is to use a table. This keeps the different parts of your PICO question and their various keywords and subject terms together. This document shows you how to use the tables and provides a few options to organize your table. Use whichever works best for you!  Search Strategy Tables to Break your PICO into Concepts .

PICO and Qualitative Questions

A qualitative PICO question focuses on in-depth perspectives and experiences.  It does not try to solve a problem by analyzing numbers, but rather to enrich understanding through words.  Therefore, the emphasis in qualitative PICO questions is on fully representing the information gathered, rather than primarily emphasizing ways the information can be broken down and expressed through measurable units (though measurability can also play an important role). 

A strength of a qualitative PICO question is that it can investigate what patient satisfaction looks like, for example, instead of only reporting that 25% of patients who took a survey reported that they are satisfied. 

When working with qualitative questions, an alternative to using PICO in searching for sources is the SPIDER search tool.  SPIDER is an acronym that breaks down like this:

P=Phenomena of Interest

E=Evaluation

R=Research Type

Cooke, A., Smith, D., & Booth, A. (2012). Beyond PICO: The SPIDER tool for qualitative evidence synthesis . Qualitative Health Research, 22 (10), 1435-1443. doi:10.1177/1049732312452938

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Nursing Research Guide

• General Search Strategies
• Searching by Author & Theory
• Searching for Qualitative Studies
• Searching for Systematic Reviews & Controlled Trials
• Health Data & Statistics
• Tutorials & Help
• SoN and APA (7th Ed.)
• NSC 890: PICOT Searches

What is qualitative research?

Qualitative research  in Nursing approaches a clinical question from a place of unknowing in an attempt to understand the complexity, depth, and richness of a particular situation from the perspective of the person or persons impacted by the situation (i.e., the subjects of the study).

Study subjects may include the patient(s), the patient's caregivers, the patient's family members, etc. Qualitative research may also include information gleaned from the investigator's or researcher's observations.

While typically more subjective than quantitative research (which focuses on measurements and numbers), qualitative research still employs a systematic approach.

Qualitative research  is generally preferred over quantitative research (which on measurements and numbers) when the clinical question centers around life experiences or meaning.

Adapted from:

• Wilson, B., Austria, M.J., & Casucci, T. (2021 March 21).  Understanding Quantitative and Qualitative Approaches  
• Chicca, J. (2020 June 5).  Introduction to qualitative nursing research.   American Nurse Journal.

Where can I find qualitative research?

Qualitative research can be found in numerous databases. Some good starting options are:

• CINAHL Ultimate Journal articles and eBooks in nursing and allied health.
• MEDLINE (EBSCOhost Web) Journal articles in medicine, life sciences, health care, and biomedical research.
• APA PsycINFO Articles from journals, newspapers, and magazines, along with eBooks in nearly every social science subject area.
• PubMed Citation search of journal articles and books in health and life sciences.

How can I find qualitative research?

Cinahl and/or  medline.

• Start at the Advanced Search  screen.
• Add a search term that represents the topic you are interested in into one (or more) of the search boxes.
• Scroll down until you see the Limit your results  section.
• Qualitative - High Sensitivity (broadest category/broad search)
• Qualitative - High Specificity (narrowest category/specific search)
• Qualitative - Best Balance (somewhere in between)
• Select or click the search button.

APA PsycINFO

• Start at the Advanced Search  screen.
• Use the  Methodology menu to select  Qualitative .

• Use the drop-down menu next the Enter search term  box to set the search to MeSH Terms
• Qualitative Research
• Nursing Methodology Research

How can I use keywords to search for qualitative research?

Try adding adding a keyword that might specifically identify qualitative research. You could add the term qualitative  to your search and/or your could add different types of qualitative research according to your specific needs and/or research assignment.

For example, consider the following types of qualitative research in light of the types of questions a researcher might be trying to answer with each qualitative research type: 

•   Clinical question: What happens to the quality of nursing practice when we implement a peer-mentoring system?
• Clinical question: How is patient autonomy promoted by a unit?
• Clinical question: What is the nursing role in end-of-life decisions?
• Clinical question: What discourses are used in nursing practice and how do they shape practice?
• Clinical question: How does Filipino culture influence childbirth experiences?
• Clinical question: What are the immediate underlying psychological and environmental causes of incivility in nursing?
• Clinical question: How does the basic social process of role transition happen within the context of advanced practice nursing transitions?
• Clinical question: When and why did nurses become researchers?
• Clinical question: How does one live with a diagnosis of scleroderma?
• Clinical question:  What is the lived experience of nurses who were admitted as patients on their home practice units?

Adapted from: Chicca, J. (2020 June 5).  Introduction to qualitative nursing research . American Nurse Journal.

Need more help?

Finding relevant qualitative research can be both difficult and time consuming. Once you conduct a search, you will need to review your search results and look at individual articles, their subject terms, and abstracts to determine if they are truly qualitative research articles. And that's a determination that only you can make.

If you still need help after trying the search strategies and tips suggested on this research guide, we encourage you to schedule an in-person or Zoom research appointment . Health Services librarian Rachel Riffe-Albright is a great bet, but any librarian would be happy to help!

Additonal resources on qualitative research

The following are research guides created by other academic libraries. While you likely will not have access to any of their linked resources, the tips and tricks shared may be useful to you as you search for qualitative research:

• What is Qualitative Research? from UTA Libraries at University of Texas Arlington
• Finding Qualitative Research Articles from Ashland University Library
• Finding Qualitative Research Articles from the Health Sciences Library at University of Washington
• Advanced Search Guide: Qualitative and Quantitative Studies from Southern Connecticut State University Library
• Finding Qualitative and Quantitative Studies in CINAHL from Southern Connecticut State University Library
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• Research article
• Open access
• Published: 14 June 2021

Nurses in the lead: a qualitative study on the development of distinct nursing roles in daily nursing practice

• Jannine van Schothorst–van Roekel 1 ,
• Anne Marie J.W.M. Weggelaar-Jansen 1 ,
• Carina C.G.J.M. Hilders 1 ,
• Antoinette A. De Bont 1 &
• Iris Wallenburg 1  

BMC Nursing volume  20 , Article number:  97 ( 2021 ) Cite this article

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Transitions in healthcare delivery, such as the rapidly growing numbers of older people and increasing social and healthcare needs, combined with nursing shortages has sparked renewed interest in differentiations in nursing staff and skill mix. Policy attempts to implement new competency frameworks and job profiles often fails for not serving existing nursing practices. This study is aimed to understand how licensed vocational nurses (VNs) and nurses with a Bachelor of Science degree (BNs) shape distinct nursing roles in daily practice.

A qualitative study was conducted in four wards (neurology, oncology, pneumatology and surgery) of a Dutch teaching hospital. Various ethnographic methods were used: shadowing nurses in daily practice (65h), observations and participation in relevant meetings (n=56), informal conversations (up to 15 h), 22 semi-structured interviews and member-checking with four focus groups (19 nurses in total). Data was analyzed using thematic analysis.

Hospital nurses developed new role distinctions in a series of small-change experiments, based on action and appraisal. Our findings show that: (1) this developmental approach incorporated the nurses’ invisible work; (2) nurses’ roles evolved through the accumulation of small changes that included embedding the new routines in organizational structures; (3) the experimental approach supported the professionalization of nurses, enabling them to translate national legislation into hospital policies and supporting the nurses’ (bottom-up) evolution of practices. The new roles required the special knowledge and skills of Bachelor-trained nurses to support healthcare quality improvement and connect the patients’ needs to organizational capacity.

Conclusions

Conducting small-change experiments, anchored by action and appraisal rather than by design , clarified the distinctions between vocational and Bachelor-trained nurses. The process stimulated personal leadership and boosted the responsibility nurses feel for their own development and the nursing profession in general. This study indicates that experimental nursing role development provides opportunities for nursing professionalization and gives nurses, managers and policymakers the opportunity of a ‘two-way-window’ in nursing role development, aligning policy initiatives with daily nursing practices.

Peer Review reports

The aging population and mounting social and healthcare needs are challenging both healthcare delivery and the financial sustainability of healthcare systems [ 1 , 2 ]. Nurses play an important role in facing these contemporary challenges [ 3 , 4 ]. However, nursing shortages increase the workload which, in turn, boosts resignation numbers of nurses [ 5 , 6 ]. Research shows that nurses resign because they feel undervalued and have insufficient control over their professional practice and organization [ 7 , 8 ]. This issue has sparked renewed interest in nursing role development [ 9 , 10 , 11 ]. A role can be defined by the activities assumed by one person, based on knowledge, modulated by professional norms, a legislative framework, the scope of practice and a social system [ 12 , 9 ].

New nursing roles usually arise through task specialization [ 13 , 14 ] and the development of advanced nursing roles [ 15 , 16 ]. Increasing attention is drawn to role distinction within nursing teams by differentiating the staff and skill mix to meet the challenges of nursing shortages, quality of care and low job satisfaction [ 17 , 18 ]. The staff and skill mix include the roles of enrolled nurses, registered nurses, and nurse assistants [ 19 , 20 ]. Studies on differentiation in staff and skill mix reveal that several countries struggle with the composition of nursing teams [ 21 , 22 , 23 ].

Role distinctions between licensed vocational-trained nurses (VNs) and Bachelor of Science-trained nurses (BNs) has been heavily debated since the introduction of the higher nurse education in the early 1970s, not only in the Netherlands [ 24 , 25 ] but also in Australia [ 26 , 27 ], Singapore [ 20 ] and the United States of America [ 28 , 29 ]. Current debates have focused on the difficulty of designing distinct nursing roles. For example, Gardner et al., revealed that registered nursing roles are not well defined and that job profiles focus on direct patient care [ 30 ]. Even when distinct nursing roles are described, there are no proper guidelines on how these roles should be differentiated and integrated into daily practice. Although the value of differentiating nursing roles has been recognized, it is still not clear how this should be done or how new nursing roles should be embedded in daily nursing practice. Furthermore, the consequences of these roles on nursing work has been insufficiently investigated [ 31 ].

This study reports on a study of nursing teams developing new roles in daily nursing hospital practice. In 2010, the Dutch Ministry of Health announced a law amendment (the Individual Health Care Professions Act) to formalize the distinction between VNs and BNs. The law amendment made a distinction in responsibilities regarding complexity of care, coordination of care, and quality improvement. Professional roles are usually developed top-down at policy level, through competency frameworks and job profiles that are subsequently implemented in nursing practice. In the Dutch case, a national expert committee made two distinct job profiles [ 32 ]. Instead of prescribing role implementation, however, healthcare organizations were granted the opportunity to develop these new nursing roles in practice, aiming for a more practice-based approach to reforming the nursing workforce. This study investigates a Dutch teaching hospital that used an experimental development process in which the nurses developed role distinctions by ‘doing and appraising’. This iterative process evolved in small changes [ 33 , 34 , 35 , 36 ], based on nurses’ thorough knowledge of professional practices [ 37 ] and leadership role [ 38 , 39 , 40 ].

According to Abbott, the constitution of a new role is a competitive action, as it always leads to negotiation of new openings for one profession and/or degradation of adjacent professions [ 41 ]. Additionally, role differentiation requires negotiation between different professionals, which always takes place in the background of historical professionalization processes and vested interests resulting in power-related issues [ 42 , 43 , 44 ]. Recent studies have described the differentiation of nursing roles to other professionals, such as nurse practitioners and nurse assistants, but have focused on evaluating shifts in nursing tasks and roles [ 31 ]. Limited research has been conducted on differentiating between the different roles of registered nurses and the involvement of nurses themselves in developing new nursing roles. An ethnographic study was conducted to shed light on the nurses’ work of seeking openings and negotiating roles and responsibilities and the consequences of role distinctions, against a background of historically shaped relationships and patterns.

The study aimed to understand the formulation of nursing role distinctions between different educational levels in a development process involving experimental action (doing) and appraisal.

We conducted an ethnographic case study. This design was commonly used in nursing studies in researching changing professional practices [ 45 , 46 ]. The researchers gained detailed insights into the nurses’ actions and into the finetuning of their new roles in daily practice, including the meanings, beliefs and values nurses give to their roles [ 47 , 48 ]. This study complied with the consolidated criteria for reporting qualitative research (COREQ) checklist.

Setting and participants

Our study took place in a purposefully selected Dutch teaching hospital (481 beds, 2,600 employees including 800 nurses). Historically, nurses in Dutch hospitals have vocational training. The introduction of higher nursing education in 1972 prompted debates about distinguishing between vocational-trained nurses (VNs) and bachelor-trained nurses (BNs). For a long time, VNs resisted a role distinction, arguing that their work experience rendered them equally capable to take care of patients and deal with complex needs. As a result, VNs and BNs carry out the same duties and bear equal responsibility. To experiment with role distinctions in daily practice, the hospital management and project team selected a convenience but representative sample of wards. Two general (neurology and surgery) and two specific care (oncology and pneumatology) wards were selected as they represent the different compositions of nursing educational levels (VN, BN and additional specialized training). The demographic profile for the nursing teams is shown in Table  1 . The project team, comprising nursing policy staff, coaches and HR staff ( N  = 7), supported the four (nursing) teams of the wards in their experimental development process (131 nurses; 32 % BNs and 68 % VNs, including seven senior nurses with an organizational role). We also studied the interactions between nurses and team managers ( N  = 4), and the CEO ( N  = 1) in the meetings.

Data collection

Data was collected between July 2017 and January 2019. A broad selection of respondents was made based on the different roles they performed. Respondents were personally approached by the first author, after close consultation with the team managers. Four qualitative research methods were used iteratively combining collection and analysis, as is common in ethnographic studies [ 45 ] (see Table  2 ).

Shadowing nurses (i.e. observations and questioning nurses about their work) on shift (65 h in total) was conducted to observe behavior in detail in the nurses’ organizational and social setting [ 49 , 50 ], both in existing practices and in the messy fragmented process of developing distinct nursing roles. The notes taken during shadowing were worked up in thick descriptions [ 46 ].

Observation and participation in four types of meetings. The first and second authors attended: (1) kick-off meetings for the nursing teams ( n  = 2); (2) bi-monthly meetings ( n  = 10) between BNs and the project team to share experiences and reflect on the challenges, successes and failures; and (3) project group meetings at which the nursing role developmental processes was discussed ( n  = 20). Additionally, the first author observed nurses in ward meetings discussing the nursing role distinctions in daily practice ( n  = 15). Minutes and detailed notes also produced thick descriptions [ 51 ]. This fieldwork provided a clear understanding of the experimental development process and how the respondents made sense of the challenges/problems, the chosen solutions and the changes to their work routines and organizational structures. During the fieldwork, informal conversations took place with nurses, nursing managers, project group members and the CEO (app. 15 h), which enabled us to reflect on the daily experiences and thus gain in-depth insights into practices and their meanings. The notes taken during the conversations were also written up in the thick description reports, shortly after, to ensure data validity [ 52 ]. These were completed with organizational documents, such as policy documents, activity plans, communication bulletins, formal minutes and in-house presentations.

Semi-structured interviews lasting 60–90 min were held by the first author with 22 respondents: the CEO ( n  = 1), middle managers ( n  = 4), VNs ( n  = 6), BNs ( n  = 9, including four senior nurses), paramedics ( n  = 2) using a predefined topic list based on the shadowing, observations and informal conversations findings. In the interviews, questions were asked about task distinctions, different stakeholder roles (i.e., nurses, managers, project group), experimental approach, and added value of the different roles and how they influence other roles. General open questions were asked, including: “How do you distinguish between tasks in daily practice?”. As the conversation proceeded, the researcher asked more specific questions about what role differentiation meant to the respondent and their opinions and feelings. For example: “what does differentiation mean for you as a professional?”, and “what does it mean for you daily work?”, and “what does role distinction mean for collaboration in your team?” The interviews were tape-recorded (with permission), transcribed verbatim and anonymized.

The fieldwork period ended with four focus groups held by the first author on each of the four nursing wards ( N  = 19 nurses in total: nine BNs, eight VNs, and two senior nurses). The groups discussed the findings, such as (nurses’ perceptions on) the emergence of role distinctions, the consequences of these role distinctions for nursing, experimenting as a strategy, the elements of a supportive environment and leadership. Questions were discussed like: “which distinctions are made between VN and BN roles?”, and “what does it mean for VNs, BNs and senior nurses?”. During these meetings, statements were also used to provoke opinions and discussion, e.g., “The role of the manager in developing distinct nursing roles is…”. With permission, all focus groups were audio recorded and the recordings were transcribed verbatim. The focus groups also served for member-checking and enriched data collection, together with the reflection meetings, in which the researchers reflected with the leader and a member of the project group members on program, progress, roles of actors and project outcomes. Finally, the researchers shared a report of the findings with all participants to check the credibility of the analysis.

Data analysis

Data collection and inductive thematic analysis took place iteratively [ 45 , 53 ]. The first author coded the data (i.e. observation reports, interview and focus group transcripts), basing the codes on the research question and theoretical notions on nursing role development and distinctions. In the next step, the research team discussed the codes until consensus was reached. Next, the first author did the thematic coding, based on actions and interactions in the nursing teams, the organizational consequences of their experimental development process, and relevant opinions that steered the development of nurse role distinctions (see Additional file ). Iteratively, the research team developed preliminary findings, which were fed back to the respondents to validate our analysis and deepen our insights [ 54 ]. After the analysis of the additional data gained in these validating discussions, codes were organized and re-organized until we had a coherent view.

Ethnography acknowledges the influence of the researcher, whose own (expert) knowledge, beliefs and values form part of the research process [ 48 ]. The first author was involved in the teams and meetings as an observer-as-participant, to gain in-depth insight, but remained research-oriented [ 55 ]. The focus was on the study of nursing actions, routines and accounts, asking questions to obtain insights into underlying assumptions, which the whole research group discussed to prevent ‘going native’ [ 56 , 57 ]. Rigor was further ensured by triangulating the various data resources (i.e. participants and research methods), purposefully gathered over time to secure consistency of findings and until saturation on a specific topic was reached [ 54 ]. The meetings in which the researchers shared the preliminary findings enabled nurses to make explicit their understanding of what works and why, how they perceived the nursing role distinctions and their views on experimental development processes.

Ethical considerations

All participants received verbal and written information, ensuring that they understood the study goals and role of the researcher [ 48 ]. Participants were informed about their voluntary participation and their right to end their contribution to the study. All gave informed consent. The study was performed in accordance with the Declaration of Helsinki and was approved by the Erasmus Medical Ethical Assessment Committee in Rotterdam (MEC-2019-0215), which also assessed the compliance with GDPR.

Our findings reveal how nurses gradually shaped new nursing role distinctions in an experimental process of action and appraisal and how the new BN nursing roles became embedded in new nursing routines, organizational routines and structures. Three empirical appeared from the systematic coding: (1) distinction based on complexity of care; (2) organizing hospital care; and (3) evidence-based practices (EBP) in quality improvement work.

Distinction based on complexity of care

Initially, nurses distinguished the VN and BN roles based on the complexity of patient care, as stated in national job profiles [ 32 ]. BNs were supposed to take care of clinically complex patients, rather than VNs, although both VNs and BNs had been equally taking care of every patient category. To distinguish between highly and less complex patient care, nurses developed a complexity measurement tool. This tool enabled classification of the predictability of care, patient’s degree of self-reliance, care intensity, technical nursing procedures and involvement of other disciplines. However, in practice, BNs questioned the validity of assessing a patient’s care complexity, because the assessments of different nurses often led to different outcomes. Furthermore, allocating complex patient care to BNs impacted negatively on the nurses’ job satisfaction, organizational routines and ultimately the quality of care. VNs experienced the shift of complex patient care to BNs as a diminution of their professional expertise. They continuously stressed their competencies and questioned the assigned levels of complexity, aiming to prevent losses to their professional tasks:

‘Now we’re only allowed to take care of COPD patients and people with pneumonia, so no more young boys with a pneumothorax drain. Suddenly we are not allowed to do that. (…) So, your [professional] world is getting smaller. We don’t like that at all. So, we said: We used to be competent, so why aren’t we anymore?’ (Interview VN1, in-service trained nurse).

In discussing complexity of care, both VNs and BNs (re)discovered the competencies VNs possess in providing complex daily care. BNs acknowledged the contestability of the distinction between VN and BN roles related to patient care complexity, as the next quote shows:

‘Complexity, they always make such a fuss about it. (…) At a given moment you’re an expert in just one certain area; try then to stand out on your ward. (…) When I go to GE [gastroenterology] I think how complex care is in here! (…) But it’s also the other way around, when I’m the expert and know what to expect after an angioplasty, or a bypass, or a laparoscopic cholecystectomy (…) When I’ve mastered it, then I no longer think it’s complex, because I know what to expect!’ (Interview BN1, 19-07-2017).

This quote illustrates how complexity was shaped through clinical experience. What complex care is , is influenced by the years of doing nursing work and hence is individual and remains invisible. It is not formally valued [ 58 ] because it is not included in the BN-VN competency model. This caused dissatisfaction and feelings of demotion among VNs. The distinction in complexities of care was also problematic for BNs. Following the complexity tool, recently graduated BNs were supposed to look after highly complex patients. However, they often felt insecure and needed the support of more experienced (VN) colleagues – which the VNs perceived as a recognition of their added value and evidence of the failure of the complexity tool to guide division of tasks. Also, mundane issues like holidays, sickness or pregnancy leave further complicated the use of the complexity tool as a way of allocating patients, as it decreased flexibility in taking over and swapping shifts, causing dissatisfaction with the work schedule and leading to problems in the continuity of care during evening, night and weekend shifts. Hence, the complexity tool disturbed the flexibility in organizing the ward and held possible consequences for the quality and safety of care (e.g. inexperienced BNs providing complex care), Ultimately, the complexity tool upset traditional teamwork, in which nurses more implicitly complemented each other’s competencies and ability to ‘get the work done’ [ 59 ]. As a result, role distinction based on ‘quantifiable’ complexity of care was abolished. Attention shifted to the development of an organizational and quality-enhancing role, seeking to highlight the added value of BNs – which we will elaborate on in the next section.

Organizing hospital care

Nurses increasingly fulfill a coordinating role in healthcare, making connections across occupational, departmental and organizational boundaries, and ‘mediating’ individual patient needs, which Allen describes as organizing work [ 49 ]. Attempting to make a valuable distinction between nursing roles, BNs adopted coordinating management tasks at the ward level, taking over this task from senior nurses and team managers. BNs sought to connect the coordinating management tasks with their clinical role and expertise. An example is bed management, which involves comparing a ward’s bed capacity with nursing staff capacity [ 1 , 60 ]. At first, BNs accompanied middle managers to the hospital bed review meeting to discuss and assess patient transfers. On the wards where this coordination task used to be assigned to senior nurses, the process of transferring this task to BNs was complicated. Senior nurses were reluctant to hand over coordinating tasks as this might undermine their position in the near future. Initially, BNs were hesitant to take over this task, but found a strategy to overcome their uncertainty. This is reflected in the next excerpt from fieldnotes:

Senior nurse: ‘First we have to figure out if it will work, don’t we? I mean, all three of us [middle manager, senior nurse, BN] can’t just turn up at the bed review meeting, can we? The BN has to know what to do first, otherwise she won’t be able to coordinate properly. We can’t just do it.’ BN: ‘I think we should keep things small, just start doing it, step by step. (…) If we don’t try it out, we don’t know if it works.’ (Field notes, 24-05-2018).

This excerpt shows that nurses gradually developed new roles as a series of matching tasks. Trying out and evaluating each step of development in the process overcame the uncertainty and discomfort all parties held [ 61 ]. Moreover, carrying out the new tasks made the role distinctions become apparent. The coordinating role in bed management, for instance, became increasingly embedded in the new BN nursing role. Experimenting with coordination allowed BNs prove their added value [ 62 ] and contributed to overall hospital performance as it combined daily working routines with their ability to manage bed occupancy, patient flow, staffing issues and workload. This was not an easy task. The next quote shows the complexity of creating room for this organizing role:

The BNs decide to let the VNs help coordinate the daily care, as some VNs want to do this task. One BN explains: ‘It’s very hard to say, you’re not allowed.’ The middle manager looks surprised and says that daily coordination is a chance to draw a clear distinction and further shape the role of BNs. The project group leader replies: ‘Being a BN means that you dare to make a difference [in distinctive roles]. We’re all newbies in this field, but we can use our shared knowledge. You can derive support from this task for your new role.’ (Field notes, 09-01-2018).

This excerpt reveals the BNs’ thinking on crafting their organizational role, turning down the VNs wishes to bear equal responsibility for coordinating tasks. Taking up this role touched on nurse identity as BNs had to overcome the delicate issue of equity [ 63 ], which has long been a core element of the Dutch nursing profession. Taking over an organization role caused discomfort among BNs, but at the same time provided legitimation for a role distinction.

Legitimation for this task was also gained from external sources, as the law amendment and the expert committee’s job descriptions both mentioned coordinating tasks. However, taking over coordinating tasks and having an organizing role in hospital care was not done as an ‘implementation’; rather it required a process of actively crafting and carving out this new role. We observed BNs choosing not to disclose that they were experimenting with taking over the coordinating tasks as they anticipated a lack of support from VNs:

BN: ‘We shouldn’t tell the VNs everything. We just need this time to give shape to our new role. And we all know who [of the colleagues] won’t agree with it. In my opinion, we’d be better off hinting at it at lunchtime, for example, to figure out what colleagues think about it. And then go on as usual.’ (Field notes, 12-06-2018).

BNs stayed ‘under the radar’, not talking explicitly about their fragile new role to protect the small coordination tasks they had already gained. By deliberately keeping the evaluation of their new task to themselves, they protected the transition they had set into motion. Thus, nurses collected small changes in their daily routines, developing a new role distinction step by step. Changes to single tasks accumulated in a new role distinction between BNs, VNs and senior nurses, and gave BNs a more hybrid nursing management role.

Evidence-based practices in quality improvement work

Quality improvement appeared to be another key concern in the development of the new BN role. Quality improvement work used to be carried out by groups of senior nurses, middle managers and quality advisory staff. Not involved in daily routines, the working group focused on nursing procedures (e.g. changing infusion system and wound treatment protocols). In taking on this new role BNs tried different ways of incorporating EBP in their routines, an aspect that had long been neglected in the Netherlands. As a first step, BNs rearranged the routines of the working group. For example, a team of BNs conducted a quality improvement investigation of a patient’s formal’s complaint:

Twenty-two patients registered a pain score of seven or higher and were still discharged. The question for BNs was: how and why did this bad care happen? The BNs used electronic patient record to study data on the relations between pain, medication and treatment. Their investigation concluded: nurses do not always follow the protocols for high pain scores. Their improvement plan covered standard medication policy, clinical lessons on pain management and revisions to the patient information folder. One BN said: ‘I really loved investigating this improvement.’ (Field notes, 28-05-2018).

This fieldnote shows the joy quality improvement work can bring. During interviews, nurses said that it had given them a better grip on the outcome of nursing work. BNs felt the need to enhance their quality improvement tasks with their EBP skills, e.g. using clinical reasoning in bedside teaching, formulating and answering research questions in clinical lessons and in multi-disciplinary patient rounds to render nursing work more evidence based. The BNs blended EBP-related education into shift handovers and ward meetings, to show VNs the value of doing EBP [ 64 ]. In doing so, they integrated and fostered an EBP infrastructure of care provision, reflecting a new sense of professionalism and responsibility for quality of care.

However, learning how to blend EPB quality work in daily routines – ‘learning in practice’ –requires attention and steering. Although the BNs had a Bachelor’s degree, they had no experience of a quality-enhancing role in hospital practice [ 65 ]. In our case, the interplay between team members’ previous education and experienced shortcomings in knowledge and skills uncovered the need for further EBP training. This training established the BNs’ role as quality improvers in daily work and at the same time supported the further professionalization of both BNs and VNs. Although introducing the EBP approach was initially restricted to the BNs, it was soon realized that VNs should be involved as well, as nursing is a collaborative endeavor [ 1 ], as one team member (the trainer) put it:

‘I think that collaboration between BNs and VNs would add lots of value, because both add something different to quality work. I’d suggest that BNs could introduce the process-oriented, theoretical scope, while VNs could maybe focus on the patients’ interest.’ (Fieldnote, informal conversation, 11-06-2018).

During reflection sessions on the ward level and in the project team meetings BNs, informed by their previous experience with the complexity tool, revealed that they found it a struggle to do justice to everyone’s competencies. They wanted to use everyone’s expertise to improve the quality of patient care. They were for VNs being involved in the quality work, e.g. in preparing a clinical lesson, conducting small surveys, asking VNs to pose EBP questions and encourage VNs to write down their thoughts on flip over charts as means of engaging all team members.

These findings show that applying EPB in quality improvement is a relational practice driven by mutual recognition of one another’s competencies. This relational practice blended the BNs’ theoretical competence in EBP [ 66 ] with the VNs’ practical approach to the improvement work they did together. As a result, the blend enhanced the quality of daily nursing work and thus improved the quality of patient care and the further professionalization of the whole nursing team.

This study aimed to understand how an experimental approach enables differently educated nurses to develop new, distinct professional roles. Our findings show that roles cannot be distinguished by complexity of care; VNs and BNs are both able to provide care to patients with complex healthcare needs based on their knowledge and experience. However, role distinctions can be made on organizing care and quality improvement. BNs have an important role organizing care, for example arranging the patient flow on and across wards at bed management meetings, while VNs contribute more to organizing at the individual patient level. BNs play a key role in starting and steering quality improvement work, especially blending EBP in with daily nursing tasks, while VNs are involved but not in the lead. Working together on quality improvement boosts nursing professionalization and team development.

Our findings also show that the role development process is greatly supported by a series of small-change experiments, based on action and appraisal. This experimental approach supported role development in three ways. First, it incorporates both formal tasks and the invisible, unconscious elements of nursing work [ 49 ]. Usually, invisible work gets no formal recognition, for example in policy documents [ 55 ], whereas it is crucial in daily routines and organizational structures [ 49 , 60 ]. Second, experimenting triggers an accumulation of small changes [ 33 , 35 ] leading to the embeddedness of role distinctions in new nursing routines, allowing nurses to influence the organization of care. This finding confirms the observations of Reay et al. that nurses can create small changes in daily activities to craft a new nursing role, based on their thorough knowledge of their own practice and that of the other involved professional groups [ 37 ]. Although these changes are accompanied by tension and uncertainty, the process of developing roles generates a certain joy. Third, experimenting stimulated nursing professionalization, enabling the nurses to translate national legislation into hospital policy and supporting the nurses’ own (bottom-up) evolution of practices. Historically, nursing professionalization is strongly influenced by gender and education level [ 43 ] resulting in a subordinate position, power inequity and lack of autonomy [ 44 ]. Giving nurses the lead in developing distinct roles enables them to ‘engage in acts of power’ and obtain more control over their work. Fourth, experimenting contributes to role definition and clarification. In line with Poitras et al. [ 12 ] we showed that identifying and differentiating daily nursing tasks led to the development of two distinct and complementary roles. We have also shown that the knowledge base of roles and tasks includes both previous and additional education, as well as nursing experience.

Our study contributes to the literature on the development of distinct nursing roles [ 9 , 10 , 11 ] by showing that delineating new roles in formal job descriptions is not enough. Evidence shows that this formal distinction led particularly to the non-recognition, non-use and degradation [ 41 ] of VN competencies and discomforted recently graduated BNs. The workplace-based experimental approach in the hospital includes negotiation between professionals, the adoption process of distinct roles and the way nurses handle formal policy boundaries stipulated by legislation, national job profiles, and hospital documents, leading to clear role distinctions. In addition to Hughes [ 42 ] and Abbott [ 67 ] who showed that the delineation of formal work boundaries does not fit the blurred professional practices or individual differences in the profession, we show how the experimental approach leads to the clarification and shape of distinct professional practices.

Thus, an important implication of our study is that the professionals concerned should be given a key role in creating change [ 37 , 39 , 40 ]. Adding to Mannix et al. [ 38 ], our study showed that BNs fulfill a leadership role, which allows them to build on their professional role and identity. Through the experiments, BNs and VNs filled the gap between what they had learned in formal education, and what they do in daily practice [ 64 , 65 ]. Experimenting integrates learning, appraising and doing much like going on ‘a journey with no fixed routes’ [ 34 , 68 ] and no fixed job description, resulting in the enlargement of their roles.

Our study suggests that role development should involve professionalization at different educational levels, highlighting and valuing specific roles rather than distinguishing higher and lower level skills and competencies. Further research is needed to investigate what experimenting can yield for nurses trained at different educational levels in the context of changing healthcare practices, and which interventions (e.g., in process planning, leadership, or ownership) are needed to keep the development of nursing roles moving ahead. Furthermore, more attention should be paid to how role distinction and role differentiation influence nurse capacity, quality of care (e.g., patient-centered care and patient satisfaction), and nurses’ job satisfaction.

Limitations

Our study was conducted on four wards of one teaching hospital in the Netherlands. This might limit the potential of generalizing our findings to other contexts. However, the ethnographic nature of our study gave us unique understanding and in-depth knowledge of nurses’ role development and distinctions, both of which have broader relevance. As always in ethnographic studies, the chances of ‘going native’ were apparent, and we tried to prevent this with ongoing reflection in the research team. Also, the interpretation of research findings within the Dutch context of nurse professionalization contributed to a more in-depth understanding of how nursing roles develop, as well as the importance of involving nurses themselves in the development of these roles to foster and support professional development.

We focused on role distinctions between VNs and BNs and paid less attention to (the collaboration with) other professionals or management. Further research is needed to investigate how nursing role development takes place in a broader professional and managerial constellation and what the consequences are on role development and healthcare delivery.

This paper described how nurses crafted and shaped new roles with an experimental process. It revealed the implications of developing a distinct VN role and the possibility to enhance the BN role in coordination tasks and in steering and supporting EBP quality improvement work. Embedding the new roles in daily practice occurred through an accumulation of small changes. Anchored by action and appraisal rather than by design , the changes fostered by experiments have led to a distinction between BNs and VNs in the Netherlands. Furthermore, experimenting with nursing role development has also fostered the professionalization of nurses, encouraging nurses to translate knowledge into practice, educating the team and stimulating collaborative quality improvement activities.

This paper addressed the enduring challenge of developing distinct nursing roles at both the vocational and Bachelor’s educational level. It shows the importance of experimental nursing role development as it provides opportunities for the professionalization of nurses at different educational levels, valuing specific roles and tasks rather than distinguishing between higher and lower levels of skills and competencies. Besides, nurses, managers and policymakers can embrace the opportunity of a ‘two-way window’ in (nursing) role development, whereby distinct roles are outlined in general at policy levels, and finetuned in daily practice in a process of small experiments to determine the best way to collaborate in diverse contexts.

Availability of data and materials

The data generated and analyzed during the current study is not publicly available to ensure data confidentiality but is available from the corresponding author on reasonable request and with the consent of the research participants.

Abbreviations

Bachelor-trained nurse

Vocational-trained nurse

Evidence-based Practices

Allen D. Nursing and the future of ‘care’ in health care systems. J Health Serv Res Policy. 2015;20(3):129–30. https://doi.org/10.1177/1355819615577806 .

Article   PubMed   Google Scholar  

NHS England. Leading change, adding value. A framework for nursing, midwifery and care staff. 2016. https://www.england.nhs.uk/wp-content/uploads/2016/05/nursing-framework.pdf . Accessed 11 Nov 2020.

Institute of Medicine (IOM). The future of nursing; Leading change, advancing Health. Washington (DC): National Academies Press; 2011.

Google Scholar  

World Health Organization (WHO). Gloabal strategic directions for strengthening nursing and midwifery 2016–2020. Geneva: WHO Press; 2016.

Dawson AJ, Stasa H, Roche MA, et al. Nursing churn and turnover in Australian hospitals: nurses perceptions and suggestions for supportive strategies. BMC Nurs. 2014;13:11. https://doi.org/10.1186/1472-6955-13-11 .

Article   PubMed   PubMed Central   Google Scholar  

Hayes LJ, O’Brien-Pallas L, Duffield C, et al. Nurse turnover: a literature review–an update. Intern J Nurs Stud. 2012;49(7):887–905. https://doi.org/10.1016/j.ijnurstu.2011.10.001 .

Article   Google Scholar  

Persson U, Carlson E. Conceptions of professional work in contemporary health care—Perspectives from registered nurses in somatic care: A phenomenographic study. J Clin Nurs. 2019;28(1–2):201–8. https://doi.org/10.1111/jocn.14628 .

Senek M, Robertson S, Ryan T, et al. Determinants of nurse job dissatisfaction-findings from a cross-sectional survey analysis in the UK. BMC Nurs. 2020;19(1):1–10. https://doi.org/10.1186/s12912-020-00481-3 .

Jacob ER, McKenna L, D’Amore A. The changing skill mix in nursing: considerations for and against different levels of nurse. J Nurs Manag. 2015;23(4):421–6. https://doi.org/10.1111/jonm.12162 .

Sermeus W, Aiken LH, Van den Heede K, et al. Nurse forecasting in Europe (RN4CAST): Rationale, design and methodology. BMC Nurs. 2011;10:6. https://doi.org/10.1186/1472-6955-10-6 .

de Bont A, van Exel Job, Coretti S, Ökem ZG, Janssen M, Hope KL, Ludwicki T, Zander B, Zvonickova M, Bond C, Wallenburg I. Reconfiguring health workforce: a case-based comparative study explaining the increasingly diverse professional roles in Europe. BMC Health Serv Res. 2016;16(1).

Poitras ME, Chouinard MC, Fortin M, et al. How to report professional practice in nursing? A scoping review. BMC Nurs. 2016;15(1):31. https://doi.org/10.1186/s12912-016-0154-6 .

Jones ML. Role development and effective practice in specialist and advanced practice roles in acute hospital settings: systematic review and meta-synthesis. J Adv Nurs. 2005;49(2):191–209. https://doi.org/10.1111/j.1365-2648.2004.03279.x .

Ranchal A, Jolley MJ, Keogh J, et al. The challenge of the standardization of nursing specializations in Europe. Int Nurs Rev. 2015;62(4):445–52. https://doi.org/10.1111/inr.12204 .

Article   CAS   PubMed   Google Scholar  

Lowe G, Plummer V, O’Brien AP, et al. Time to clarify–the value of advanced practice nursing roles in health care. J Adv Nurs. 2012;68(3):677–85. https://doi.org/10.1111/j.1365-2648.2011.05790.x .

Fealy GM, Casey M, O’Leary DF, et al. Developing and sustaining specialist and advanced practice roles in nursing and midwifery: A discourse on enablers and barriers. J Clin Nurs. 2018;27(19–20):3797–809. https://doi.org/10.1111/jocn.14550 .

Aiken LH, Sermeus W, Van den Heede K, et al. Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States. BMJ. 2012;344;e1717. https://doi.org/10.1136/bmj.e1717

Lu H, Zhao Y, While A. Job satisfaction among hospital nurses: A literature review. Intern J Nurs Stud. 2019;94:21–31. https://doi.org/10.1016/j.ijnurstu.2019.01.011 .

Duffield C, Roche M, Twigg D, et al. Adding unregulated nursing support workers to ward staffing: Exploration of a natural experiment. J Clin Nurs. 2018;27(19–20):3768–79. https://doi.org/10.1111/jocn.14632 .

Chua WL, Legido-Quigley H, Ng PY, et al. Seeing the whole picture in enrolled and registered nurses’ experiences in recognizing clinical deterioration in general ward patients: A qualitative study. Intern J Nurs Stud. 2019;95:56–64. https://doi.org/10.1016/j.ijnurstu.2019.04.012 .

van Oostveen CJ, Mathijssen E, Vermeulen H. Nurse staffing issues are just the tip of the iceberg: a qualitative study about nurses’ perceptions of nurse staffing. Intern J Nurs Stud. 2015;52(8):1300–9. https://doi.org/10.1016/j.ijnurstu.2015.04.002 .

Saville CE, Griffiths P, Ball JE, et al. How many nurses do we need? A review and discussion of operational research techniques applied to nurse staffing. Intern J Nurs Stud. 2019;97:7–13. https://doi.org/10.1016/j.ijnurstu.2019.04.015 .

Vatnøy TK, Sundlisæter Skinner M, Karlsen T, et al. Nursing competence in municipal in-patient acute care in Norway: a cross-sectional study. BMC Nurs. 2020;9:70. https://doi.org/10.1186/s12912-020-00463-5 .

De Jong JHJ, Kerstens JAM, Sesink EM, et al. Deskundigheidsbevordering en professionalisering. In: Handboek verpleegkunde. Houten: Bohn Stafleu van Loghum; 2003. p. 396–421. https://doi.org/10.1007/978-90-313-9699-3_13 .

Lalleman P, Stalpers D, Goossens L, et al. RN2Blend: meerjarig onderzoek naar gedifferentieerde inzet van verpleegkundigen. Verpleegkunde. 2020;1:4–6.

Endacott R, O’Connor M, Williams A, et al. Roles and functions of enrolled nurses in Australia: Perspectives of enrolled nurses and registered nurses. J Clin Nurs. 2018;27(5–6):e913–20. https://doi.org/10.1111/jocn.13987 .

Jacob E, Sellick K, McKenna L. Australian registered and enrolled nurses: Is there a difference? Intern J Nurs Pract. 2012;18(3):303–7. https://doi.org/10.1111/j.1440-172X.2012.02037.x .

Matthias AD. Educational pathways for differentiated nursing practice: a continuing dilemma. In: Lewenson SB, McAllister A, Smith KM, editors. Nursing History for Contemporary Role Development. New York: Springer Publishing Company; 2017. p. 121–40.

Boston-Fleischhauer C. Another Look at Differentiating Nursing Practice. J Nurs Adm. 2019;49(6):291–3. https://doi.org/10.1097/NNA.0000000000000754 .

Gardner G, Duffield C, Doubrovsky A, et al. Identifying advanced practice: a national survey of a nursing workforce. Intern J Nurs Stud. 2016;55:60–70. https://doi.org/10.1016/j.ijnurstu.2015.12.001 .

Duffield C, Twigg D, Roche M, et al. Uncovering the disconnect between nursing workforce policy intentions, implementation, and outcomes: Lessons learned from the addition of a nursing assistant role. Policy Polit Nurs Pract. 2019;20(4):228–238. https://doi.org/10.1177/1527154419877571

Terpstra D, Van den Berg A, Van Mierlo C, et al. Toekomstbestendige beroepen in de verpleging en verzorging: rapport stuurgroep over de beroepsprofielen en de overgangsregeling. 2015. http://www.nfu.nl/img/pdf/Rapport_toekomstbestendige-beroepen-in-de-verpleging-en-verzorging.pdf

Bohmer RM. The hard work of health care transformation. N Engl J Med 2016;375(8):709–11. doi: https://doi.org/10.1056/NEJMp1606458

Ellström PE. Integrating learning and work: Problems and prospects. Hum Res Dev Q. 2001;12(4):421–35. https://doi.org/10.1002/hrdq.1006 .

Lyman B, Hammond E, Cox J. Organizational learning in hospitals: A concept analysis. J Nurs Manag. 2019;27:633–46. https://doi.org/10.1111/jonm.12722 .

van Schothorst J, van Roekel AM,  Weggelaar-Jansen JWM, de Bont A, Wallenburg I. The balancing act of organizing professionals and managers: An ethnographic account of nursing role development and unfolding nurse-manager relationships. J Professions an Orga. 2020;7(3):283–99.

Reay T, Golden-Biddle K, Germann K. Legitimizing a New Role: Small Wins and Microprocesses of Change. Acad Manag J. 2006;49(5):977–98. https://doi.org/10.5465/amj.2006.22798178 .

Mannix J, Wilkes L, Jackson D. Marking out the clinical expert/clinical leader/clinical scholar: perspectives from nurses in the clinical arena. BMC Nurs. 2013:12;12. https://doi.org/10.1186/1472-6955-12-12

Nelson-Brantley HV, Ford DJ. Leading change: a concept analysis. J Adv Nurs. 2017;73(4):834–46. https://doi.org/10.1111/jan.13223 .

Boamah SA. Emergence of informal clinical leadership as a catalyst for improving patient care quality and job satisfaction. J Adv Nurs. 2019;75(5):1000–9. https://doi.org/10.1111/jan.13895 .

Abbott A. Linked ecologies: States and universities as environments for professions. Sociol Theory. 2005;23(3):245–74. https://doi.org/10.1111/j.0735-2751.2005.00253.x .

Hughes D. Nursing and the division of labour: sociological perspectives. In: Allen D, Hughes D, editors. Nursing and the Division of Labour in Healthcare. Hampshire and New York: Palgrave Macmillan; 2017. p. 1–21.

Ayala RA. Towards a Sociology of Nursing. Palgrave Macmillan; 2020.

Chua WF, Clegg S. Professional closure. Theory Soc. 1990;19(2):135–72.

Roper JM, Shapira J. Ethnography in nursing research. Thousand Oaks: Sage Publications; 2000.

Book   Google Scholar  

Polit DF, Beck CT. Nursing research: Generating and assessing evidence for nursing practice, 8th Edition. Philadelphia: Wolters Kluwer Health/ Lippincott Williams & Wilkins; 2008.

Atkinson P, Hammersley M. Ethnography: Principles in practice. New York: Routledge; 2007.

Draper J. Ethnography: Principles, practice and potential. Nurs Stand. 2015;29(36):36–41. https://doi.org/10.7748/ns.29.36.36.e8937 .

Allen D. The invisible work of nurses: Hospitals, organisation and healthcare. The Invisible Work of Nurses: Hospitals, Organisation and Healthcare. Oxfordshire and New York: Routledge; 2014.

Lalleman P, Bouma J, Smid G, et al. Peer-to-peer shadowing as a technique for the development of nurse middle managers clinical leadership: An explorative study. Leader Health Serv. 2017;30(4):475–90. https://doi.org/10.1108/LHS-12-2016-0065 .

Atkins S, Lewin S, Smith H, et al. Conducting a meta-ethnography of qualitative literature: lessons learned. BMC Med Res Methodol. 2008;8:21. https://doi.org/10.1186/1471-2288-8-21

Houghton C, Casey D, Shaw D, et al. Rigour in qualitative case-study researh. Nurse Res. 2013;20(4):12–7. https://doi.org/10.7748/nr2013.03.20.4.12.e326 .

Denzin NK, Lincoln YS, editors. The Sage handbook of Qualitative research. Thousands Oak: Sage; 2011.

Creswell JW, Miller DL. Determining validity in qualitative inquiry. Theory Pract. 2000;39(3):124–30. https://doi.org/10.1207/s15430421tip3903_2 .

Baker L, Observation. A complex research method. Library Trends. 2006;55(1):171–89.

Kanuha VK. “Being” native versus “going native”: Conducting social work research as an insider. Social Work. 2000;45(5):439–47. https://doi.org/10.1093/sw/45.5.439 .

Dwyer SC, Buckle JL. The space between: On being an insider-outsider in qualitative research. Intern J Qual Methods. 2009;8(1):54–63. https://doi.org/10.1177/160940690900800105 .

Star SL, Strauss A. Layers of silence, arenas of voice: The ecology of visible and invisible work. Comp Support Coop Work. 1999;8(1–2):9–30. https://doi.org/10.1023/A:1008651105359 .

Allen DA, Lyne PA. Nurses’ flexible working practices: some ethnographic insights into clinical effectiveness. Clin Effective Nurs. 1997;1(3):131–8. https://doi.org/10.1016/S1361-9004(97)80048-9 .

Allen D. Translational mobilisation theory: a new paradigm for understanding the organisational elements of nursing work. Intern J Nurs Stud. 2018;79:36–42. https://doi.org/10.1016/j.ijnurstu.2017.10.010 .

Arrowsmith V, Lau-Walker M, Norman I, et al. Nurses’ perceptions and experiences of work role transitions: a mixed methods systematic review of the literature. J Adv Nurs. 2016;72(8):1735–50. https://doi.org/10.1111/jan.12912 .

Apker J, Propp KM, Ford WSZ, et al. Collaboration, credibility, compassion, and coordination: professional nurse communication skill sets in health care team interactions. J Prof Nurs. 2006;22(3):180–9. https://doi.org/10.1016/j.profnurs.2006.03.002 .

Currie G, Koteyko N, Nerlich B. The dynamics of professions and development of new roles in public services organizations. The case of modern matrons in the English NHS. Public Adm. 2009;87(2):295–311. https://doi.org/10.1111/j.1467-9299.2009.01755.x .

Skela-Savič B, Hvalič-Touzery S, Pesjak K. Professional values and competencies as explanatory factors for the use of evidence-based practice in nursing. J Adv Nurs. 2017;73(8):1910–23. https://doi.org/10.1111/jan.13280 .

FURÅKER C. Registered Nurses’ views on their professional role. J Nurs Manag. 2008;16(8):933–41. https://doi.org/10.1111/j.1365-2834.2008.00872.x .

Stokke K, Olsen NR, Espehaug B, et al. Evidence based practice beliefs and implementation among nurses: a cross-sectional study. BMC Nurs. 2014;13(1):8.

Abbott A. The system of professions: an essay on the expert division of labor. Chicago: The University of Chicago Press; 1988.

Clegg SR, Kornberger M, Rhodes C. Learning/becoming/organizing. Organization. 2005;12(2):147–67. https://doi.org/10.1177/1350508405051186 .

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Acknowledgements

The authors would like to thank all participants for their contribution to this study.

The Reinier de Graaf hospital in Delft, who was central to this study provided financial support for this research.

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Jannine van Schothorst–van Roekel, Anne Marie J.W.M. Weggelaar-Jansen, Carina C.G.J.M. Hilders, Antoinette A. De Bont & Iris Wallenburg

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van Schothorst–van Roekel, J., Weggelaar-Jansen, A.M.J., Hilders, C.C. et al. Nurses in the lead: a qualitative study on the development of distinct nursing roles in daily nursing practice. BMC Nurs 20 , 97 (2021). https://doi.org/10.1186/s12912-021-00613-3

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• Qualitative vs. Quantitative Research | Differences, Examples & Methods

Qualitative vs. Quantitative Research | Differences, Examples & Methods

Published on April 12, 2019 by Raimo Streefkerk . Revised on June 22, 2023.

When collecting and analyzing data, quantitative research deals with numbers and statistics, while qualitative research deals with words and meanings. Both are important for gaining different kinds of knowledge.

Common quantitative methods include experiments, observations recorded as numbers, and surveys with closed-ended questions.

Quantitative research is at risk for research biases including information bias , omitted variable bias , sampling bias , or selection bias . Qualitative research Qualitative research is expressed in words . It is used to understand concepts, thoughts or experiences. This type of research enables you to gather in-depth insights on topics that are not well understood.

Common qualitative methods include interviews with open-ended questions, observations described in words, and literature reviews that explore concepts and theories.

Table of contents

The differences between quantitative and qualitative research, data collection methods, when to use qualitative vs. quantitative research, how to analyze qualitative and quantitative data, other interesting articles, frequently asked questions about qualitative and quantitative research.

Quantitative and qualitative research use different research methods to collect and analyze data, and they allow you to answer different kinds of research questions.

Quantitative and qualitative data can be collected using various methods. It is important to use a data collection method that will help answer your research question(s).

Many data collection methods can be either qualitative or quantitative. For example, in surveys, observational studies or case studies , your data can be represented as numbers (e.g., using rating scales or counting frequencies) or as words (e.g., with open-ended questions or descriptions of what you observe).

However, some methods are more commonly used in one type or the other.

Quantitative data collection methods

• Surveys :  List of closed or multiple choice questions that is distributed to a sample (online, in person, or over the phone).
• Experiments : Situation in which different types of variables are controlled and manipulated to establish cause-and-effect relationships.
• Observations : Observing subjects in a natural environment where variables can’t be controlled.

Qualitative data collection methods

• Interviews : Asking open-ended questions verbally to respondents.
• Focus groups : Discussion among a group of people about a topic to gather opinions that can be used for further research.
• Ethnography : Participating in a community or organization for an extended period of time to closely observe culture and behavior.
• Literature review : Survey of published works by other authors.

A rule of thumb for deciding whether to use qualitative or quantitative data is:

• Use quantitative research if you want to confirm or test something (a theory or hypothesis )
• Use qualitative research if you want to understand something (concepts, thoughts, experiences)

For most research topics you can choose a qualitative, quantitative or mixed methods approach . Which type you choose depends on, among other things, whether you’re taking an inductive vs. deductive research approach ; your research question(s) ; whether you’re doing experimental , correlational , or descriptive research ; and practical considerations such as time, money, availability of data, and access to respondents.

Quantitative research approach

You survey 300 students at your university and ask them questions such as: “on a scale from 1-5, how satisfied are your with your professors?”

You can perform statistical analysis on the data and draw conclusions such as: “on average students rated their professors 4.4”.

Qualitative research approach

You conduct in-depth interviews with 15 students and ask them open-ended questions such as: “How satisfied are you with your studies?”, “What is the most positive aspect of your study program?” and “What can be done to improve the study program?”

Based on the answers you get you can ask follow-up questions to clarify things. You transcribe all interviews using transcription software and try to find commonalities and patterns.

Mixed methods approach

You conduct interviews to find out how satisfied students are with their studies. Through open-ended questions you learn things you never thought about before and gain new insights. Later, you use a survey to test these insights on a larger scale.

It’s also possible to start with a survey to find out the overall trends, followed by interviews to better understand the reasons behind the trends.

Qualitative or quantitative data by itself can’t prove or demonstrate anything, but has to be analyzed to show its meaning in relation to the research questions. The method of analysis differs for each type of data.

Analyzing quantitative data

Quantitative data is based on numbers. Simple math or more advanced statistical analysis is used to discover commonalities or patterns in the data. The results are often reported in graphs and tables.

Applications such as Excel, SPSS, or R can be used to calculate things like:

• Average scores ( means )
• The number of times a particular answer was given
• The correlation or causation between two or more variables
• The reliability and validity of the results

Analyzing qualitative data

Qualitative data is more difficult to analyze than quantitative data. It consists of text, images or videos instead of numbers.

Some common approaches to analyzing qualitative data include:

• Qualitative content analysis : Tracking the occurrence, position and meaning of words or phrases
• Thematic analysis : Closely examining the data to identify the main themes and patterns
• Discourse analysis : Studying how communication works in social contexts

If you want to know more about statistics , methodology , or research bias , make sure to check out some of our other articles with explanations and examples.

• Chi square goodness of fit test
• Degrees of freedom
• Null hypothesis
• Discourse analysis
• Control groups
• Mixed methods research
• Non-probability sampling
• Quantitative research
• Inclusion and exclusion criteria

Research bias

• Rosenthal effect
• Implicit bias
• Cognitive bias
• Selection bias
• Negativity bias
• Status quo bias

Quantitative research deals with numbers and statistics, while qualitative research deals with words and meanings.

Quantitative methods allow you to systematically measure variables and test hypotheses . Qualitative methods allow you to explore concepts and experiences in more detail.

In mixed methods research , you use both qualitative and quantitative data collection and analysis methods to answer your research question .

The research methods you use depend on the type of data you need to answer your research question .

• If you want to measure something or test a hypothesis , use quantitative methods . If you want to explore ideas, thoughts and meanings, use qualitative methods .
• If you want to analyze a large amount of readily-available data, use secondary data. If you want data specific to your purposes with control over how it is generated, collect primary data.
• If you want to establish cause-and-effect relationships between variables , use experimental methods. If you want to understand the characteristics of a research subject, use descriptive methods.

Data collection is the systematic process by which observations or measurements are gathered in research. It is used in many different contexts by academics, governments, businesses, and other organizations.

There are various approaches to qualitative data analysis , but they all share five steps in common:

• Prepare and organize your data.
• Review and explore your data.
• Develop a data coding system.
• Assign codes to the data.
• Identify recurring themes.

The specifics of each step depend on the focus of the analysis. Some common approaches include textual analysis , thematic analysis , and discourse analysis .

A research project is an academic, scientific, or professional undertaking to answer a research question . Research projects can take many forms, such as qualitative or quantitative , descriptive , longitudinal , experimental , or correlational . What kind of research approach you choose will depend on your topic.

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This article has a correction. Please see:

• Correction: How to appraise quantitative research - April 01, 2019

• Xabi Cathala 1 ,
• Calvin Moorley 2
• 1 Institute of Vocational Learning , School of Health and Social Care, London South Bank University , London , UK
• 2 Nursing Research and Diversity in Care , School of Health and Social Care, London South Bank University , London , UK
• Correspondence to Mr Xabi Cathala, Institute of Vocational Learning, School of Health and Social Care, London South Bank University London UK ; cathalax{at}lsbu.ac.uk and Dr Calvin Moorley, Nursing Research and Diversity in Care, School of Health and Social Care, London South Bank University, London SE1 0AA, UK; Moorleyc{at}lsbu.ac.uk

https://doi.org/10.1136/eb-2018-102996

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Introduction

Some nurses feel that they lack the necessary skills to read a research paper and to then decide if they should implement the findings into their practice. This is particularly the case when considering the results of quantitative research, which often contains the results of statistical testing. However, nurses have a professional responsibility to critique research to improve their practice, care and patient safety. 1  This article provides a step by step guide on how to critically appraise a quantitative paper.

Title, keywords and the authors

The authors’ names may not mean much, but knowing the following will be helpful:

Their position, for example, academic, researcher or healthcare practitioner.

Their qualification, both professional, for example, a nurse or physiotherapist and academic (eg, degree, masters, doctorate).

This can indicate how the research has been conducted and the authors’ competence on the subject. Basically, do you want to read a paper on quantum physics written by a plumber?

The abstract is a resume of the article and should contain:

Introduction.

Research question/hypothesis.

Methods including sample design, tests used and the statistical analysis (of course! Remember we love numbers).

Main findings.

Conclusion.

The subheadings in the abstract will vary depending on the journal. An abstract should not usually be more than 300 words but this varies depending on specific journal requirements. If the above information is contained in the abstract, it can give you an idea about whether the study is relevant to your area of practice. However, before deciding if the results of a research paper are relevant to your practice, it is important to review the overall quality of the article. This can only be done by reading and critically appraising the entire article.

The introduction

Example: the effect of paracetamol on levels of pain.

My hypothesis is that A has an effect on B, for example, paracetamol has an effect on levels of pain.

My null hypothesis is that A has no effect on B, for example, paracetamol has no effect on pain.

My study will test the null hypothesis and if the null hypothesis is validated then the hypothesis is false (A has no effect on B). This means paracetamol has no effect on the level of pain. If the null hypothesis is rejected then the hypothesis is true (A has an effect on B). This means that paracetamol has an effect on the level of pain.

Background/literature review

The literature review should include reference to recent and relevant research in the area. It should summarise what is already known about the topic and why the research study is needed and state what the study will contribute to new knowledge. 5 The literature review should be up to date, usually 5–8 years, but it will depend on the topic and sometimes it is acceptable to include older (seminal) studies.

Methodology

In quantitative studies, the data analysis varies between studies depending on the type of design used. For example, descriptive, correlative or experimental studies all vary. A descriptive study will describe the pattern of a topic related to one or more variable. 6 A correlational study examines the link (correlation) between two variables 7  and focuses on how a variable will react to a change of another variable. In experimental studies, the researchers manipulate variables looking at outcomes 8  and the sample is commonly assigned into different groups (known as randomisation) to determine the effect (causal) of a condition (independent variable) on a certain outcome. This is a common method used in clinical trials.

There should be sufficient detail provided in the methods section for you to replicate the study (should you want to). To enable you to do this, the following sections are normally included:

Overview and rationale for the methodology.

Participants or sample.

Data collection tools.

Methods of data analysis.

Ethical issues.

Data collection should be clearly explained and the article should discuss how this process was undertaken. Data collection should be systematic, objective, precise, repeatable, valid and reliable. Any tool (eg, a questionnaire) used for data collection should have been piloted (or pretested and/or adjusted) to ensure the quality, validity and reliability of the tool. 9 The participants (the sample) and any randomisation technique used should be identified. The sample size is central in quantitative research, as the findings should be able to be generalised for the wider population. 10 The data analysis can be done manually or more complex analyses performed using computer software sometimes with advice of a statistician. From this analysis, results like mode, mean, median, p value, CI and so on are always presented in a numerical format.

The author(s) should present the results clearly. These may be presented in graphs, charts or tables alongside some text. You should perform your own critique of the data analysis process; just because a paper has been published, it does not mean it is perfect. Your findings may be different from the author’s. Through critical analysis the reader may find an error in the study process that authors have not seen or highlighted. These errors can change the study result or change a study you thought was strong to weak. To help you critique a quantitative research paper, some guidance on understanding statistical terminology is provided in  table 1 .

• View inline

Some basic guidance for understanding statistics

Quantitative studies examine the relationship between variables, and the p value illustrates this objectively.  11  If the p value is less than 0.05, the null hypothesis is rejected and the hypothesis is accepted and the study will say there is a significant difference. If the p value is more than 0.05, the null hypothesis is accepted then the hypothesis is rejected. The study will say there is no significant difference. As a general rule, a p value of less than 0.05 means, the hypothesis is accepted and if it is more than 0.05 the hypothesis is rejected.

The CI is a number between 0 and 1 or is written as a per cent, demonstrating the level of confidence the reader can have in the result. 12  The CI is calculated by subtracting the p value to 1 (1–p). If there is a p value of 0.05, the CI will be 1–0.05=0.95=95%. A CI over 95% means, we can be confident the result is statistically significant. A CI below 95% means, the result is not statistically significant. The p values and CI highlight the confidence and robustness of a result.

Discussion, recommendations and conclusion

The final section of the paper is where the authors discuss their results and link them to other literature in the area (some of which may have been included in the literature review at the start of the paper). This reminds the reader of what is already known, what the study has found and what new information it adds. The discussion should demonstrate how the authors interpreted their results and how they contribute to new knowledge in the area. Implications for practice and future research should also be highlighted in this section of the paper.

A few other areas you may find helpful are:

Limitations of the study.

Conflicts of interest.

Table 2 provides a useful tool to help you apply the learning in this paper to the critiquing of quantitative research papers.

Quantitative paper appraisal checklist

• 1. ↵ Nursing and Midwifery Council , 2015 . The code: standard of conduct, performance and ethics for nurses and midwives https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf ( accessed 21.8.18 ).
• Gerrish K ,
• Moorley C ,
• Tunariu A , et al
• Shorten A ,

Competing interests None declared.

Patient consent Not required.

Provenance and peer review Commissioned; internally peer reviewed.

Correction notice This article has been updated since its original publication to update p values from 0.5 to 0.05 throughout.

Linked Articles

• Miscellaneous Correction: How to appraise quantitative research BMJ Publishing Group Ltd and RCN Publishing Company Ltd Evidence-Based Nursing 2019; 22 62-62 Published Online First: 31 Jan 2019. doi: 10.1136/eb-2018-102996corr1

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