Nur3052 ch6

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Chapter 6Critically Appraising Qualitative

Evidence for Clinical Decision Making


Qualitative Research and Decision-Making Qualitative research is usually placed near the bottom of

hierarchies of evidence

However, it is important in regard to clinical questions that address human responses and meaning

Recall that patient preferences and values are key components of EBP

Qualitative methods have evolved and expanded in recent years


Question

Qualitative evidence is most likely to inform which of the following aspects of the care of patients with cancer?

a. Cancer patients’ perceptions of hope during chemotherapy treatment

b. Treatment options for chemotherapy-induced nausea

c. Clinicians’ choices of chemotherapeutic agents

d. The relationship between anxiety and nausea in patients undergoing chemotherapy


Answer

a. Cancer patients’ perceptions of hope during chemotherapy treatment

Rationale: The concept of hope is an aspect of the human responses and meaning that surround a health experience. Treatment options and the relationships between different concepts are likely better addressed by quantitative evidence.


Qualitative Research Traditions

Clinicians must appreciate the diversity within the methodology

Ethnography - the study of a social group’s culture through combining participant observation, in-depth interviews, and the collection of artifacts

Useful for elucidating

People’s experiences of health/illness

Issues of concern to caregivers

Individuals’ experiences in certain types of settings


Qualitative Research Traditions (cont’d) Grounded theory

Purpose is to generate theory about how people deal with life situations that is “grounded” in empirical data

Movement through time is often expressed in terms of stages or phases

Phenomenology - the study of essences (meaning structures) intuited or grasped through descriptions of lived experience

Hermeneutics - viewing human “lived experience” as a text that is to be understood through the interpreter’s dialogical engagement


Question

Tell whether the following statement is true or false.

Grounded theory is the most appropriate tradition for a study that explores women’s coping as they move through different stages of fertility treatment.


Answer

True

Rationale: Grounded theory often focuses on changes in the human experience as they move through time.


Internal Diversity in Qualitative Research

Representation and conceptualization

Historical evolution

Description, interpretation, and theory generation

Qualitative descriptive studies

Generic qualitative studies

Qualitative evaluation and action research studies


Qualitative Research Techniques

Observation and field notes

Interviews and focus groups

Narrative and content analysis

Sampling strategies

Data management and analysis


Appraising Qualitative Studies

No single set of criteria can serve all qualitative approaches equally well

Lincoln and Guba’s (1985) trustworthiness criteria have broad application

Credibility

Demonstrated by accuracy and validity that is assured through documentation

Roughly parallel to internal validity in quantitative appraisal


Appraising Qualitative Studies (cont’d)Lincoln and Guba

Transferability

Demonstrated by information that is sufficient for a research consumer to determine whether findings are meaningful to other people in similar situations

Parallels external validity

Dependability

Demonstrated by a research process that is carefully documented to provide evidence of how conclusions were reached and whether, under similar conditions, a researcher might expect to obtain similar findings

Parallels reliability


Confirmability

Demonstrated by providing substantiation that findings and interpretations are grounded in the data

Parallels objectivity

Authenticity criteria (Guba & Lincoln, 1989)

Less commonly used than Lincoln & Guba’s trustworthiness criteria

Appraising Qualitative Studies (cont’d)Lincoln and Guba


Question

A nurse has examined whether the participants in a qualitative study on the meaning of dependence among IV drug users are similar to the clients that the nurse works with. This nurse has evaluated this study’s:

a. Dependability

b. Confirmability

c. Transferability

d. Credibility


Answer

c. Transferability

Rationale: Transferability addresses the question of whether the findings of a qualitative study are applicable to other people who are in similar situations.


Synthesizing Qualitative Evidence

Meta-studies

Meta-summaries

Nur3052 ch6

Technology

qualitative study

health experience

qualitative approaches

action research studies

research consumer

research process

human experience

treatment options