Acceptance of Qualitative Research :Acceptance of Qualitative Research In Evidenced-Based Practice Elizabeth Lee MSN, APN, ACNS-BC


Definition of Terms :Definition of Terms Evidenced-Based Practice (EBP) best practice care can refer to: EBM which relies on randomized clinical trials as the gold standard for clinical decisions (Rogers, 2004) EBN which incorporates qualitative and quantitative research, patient preference, and clinical experience Qualitative Research “humanizes health care” (Zuzelo, 2007) Clinical Guidelines provide EBP reference for clinicians (AHRQ, 2007) What role does qualitative research play in the generation of EBP guidelines?


Generation of EBP Guidelines :Generation of EBP Guidelines AHRQ’s National Guideline Clearinghouse provides free online national health care guidelines for practicing clinicians at www.guidelines.gov Cochrane Collection provides free online international, interdisciplinary guidelines at http://www.cochrane.org/reviews/ Cochrane Qualitative Research Methods Group provides a database of systematic reviews by subscription through http://www.joannabriggs.edu.au/cqrmg/about.html McMaster PLUS provides online health care guidelines at http://hiru.mcmaster.ca/hiru/Default.aspx These and other organizations generate EBN guidelines useful for nursing textbooks and journals (Ackley & Ladwig, 2006) What criteria are used to evaluate qualitative research for inclusion in EBP guidelines?


Criteria for Qualitative Research :Criteria for Qualitative Research One set of criteria does not fit all…


Criteria for Qualitative Research :Criteria for Qualitative Research Common criteria for rigorous qualitative research (Cohen & Crabtree, 2008) Be ethical Answer an important question Display clarity and coherence Use of appropriate and rigorous methods Address researcher bias Seek to establish validity or credibility Seek verification or reliability How can different perspectives in evaluating criteria create barriers to acceptance of qualitative research?


Barriers to Acceptance :Barriers to Acceptance Sandelowski and Barroso (2002) Lack of standardization Inconsistent terms Difficulty finding published qualitative research Misrepresentation of data and analysis Findings not clearly stated Paperwork overload Misperceptions of scientific inadequacies-small sample size (Zuzelo, 2007) How can these and other barriers be overcome and acceptance of qualitative research in EBP be enhanced?


Overcoming Barriers :Overcoming Barriers Building strong primary qualitative research Adapted: (Russell & Gregory, 2003) Construct valid findings Describe findings thoroughly Apply the findings to practice To promote acceptance of qualitative research, what measures can be taken to decrease researcher bias and promote greater validity and reliability?


Overcoming Barriers :Overcoming Barriers Hallmarks of good research (Cohen & Crabtree, 2008) Limit bias: Record and report preconceptions—reflective journaling Utilize triangulation, peer review, external audit, and member checking to verify and confirm findings Improve validity: Provide detailed accounts of participant perceptions and experiences with strong links to inferences and conclusions Enhance reliability: Utilize member checking, peer review, debriefing, and external audits to enhance dependability What strong qualitative research is already incorporated into EBP?


Qualitative Research in EBP :Qualitative Research in EBP Individualized care of rare cases: Care of clients with a neobladder (Beitz & Zuzelo, 2003) Instrument development/refinement: Clinical Assessment Package for Risks and Strengths (CASPARS) and the 4-D for youth in adversity (Gilgun, 2004) Theory development: Theory for postpartum depression (Beck, 1993) Exploration of perceptions: Nurse perception of pain assessment and treatment of clients with late stage dementia (Kovach et al., 2000) How could synthesis of strong primary qualitative research enhance acceptance into guidelines for EBP?


Synthesis of Qualitative Research :Synthesis of Qualitative Research Synthesis of qualitative research can overcome limitations of individual primary research and contribute to EBP through: New insights from primary research Enhanced generalisability Provision of context to systematic reviews of effectiveness (Flemming, 2007)


Future :Future Will there be equal weight given to quantitative and qualitative research in future EBP guidelines?


Conclusions :Conclusions “The relevance of qualitative research to the assessment of health interventions has only recently been given recognition… findings from qualitative studies … have an important role to ensuring the systematic reviews are of maximum value to policy and practice decision making.” Cochrane Qualitative Research Method Group (2008, para. 3-4)


Discussion Question #1 :Discussion Question #1 Rogers (2004, p.63) states, “In the so-called paradigm wars, quantitative methods such as RCTs [random clinical trials] have been characterized as masculine, objective, experimental and controlling, in contrast with qualitative methods which are seen to be feminine, subjective, observational, and context-dependant. Qualitative methods are favored by some feminist researchers for allowing the voices of women to be heard in describing problems and in finding solutions.” Describe how this comment can both promote and hinder acceptance of qualitative research in evidence-based practice.


Discussion Question #2 :Discussion Question #2 According to Flemming (2007), qualitative purists oppose qualitative synthesis claiming primary qualitative research presents unique multiple realities and synthesis requires belief in one “subtle” reality. Support your stance on this issue.


Discussion Question #3 :Discussion Question #3 Cite a specific example of how qualitative research contributed to EBP guidelines in your area of practice and describe how you can contribute to acceptance of qualitative research in the future.


Questions? :Questions? I may not have the answer but I have a good idea of where to begin looking.