The Importance of Good Rapport Between Patients and Advanced Nursing Staff - Research Paper Example

 The research methodologies defined by qualitative and quantitative paradigms of clinical research each play an important role in evidence based practice. In order to design effective and relevant experimental research, it is important to distinguish between these two important research paradigms and determine their appropriate applications in clinical medicine. In recent years, qualitative research methodologies have become increasingly important research tools in evidence based practice of mental health nursing. This area of research deals specifically with areas of patient care that include patient awareness and sensitivities to health issues related to the practice of clinical medicine. The origins of qualitative research are the disciplines of philosophy and the social sciences. Many of the empirical tools used in these academic disciplines have relevant applications to qualitative research in evidence based practice. This area of research can provide valuable information regarding patients’ behaviors, values, beliefs and cultural environment. The assessment of each of these parameters is critical to the practice of effective mental health nursing. Naturalistic inquiry is an essential component of qualitative research design. This mode of inquiry deals with the direct assessment of patients in their “natural” setting in order to evaluate the complex issues that drive human behavior. The primary attribute of this research paradigm is its unique capacity to yield in-depth information of the multi-faceted dimensions of human behavior and their complex interconnected origins. The holistic view of the patient and the complex dimensions that surround important health issues are the purview of the qualitative researcher. There are several important broad areas of qualitative research. These include ethnography, which involves the description and evaluation of cultures and social groups. This discipline is closely related to the study of anthropology. The experimental design frequently involves field work to assess cultures in an observational format. This affords the researcher a better understanding of cultural and social interactions that define a group. Phenomenology is another important area of qualitative research. Phenomenology involves the assessment of subjective reality, specifically through the eyes of the study participant. This is a critical area of research for mental health nursing as this may define a patient’s perspective on reality and issues that pertain to behavior and mental attitudes. Symbolic interactionism is used to define experience and reality using symbols. Semiotic analysis is often used in research in this area. This area of research is closely allied with grounded theory, which is an observational approach to inductive reasoning. The core of grounded theory is the data; the theory is inductively generated based on qualitative input. In this theory, concepts are source of analysis and categories are established to produce a formalized theory. The ultimate goal of qualitative research is phenomenological: to allow for increased understanding of complex phenomena.. This type of research is especially important in defining evidence-based practice of mental health nursing, as the multi-faceted origins of human behavior must be understood in the context of mental disorder. The focus of qualitative research is process, rather than specific outcomes, which falls in the realm of quantitative research paradigms. Thus, the description and exploration of behavioral phenomena is a major goal of qualitative research studies in the area of mental health. The role of unique personal experience is given voice in this type of research, whose goal is to explore the context of phenomena in the realm of human experience. Qualitative research may thus afford a greater understanding of the individual as wellas the environment or natural context of individual personal experiences. Complex phenomena are studied in the natural setting, in a context that embraces the complexity of human behavior and may afford insightful, holistic understanding of the human mind. The defining characteristics of qualitative research include the natural setting as the experimental venue, the use of multiple methods of inquiry, a holistic viewpoint of data collection and interpretation, awareness of the individual in the context of a wider cultural environment, and personal awareness of the researcher’s involvement as a study participant that affects perception, evaluation and interpretation of study findings. It is essential that qualitative research methods that focus on the individual embody ethical principles of respect for the individual and the community in which the research takes place. The primary goal of quantitative research is to identify the relationship between variables that can be measured. Some types of variables used in quantitative research include types of treatments, duration of treatment, dosing levels, performance measurements and physiological measurements.    The variables are assessed in groups of subjects and then analyzed by statistical methods to discern correlations, differences and other measurable relationships. In contrast to naturalistic experimental approaches, cause and effect thinking is an integral component of positivist paradigms of research and involves the use of variables and hypotheses to assess specific theories relevant to evidence based practice Quantitative research involves the determination of the relationship between a discrete variable and a result or outcome associated with that variable. The former is termed the independent variable; it is subject to experimental manipulation and the effects on the dependent variable can thus be ascertained. The variables are assessed in groups of subjects and then analyzed by statistical methods to discern correlations, differences and other measurable relationships. There are two major types of quantitative research: descriptive and experimental. Descriptive studies are observational; no attempt is made to manipulate experimental conditions. Descriptive quantitative research measures a subject once. Experimental quantitative studies generally involve before and after measurements of a study subject. Descriptive studies generally identify correlations between variables, while experimental studies can be used to determine cause and effect relationships between variables. The methods used in data collection are significantly different in qualitative and quantitative experimental design. Qualitative research methodology includes a number of obtrusive methods, including semi-structured and in-depth interviews, focus groups, life history and other types of narratives, ethnography, observation of participants and participatory action. Unobtrusive data collection methods include the analysis of written records, observation, analysis of texts as part of discourse analysis, audio-visual methods, material culture methods and auto-ethnography. The experimental methods most frequently used in qualitative research are participant observation, in-depth interviews and focus groups. Participant observation allows data collection in the natural context and environment in which human behavior occurs. In-depth patient interviews provide the researcher with valuable information on a patient’s life history, experiences and point of view. Focus groups can be very useful in obtaining information on cultural issues of a group that may affect individual perceptions, values, attitudes and behavior. Qualitative data sampling methods most frequently involve purposive sampling, quota sampling and snowball sampling. The most common sampling method is purposive sampling, which is carried out according to specific selected criteria that are designed to address an important research question. Sample sizes tend to vary widely in this type of sampling method. Quota sampling involves an a priori decision as to sample size and inclusion/exclusion criteria as an integral component of the research plan. The rationale for these criteria is that specific study participation requirements may eliminate variables that could interfere with appropriate data assessment. Snowball sampling is sometimes called chain referral sampling. This methodology allows study participants to recruit additional potential study subjects who may have potentially important contributions to make to the research study. The experimental design is generally fluid, beginning with a broad conceptual approach that can be defined as emergent, developing in the course of inquiry. This lack of rigidity in experimental design affords the research maximal latitude in defining the research methodology to suit the requirements of the experimental setting. Data analysis involves the identification of important themes and categories of data analyzed during and after the collection process. Data analysis involves interpretive techniques, coding, recursive abstraction and content analysis. In contrast to qualitative research, quantitative studies generally require large sample size to permit quantitative assessment that is statistically significant. Other important study parameters include random sampling to avoid bias associated with specific group characteristics. Many quantitative research studies are double-blinded, which means that the subjects and researchers do not know the identity of the control and experimental group. Blinded experiments reduce the likelihood of experimenter bias or placebo effect in subject groups. Descriptive quantitative research measures a subject once. Experimental quantitative studies generally involve before and after measurements of a study subject or multiple experimental trials within a group.. Descriptive studies generally identify correlations between variables, while experimental studies can be used to determine cause and effect relationships between variables. In contrast to qualitative research, quantitative studies generally require large sample sizes to permit quantitative assessment that is statistically significant. Other important study parameters include random sampling to avoid bias associated with specific group characteristics. Many quantitative research studies are double-blinded, which means that the subjects and researchers do not know the identity of the control and experimental group. Blinded experiments reduce the likelihood of experimenter bias or placebo effect in subject groups. Descriptive studies are termed observational. The simplest type of descriptive study is the case study which frequently involves the observational assessment of a single individual. When several individuals are assessed as a group, this is called a case series. Cross-sectional studies involve a single assessment of variables within a subject group. Prospective, longitudinal or cohort studies involve the assessment of variables at the beginning of the study, and assessed at a later time following an experimental intervention or manipulation. Case-control studies involve comparisons between a control group and an experimental group. These types of studies are often retrospective as the groups are analyzed based on patient records. In contrast, experimental studies are empirical and involve the use of measurements often involving experimental manipulations of variables. These types of studies include repeated measure studies and longitudinal studies. This type of research is also described as interventional as experimental variables are usually manipulated by the investigator to determine cause and effect relationships. A time=series experiment involves before-and –after study subject assessment. In a single-subject design repetitive measurements are taken on a single subject before and after an experimental manipulation. Repeated assessments may induce artifacts as subjects become more adept at the study parameter measurements. Crossovers involving a placebo and actual experimental treatment in random sequence can mitigate this effect. Another approach involves the use.of a control group that does not receive experimental variable and their results can be compared to those of the experimental group. When the groups are organized on a random basis, this is called a randomized controlled trial. Different experimental designs produce different levels of evidential quality. Case study and case series studies generally provide the least reliable data due to the limited number of study subjects. Cross-sectional and case control studies may provide data that is more rigorous and suggestive of cause and effect relationships Prospective studies can produce high quality data, but they often require many years of research study before yielding usable data. The major criticism of qualitative research involves the question of validity. The more complex nature of the naturalistic process invites criticism of its potential lack of quantitative rigor. The subjective nature of interviews, interviewer bias, and the confirmability of data represent challenges faced by researchers engaged in qualitative research studies. These criticisms of qualitative research may be offset by the use of triangulation, which involves the use of more than one method of assessment to generate qualitative research data. In conclusion, qualitative and quantitative research paradigms each address critical and often non-overlapping dimensions of human behavior and physiology The general framework of qualitative research is the naturalistic paradigm that involves the evaluation of phenomena. Quantitative research frameworks are positivist; they are more directed, seeking to confirm or repudiate hypotheses or even to establish new paradigms through the quantitative assessment of variables. Prediction is an important objective of the positivist paradigm; in contrast, understanding is the primary goal of naturalistic research paradigms. Each of these research paradigms plays an important role in clinical research. Research Study Evaluation A research study by All (2004) was designed to evaluate the psychosocial issues faced by patients diagnosed with HIV. The experimental design was a qualitative structure that involved a comparative observational study of two groups of patients, one with a low viral load and the second showing higher titers of viremia. The rationale for this study was the hypothesis that medication adherence issues and adherence to treatment procedures are affected by one’s psychosocial adjustment to illness. Medications used to treat HIV-positive patients can extend life markedly and control disease progression. In order for this to occur, patients must accept a difficult treatment regimen. It is essential for health professionals to understand and help the patient to manage psychosocial issues related to the difficulties of dealing with chronic illness in order to maximize positive patient outcome. The goal of this research study was to evaluate the psychosocial factors that may affect patient outcome. Among the identified factors that influence patient adherence to prescribed treatment plans include medication side effects, the complexity of the treatment protocol, awareness of the nature of the chronic illness and the need for ongoing medical treatment, lack of family and social support, cultural beliefs, the use of other drugs and alcohol and views about healthcare providers and wellness. The stated purpose of this research study was to determine whether a relationship existed between patient viral loads and psychosocial adjustment factors that have been shown by previous studies to affect compliance with therapeutic regimens of disease management. The study was also designed to identify those variables that correlated most closely with virus load levels in the two groups of patients. The Health Belief Model (HBM) is used to assess behaviors that may contribute to good patient outcome. This model involves the use of PAIS-SR and MHLC psychological tests as methods of assessment. Blame, harm reduction and healthcare belief models provided the conceptual framework for this research study. Harm reduction is a preventive approach to therapeutic compliance. Harm reduction includes primary care factors such as treatment program enrollment and compliance and approaches to avoid disease transmission to others. To assess these issues, Psychological Adjustment to Illness Self-Report (PAIS-SR) was used as an evaluation instrument. The PAIS-SR examines seven important areas of adjustment to illness. These include healthcare orientation, vocation, domestic issues, sexual relationships, family relationships, social context and psychological factors. The reliability coefficients of this test used in patients with serious disease are generally 0.85 or higher. To explore issues related to the locus control, the Multi-Dimensional Locus of Control (MHLC) tool was used in this study. This research tool provides measurements of an individual’s perceptions of control of health and the role of chance in determining outcome. The MHLC scale-Form C measures three scores: belief that health is controlled by self, controlled by others, or by chance. Measured reliabilities range from 0.67-0.77. The sample size was 54 patients and the numbers between the two groups were non-identical. 36 patients were enrolled in the low HIV titer arm whereas only 18 were enrolled in the high titer arm. Because the study group size was so small, this reduces the generalizable study impact. Inclusion criteria included patient enrollment in HART medication protocols and were stratified into two groups based on measured viral load. Participation in the study was voluntary and adhered to all ethical guidelines. All other demographics were similar between the two groups. The data were collected and patient scores for the MHLC and the PAIS-SR were analyzed by inferential statistics to determine the degree of association between variables within each of the two study groups. The primary identified challenge to this study was patient reluctance to participate. The study limitation is that patient willingness to participate may itself be a factor that could result in the incomplete representation of psychosocial issues faced by HIV+ patients. Statistical assessment of the parameters measured in the two study groups revealed no statistical differences between the groups except for the area of extended family relations. The study conclusions were that patients with low virus loads exhibited a higher degree of internal locus control than patients with higher virus loads and more consistently held the belief that healthcare providers played an influential role in assisting with disease management. Both groups scored high in the belief that healthcare professionals play an important role in patient health and disease management. The study authors concluded that this study supports the importance of good rapport between patients and advanced nursing staff as a critical determinant of effective long-term disease management and identifies important psychosocial issues that need to be considered in patient care. References All, A., Nishakawa, H., Vinson, N., and Huycke, M. 2004. Psychosocial Variables that Relate to Blood HIV Virus Load Levels. The Internet Journal of Advanced Nursing Practice, 6 (2), pp. 41-53. Creswell, J.W., 2003. Research design.  Qualitative, quantitative and mixed methods approaches.  Thousand Oaks, CA: Sage Press. Ploeg J., 1999. Identifying the best research design to fit the question. Part 2: qualitative designs. Evid Based Nurs, 2, pp. 36-37. Read More