Helen Noble

Issues of validity and reliability in qualitative research

Evaluating the quality of research is essential if findings are to be utilised in practice and incorporated into care delivery. In a previous article we explored ‘bias’ across research designs and outlined strategies to minimise bias.1 The aim of this article is to further outline rigour, or the integrity in which a study is conducted, and ensure the credibility of findings in relation to qualitative research. Concepts such as reliability, validity and generalisability typically associated with quantitative research and alternative terminology will be compared in relation to their application to qualitative research. In addition, some of the strategies adopted by qualitative researchers to enhance the credibility of their research are outlined. Assessing the reliability of study findings requires researchers and health professionals to make judgements about the ‘soundness’ of the research in relation to …

EXPLORING SYMPTOMS IN PATIENTS MANAGED WITHOUT DIALYSIS: A QUALITATIVE RESEARCH STUDY

Little is known about the prevalence and burden of symptoms in patients managed without dialysis. This study was the result of a larger study exploring the experiences of 30 such patients and their trajectories to death. Data were analysed relating to symptoms once the patients had been referred to a Renal Supportive Care Service based in the East End of London, UK. A high symptom prevalence was found with 30 different symptoms reported at first consultation. Widely reported symptoms impacting on daily living included breathlessness, oedema, pruritus, nausea and vomiting and pain. Findings indicate that as symptoms escalate and death approaches, some symptoms, such as fluid overload and lethargy become difficult to treat indicating that death is close. This new knowledge can help staff as they attempt to determine when the end of life is approaching in order to support and care for patients appropriately. This paper highlights a need for effective identification and management of symptoms as they arise and further exploration of the effects of these symptoms on daily living.

Exploring public awareness and perceptions of palliative care: a qualitative study.

Background: Research suggests that the public appear to be confused about the meaning of palliative care. Given the ageing population and associated increase in the number of patients requiring palliative care, it is vital to explore the public’s understanding of this concept. Health-promoting palliative care seeks to translate hospice and palliative care ideals into broader public health practice. Aim: To explore public perceptions of palliative care and identify strategies to raise awareness. Design: An exploratory qualitative approach. Participants: Semi-structured telephone interviews were undertaken (N = 50) with members of the public who volunteered to participate in the study. The interviews focused on knowledge and perceptions of palliative care, expectations of palliative care services and the identification of strategies to raise public awareness of palliative care. The interviews were audio recorded and content analysed. Results: Most participants had a general knowledge of palliative care, largely influenced by their own personal experience. They identified that palliative care was about caring for people who were dying and maintaining comfort in the last days of life. Participant’s expectations of services included the following: holistic support, symptom management, good communication and practical support to enable choice and carer support. Key aspects identified for promoting palliative care were the development of understanding and use of the term itself and targeted educational strategies. Conclusion: Experience of palliative care generates understanding in the general public who also have ideas for increasing knowledge and awareness. The findings can inform policymakers about strategies to raise public awareness of palliative care.

Qualitative data analysis: a practical example

The aim of this paper is to equip readers with an understanding of the principles of qualitative data analysis and offer a practical example of how analysis might be undertaken in an interview-based study. Qualitative research is a generic term that refers to a group of methods, and ways of collecting and analysing data that are interpretative or explanatory in nature and focus on meaning. Data collection is undertaken in the natural setting, such as a clinic, hospital or a participants home because qualitative methods seek to describe, explore and understand phenomena from the perspective of the individual or group. Reality is coconstructed by the research participants and the researcher, with the depth of data collected more important than recruiting large samples. The individual interview method is the most widely used method of data collection in qualitative research and a range of data can be collected including field notes, audio and video recordings, images or documents. Qualitative researchers usually work with text when analysing data; data can be transcribed in entirety or focus on selected sections. However, focusing on selected sections of the data may not capture the nuances of observations or participants’ descriptions and may fragment the data. The challenge for qualitative researchers is to present a cohesive representation of the data, which can be …

Reviewing the literature

Implementing evidence into practice requires nurses to identify, critically appraise and synthesise research. This may require a comprehensive literature review: this article aims to outline the approaches and stages required and provides a working example of a published review. Literature reviews aim to answer focused questions to: inform professionals and patients of the best available evidence when making healthcare decisions; influence policy; and identify future research priorities. Although over 14 types of reviews have been identified,1 literature reviews can be broadly divided into narrative (descriptive) reviews, scoping reviews, rapid evidence assessments (rapid reviews) and systematic reviews. In terms of rigour, if viewed as a continuum, narrative and systematic reviews would be at opposing ends of the continuum with scoping and rapid reviews at the midpoint. Narrative reviews usually provide a summary of a small selection of studies in order to support empirical research, are often difficult to replicate and can be biased because the review may not be …

Bias in research.

The aim of this article is to outline types of ‘bias’ across research designs, and consider strategies to minimise bias. Evidence-based nursing, defined as the “process by which evidence, nursing theory, and clinical expertise are critically evaluated and considered, in conjunction with patient involvement, to provide the delivery of optimum nursing care,”1 is central to the continued development of the nursing professional. Implementing evidence into practice requires nurses to critically evaluate research, in particular assessing the rigour in which methods were undertaken and factors that may have biased findings. Bias is defined by the Oxford Dictionary as: “an inclination or prejudice for or against one person or group, especially in a way considered to be unfair”; “a concentration on an interest in one particular area or subject”; “a systematic distortion of statistical results due to a factor not allowed for in their derivation” (http://www.oxforddictionaries.com). Understanding research bias is important for several reasons: first, bias exists in all research, across research designs and is difficult to eliminate; second, bias can occur at each stage of the research process; third, bias impacts on the validity and reliability …

Clinician views of patient decisional conflict when deciding between dialysis and conservative management: Qualitative findings from the PAlliative Care in chronic Kidney diSease (PACKS) study

Background: Only a paucity of studies have addressed clinician perspectives on patient decisional conflict, in making complex decisions between dialysis and conservative management (renal supportive and palliative care). Aim: To explore clinician views on decisional conflict in patients with end-stage kidney disease. Design: Interpretive, qualitative study. Setting and participants: As part of the wider National Institute for Health Research, PAlliative Care in chronic Kidney diSease study, semi-structured interviews were conducted with clinicians (nephrologists n = 12; 7 female and clinical nurse specialists n = 15; 15 female) across 10 renal centres in the United Kingdom. Interviews took place between April 2015 and October 2016 and a thematic analysis of the interview data was undertaken. Results: Three major themes with associated subthemes were identified. The first, ‘Frequent changing of mind regarding treatment options’, revealed how patients frequently altered their treatment decisions, some refusing to make a decision until deterioration occurred. The second theme, ‘Obligatory beneficence’, included clinicians helping patients to make informed decisions where outcomes were uncertain. In weighing up risks and benefits, and the impact on patients, clinicians sometimes withheld information they thought might cause concern. Finally, ‘Intricacy of the decision’ uncovered clinicians’ views on the momentous and brave decision to be made. They also acknowledged the risks associated with this complex decision in giving prognostic information which might be inaccurate. Limitations: Relies on interpretative description which uncovers constructed truths and does not include interviews with patients. Conclusion: Findings identify decisional conflict in patient decision-making and a tension between the prerequisite for shared decision-making and current clinical practice. Clinicians also face conflict when discussing treatment options due to uncertainty in equipoise between treatments and how much information should be shared. The findings are likely to resonate across countries outside the United Kingdom.

CE: continuing education article. Integration of palliative care for patients with stage 5 chronic kidney disease.

Patients with advanced chronic kidney disease (Stage 5 CKD) have palliative care needs similar to patients with cancer. The decision not to commence dialysis or to withdraw from active treatment can have a profound impact upon all those closely involved in the patients care. It is essential that every effort is made to minimise the physical and psycho-social symptoms experienced by patients who require palliative care. Effective teamwork across professional boundaries and specialities will ensure that patients and their families are provided with maximum comfort during their final days. All members of the healthcare team must strive to ensure patient and family are actively encouraged in the decision-making process surrounding palliative care needs.

What is grounded theory

Grounded theory (GT) is a research method concerned with the generation of theory,1 which is ‘grounded’ in data that has been systematically collected and analysed.2 It is used to uncover such things as social relationships and behaviours of groups, known as social processes.3 It was developed in California, USA by Glaser and Strauss during their study—‘Awareness of Dying’.1 It is a general methodology for developing theory that is grounded in data which is systematically gathered and analysed. First the area of interest is identified. Theoretical preconceptions should be avoided, although it is accepted this is difficult in practice. Analytical procedures and sampling strategies are then used and the study is finished when theoretical sampling reached5 all discussed below. Data collected may be qualitative or quantitative or a combination of both. Data collection methods often include in-depth interviews using open-ended questions. Questions can be adjusted as theory emerges. Observational methods and focus groups may also be used. Glaser and Strauss (1967) first mentioned theoretical sampling and described a process of generating theory from data which includes collecting the data, then coding …

Type 2 diabetes: a case study

Increased prevalence of diabetes in the community has been accompanied by an increase in diabetes in hospitalised patients. About a quarter of these patients experience a hypoglycaemic episode during their admission, which is associated with increased risk of mortality and length of stay. This article examines the aetiology, pathophysiology, diagnosis and treatment of type 2 diabetes using a case study approach. The psychosocial implications for the patient are also discussed. The case study is based on a patient with diabetes who was admitted to hospital following a hypoglycaemic episode and cared for during a practice placement. The importance of early diagnosis of diabetes and the adverse effects of delayed diagnosis are discussed.