Joanna Smith

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 …

Does palliative home oxygen improve dyspnoea? A consecutive cohort study

Palliative oxygen for refractory dyspnoea is frequently prescribed, even when the criteria for long-term home oxygen (based on survival, rather than the symptomatic relief of breathlessness) are not met. Little is known about how palliative home oxygen affects symptomatic breathlessness. A 4 -year consecutive cohort from a regional community palliative care service in Western Australia was used to compare baseline breathlessness before oxygen therapy with dyspnoea sub-scales on the symptom assessment scores (SAS; 0–10) 1 and 2 weeks after the introduction of oxygen. Demographic and clinical characteristics of people who responded were included in a multi-variable logistic regression model. Of the study population (n = 5862), 21.1% (n = 1239) were prescribed oxygen of whom 413 had before and after data that could be included in this analysis. The mean breathlessness before home oxygen was 5.3 (SD 2.5; median 5; range 0–10). There were no significant differences overall at 1 or 2 weeks (P = 0.28) nor for any diagnostic sub-groups. One hundred and fifty people (of 413) had more than a 20% improvement in mean dyspnoea scores. In multi-factor analysis, neither the underlying diagnosis causing breathlessness nor the demographic factors predicted responders at 1 week. Oxygen prescribed on the basis of breathlessness alone across a large population predominantly with cancer does not improve breathlessness for the majority of people. Prospective randomised trials in people with cancer and non-cancer are needed to determine whether oxygen can reduce the progression of breathlessness compared to a control arm.

Frontline grief: the workplace support needs of community palliative care nurses after the death of a patient

This study describes the impact of multiple deaths on nursing staff who work exclusively with palliative care patients in the community and identifies the types of workplace support required after the death of a patient. A self-report questionnaire was mailed to community palliative care nursing staff (n = 101). Fifty-nine questionnaires were returned (58% response rate). Requesting workplace support following the death of a patient was associated with higher levels of emotional exhaustion (P =.001) and depersonalization (P =.04). Registered nurses with less than 10 years community care experience reported higher levels of depersonalization (P =.01) and lower levels of personal accomplishment (P =.03). A reported lack of training in grief responses was associated with depression (P =.02), guilt (P =.03), and physical distress (P =.02). Peer debriefing was identified as the most appropriate workplace support; however, most respondents reported they lacked debriefing skills, and this was associated with lower levels of personal accomplishment (P =.01). Staff working in this community palliative care service were not adversely affected by the deaths of their patients. It appears that training in grief responses is psychologically protective. Key recommendations for workplace support include training in debriefing, communication skills around death and dying, grief responses, and access to workplace-based complementary therapies.

Do Terminally Ill People who Live Alone Miss Out on Home Oxygen Treatment? An Hypothesis Generating Study

INTRODUCTION Oxygen for refractory dyspnea at the end of life is commonly prescribed, even when the criteria for long-term home oxygen therapy are not met. Is palliative oxygen less likely to be prescribed when a person lives alone at the end of life? METHODS Three years of consecutively collected clinical data from a regional community palliative care program in Western Australia were used in univariate analyses utilizing chi(2) and analysis of variance, as appropriate. Multivariable logistic regression was used to identify characteristics of people for who oxygen has been prescribed. RESULTS Of the study population (n = 5203), 9.8% (n = 507) did not have a caregiver. Oxygen was less likely to be prescribed for patients living alone (11.8% versus caregiver 20.6%; p < 0.001), those with cancer (18.8% versus noncancer 26.5%; p < 0.001), and older people (oxygen 68.1 years versus no oxygen 69.6 years; p = 0.005), and more likely to be prescribed for those with worse dyspnea (mean score 7/10, oxygen 7.6 versus no oxygen 4.2; p < 0.001). With severe dyspnea (= 7/10), people who lived alone had twice as many clinician visits before oxygen was prescribed (4.2 versus caregiver 1.7; p = 0.03). In multifactor analyses lung disease, dyspnea severity, and female gender predicted oxygen prescription, while not having a caregiver reduced the likelihood significantly (odds ration [OR] 0.51, 95% confidence interval [CI] 0.35-0.74; p < 0.001). DISCUSSION Presence of a caregiver in the home is associated with palliative oxygen prescription having controlled for time in hospital. This study raises questions about the reasons for oxygen prescription, and the role caregivers may play in initiating requests for therapy.

Do models of care designed for terminally ill ‘home alone’ people improve their end‐of‐life experience? A patient perspective

Palliative care patients who live alone report greater psychological distress, and are less likely to die at home than those living with a family carer. However, there is a lack of research on the value of models of care that specifically address this disadvantage. This article describes the experiences of terminally ill ‘home alone’ people using one of two models of care aimed at maintaining participants’ need for independent living, focusing on the effect of these two models of care on their physical, social and emotional needs. Twenty six palliative care patients of Silver Chain Hospice Care, in Western Australia, were randomly assigned to either having a personal alarm or additional care-aide hours in their home. An in-depth qualitative study was conducted in two phases in 2010 using face-to-face interviews. The care-aide model of care resulted in benefits such as easing the burden of everyday living; supporting well-being; enhancing quality of life and preserving a sense of dignity; and reducing loneliness and isolation. The personal alarm model of care imparted a sense of security; provided peace of mind; and helped to deal with feelings of isolation. Participants in both groups felt that they could remain at home longer. By providing a safer, more secure environment through the use of a personal alarm or additional care-aide hours, patients were able to continue their activities of daily living, could build a sense of ‘normality’ into their lives, and they could live independently through support and dignity.

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 …

Young People’s, Parents’, and Professionals’ Views on Required Components of Mobile Apps to Support Self-Management of Juvenile Arthritis: Qualitative Study

Background There is growing evidence that supporting self-management of Juvenile Arthritis can benefit both patients and professionals. Young people with Juvenile Arthritis and their healthy peers increasingly use mobile technologies to access information and support in day-to-day life. Therefore, a user-led, rigorously developed and evaluated mobile app could be valuable for facilitating young people’s self-management of Juvenile Arthritis. Objective The objective of this study was to seek the views of young people with Juvenile Arthritis, their parents or carers, and health care professionals (HCPs) as to what should be included in a mobile app to facilitate young people’s self-management of chronic Juvenile Arthritis. Methods A qualitative approach was adopted with a purposeful sample of 9 young people aged 10-18 years with Juvenile Arthritis, 8 parents or carers, and 8 HCPs involved in their care. Data were gathered through semi-structured focus group and individual interviews with young people and their parents or carers and HCPs. Interview discussion was facilitated through demonstration of four existing health apps to explore participants’ views on strengths and limitations of these, barriers and facilitators to mobile app use, preferred designs, functionality, levels of interaction, and data sharing arrangements. Data were analyzed using the framework approach. Results Analysis revealed three interlinked, overarching themes: (1) purpose, (2) components and content, and (3) social support. Despite some differences in emphasis on essential content, general agreement was found between young people with Juvenile Arthritis their parents or carers, and professionals that a mobile app to aid self-management would be useful. Underpinning the themes was a prerequisite that young people are enabled to feel a sense of ownership and control of the app, and that it be an interactive, engaging resource that offers developmentally appropriate information and reminders, as well as enabling them to monitor their symptoms and access social support. Conclusions Findings justify and pave the way for a future feasibility study into the production and preliminary testing of such an app. This would consider issues such as compatibility with existing technologies, costs, age, and cross-gender appeal as well as resource implications.

Relevance of social media to nurses and healthcare: 'to tweet or not to tweet'.

EBN engages readers through a range of online social media activities to debate issues important to nurses and nursing. EBN Opinion papers highlight and expand on these debates. Online social media tools and platforms such as Facebook, MySpace, Tumblr, Blogger and Twitter are increasingly being used by nurses and health professionals for professional development, to share health information to global communities and as a way of providing personalised care to individual patients.1 Twitter is probably the most recognised of the online microblogging platforms, launched in 2006 (https://about.twitter.com/company/press/milestones) now has ∼310 million monthly active users (https://about.twitter.com/company). Over the past 10 years, Twitter has been used in many different ways by individuals, professional bodies and organisations, and there is a developing evidence base supporting the use of Twitter professionally.2 ,3 The potential value and opportunities for using social media tools and platforms in healthcare has resulted in guidelines and policies on how to use social media professionally beginning to emerge.3 ,4 Although for many nurses the use of social media is part of everyday life, with individuals choosing how to engage with online tools and platforms, and use and share information, there can be challenges to ensure that personal and professional boundaries are not blurred. For others, the value and connectivity of the social world lacks relevance and therefore many health professionals remain sceptical about the usefulness of …