N Siddiqui

Elaborated Integration of Qualitative and Quantitative Perspectives in Mixed Methods Research: A Profound Enquiry into the Nursing Practice Environment

Abstract Integration of quantitative and qualitative components in mixed methods research deserves more discussion in the literature, as it is critical for quality research outcomes. This paper describes an elaborated integration of these two components in the context of an empirical research study about nursing practice environments (NPE). Different types of integration such as combining notions at research conceptualisation stage, mixing data collection methods and synthesising findings, are described to show how qualitative and quantitative components can work interdependently to reveal ‘what’ and ‘how’ components of the research phenomenon. For example, through application of elaborated integration, it was revealed that ‘concern for cost’ is a defining organisational characteristic of the current NPE. Additionally, we learnt about the ‘how’ component with the revelation of nurses’ belief that nurse administrators are acting with the intention of saving costs rather than enhancing quality of care. Therefore, this paper provides an empirical case of how to conduct integration of different components of mixed methods research with a great deal of depth, rationality and inquisitiveness.

Hospital length of stay variation and comorbidity of mental illness: a retrospective study of five common chronic medical conditions

BackgroundWith the increasing burden of mental illness globally, it is becoming common for hospitalised patients with chronic medical conditions to have a comorbidity of mental illness. This combination could prolong length of stay (LOS) of this patient cohort. We conducted an investigation in Tasmania, Australian hospitals to characterise this cohort and assess if co-morbidity of mental illness is a distinguishing factor that generates LOS variation across different chronic medical conditions.MethodsThe retrospective study analysed 16,898 admissions of patients with a primary diagnosis of one of five chronic medical conditions: lung or colorectal cancer, chronic obstructive pulmonary disease (COPD), type II diabetes, ischaemic heart disease (IHD) and stroke. Data were from July 2010 to June 2015, across four hospitals that collectively cover 95% of public hospital admissions in Tasmania, Australia. Descriptive statistics were used to compare characteristics of patients between the scenarios of with and without co-morbidity of mental illness. We used negative binomial regression models to assess whether co-morbidity of mental illness, along with its sub-types, after adjustment for potential confounding variables, associated with LOS variation in patients of each medical condition. Based on the adjusted LOS variation, we estimated differences in bed days’ use between patients with and without comorbidity of mental illness.ResultsPatients with co-morbidity of mental illness were significantly younger in comparison to patients without mental illness. With each medical condition, patients with comorbidity of mental illness had incurred higher bed days’ use than for those without mental illness. In cancer and stroke cohorts, co-morbidity of mental illness unfavourably affected the LOS variation by as high as 97% (CI: 49.9%–159%) and 109% (78%–146%), respectively. Though mental and behavioural disorders due to psychoactive substances was a dominant sub-type of mental illness across the medical conditions, it contributed significant unfavourable LOS variation only in the stroke patients i.e. 36.3% (CI: 16.2%–59.9%).ConclusionsMental illness consistently produced unfavourable LOS variation. Upskilling of healthcare teams and greater reporting and analysis of LOS variation for this patient cohort, and the sub-cohorts within it, are necessary to provide improved medical care and achieve system efficiencies.

Patient-centric workplace culture: a balancing act for nursing leaders

In Australia and globally, developing a patient-centric workplace culture is an ongoing challenge. Nurse managers must reflect on what a balanced functioning of patient-centric workplace culture entails and how to develop it in a context constrained by rising healthcare costs. This study has investigated nurses’ perspective of the association between a patient-centric workplace culture and practical issues such as nurse staffing and perceived quality of nursing care. A mixed methods study design involved sequential (equal status and partially mixed) data gathering from nurses in public hospitals in NSW, Australia. First, a survey questionnaire was employed and yielded 136 responses after adjustment for missing data. This data was analysed using descriptive analysis techniques in SPSS. Then 21 self-nominated nurse managers were interviewed face to face. This qualitative data was transcribed and analysed for recurring themes using a continuous comparative method (CCM). Correlations of patient-centric workplace culture, with nurse staffing (rS = .655) and perceived quality of nursing care (rS = .593) were moderate. Correlation between nurse staffing and perceived quality of nursing care (rS = .410) also existed. Analysis of the interview data resulted in two major themes: the first theme confirmed the association between the three constructs of patient-centric workplace culture, nurse staffing and perceived quality of nursing care. The second theme identified gaps in embedding the espoused patient-centric workplace culture. The study revealed that a patient-centric workplace culture could facilitate positive relationships between nurse staffing and the perceived quality of nursing care. This would happen when patient-centric workplace culture focuses on proactive change management, teamwork and prioritises patient care and adequate nurse staffing. A critical need for nurse managers is to become positive leaders, who can build and embed a patient-centric workplace culture in today’s resource constrained environment.

Managing Change for Better: New Zealand Dairy Products Bangladesh Ltd

Effective management of change presents an ongoing series of challenges for organisations, especially for the ones operating in third world countries. This case study has depicted a rare story of successful change management of a real-life organisation, New Zealand Dairy Products Bangladesh Ltd (NZDPBL), articulating experiences such as change of ownership, legal battle, retrenchment and new leadership that took place between years 2002 and 2012. Data for this case were collected between April 2011 and June 2012, mostly through semi-structured interviews of the managing director and six other employees at NZDPBL. The purpose of the case study is to offer management insights to business students and managers. These insights were developed through an exposure to practitioner’s perspective and relevance of that perspective to literature of organisational change management. Authors find that five organisational features for successful change management, that is, organisational structure, organisational culture, organisational learning, managerial behaviour and power and politics, as proposed by scholars, were relevant in the case of NZDPBL. Furthermore, managers are urged to work on these five features collectively for effective management of change. Since the account of NZDPBL evidenced an overlap in the influence of these five features.