Practice-Based Evidence and Qualitative Inquiry
ABSTRACT Nurses and other healthcare providers continue to underuse interventions demonstrated to be effective at improving health outcomes. We propose in this article that if more evidence-based practice is wanted, greater use must be made of qualitative inquiry to obtain practice-based evidence derived from the experiences and practices of healthcare providers and the contexts of healthcare provision.
We present a framework for the use of qualitative methods to contribute to the following categories of practice-based evidence: (a) practice-based interventions and implementation strategies, (b) causal mechanisms, (c) approaches to adaptation, (d) how-to guidance, (e) unanticipated effects, and (f) relevant contextual factors.
Qualitative inquiry has an essential role to play in incorporating more practice-based evidence into the evidence base for nursing practice.
This framework can be used by clinicians to plan for the implementation of interventions in practice, by researchers to discuss the practice implications of their findings, and by researchers to launch qualitative studies explicitly designed to capture practice-based evidence.
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- "Practice-relevant models informed by both patients' and health professionals' experiential knowledge that goes beyond purely providing information are needed to meet these demands. Important here too are establishing procedures to make practice-based evidence more transparent (Morse et al., 2000) and providing tools supporting knowledge translation for implementation of research (Leeman & Sandelowski, 2012). This would improve conditions for patient safety (Martin et al., 2013) and assure a stringent discussion about practicebased ethics related to person-centered information and communication (Redman, 2013). "
ABSTRACT: In clinical palliative cancer care, the diversity of patient concerns over time makes information provision a critical issue, the demands of information-seeking patients presenting a challenge to both the communicative and organizational skills of the health provider. This study puts forward a practice model for communication between patients, their family members, and professional health providers during ongoing palliative chemotherapy; a model which supports the providers in enabling person-centered communication. A constant comparative analysis adapted to participatory action research was applied. The model was developed step-wise in three interrelated cycles, with results from previous studies from palliative cancer care processed in relation to professional health providers' experience-based clinical knowledge. In doing this, focus group discussions were carried out with providers and patients to develop and revise the model. The Enabling Sense Making model for person-centered communication gave rise to three domains (which are also the major communicative actors in palliative care): the patient, the family, and the provider. These actors were placed in the context of a communicative arena. The three respective domains were built up in different layers discriminating between significant aspects of person-centered communication, from the manifest that is most usually explicated in dialogues, to the latent that tends to be implicitly mediated. The model intends to facilitate timely reorientation of care from curative treatment or rehabilitation to palliation, as well as the introduction of appropriate palliative interventions over time during palliative phases. In this way the model is to be regarded a frame for directing the awareness of the professionals, which focuses on how to communicate and how to consider the patient's way of reasoning. The model could be used as a complement to other strategic initiatives for the advancement of palliative care communication. It needs to be further evaluated in regard to practice evidence.Palliative and Supportive Care 08/2015; DOI:10.1017/S1478951515000814 · 0.98 Impact Factor
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- "Qualitative research from singular empirical studies is often referred to as first level research or primary studies. However, the findings in these qualitative studies may involve small numbers of participants, be scattered, conflicting or in need of systematising (Leeman & Sandelowski, 2012). Qualitative metasynthesis is secondary level research that interprets available primary qualitative studies within a field of inquiry by bringing together and breaking down the findings, elucidating the key features, and combining the findings from primary studies into a transformed whole, i. e. to a single description of the findings (Zimmer, 2006; Sandelowski & Barroso, 2007). "
ABSTRACT: The debate about the "right" methods and designs for nursing research is on-going. According to international surveys, studies on the effectiveness and safety of nursing interventions are rare. Since nursing practice deals daily with interventions, nurses ostensibly expose hospital patients and nursing home residents frequently to unproven therapeutic and preventive nursing interventions. Nursing interventions are predominately of a complex nature, consisting of several components depending on and interacting with each other and their complex contextual factors. Thus, evaluation studies are often challenging and need especially careful development, ambitious designs and systematic evaluations. The UK Medical Research Council (MRC) has proposed a framework, where qualitative and quantitative research rely on each other in order to develop theory-based complex interventions, prepare and conduct their optimal delivery, explain how the interventions work and which conditions contributed in case they did not work. The present essay outlines the points where qualitative research contributes towards the development and evaluation of complex interventions. First, the UK MRC framework is introduced, and secondly it is illustrated where qualitative research should necessarily be located using examples from a handful of qualitative studies. Future clinically meaningful and implementable nursing interventions should best be developed by research groups with both excellent qualitative and quantitative research skills.Pflege 06/2013; 26(3):207-14. DOI:10.1024/1012-5302/a000292 · 0.22 Impact Factor
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ABSTRACT: Comparative effectiveness research (CER) is an important foundation in the development of scientific evidence that can assist patients, clinicians, and policy makers in making decisions that improve patient and system outcomes, including cost. CER is a part of what is now called dissemination and implementation science, which focuses on translating knowledge into practice by facilitating stakeholder access to more interpretable findings. CER has evolved from a rich history that aims to compare the effectiveness of select clinical treatments, approaches, or programs. This article describes the development of CER, approaches to designing and analyzing this research, and resources useful in generating such knowledge by nurse scientists.Western Journal of Nursing Research 01/2013; 35(6). DOI:10.1177/0193945912474501 · 1.03 Impact Factor