Qualitative research methods in nursing fall prevention studies

¶ … quality where data is gathered through interviews, surveys and observations, while quantitative study establishes its results on the basis of surveys, questionnaires and statistical data. A quantitative study "Study of Nurses' Knowledge about Palliative Care: A Quantitative Cross-sectional Survey" by Prem et al. can be compared with the qualitative study in question to understand the difference. The aim of this study is to assess the knowledge of nursing professionals about palliative care through a palliative care knowledge test (PCKT) (Prem et al., 2012).

A cross-sectional survey has been done amongst 363 nurses working in a multi-speciality hospital by using a questionnaire PCKT, unlike qualitative study done by Dykes et al. that utilized a sample of 23 RNs and 19 NAs which can be easily interviewed, questioned and observed. A general finding of the quantitative study was in agreement with the previously established facts of poorer knowledge of palliative care but as interviews and suggestions were not incorporated in the survey being it a quantitative study, this study does not provide any suggestions or interventions to improve this knowledge. However, the qualitative study, including the views and suggestions of RNs and NAs expressed in interviews, provides many suggestions for prevention of patient falls (Prem et al., 2012).

Similarity and Difference between Qualitative and Quantitative Research

Both qualitative and quantitative research approaches are used to investigate some phenomenon of interest in various fields of studies. The difference occurs in the methods of carrying out this investigation. The qualitative approach, being of exploratory nature, examines the causes, opinions and motivations and inspirations while quantitative approach, being of calculative nature, examines the problem by collecting numerical data and converting it into useable statistics by generalising findings from a larger group of samples. The qualitative study uses methods like focus groups, field observations and individual interviews with a small sample size, whereas quantitative analysis utilizes structured methods like mobile surveys, online surveys and polls, telephonic or face-to-face interviews, paper surveys and organized observations (Wyse, 2011).

Statement of the Phenomenon of Interest

The title of the article "Why Do Patients in Acute Care Hospitals Fall? Can Falls Be Prevented?" clearly states the phenomenon of interest in the study, without using superfluous words, it explains and informs the readers of the purpose of the study (Dykes et al., 2009).

The qualitative study supplies such evidences through which nurses can gain direct access to the patient's experiences, helping to increase nurses' ability to understand their patients and thereby leads to more supportive methods to care (Lobiondo-Wood& Haber, 2014, p. 116). The use of qualitative method is appropriate for this study as the researcher wants to focus on the attitudes and experiences of the RNs and NAs regarding patients fall. This study focuses on participants' responses and individual experiences rather than statistics. Thus, qualitative approach is more suitable as it highlights the crux of social phenomena i.e. provides evidences for what has been done and why (Dykes et al., 2009).

The philosophical underpinnings include the common challenges regarding treatments, severe illness, unaccustomed surroundings, bed rest, medications, location of different tubes and catheters, surgery etc., due to which patients are at risk of falling. However, hospitals are trying urgently to prevent falls and protect patients from harm, also because Medicare refuses to reimburse the expenses for fall related injuries; but U.S. hospitals still struggles with patient falls as a serious problem (Dykes et al., 2009).

Purpose

The common challenges regarding treatments, severe illness, unaccustomed surroundings, bed rest, medications, location of different tubes and catheters, surgery etc., due to which patients are at risk of falling, are disturbing for the patients, his family members and care providers. Abundant research has successfully been done to assess the fall risk factors but none of these addressed the interventions required to prevent the falls. The purpose of this study, therefore, is to assess why patients fall and what interventions are required to prevent it. Unfortunately, the evidence gathered regarding the efficiency of fall prevention programs is inadequate, due to numerous barriers in hospitals while reviewing fall prevention. Thus, this study is very significant for the prevention of patients fall in nursing (Dykes et al., 2009).

Method

The researcher has employed the grounded theory method for the qualitative study in question, as through this method the theory develops straight from the data and reveals the appropriate values that are essential to the social processes in question. Thus, the new 'grounded in data' theory can be employed in practice, which is the basic purpose of this study i.e. to assess the cause of patient falls and to prevent them in future. The theory, thus observed for the prevention of falls, can be used in future through interventions to prevent the falls (Lobiondo-Wood & Haber, 2014, p. 116). Yes, the research process can be applied to that too, as the research design is easily identifiable and effortlessly read.

Sampling

The selection of participants has been done through purposive sampling, appropriate to the grounded theory method, as all the participants selected understand and were part of the problem of patient falls. The researcher conducted group interviews on 3-10 nurses per group, through 4 audiotaped focus style group methods, making a total number of RNs 23 and other 4 groups with 4-6 NAs per group i.e. a total of 19 NAs in 4 acute hospitals, 2 suburban teaching hospitals and 2 urban academic medical centres in the same systems. They can be considered well-informed and appropriate for the study as potential RN and NA participants were recognized by nursing leaders, employed through hand-outs and personal invitations, also most of the RNs and NAs were experienced women in the field, with a median age of 39 and 49 years and an experience of 12 & 10 years (median) respectively (Dykes et al., 2009).

Data Analysis

The data collected has been transcribed into MS Word, reviewed for accuracy and corrected where required for precision in transcription, covering of identifying physiognomies. Later, this corrected data is transformed into NVivo software program, a 2-person consent approach was used for selectively coding and open coded for meaning apprehension. These descriptive data were interpreted through basic content analysis methods. An entire procedure of questioning and examination among researchers, sessions with raw data and codes, along with using insightful and field notes was followed to confirm reliability and validity. Concepts were connected from the versions of participants' experiences to determine new perspectives. However, the study does not include any declaration or explanation regarding the authenticity on researcher's part yet the data handling can be assumed truthful as the researcher provided complete account of the participants and sites involved, along with the questions asked and the quotes of the experiences of participants; as well as followed the complete process for data collection, analysis and interpretation as guided by grounded theory method. The researchers have addressed the issue of credibility as evident through their repetitive exchanges with participants, peer discussions, using multiple methods for gathering data. The fittingness has also been achieved as the knowledge thus gained can be applied later to understand the risk assessment and status of patients, as well as the study discloses some other solutions that can help nurse executives in future (Dykes et al., 2009),

Credibility

The participants i.e. the RNs and NAs reported their own experiences with the patients as the study includes the quotes from participants' accounts throughout the analysis. The setting of the study being the hospitals and medical centres itself validates the accuracy of the research and researchers can be said to have provided ample time to observe, interview and repeatedly contact the participants to interpret sincere results (Dykes et al., 2009).

Auditability

The reader can easily identify and understand the auditability i.e. the paper trail and documentation and field notes, as clearly stated by the researchers in the study. The researchers clearly stated the process of basic content analysis method for analysing the data; however, the employment of grounded theory method for research process has not been mentioned in the study (Dykes et al., 2009).

Fittingness

The findings can be applied outside of this study situation also as the knowledge thus gained can be applied later to understand the risk assessment and status of patients, as well as the study discloses some other solutions that can help nurse executives in future; however, fittingness has not been clearly stated in the study. The result thus gathered can be meaningful for other individuals also such as for patients at risk for falls, their family members, policy makers, manufacturers of equipment needed for fall prevention, etc. The strategy used for data analysis is compatible with the purpose of the study (Dykes et al., 2009).

Findings

The findings are within the context of the purpose stated, as the study presented some insights about barriers in overcoming falls and facilitators to improve its prevention, based on the views of some RN and NA bedside caregivers. Through a complete list of barriers and facilitators in Table 1, the researcher provided easily apprehensible findings for readers to understand. The researcher's concept of patient's fall and search for interventions to prevent it is very much evident throughout the study and they presented some thoughtful solutions to apply. The study evidently reveals that abundant research has already been done about the phenomenon of interest and established the cause of falls, but none of these addressed the issue or revealed any solution for the prevention of falls. This study, however, reveals some valuable insights for the phenomenon (Dykes et al., 2009).

Conclusions, Implication, and Recommendations

The conclusion, implication and recommendations provide readers with some practical solutions that can be applied in the future to prevent these falls, by using proper equipment for prevention, use of signage, pictograms, using predictive model strategies, stressing addition of all stakeholders to be acquainted with the status of patients' risk factors and developing the plan accordingly. This study is therefore, well designed with significant results and useful findings. The purposes and contextual evidence is impeccable, providing researchers with sufficient reasons to conduct this research. The findings are well examined and the discussion supports it completely (Dykes et al., 2009).

Assessment of fall risk factors is an essential but inadequate stage of a prevention program of patients' fall, if stakeholders are unaware of the risk status and have not designed an individual plan accordingly. As the connections between the risk status assessment and an individualized plan are unknown, further researches can be conducted in this area. The study, thus provides, some useful solutions for the nurse executives and some recommendations for future research in order to solve the critical problem of patient falls (Dykes et al., 2009).

6. Which type of study do you prefer to read? Why do you like it?

The qualitative research method is preferred by most of the researchers nowadays and the same is applicable to me. The reason for its preference is that the qualitative method offers an outstanding approach for collection and analysis of information regarding significant questions related to health education research. The information thus gathered provides readers with a profound understanding of the subject (Dykes et al., 2009).