nrs 433v – discussion question response

I’m studying for my Nursing class and need an explanation.

Response to the posts in about 150-200 and no references required


1 – With all the various types of research that is being conducted, there needs to be various different methods to gather the data that will be used to influence some form of change. Quantitative and qualitative research methods have great value, but similarly with using tools, you have to use the right tool for the right job. If quantitative research is to be conducted, it is typically to address an unanswered research question, using controls over variables to address a hypothesis (Rutberg & Bouikidis, 2018). Qualitative methodology is used to inquire about a topic thoroughly to gain insight into a narrative that is involved in addressing the research question (Rutberg & Bouikidis, 2018).

A benefit of employing a qualitative method is to make exact measurements of an event, such as how a patient would respond to a specific medication, but this would not address the narrative of how the patient felt or provide further insight on the patient’s experience in a qualitative study. The converse could be said for the use of qualitative study, which would look at the narrative, but does not address the measurable aspects of the physical response to an event. Due to the specificity of each type of these methodologies it is difficult to find an application for both of these, but there are mixed methods research that addresses both methods and they have been shown to be very valid in the right studies.


2- The term “mixed methods” refers to an emergent methodology of research that advances the systematic integration, or “mixing,” of quantitative and qualitative data within a single investigation or sustained program of inquiry. The basic premise of this methodology is that such integration permits a more complete and synergistic utilization of data than do separate quantitative and qualitative data collection and analysis. The evaluation of PCMHs provide an ideal opportunity for mixed methods studies to contribute to learning about best practices in how to implement a PCMH as well as PCMH effectiveness in achieving the triple aim outcomes of cost, quality, and patient experience of care.

Mixed methods research originated in the social sciences and has recently expanded into the health and medical sciences including fields such as nursing, family medicine, social work, mental health, pharmacy, allied health, and others. In the last decade, its procedures have been developed and refined to suit a wide variety of research questions (Creswell and Plano Clark, 2011). These procedures include advancing rigor, offering alternative mixed methods designs, specifying a shorthand notation system for describing the designs to increase communication across fields, visualizing procedures through diagrams, noting research questions that can particularly benefit from integration, and developing rationales for conducting various forms of mixed methods studies.

The core characteristics of a well-designed mixed methods study in PCMH research include the following:

1.Collecting and analyzing both quantitative (closed-ended) and qualitative (open-ended) data.

2.Using rigorous procedures in collecting and analyzing data appropriate to each method’s tradition, such as ensuring the appropriate sample size for quantitative and qualitative analysis.

3.Integrating the data during data collection, analysis, or discussion.

4.Using procedures that implement qualitative and quantitative components either concurrently or sequentially, with the same sample or with different samples.

5.Framing the procedures within philosophical/theoretical models of research, such as within a social constructionist model that seeks to understand multiple perspectives on a single issue—for example, what patients, caregivers, clinicians, and practice staff would characterize as “high quality treatment” in a PCMH.

Advantage-Compares quantitative and qualitative data. Mixed methods are especially useful in understanding contradictions between quantitative results and qualitative findings.

Disadvantage-Mixed methods studies are challenging to implement, especially when they are used to evaluate complex interventions such as a PCMH model. Below we discuss several challenges.

The integration of quantitative and qualitative data in the form of a mixed methods study has great potential to strengthen the rigor and enrich the analysis and findings of any PCMH evaluation. By carefully selecting the mixed method design that best suits the evaluation’s questions and meets its resource constraints, evaluators can facilitate deeper, more meaningful learning regarding the effectiveness and implementation of PCMH models.


3- Qualitative and quantitative research methods are very different in natural but both provide an important aspect to a nursing study. Qualitative methods help the researcher deepen their understand of a given problem, whereas quantitative research gives accurate and reliable measurements to allow statistical analysis of an issue (Queiros, Faria, & Almeida, 2017). Qualitative focuses on the experiences of people who have firsthand observed or experienced the issue and quantitative gives the research hard numerical evidence of how prevalent the issue it.

Advantages of qualitative research methods are, obtainment of detailed and insightful information, helps bud further research, and offers opportunity for clarification. Being able to talk with the people that work in the nursing problem everyday can provide very detailed information on what the problem is and possible solutions on how to fix the problem. Some disadvantages to this type of research is very time consuming, potential bias from the interviewers, small sample groups, documentation and interpretation could be difficult, and hard to generalize the issue. Most of the studies within qualitative research involve interviews with small sample groups and can have bias based on the interpretation of the interviewer.

Advantages of quantitative research methods are, larger scale research, easier data collection, less bias, and not as time consuming. Quantitative research methods allow researchers to generalize an issue and helps give reliable results that confirm or deny a research question. Disadvantages of quantitative research methods are not having the ability to capture emotions or behaviors, complexity of research methods and use of specialized software. Not being able to capture emotions or behaviors of the research participants limits the true understanding of the issue at hand. Researchers are responsible to choose the research method that best suits the situation under analysis (Queiros, Faria, & Almeida, 2017). Both methods of research have their issues but in order to fully understand an issue within the nursing field it is important to include both types of research methods. Most issues within the nursing practice start with qualitative research in order to understand the issue and the need for further quantitative research. Prime example of this is the different research articles in the final paper and how it relates to the PICOT question.


4- Mixed methods research is the use of quantitative and qualitative methods in a single study or series of studies. It is an emergent methodology that is increasingly used by health researchers, especially within health services research. The most widely accepted definition of mixed methods research is research that ‘focuses on collecting, analyzing, and mixing both quantitative and qualitative data in a single study or a series of studies. There are many reasons why researchers choose to combine quantitative and qualitative methods in a study. The reasons are complementarity ( Using data obtained by one method to illustrate results from another), development (Using results from one method to develop or inform the use of the other method), initiation (Using results from different methods specifically to look for areas of incongruence to generate new insights). An illustration of this would be a study exploring the discrepancy between reported adherence in-clinic consultations and actual medication adherence. There are several quantitative designs developed for conducting research such as descriptive, correlational, quasi-experimental, and experimental studies. Qualitative research is primarily exploratory research. It is used to gain an understanding of underlying reasons, opinions, and motivations. It provides insights into the problem or helps to develop ideas or hypotheses for potential quantitative research. (Grove et al., 2015). Mixed methods research refers to those studies or lines of inquiry that integrate one or more qualitative and quantitative techniques for data collection and/or analysis. The term “mixed methods” refers to an emergent methodology of research that advances the systematic integration, or “mixing,” of quantitative and qualitative data within a single investigation or sustained program of inquiry. The basic premise of this methodology is that such integration permits a more complete and synergistic utilization of data than do separate quantitative and qualitative data collection and analysis. (Agency for Healthcare Research and Quality (AHRQ), 2013)

Mixed methods have various advantages. First, mixed methods are helpful to understand contradictions between the several types of studies; second, mixed studies add a wide range to multidisciplinary teams and interaction of qualitative and quantitative research; lastly, mixed methods collect more comprehensive data and a more detailed story than just one type alone. (Agency for Healthcare Research and Quality, 2013). Mixed methods also have some disadvantages:

Mixed methods studies are complex to plan and conduct.

Conducting high-quality mixed methods studies requires a multidisciplinary team of researchers who, in the service of the larger study, must be open to methods that may not be their area of expertise.

Mixed methods studies are labor-intensive and require greater resources and time than those needed to conduct a single method study. (AHRQ, 2013). Quantitative research results in numbers that can validate the qualitative data that is collected by interviewing participants. The main advantage of mixed-method is, it gives a deeper meaning and understanding of the data that is collected and the researcher can see from both ways of research.


5.2 – Our textbook identified two models that are often used to encourage nursing to be involved in the identification of practice issues and the development and implementation of evidence-based practice to improve all areas of nursing practice. The Iowa Evidence-Based Practice Model is a 10-step method from PICOT identification of an issue to implementation of a new practice change and promotion of the new practice. The ACE Academic Center for Evidence-Based Practice star Model of Knowledge Transformation is another way to develop a PICOT toward EBP within an organization. (Green & Johnson, 2018) EBP is used to provide the best education of nurses and nurses then carry that forward as lifelong learners to attempt to improve and optimize practice. In order to advocate for our patients’ nurses, need to stay abreast of the latest EBP and identify areas in their practice that need changing.

I was involved in three EBP practice changes in my organization with varying degrees of involvement. The first was implementing the EBP of not treating the freshly cut umbilicus of a baby with triple dye. After years of applying different agents to the umbilical cord to prevent infection, high levels of evidence showed it made no difference whether it was treated or not. New clinical practice guidelines were written by our clinical practice team consisting of myself, three other NICU nurses, and our NNP once approved at upper levels we developed education and rollouts to the NICU staff. The next step was to educate the two special care nurseries at our other system hospitals. The practice committee presented the changes and education and then helped support management in presenting the change to Labor and delivery and Postpartum for system-wide support. The biggest issue was getting staff on board with the changes! The money saved in not using triple dye and ruined, stained infant t-shirts was significant over three busy hospitals and several years. Our clinical practice committee also implemented delayed infant bathing at a time when it was still very novel! We also changed our infant positioning to strict back to sleep guidelines from 34 weeks and up unless medically indicated prone positioning was required. No nesting, toys, fluffy blankets, hats once growing and stable, that was a hard one to sell to the NICU nurses, but post-partum did great with it. Now it is “normal” care and the changes are distant thoughts. EBP at work, dynamic and ever-evolving.


6.2 I see the application of evidence-based practice during our shift huddles. Typically an article is reviewed by our educator at least once a week and presented with suggestions on how we can improve our bedside skills. While reading the chapter this week the following quote resonated with me, “Two concepts central to the issue of using evidence-based practice are ownership of a problem and involvement with the process to solve the problem” (Schmidt, 2018). Staff RNs need to be open to new ideas and be lifelong learners. If this mindset is not adopted, care for patients will never improve. It is incumbent on the leadership to not only educate, but also provide the why that a particular technique is being adopted or changed. More often than not, I hear coworkers resisting change, rather than embracing it with a willingness to enhance care.