Basics of qualitative research: Grounded theory procedures and techniques

Consensus methods such as the Delphi survey technique are being employed to help enhance effective decision-making in health and social care. The Delphi survey is a group facilitation technique, which is an iterative multistage process, designed to transform opinion into group consensus. It is a flexible approach, that is used commonly within the health and social sciences, yet little guidance exists to help researchers undertake this method of data collection. This paper aims to provide an understanding of the preparation, action steps and difficulties that are inherent within the Delphi. Used systematically and rigorously, the Delphi can contribute significantly to broadening knowledge within the nursing profession. However, careful thought must be given before using the method; there are key issues surrounding problem identification, researcher skills and data presentation that must be addressed. The paper does not claim to be definitive; it purports to act as a guide for those researchers who wish to exploit the Delphi methodology.

Research guidelines for the Delphi survey technique.

This new edition of Ann Bowling's well-known and highly respected text has been thoroughly revised and updated to reflect key methodological developments in health research. It is a comprehensive, easy to read, guide to the range of methods used to study and evaluate health and health services. It describes the concepts and methods used by the main disciplines involved in health research, including: demography, epidemiology, health economics, psychology and sociology.The research methods described cover the assessment of health needs, morbidity and mortality trends and rates, costing health services, sampling for survey research, cross-sectional and longitudinal survey design, experimental methods and techniques of group assignment, questionnaire design, interviewing techniques, coding and analysis of quantitative data, methods and analysis of qualitative observational studies, and types of unstructured interviewing. With new material on topics such as cluster randomization, utility analyses, patients' preferences, and perception of risk, the text is aimed at students and researchers of health and health services. It has also been designed for health professionals and policy makers who have responsibility for applying research findings in practice, and who need to know how to judge the value of that research.

Research Methods in Health. Investigating health and health services

BACKGROUND: The delivery of effective, high-quality patient care is a complex activity. It demands health and social care professionals collaborate in an effective manner. Research continues to suggest that collaboration between these professionals can be problematic. Interprofessional education (IPE) offers a possible way to improve interprofessional collaboration and patient care. OBJECTIVES: To assess the effectiveness of IPE interventions compared to separate, profession-specific education interventions; and to assess the effectiveness of IPE interventions compared to no education intervention.
SEARCH METHODS: For this update we searched the Cochrane Effective Practice and Organisation of Care Group specialised register, MEDLINE and CINAHL, for the years 2006 to 2011. We also handsearched the Journal of Interprofessional Care (2006 to 2011), reference lists of all included studies, the proceedings of leading IPE conferences, and websites of IPE organisations. SELECTION CRITERIA: Randomised controlled trials (RCTs), controlled before and after (CBA) studies and interrupted time series (ITS) studies of IPE interventions that reported objectively measured or self reported (validated instrument) patient/client or healthcare process outcomes. DATA COLLECTION AND ANALYSIS: At least two review authors independently assessed the eligibility of potentially relevant studies. For included studies, at least two review authors extracted data and assessed study quality. A meta-analysis of study outcomes was not possible due to heterogeneity in study designs and outcome measures. Consequently, the results are presented in a narrative format. MAIN RESULTS: This update located nine new studies, which were added to the six studies from our last update in 2008. This review now includes 15 studies (eight RCTs, five CBA and two ITS studies). All of these studies measured the effectiveness of IPE interventions compared to no educational intervention. Seven studies indicated that IPE produced positive outcomes in the following areas: diabetes care, emergency department culture and patient satisfaction; collaborative team behaviour and reduction of clinical error rates for emergency department teams; collaborative team behaviour in operating rooms; management of care delivered in cases of domestic violence; and mental health practitioner competencies related to the delivery of patient care. In addition, four of the studies reported mixed outcomes (positive and neutral) and four studies reported that the IPE interventions had no impact on either professional practice or patient care. AUTHORS' CONCLUSIONS: This updated review reports on 15 studies that met the inclusion criteria (nine studies from this update and six studies from the 2008 update). Although these studies reported some positive outcomes, due to the small number of studies and the heterogeneity of interventions and outcome measures, it is not possible to draw generalisable inferences about the key elements of IPE and its effectiveness. To improve the quality of evidence relating to IPE and patient outcomes or healthcare process outcomes, the following three gaps will need to be filled: first, studies that assess the effectiveness of IPE interventions compared to separate, profession-specific interventions; second, RCT, CBA or ITS studies with qualitative strands examining processes relating to the IPE and practice changes; third, cost-benefit analyses.

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Interprofessional education: effects on professional practice and healthcare outcomes (update)

Each health care profession has a different culture which includes values, beliefs, attitudes, customs and behaviours. Professional cultures evolved as the different professions developed, reflecting historic factors, as well as social class and gender issues. Educational experiences and the socialization process that occur during the training of each health professional reinforce the common values, problem-solving approaches and language/jargon of each profession. Increasing specialization has lead to even further immersion of the learners into the knowledge and culture of their own professional group. These professional cultures contribute to the challenges of effective interprofessional teamwork. Insight into the educational, systemic and personal factors which contribute to the culture of the professions can help guide the development of innovative educational methodologies to improve interprofessional collaborative practice.

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Interprofessional teamwork: Professional cultures as barriers

Developing an evidence base for interdisciplinary learning: a systematic review

Aim of the study. The overall aim of the study was to explore the feasibility of introducing interdisciplinary education within undergraduate health professional programmes. This paper reports on the first stage of the study in which a systematic review was conducted to summarize the evidence for interdisciplinary education of undergraduate health professional students.

Methods. Systematic reviews integrate valid information providing a basis for rational decision making about health care which should be based on empirical and not anecdotal evidence. The accepted principles for systematic reviews were adapted in order to allow integration of the literature to produce recommendations for educational practice and guidelines for future research.

Findings. The literature on interdisciplinary education was found to be diverse, including relatively small amounts of research data and much larger amounts of evaluation literature. Methodological rating schemes were used to test for confounding influences in the research studies. The number of studies found was 141 but only 30 (21%) were included in the analysis because of lack of methodological rigour in the research and poorly developed outcome measures.

Conclusions. Student health professionals were found to benefit from interdisciplinary education with outcome effects primarily relating to changes in knowledge, skills, attitudes and beliefs. Effects upon professional practice were not discernible and educational and psychological theories were rarely used to guide the development of the educational interventions.

http://ashs-ipec.weebly.com/uploads/1/1/8/2/11827152/cooper_et_al_2001.pdf

Developing an evidence base for interdisciplinary learning: a systematic review

Choices and Control: Parental Experiences in Pediatric Terminal Home Care

There is a growing interest internationally in the development of interprofessional education (IPE), with the potential goal of achieving more effective healthcare delivery. The aim of this study is to explore the feasibility of introducing IPE within undergraduate health professional programmes, using a systematic review of the evidence and focus-group interviews. This paper reports findings from the focus-group interviews. Three focus-group interviews, each lasting two hours, were conducted. Participants (n = 34) were drawn from the clinical and academic environments, from health service consumers and from health professional students. Two areas were explored: (1) the feasibility of IPE and (2) perceptions of its effects. Each focus group had a primary facilitator who led the group discussion and a second facilitator audiotaping discussions and writing observational notes. Three main themes emerged: the advantages of IPE, the challenges of initiating IPE, and the role of IPE in the creation of professional identification. There was consensus in the view that IPE had much potential in breaking down traditional barriers to team working, including professional 'tribalism'. It is important for IPE to be integrated with interprofessional experiences in clinical practice. Further empirical work, focusing on student and patient outcomes in IPE, is needed.

"Do none of you talk to each other?": the challenges facing the implementation of interprofessional education.

1. Introduction 2. Historical Developments 3. The Changing Dynamic of Stigma 4. Relationship to Practice 5. The Stigma of Congenital Abnormalities 6. Aspects of Stigma Associated with Genetic Conditions 7. Hearing Loss - Scope for Concealment 8. Marked on Sight 9. The Stigma of 'Sexuality': Concealability and Course 11. HIV and Aids 12. The Stigma of Epilepsy: Implications for Clinical Management 13. Burns and Social Stigma 14. Exclusive Language? 15. Race, Stigma and Stereotyping: The Construction of Difference in Forensic Care 16. The Mentally Disordered Offender: Looking Glass Monsters: Reflections of the Paedophile in Popular Culture 17. Not In My Back Yard: Stigma From A Personal Perspective 18. Smackheads, Crackheads and Other Junkies: Dimensions of the Stigma of Drug Use 19. Rosa's Story: The Burden of Ill Health When Homeless 20. Involuntary Childlessness and Stigma, 21. Teen Pregnancy, Stigma and Differential Provision of Health Care 22. The Stigmatisation of Breastfeeding 23. The Stigma of Terminal Cancer 24. Stroke 25. Elderly 26. From Stigma to Social Exclusion of Disabled People 27. Manifesto for Change

Stigma and Social Exclusion in Healthcare

This paper reports on part of a national study conducted between 1994 and 1996, the overall aim of which was to examine the `fitness for purpose' of the Project 2000 nursing education reforms. The study used multiple methods of data collection, including an individual and group interview study of nurse managers (n = 132) and a national survey of Project 2000 diplomates and traditionally prepared registered nurses (n = 5417). Findings in relation to the managers' expectations and experiences of diplomates are presented. This includes views on the level of skills achievement and skills acquisition of diploma level education. The qualities of the diplomates are discussed and this includes those areas where the skills of the diplomates are felt to achieve what is required of the role. Also included is an exploration of those skills which the managers felt fell short of expectations. Managers raised the long-standing concerns of clinical skills and competencies and discussed these in relation to the changing health care environment and the relative roles of other health care workers. The conclusions highlight the need to identify what could be seen as the `core skills' required of a registered nurse and the need to explore the environment in which the diplomate takes up first appointment.

Caroline Carlisle

Papers

Developing an evidence base for interdisciplinary learning: a systematic review

Choices and Control: Parental Experiences in Pediatric Terminal Home Care

"Do none of you talk to each other?": the challenges facing the implementation of interprofessional education.

Stigma and Social Exclusion in Healthcare

Skills competency in nurse education: nurse managers' perceptions of diploma level preparation.