자연주의적 탐구조사(Naturalistic Inquiry)

Qualitative case study methodology provides tools for researchers to study complex phenomena within their contexts. When the approach is applied correctly, it becomes a valuable method for health science research to develop theory, evaluate programs, and develop interventions. The purpose of this paper is to guide the novice researcher in identifying the key elements for designing and implementing qualitative case study research projects. An overview of the types of case study designs is provided along with general recommendations for writing the research questions, developing propositions, determining the “case” under study, binding the case and a discussion of data sources and triangulation. To facilitate application of these principles, clear examples of research questions, study propositions and the different types of case study designs

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Qualitative Case Study Methodology: Study Design and Implementation for Novice Researchers

The case study approach allows in-depth, multi-faceted explorations of complex issues in their real-life settings. The value of the case study approach is well recognised in the fields of business, law and policy, but somewhat less so in health services research. Based on our experiences of conducting several health-related case studies, we reflect on the different types of case study design, the specific research questions this approach can help answer, the data sources that tend to be used, and the particular advantages and disadvantages of employing this methodological approach. The paper concludes with key pointers to aid those designing and appraising proposals for conducting case study research, and a checklist to help readers assess the quality of case study reports.

https://link.springer.com/content/pdf/10.1186%2F1471-2288-11-100.pdf

The case study approach

Purpose: To explore various types of triangulation strategies and to indicate when different types of triangulation should be used in research.

Methods: Reviews included literature on triangulation and multimethod strategies published since 1960 and research books specifically focusing on triangulation.

Findings: Triangulation is the combination of at least two or more theoretical perspectives, methodological approaches, data sources, investigators, or data analysis methods. The intent of using triangulation is to decrease, negate, or counterbalance the deficiency of a single strategy, thereby increasing the ability to interpret the findings.

Conclusions: The use of triangulation strategies does not strengthen a flawed study. Researchers should use triangulation if it can contribute to understanding the phenomenon; however, they must be able to articulate why the strategy is being used and how it might enhance the study.

https://www.utas.edu.au/__data/assets/pdf_file/0004/165208/the-point-of-triangulation.pdf

The point of triangulation.

ed summaries and general concepts can be formulated, which may, upon further investigation, be found to be germane to a wider variety of settings. Case studies, therefore are not necessarily restricted

/pdf/qualitative-research-methods-in-health-technology-assessment-1ma11mg407.pdf

Qualitative research methods in health technology assessment: a review of the literature.

There are many ethical issues in relation to research when dealing with human subjects, e.g. confidentiality, dignity, benefit-to-risk ratio and informed consent. The integrity of researchers is paramount. For nurses, there is potential role conflict between the role of researcher and the role of patient's advocate. Cultural variations in ethical acceptability complicate the issues in a multicultural mix of researchers and human subjects.

Ethical issues in research.

Aim: This paper is a report of a study to identify factors influencing advanced practice nurses’ contribution to promoting evidence-based practice among front-line nurses. Background: Despite widespread recognition that care should be evidence-based, nurses experience challenges implementing evidence-based practice. As opinion leaders, advanced practice nurses can influence the practice of front-line nurses by promoting research use. Little is known about how advanced practice nurses use evidence and their influence on care provided by front-line nurses. Method: A cross-sectional survey of 855 advanced practice nurses working in 87 hospital/primary care settings in England. The questionnaire examined understandings of evidence-based practice, sources of evidence used, ways of working with front-line nurses, perceived impact on front-line nurses, skills in evidence-based practice and barriers to promoting evidence-based practice. Data were collected in 2005 and analysed using descriptive statistics. Comparisons were made between advanced practice nurses with master’s qualifications and those with lower qualifications. Findings: Advanced practice nurses used different sources of evidence. They engaged in various activities to promote evidence-based practice and had a positive influence on front-line nurses’ practice. Advanced practice nurses’ skills in evidence-based practice varied with few considering themselves expert. Advanced practice nurses with master’s qualifications perceived themselves to be more skilled in all aspects of evidence-based practice that those with lower qualifications. Conclusion: Advanced practice nurses are well-placed as clinical leaders to promote evidence-based practice by front-line nurses but require further development of their skills in evidence-based practice. In order to maximize their potential, advanced practice nurses require master’s preparation.

Factors influencing the contribution of advanced practice nurses to promoting evidence-based practice among front-line nurses: findings from a cross-sectional survey.

This article describes how researchers, practitioners and technicians in West Sweden worked together with older people with early stage dementia and their family members to develop a user-friendly technology-based information, education and support service, based on the generic ACTION participatory design model. Ways of working in partnership with older people with early stage dementia and their family members are explored, and key lessons learned are highlighted. The overriding message is that elders with early stage dementia can be actively involved throughout the entire research and development process. Essential prerequisites are time and ongoing support by skilled practitioners and family members. Preliminary findings reveal that older people with early stage dementia can learn and benefit from user-friendly technology, especially when used together with others in a similar situation.

Working together with persons with early stage dementia and their family members to design a user-friendly technology-based support service

Long‐term care in general, and care homes in particular, have never enjoyed high status as a place to live and work. This remains the case. In large part this marginalised position is due to the continued failure to value the contribution that care homes make to supporting frail and vulnerable older people. In order to promote a more positive vision of what can be achieved in care homes, this paper argues for the adoption of a relationship‐centred approach to care. The need for such a model is described, and how it might be applied using the ‘Senses Framework’ is considered. It is argued that adopting such a philosophy will provide a clearer sense of therapeutic direction for staff working in care homes, as well as more explicitly recognising the contribution that residents and relatives can make to creating an ‘enriched environment’ of care.

Transitions in care homes: towards relationship‐centred care using the ‘Senses Framework’

Empirical and conceptual explorations of informal care have concentrated largely on the difficulties and problems of carers to the virtual exclusion of the gratifications and rewards that can be experienced. Whilst not seeking to minimize the undoubted problems which carers face, this paper attempts to redress the balance by providing evidence that caring can be a source of personal satisfaction for many individuals and that such satisfaction can co-exist with high levels of stress. It begins by highlighting some common conceptual elements from the available literature on the satisfactions of informal carers. Qualitative data from an investigation by the authors are used to illustrate the range of rewards and satisfactions experienced by informal carers. Analysis of the presence of rewards and satisfactions suggest that factors in the social context of care rather than the personal or dependency characteristics of the cared-for are important concomitants. Theoretical, methodological, policy and practice implications are considered in turn.

Mike Nolan

Papers

Ethical issues in research.

Factors influencing the contribution of advanced practice nurses to promoting evidence-based practice among front-line nurses: findings from a cross-sectional survey.

Working together with persons with early stage dementia and their family members to design a user-friendly technology-based support service

Transitions in care homes: towards relationship‐centred care using the ‘Senses Framework’

Informal carers: sources and concomitants of satisfaction