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

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

This paper describes the trend apparent in nursing and other practice disciplines towards more participative and collaborative methods of enquiry as exemplified by action research. In so doing it notes the conceptual similarities between action research, change theory and quality initiatives. Particular attention is focused on the need to establish the basic values which provide the impetus and direction for subsequent activity. The difficulties this may pose are illustrated by reference to the application in two continuing care hospital wards for elderly patients of a checklist operationalizing a typology of care. A mechanism to facilitate and make explicit the values underpinning care in any given environment is suggested.

Action research and quality of care: a mechanism for agreeing basic values as a precursor to change*

Government policy in Sweden, as in other developed countries, pays increasing attention as to how best to support the family carers of older people. New and innovative means of support, such as information and communication technology, are emerging. This paper explores the perceived benefits of, and barriers to, information technology as a means of supporting family carers of older people. Following a brief overview of the care-giving literature, with particular reference to the Swedish context, interview and questionnaire data collected from 34 families who took part in the Swedish ACTION project are used to explore the role of user-friendly information and communication technology to inform and enable family carers of older people to exercise choice, to care more effectively and to work in partnership with professionals. Interview data from two groups of professionals that utilised ACTION are also examined to throw light on its potential benefits for both carers and professionals. Consideration is given to the barriers to using information technology, and to identifying those carers most likely to benefit. Areas for further development are the need for practitioners’ education and a wider range of programmes to address carers’ diverse needs. Clearly, lessons learned from the Swedish project have wider relevance, given that new forms of support are being developed in most technically advanced countries.

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The impact of information and communication technology on family carers of older people and professionals in Sweden

In this article those factors which influence the job satisfaction and morale of nurses are considered. It is suggested that action is needed if the profession is to continue to grow and develop.

Maintaining nurses' job satisfaction and morale

Background: Advanced practice nurses (APNs) have an important role in promoting evidence-based practice (EBP) among frontline nurses (FLNs) Factors influencing FLNs’ engagement with EBP are well documented but little is known about factors that affect APNs’ ability to facilitate evidence in practice
Aims: To identify factors that influence APNs’ ability to promote EBP among FLNs
Methods: A multiple case study of 23 APNs from hospital and primary care settings across seven English health authorities was undertaken Data collection comprised interviews and observation of APNs and interviews with FLNs and other healthcare professionals Data were analysed using the Framework approach
Findings: Four groups of influencing factors were identified: (1) Personal attributes of APNs included knowledge and skills in EBP, clinical credibility with frontline staff and leadership style (2) Relationships with stakeholders included APNs’ interactions with FLNs and the level of support from managers and medical colleagues (3) Aspects of the APN role included their sphere of responsibility and workload (4) Organisational context included the organisational culture, FLNs’ workload, professional networks and available resources
Implications: Educational preparation for APNs should enable them to develop expertise in EBP plus interpersonal and leadership skills to manage relational dynamics in clinical settings APN role specifications should provide the opportunity to promote EBP The organisational culture should be conducive to enabling EBP with managers supportive of this aspect of the APNs’ role
Conclusions: APNs need to be supported to address the individual, interpersonal and organisational factors, which influence their ability to promote EBP Organisational commitment at the highest level is key to APNs’ ability to fulfil this aspect of their role

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Factors Influencing Advanced Practice Nurses’ Ability to Promote Evidence-Based Practice among Frontline Nurses

Evidence-based care has become the new mantra within the NHS, despite the fact that the concept of applying research to practice has been promoted for several decades. However, literature on the subject suggests that formidable obstacles remain to the integration of research into care delivery. This article describes a study which used Funk et al's (1991a,b) Barriers Scale with a population of nurses in a large teaching hospital in the UK. This scale was specifically developed to identify barriers to the introduction of research into practice, and modified for a UK context. The results suggest that a complex array of barriers exist but that foremost among these is the nature of the organizations within which nurses work. Comparisons are made with data from the USA, and the need to create time for nurses to implement change, and to empower them to do so, is stressed.

Mike Nolan

Papers

Action research and quality of care: a mechanism for agreeing basic values as a precursor to change*

The impact of information and communication technology on family carers of older people and professionals in Sweden

Maintaining nurses' job satisfaction and morale

Factors Influencing Advanced Practice Nurses’ Ability to Promote Evidence-Based Practice among Frontline Nurses

Evidence-based care: can we overcome the barriers?