Abstract
The purpose of this editorial is to initiate a global academic discussion regarding the value of qualitative methods in prioritised healthcare research.
It is well documented that evidence-based research methods such as intervention studies, have a prominent position in prioritised healthcare areas. 1 It is also widely accepted that healthcare research needs to be structured and featured within university-led centres of excellence and that scientific evidence is necessary. However, in my opinion, the emphasis on evidence-based research presents a challenge for nursing research because the benefits of using qualitative methods must be highlighted. In other words, the research findings should lead to the endorsement of the value of qualitative methods within an evidence-based research context.
One of the main goals of qualitative nursing research is to achieve an in-depth understanding of the healthcare needs of individuals who nurses encounter in different areas of practice. Yet, we must keep in mind that not all patients are able, or willing, to disclose their private thoughts and apprehensions connected to their illness or poor health. This is an interpersonal challenge in practice as well as in qualitative research. The ability to create a trusting atmosphere depends on the relationship-building skills of the researcher in addition to their methodological knowledge.
Within the current issue of NJNR you will find that seven articles based on research originating from different areas of clinical nursing practice have been included. What six of these articles have in common is the use of appropriate qualitative methods. However, each individual study is unique regarding research aim, chosen method(s) of data collection and analysis. The author of the seventh study recognises that further research using a qualitative method may be the next step in future research.
So, the question is: how then can qualitative research such as the articles within this issue integrate and contribute to profiled healthcare research? In her article on making a ‘case for qualitative research’, Kristine Florczak highlights that ontology, epistemology, context, purpose and methodology must be mapped out and clarified. 2 In each type of qualitative study, such as phenomenology, ethnography, hermeneutics, the motivation to use a qualitative method must be clearly expressed. This process should be used within all scientific fields, and it should be taken into consideration that convincing scientific arguments are especially important when developing a research proposal that is based on a qualitative method.
As we know, securing research grants is a highly competitive process and I have no doubt there many nurse-researchers have experienced a great deal of disappointment when grants are denied. There is obviously a skill in writing a convincing research proposal, one that clearly articulates the rationale of why a focus on the experience and narratives of individuals, rather at the group level, should be funded. In my view, extensive population studies should not rule out the importance of qualitative research. Small yet innovative and creative qualitative studies can uncover aspects of nursing that can be of value in theory development and contribute to the design of evidence-based research. Thus, demonstrating the success of qualitative studies in gaining insight, awareness of a specific health problem or disease is essential.
In an overview of Swedish research in medicine and health, the Swedish Research Council, summarises that the ‘best research is driven by the ideas and curiosity of individual scientist, and form the basis and innovations and thus breakthroughs’. Thus, it is ‘crucial’ that research receives support for its originality and becomes internationally recognised.3(p.6) These two statements seem to open the door for qualitative nursing research.
Returning to the articles I mentioned previously, the common aim of the patient perspective studies, is to gain knowledge and understanding of the healthcare needs of persons that in some manner have been neglected to a degree. If we compare the study of ‘Exploring lifestyle changes in women with ischemic heart disease’ with the study of ‘Transgender people in Swedish healthcare: The experience of being met with ignorance’, the two areas of research, at an initial reading, seem to be quite disparate. However, there is a clear similarity: both studies outline the importance of being seen and met with respect when receiving healthcare.
In the healthcare provider perspective studies, dementia care, residential care of older persons during downsizing, ethical reasoning in psychiatric care and home care for seriously ill children, can be traced to healthcare providers’ ethical awareness of the importance of establishing trusting relationships, and this ties in with person-centred care.
The inter-relationship between implementation of research and professional competence is a primary subject within the majority of nursing curricula. The explorative study of ophthalmic nurses’ attitudes towards nursing research is thus important since it reveals what needs to be improved in terms of nursing education. According to the author, the results reveal that further qualitative studies ‘would be beneficial to the planning of nursing education and to the integration of nurses in clinical scientific work’.4(p.215) The study begins with a quantitative explorative design and concludes with the recommendation to continue research within this area based on qualitative methodology. This is a good example of how the results of a study focusing on healthcare phenomena can generate questions that can be explored by using a quantitative approach.
Of course, generating new knowledge in any field of research takes time. However, I believe we need to be aware that knowledge gained from research is provisional in nature because what is known today about a specific phenomenon can be modified or replaced by further research that uncovers other dimensions not previously known. For example, the arguments for using a qualitative approach should not lead to a dichotomy, for example, between intervention studies and qualitative methods. Sally Thorne in an earlier article discusses the role of qualitative research within an evidence-based context, and suggests that research integration may be a way to combine ‘what is known about the questions asked on the “basis of both qualitative and quantitative methods”’.5(p.573) Each study published in this issue can be viewed as part of a continual process of developing innovative methodologies in nursing, such as ways to integrate multiple ways of knowing.
Based on my own experience and perspectives as a nurse-researcher in Sweden, I believe the topic surrounding the value of qualitative methods in nursing from other parts of the world is both intriguing and a necessary discussion what we should continue. To that end I welcome your feedback and wish you all the best for the remainder of 2017.