Lessons learned advantages and disadvantages of mixed method research
Evidence based practice can be defined as the scientific and systematic process of combining the knowledge and information derived from the authentic and reliable literature sources in order to be able to implement best practice in the care scenario. Evidence based practice is a framework that allows the nursing professionals to ensure optimal safety and efficacy of the care interventions provided to patient and enhances patient centered- ness of the care program (McKevitt et al., 2011). However, in order for the nurses to be able to perform adequate evidence based practice, it is crucial for the nurses to understand the authenticity, reliability and relevance of the literature. Critical appraisal exercise can be considered as one of the most effective technique for the nurses to develop the ability or the skills to engage in independent evidence based practice. This paper will attempt to critically appraise an article by Ekstam et al. (2015)
Body:
Ekstam, L., Johansson, U., Guidetti, S., Eriksson, G., & Ytterberg, C. (2015). The combined perceptions of people with stroke and their carers regarding rehabilitation needs 1 year after stroke: a mixed methods study. BMJ open, 5(2), e006784.
PART A
Authorship:
The author affiliations for each author respectively are:
- Division of Occupational Therapy, Department of Neurobiology Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Department of Occupational Therapy, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Research, Uppsala University/County Council of Gävle, Gävle, Sweden
- Department of Neuroscience and Rehabilitation Medicine, Uppsala University, Uppsala, Sweden
- Department of Clinical Neuroscience, Division of Neurology, Karolinska University Hospital, Huddinge, Sweden
- Division of Physiotherapy, Department of Neurobiology Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
As the all of the authors are extremely qualified and experienced they can be considered to have more than enough expertise to have conducted a valid and relevant research. As all the authors belong to same nation being Sweden and belonged to similar research domain, the possibility of conflicts is also low.
The research question asked by this particular paper is “what is the association between the dyad’s perception of the person with stroke’s rehabilitation needs, stroke severity, personal factors (gender, age, and sense of coherence), the use of rehabilitation services, amount of informal care and caregiver burden. Furthermore, the research has also questioned the personal experience of everyday life changes among persons with stroke and their caregivers and their strategies for handling these, 1 year after stroke. In justification of the needs for the study, the authors have explained that the perception of the dyads, the person coping through the period after stroke and the informal caregiver, with regards to the rehabilitation needs and plausible associations between such perceptions and caregiver burden has not been extensively explored in the previous studies (Ekstam et al., 2015). Furthermore, the authors have also stated the fact that the combination of a qualitative and quantitative data in this aspect can help in shedding light on the complex issue in post-stroke rehabilitation and the dyadic perception.
What aspects of rehabilitation provision contribute to self-reported met needs for rehabilitation one year after stroke–amount, place, operator or timing?
The authors have taken the assistance of a mixed method design which combined both the quantitative and qualitative data collection and analysis. Now it has to be mentioned that both quantitative and qualitative data is considered to be viable research methods independently. Elaborating more on the mixed method research design, it has to be mentioned that this research design represents an approach to inquiry and has a much broader perspective (Malina, Nørreklit & Selto, 2011). For this research design, the study is more focused on the research question and using all possible measures to explore the variables bearing direct or indirect link to the research problem. Along with that, it has to be mentioned in this context that a mixed method of research study design is capable of camouflaging the individual issues that persist with any one of the qualitative or quantitative studies (Lewis, 2015). With respect to the relevancy to the research study, as the research question is broad and encompasses a variety of different factors that develop the basic perception of a dyad in the aspect of stroke rehabilitation, it can be presumed only qualitative or quantitative data collection could have fallen short of addressing all the confounding factors associated with the issue. Hence, the choice of mixed method seems relevant to the needs of the research study and the research aims and objectives.
The research method selected had been mixed and the data analysis method selected by the authors has been secondary from a prospective observational study of the rehabilitation process after stroke, named ‘Life After Stroke phase 1’. 349 patients were included in the study and were taken informed consent from to participate in the study for 3,6, and 12 month follow up. For the informal caregiver the choice had been wide involving e a partner, a son or daughter or a friend; which an excellent step for inclusion for the participants. The interviews involved both open-ended and close ended questions, which provided the participants with the liberty to share information as per their liking. Lastly, the interviews were conducted in the comfort of their homes which eliminated the need for the participants to take the suffering of physically coming to follow ups and avoided the risk of participants dropping out from follow up (Christensen et al., 2011). Hence, the research methods utilized were targeted, analytical and extremely relevant.
For the data collection and analysis, the use of likert scale and ANOVA test provided excellent measures for the data to be systematically analyzed. As interview and medical records were both involved in the data collection process, the data collected had been extensive and relevant (Ekstam et al., 2015). However, the inclusion of the open ended questionnaire and use of set answers on a statement about rehabilitation needs only provided generalized information and data had not been rich enough to make comparisons between the partners in the dyads.
Unfulfilled rehabilitation needs and dissatisfaction with care 12 months after a stroke
Results:
The research question for the study had been to question the exact perception of the partners within dyad regarding the rehabilitation needs and to the different factors associated with the rehabilitation needs including the caregiver burden. The results of the study indicated 52% of the dyads perceived that need for rehabilitation in a stroke patient are met after 10 months after the stroke event. This indicates the fact that people with rehabilitation needs being met had suffered a less severe stroke and fewer stroke related difficulties with more strategies for solving everyday problems (Ekstam et al., 2015). The findings also indicated the perception of rehabilitation needs, 1 year after stroke, differs between dyads in relation to stroke severity and major life events. In dyads where rehabilitation needs were met, the persons with stroke had a higher SOC than those in dyads with discordant views. Caregiver burden was also rated lower in dyads with met rehabilitation needs with some having social advantages after the stroke. Hence the research question was met as it clearly provided the perception of the caregivers regarding the rehabilitation needs and to what extent their perceive it to be met (Gosman?Hedström & Dahlin?Ivanoff, 2012). The study re-affirmed the previous literature studies on rehabilitation needs, with the only unique contribution being the dyadic perspective.
PART B:
There are certain barriers and limitations of any literature to be able to be implemented in the practice scenario. These barriers involve quality of the research evidence, transferability of the study, clinical applicability and even patient values. This research has undoubtedly provided a clear idea on the dyadic perspective on the rehabilitation needs, there are certain barriers (Zohrabi, 2013). First and foremost, the population size had been small for the study and the results may vary in a larger setting. The qualitative data collected had also been generalized, lacking richness and can be attributed to personal biases. On a more specific note the questions about the perceived rehabilitation did not define what rehabilitation encompasses, rather the participants only responded to their best understanding and knowledge of rehabilitation. Hence, the results are based on the informal caregivers’ idea of rehabilitation which can differ from different elements of rehabilitation after stroke (Tistad et al., 2012). Hence, this study can be fertile ground for further research to emphasize on dyadic perspective, but due to the barriers identified it cannot be implemented in practice.
Conclusion:
Evidence based practice has become of the greatest pillars of health care delivery in the present scenario and as a result, it has become one of most critical requirements of the nursing professionals to adhere to with respect to the care planning and implementation. This had been an excellent opportunity for me to understand critical appraisal of articles and how to identify the strengths and limitations of an article, and lastly whether or not it can be implemented in evidence based practice. It can be hoped that this experience will help me perform evidence based practice effectively in the future practice.
References
Christensen, L. B., Johnson, B., Turner, L. A., & Christensen, L. B. (2011). Research methods, design, and analysis.
Creswell, J. W., & Creswell, J. D. (2017). Research design: Qualitative, quantitative, and mixed methods approaches. Sage publications.
Ekstam, L., Johansson, U., Guidetti, S., Eriksson, G., & Ytterberg, C. (2015). The combined perceptions of people with stroke and their carers regarding rehabilitation needs 1 year after stroke: a mixed methods study. BMJ open, 5(2), e006784
Gosman?Hedström, G., & Dahlin?Ivanoff, S. (2012). ‘Mastering an unpredictable everyday life after stroke’–older women’s experiences of caring and living with their partners. Scandinavian journal of caring sciences, 26(3), 587-597.
Lewis, S. (2015). Qualitative inquiry and research design: Choosing among five approaches. Health promotion practice, 16(4), 473-475.
Malina, M. A., Nørreklit, H. S., & Selto, F. H. (2011). Lessons learned: advantages and disadvantages of mixed method research. Qualitative Research in Accounting & Management, 8(1), 59-71.
McKevitt, C., Fudge, N., Redfern, J., Sheldenkar, A., Crichton, S., Rudd, A. R., … & Rothwell, P. M. (2011). Self-reported long-term needs after stroke. Stroke, 42(5), 1398-1403.
Tistad, M., Koch, L., Sjöstrand, C., Tham, K., & Ytterberg, C. (2013). What aspects of rehabilitation provision contribute to self?reported met needs for rehabilitation one year after stroke–amount, place, operator or timing?. Health Expectations, 16(3).
Tistad, M., Tham, K., von Koch, L., & Ytterberg, C. (2012). Unfulfilled rehabilitation needs and dissatisfaction with care 12 months after a stroke: an explorative observational study. BMC neurology, 12(1), 40.
Zohrabi, M. (2013). Mixed method research: Instruments, validity, reliability and reporting findings. Theory and Practice in Language Studies, 3(2), 254.
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