Assessment of Patient Safety Culture in Public General Hospitals

Assessment of Patient Safety Culture in Public General Hospitals

Assessment of Patient Safety Culture in Public General Hospitals

Patient Safety Culture Overview of the Topic Patient safety, which is an integral constituent of the quality of healthcare services, is defined as the avoidance of errors as well as adverse effects on patients during the provision of healthcare services. Patient safety is a product of an organization’s culture along with the conduct and standards practiced by its workforces. Thus, patient safety culture generally entails the degree to which the beliefs and practices of an organization underpin and maintain thePatient Safety Culture. It encompasses the collective values held by the members of an organization regarding what is important, their views regarding how things are done within the organization, and how all these aspects interact within the organization’s structures and work units to create behavioral norms that stimulate safety (Mrayyan, 2022).

Assessment of Patient Safety Culture in Public General Hospitals

Overall, therefore, the conception of safety culture revolves around the knowledge, perception, and principles of the safety of patients held by all organization’s members, all of which have a direct connection with its operations. Reasons for selecting the articles The article “Predictors and outcomes of patient safety culture: a cross-sectional comparative study” by Mrayyan (2022) comprises a study whose aim was to assess several factors related to patient safety culture in hospitals including its components, areas of strength, and those that require improvements. The researchers established that nurses had a moderate patient safety culture, with most of them reporting a positive perception of it. The identified area of strength included teamwork within units. The next article by Reis, Paiva, & Sousa (2018), which carried out a systematic review to explore dimensions of patient safety culture in hospitals, found that teamwork within units and organizational learning to foster constant improvement are among the key factors that promote a safety culture within an organization. Likewise, the article “Assessment of Patient Safety Culture in Public General Hospitals in Capital City of Vietnam” by Huong Tran et al. (2021) found that a large percentage of the hospital staff had positive perceptions of safety culture. The identified strength areas also included organizational learning, improving constantly, and collaboration among members. The article “Employees’ perceptions of patient safety culture in Norwegian nursing homes and home care services“ by Ree & Wiig (2019) found that teamwork appears to be a significant contributing factor to patient safety in home care while staffing greatly contributes to patient safety culture in both home care and nursing homes. In their research titled “Patient safety culture and associated factors among health care providers in bale zone hospitals, southeast Ethiopia: An institutional based cross-sectional study,” Kumbi et al. (2020) found that there are numerous factors associated with a culture that promotes patient safety. These include the number of hours worked each week, taking part in programs about patient safety, and documenting the occurrence of adverse events. Further, an article by Okuyama et al. (2019), named “Health professionals’ perception of patient safety culture in a university hospital in São Paulo: A cross-sectional study applying the Hospital Survey on Patient Safety Culture” focuses on the measurements of patient safety established that collaboration, administrative education, and constant upgrading, vital components of a positive patient safety culture, all recorded low scores, generating negative results. The authors concluded that patient safety in the studied hospital was crumbly, thus improvement is extremely vital. Abdelaliem & Alsenany’s (2022) “Factors Affecting Patient Safety Culture from Nurses’ Perspectives for Sustainable Nursing Practice” explored how nurses perceive various patient safety culture elements and noted that the nurse’s attitudes towards a culture promoting patient safety in the study setting were positive. Raeissi, Reisi, & Nasiripour (2018) in their study detailed in the article “Assessment of patient safety culture in Iranian academic hospitals: strengths and weaknesses” also reported that the dimensions of constant improvement and organizational learning were better perceived by the members of the hospital facilities. In their article “Analysis of affecting factors on patient safety culture in public and private hospitals in Iran,” Khoshakhlagh et al. (2019) found that burnout and shift work negatively affect patient safety culture while offering responses to errors efficiently exchanging patient information help stimulate a positive patient safety culture. The article “The implementation of patient safety culture in nursing practice” by Gunawan & Hariyati (2019) found that cooperation within departments, constant improvement, organizational education, regularity of incident documenting, and provision of support by the hospital management are some of the strong dimensions of patient safety culture. Weaknesses in the implementation of a safety culture consisted of dimensions such as staffing, teamwork not within but across hospital units, communicating openly, handover and transfers, and nonpunitive response to mistakes during healthcare provision. Overall, all the articles in this analysis focus on the dimensions of patient safety culture and the strengths as well as weaknesses of how they are perceived and implemented in hospitals. Such factors as teamwork within units, constant improvement, and organizational learning appear to be greatly practiced and positively perceived in virtually all hospitals studied. On the other hand, factors such as staffing, non-punitive response to mistakes, and teamwork across units all appear to be poorly perceived by hospital members and form the weaknesses of implementing a patient safety culture. Therefore, the articles were selected because they offer significant insights into the dimensions of patient safety culture and the factors that impact it, whether positively or negatively. Thus, they are extremely relevant to the selected topic. 1 Patient Safety Culture Student’s Name Institutional Affiliation Course Title Professor’ Name Date 2 Patient Safety Culture Abdelaliem, S. M. F., & Alsenany, S. A. (2022, September). Factors Affecting Patient Safety Culture from Nurses’ Perspectives for Sustainable Nursing Practice. In Healthcare (Vol. 10, No. 10, p. 1889). MDPI. https://doi.org/10.3390/healthcare10101889 The article is a study conducted to assess nurses’ perceptions of the factors influencing patient safety culture to promote practice in the long term. The authors used a descriptive crosssectional study methodology using a sample size of 146 nurses recruited from an Egyptian hospital. The authors administered printed questionnaires to collect patient data; these assessed socioeconomic data and participants’ perceptions of patient safety culture for sustainability in nursing. The study determined that nurses had a good attitude toward patient safety culture, influencing long-term patient safety in hospital settings. The study’s strength is in comprehensive information, which raises awareness about patient safety in all settings. The authors presented the research from a well-researched perspective; they have a rich medical background, giving them the authority to write on the topic. The article provides general knowledge to people seeking information about patient safety. It would be helpful in my research process in the future, as it would be a valid starting point as a literature review material. Gunawan, D., & Hariyati, R. T. S. (2019). The implementation of patient safety culture in nursing practice. Enfermeria clinica, 29, 139-145. https://doi.org/10.1016/j.enfcli.2019.05.007 In this article, Gunawan & Hariyati (2019) summarize the implementation of patient safety culture by nurses at the hospital level. They present a systematic review of peer-reviewed articles covering ten years from 2009 to 2018, collected from four trusted online databases and 3 analyzed using the 12 patient safety culture dimensions. The article concludes that many international accreditation organizations implement patient safety culture, and healthcare organizations have taken initiatives to strengthen patient safety. The article is written for people seeking knowledge on the status of patient safety in hospitals to know whether healthcare organizations treat the matter seriously. Considering the current situation and emerging issues in hospital settings, this source is useful for helping the reader gain better insight. It is timely and specific and addresses the topic from an informed perspective, considering the authors’ backgrounds. Its strength lies in the vast knowledge body since the authors selected various sources spanning a prolonged duration. It would guide policymakers in healthcare concerning the issue discussed and assist a researcher like me in the future literature search. Huong Tran, L., Thanh Pham, Q., Nguyen, D. H., Tran, T. N. H., & Bui, T. T. H. (2021). Assessment of Patient Safety Culture in Public General Hospitals in the Capital City of Vietnam. Health Services Insights, 14. https://doi.org/10.1177/11786329211036313 Huong et al. (2021) discuss the status of patient safety in an autonomous hospital in Vietnam using a cross-sectional descriptive study design; the authors used an online survey to collect data by targeting 820 healthcare professionals through convenience sampling. The authors state that the hospital perceives patient safety culture significantly but add that more emphasis should be placed on staffing and non-punitive error response. The authors are all associated with the healthcare system in Hanoi, Vietnam, in various capacities; they are connected at the academic level at the university and the professional level in the hospital department. This gives them the professional and intellectual authority to conduct this type of research and present their findings appropriately. The source’s strength lies in the 4 expansive knowledge base due to adequate research and the authors’ backgrounds. However, its weakness lies in its focus on one healthcare organization, limiting its scope for generalization into other settings. Still, it would be excellent reading for a researcher seeking literature review sources for additional knowledge. Khoshakhlagh, A. H., Khatooni, E., Akbarzadeh, I., Yazdanirad, S., & Sheidaei, A. (2019). Analysis of affecting factors on patient safety culture in public and private hospitals in Iran. BMC health services research, 19(1), 1-14. https://doi.org/10.1186/s12913019-4863-x In this source, Khoshakhlagh et al. (2019) consider patient safety culture as one of the primary components of healthcare service quality; it is also one of the priorities of health studies. They conducted this study to determine and compare healthcare staff’s views of patient safety; they also studied the influence of influential factors on patient culture safety in Iranian hospital settings. The authors explain that providing feedback on errors for incident reporting and the exchange of information is necessary to promote a patient safety culture. They discuss the need to plan and manage working shift hours and burnout since they significantly impact patient safety culture. The authors used a cross-sectional study design in identifying and mapping public and private hospitals in Tehran; they sampled target populations through stratified sampling methods, giving the source significant strength by widening the information scope. Considering the sample size collected, the source would be an essential benchmark for applying to broader policy and practice settings. The only weakness of this study is that a significant cultural difference occurs between Iran and the areas, making it difficult to generalize beyond this setting. 5 Kumbi, M., Hussen, A., Lette, A., Nuriye, S., & Morka, G. (2020). Patient safety culture and associated factors among health care providers in Bale Zone hospitals, southeast Ethiopia: An institutional based cross-sectional study. Drug, Healthcare and Patient Safety, 12, 1. https://doi.org/10.2147/DHPS.S198146 In this source, Kumbi et al. (2020) state that patient safety is a critical global public health issue, forming a crucial component of healthcare quality. They argue that a close connection exists between unsafe patient care, morbidity, and mortality globally. To validate these assertions, they conducted a study to assess patient safety culture and the associated factors among care providers in Ethiopian hospitals. They conducted a cross-section study using the Hospital Survey on Patient Safety Culture (HSOPSC) questionnaire to interview 518 healthcare providers. The authors concluded that the patient safety culture was poorly defined in the selected healthcare settings considering the low patient safety scores. The authors possess significant knowledge and experience backed by many years of research on a similar topic and other healthcare issues, giving them the academic and professional authority to write the source. The study design also allowed them to select a broader population, making the study applicable in other policymaking areas at the hospital level. The source is essential for general knowledge and research for an individual seeking additional literature sources. Mrayyan, M. T. (2022). Predictors and outcomes of patient safety culture: a cross-sectional comparative study. BMJ Open Quality, 11(3). DOI: https://doi.org.10.1136/bmjoq2022-001889 In this source, the author discusses the importance of developing a patient safety culture in hospitals and its role in improvement initiatives related to patient safety. He argues that 6 limited knowledge exists in healthcare settings concerning patient safety culture. He sought to validate this by conducting a cross-sectional comparative study to assess the reporting behavior among nurses on the predictors and outcomes of patient safety culture; they also sought to identify the differences between patient safety grades and the reported events in patient safety culture. The author concludes that the selected hospitals showed moderate patient safety cultures and a positive perception among nurses. The study offers an essential knowledge foundation on the topic, being one of the first to deal with the predictors and outcomes of patient safety culture. The author is a senior researcher in the healthcare setting in Jordan and has published many peer-reviewed articles, giving him the professional and academic authority to write this source. This gives the article significant credibility in use during future research. Okuyama, J. H. H., Galvão, T. F., Crozatti, M. T. L., & Silva, M. T. (2019). Health professionals’ perception of patient safety culture in a university hospital in São Paulo: A cross-sectional study applying the Hospital Survey on Patient Safety Culture. Sao Paulo Medical Journal, 137, 216-222. https://doi.org/10.1590/15163180.2018.0430140319 In this source, Okuyama et al. (2019) consider patient culture as a critical part of an organization’s profile in healthcare; they also associate it with better care quality. They sought to validate this point by conducting a hospital-based cross-sectional study in a Sao Paulo university hospital to assess patient safety in a university hospital setting. They targeted 68 sectors and selected five employees from each via an online platform using the Hospital Survey on Patient Safety Culture (HSOPS). The authors conclude that the university hospital setting in Brazil presented significant weaknesses, and there was poor reporting by professionals. 7 The authors possess an excellent academic background in pharmacy at the university and hospital level with excellent research backgrounds giving them considerable authority in the topic. Considering the educational background of this research, it would be an excellent addition to a literature review for future research processes. It is also recent, making it valid for current applications in hospitals and academic applications to aid in the learning process. Raeissi, P., Reisi, N., & Nasiripour, A. A. (2018). Assessment of patient safety culture in Iranian academic hospitals: strengths and weaknesses. Journal of patient safety, 14(4), 213-226. https://doi.org/10.1097/pts.0000000000000199 In this source, Raeissi et al. (2019) argue that establishing a patient safety culture is critical for providing quality patient care. They conducted a study to create a baseline for patient safety culture in the academic settings of Iranian hospitals; they also sought to determine the strengths and weaknesses of patient safety culture. They selected 26 academic hospitals in Tehran and Iran Universities of Medical Sciences. They also used the Hospital Survey on Patient Safety Culture (HSOPSC) questionnaire to collect data. The selected hospitals displayed an inadequate public safety culture, and the authors propose significant improvement. The authors double up as physicians and university professors in various institutions in Iran and have conducted research and written several published articles on medical research. This gives them credibility and makes the source reliable as an academic source that can be used as a literature source in research. It is also an original article, making it suitable considering the rich educational background on which it is founded. 8 Ree, E., & Wiig, S. (2019). Employees’ perceptions of patient safety culture in Norwegian nursing homes and home care services. BMC health services research, 19(1), 1-7 https://doi.org/10.1186/s12913-019-4456-8 In this source, Ree & Wiig (2019) argue that research in patient safety culture on healthcare services for elderly patients remains scarce. They conducted this study to describe the perception of the patient safety culture of staff in homecare and nursing homes; they sought to determine the contributions of patient safety culture on overall patient perceptions. According to the authors, perceptions of patient safety culture differs significantly between home care services and nursing homes, and staffing plays a significant role in patient safety in these settings. The authors conducted a cross-sectional survey with a large sample size of 304 respondents. This makes the research reliable and valid from a researcher’s perspective, as it would provide a solid starting point for a literature review. Additionally, the authors possess significant academic and research authority, having conducted considerable research and published various articles on healthcare issues; this makes the source authoritative on the topic. Reis, C. T., Paiva, S. G., & Sousa, P. (2018). The patient safety culture: a systematic review by characteristics of hospital survey on patient safety culture dimensions. International Journal for Quality in Health Care, 30(9), 660-677. https://doi.org/10.1093/intqhc/mzy080 The authors state the need to learn the strengths and weaknesses of patient safety culture expressed through the Hospital Survey on Patient Safety Culture (HSOPSC). They conducted a study to identify studies that have used the method to collect data on patient safety culture in the hospital setting; they also sought to survey findings in safety culture aspects to identify their potential contributions to care quality in hospitals. The authors concluded that organizational 9 cultures in hospitals were poorly developed concerning patient safety culture. They used their knowledge and experience in healthcare to propose strategies tied to safety culture evaluation n to enhance patient safety. Since the data collected spanned 21 countries, it offers a robust foundation for promoting research and widening the scope of operationalization and generalization of the topic. The authors have a rich background going by their profiles. They have published several healthcare articles and possess the knowledge and expertise to write an authoritative article. 10 References Abdelaliem, S. M. F., & Alsenany, S. A. (2022, September). Factors Affecting Patient Safety Culture from Nurses’ Perspectives for Sustainable Nursing Practice. In Healthcare (Vol. 10, No. 10, p. 1889). MDPI. https://doi.org/10.3390/healthcare10101889 Gunawan, D., & Hariyati, R. T. S. (2019). The implementation of patient safety culture in nursing practice. Enfermeria clinica, 29, 139-145. https://doi.org/10.1016/j.enfcli.2019.05.007 Huong Tran, L., Thanh Pham, Q., Nguyen, D. H., Tran, T. N. H., & Bui, T. T. H. (2021). Assessment of Patient Safety Culture in Public General Hospitals in the Capital City of Vietnam. Health Services Insights, 14. https://doi.org/10.1177/11786329211036313 Khoshakhlagh, A. H., Khatooni, E., Akbarzadeh, I., Yazdanirad, S., & Sheidaei, A. (2019). Analysis of affecting factors on patient safety culture in public and private hospitals in Iran. BMC health services research, 19(1), 1-14. https://doi.org/10.1186/s12913-0194863-x Kumbi, M., Hussen, A., Lette, A., Nuriye, S., & Morka, G. (2020). Patient safety culture and associated factors among health care providers in Bale Zone hospitals, southeast Ethiopia: An institutional based cross-sectional study. Drug, Healthcare and Patient Safety, 12, 1. https://doi.org/10.2147/DHPS.S198146 Mrayyan, M. T. (2022). Predictors and outcomes of patient safety culture: a cross-sectional comparative study. BMJ Open Quality, 11(3). DOI: https://doi.org.10.1136/bmjoq-2022001889 11 Okuyama, J. H. H., Galvão, T. F., Crozatti, M. T. L., & Silva, M. T. (2019). Health professionals’ perception of patient safety culture in a university hospital in São Paulo: A cross-sectional study applying the Hospital Survey on Patient Safety Culture. Sao Paulo Medical Journal, 137, 216-222. https://doi.org/10.1590/1516-3180.2018.0430140319 Raeissi, P., Reisi, N., & Nasiripour, A. A. (2018). Assessment of patient safety culture in Iranian academic hospitals: strengths and weaknesses. Journal of patient safety, 14(4), 213-226. https://doi.org/10.1097/pts.0000000000000199 Ree, E., & Wiig, S. (2019). Employees’ perceptions of patient safety culture in Norwegian nursing homes and home care services. BMC health services research, 19(1), 1-7 https://doi.org/10.1186/s12913-019-4456-8 Reis, C. T., Paiva, S. G., & Sousa, P. (2018). The patient safety culture: a systematic review by characteristics of hospital survey on patient safety culture dimensions. International Journal for Quality in Health Care, 30(9), 660-677. https://doi.org/10.1093/intqhc/mzy080 CHAPTER 13 Qualitative Studies Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com. 13.1 Overview ▪ Qualitative research uses in-depth interviews, focus group discussions, participant observation, and other unstructured or semi-structured methods to explore attitudes and perceptions, identify themes and patterns, and formulate new theories ▪ Qualitative research seeks to answer questions like “why?” and “how?” that numbers-focused quantitative research cannot adequately answer Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Quantitative research uses structured, hypothesis-driven approaches to gather data that can be statistically analyzed Figure 13-1 Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 13.1 Overview (Cont.) ▪ In the health sciences, many qualitative research projects aim to improve health promotion programs and clinical processes or to provide a foundation for social change ▪ Other qualitative studies seek to understand how people experience health and illness as individuals and as members of communities, why they engage in or do not engage in various health-related behaviors, and how they make healthrelated decisions Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Phenomenon: the central concept being studied during a qualitative research project 13.2 Ontology, Epistemology, and Axiology ▪ The philosophical orientations that guide both quantitative and qualitative research are rooted in ontology, epistemology, and axiology Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Because qualitative research examines thoughts and beliefs that cannot be directly measured, researchers using qualitative methods must be aware of the ways their own thoughts, experiences, biases, and assumptions shape the design and interpretation of their research studies 13.2 Ontology ▪ Ontology: the study of the nature of reality and truth Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Ontological perspectives extend from realism to relativism 13.2 Ontology (Cont.) ▪ Realism assumes that one reality exists, and it can be understood – A realist would say that meaning exists in an object independent of the subject investigating it – Quantitative research studies seek to make objective determinations about the world Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com – Objectivity: facts that can be evaluated without bias 13.2 Ontology (Cont.) – Subjectivity: claims and experiences that are interpreted based on an evaluator’s beliefs, perceptions, and feelings – A relativist would say that a subject imposes meaning on an object – Qualitative research designs typically seek to understand subjective aspects of human existence Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Relativism assumes that there are multiple realities and they cannot be fully understood 13.2 Epistemology ▪ Epistemology: the study of knowledge ▪ For example, a guiding principle for quantitative studies is empiricism, the assumption that the senses (such as seeing, hearing, and touching) are the best way to measure truth about the world Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Ontology explains how a researcher defines reality and truth, while epistemology explains how a researcher knows what is real and true 13.2 Epistemology (Cont.) ▪ Qualitative research assumes that researchers and study participants are interdependent, and they create knowledge together as they interactively explore subjective topics Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Quantitative research assumes that researchers are independent from their study subjects and that researchers can control for possible biases in order to make objective measurements 13.2 Axiology ▪ Axiology (or value theory): the study of values ▪ Qualitative researchers assume that a researcher’s values affect the study Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Quantitative researchers usually apply an axiological perspective that assumes that rigorous procedures can eliminate the impact of values and biases on study outcomes Figure 13-2 Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 13.3 Theoretical Paradigms ▪ Four of the most prominent philosophical assumptions applied to health science research are positivism, constructivism / interpretivism, critical theory, and pragmatism Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Because the goal of qualitative research is to understand a complex phenomenon rather than to predict some observable event, qualitative researchers must select the theoretical perspectives that will guide their study design, data analysis, and interpretation Figure 13-3 Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 13.3 Positivism – The word positive denotes definitiveness and certainty – Studies based on a positivist paradigm generally use empirical methods to test hypotheses and predict outcomes; they often employ quantitative experimental designs Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Positivism: a paradigm in which researchers apply a realist perspective that assumes that reality is knowable and that inquiry should be logical and valuefree 13.3 Positivism (Cont.) – Post-positivism applies a critical realist perspective to research – Studies using a post-positivist paradigm often employ quasi-experimental and mixed methods designs Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Post-positivism: a in which researchers aim to experimentally test theories about how the world works, but they acknowledge that the unpredictability of human behavior limits the validity of some empirical methods 13.3 Constructivism / Interpretivism ▪ Interpretivism: a paradigm in which researchers consider the reality in the social world to be different from reality in the natural world ▪ Interpretivism and constructivism are about understanding how various groups of people interpret reality ▪ Studies based on constructivism and interpretivism use qualitative study designs Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Constructivism: a paradigm in which researchers have a relativist perspective that considers each individual’s reality to be a function of that person’s lived experiences 13.3 Constructivism / Interpretivism (Cont.) ▪ The epistemological assumption is that researchers and participants must work together to understand reality ▪ The axiological assumption is that beliefs and values are social constructs ▪ These philosophical stances make constructivism the opposite of positivism Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ The ontological assumption of constructivism is that there are many realities, not just one reality, and realities are created as researchers and participants interact 13.3 Critical Theory – The philosophical assumption of critical theory is that participants can actively construct realities that are shaped by beliefs and values – Research conducted under a critical theory framework is change-oriented Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Critical theory: a paradigm that considers reality to be dependent on social and historical constructs and assumes that reality can be uncovered by identifying and challenging power structures 13.3 Critical Theory (Cont.) ▪ In an action research approach, participants work together to solve a social problem – Action research conducted under a transformative paradigm assumes that reality can be changed when researchers collaborate with participants from marginalized populations to address a social justice issue Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Studies based on critical theory often use participatory methods that empower participants and equip them to advocate for change 13.3 Pragmatism ▪ The goal of pragmatic research is to solve problems, so the focus is on the outcomes of the research project rather than the theories and processes that guide it Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Pragmatism: a paradigm in which researchers assume that reality is situational, and it is acceptable to use any and all research tools and frameworks to try to understand a particular problem so it can be solved 13.3 Pragmatism (Cont.) ▪ The epistemological assumption is that reality can be known and understood using many different approaches ▪ The axiological assumption is that beliefs and values are part of practical decisions ▪ Pragmatists often use mixed methods in their study designs Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ The ontological assumption of pragmatism is symbolic realism, which treats individuals’ realities as being real to those individuals, because that orientation is the most useful and practical 13.3 Pluralism ▪ Researchers using two or more theoretical perspectives must carefully explain why the theories were selected, how they were implemented, and how the use of multiple theories informed the insights gained from the study Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Theoretical pluralism occurs when a researcher draws on more than one theoretical framework to guide the design, analysis, and interpretation of a research project 13.4 Qualitative Methodologies ▪ Planning for a qualitative study often progresses from the identification of the underlying ontology and epistemology to the selection of a suitable paradigm and then the identification of methodology that aligns with the underlying theoretical perspective ▪ In the health sciences, the most popular qualitative methodologies include phenomenology, grounded theory, ethnography, and case studies Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ The methodologic approaches selected for a qualitative research project must align with the goals of the study and the selected theoretical paradigm Figure 13-4 Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Figure 13-5 Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 13.4 Phenomenology ▪ The researcher uses in-depth interviews to gather data from several people, then the transcripts of those interviews are examined so that meanings and themes can be identified and understood from the perspective of the participants ▪ Bracketing is the process of a researcher intentionally setting aside any preconceived ideas about reality in order to be open to new meanings that might be expressed by participants Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Phenomenology seeks to understand how individuals interpret and find meaning in their own unique life experiences and feelings 13.4 Grounded Theory ▪ Data collection and data analysis occur simultaneously, so that theories can be developed and refined ▪ Theoretical sampling uses the emerging theory to guide the selection of new data sources, with data collection continuing until data saturation has been reached Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Grounded theory is an inductive reasoning process that uses observations to develop general theories that explain human behavior or other phenomena 13.4 Ethnography ▪ Ethnography is an anthropological approach in which researchers aim to develop an insider’s view (an emic perspective), rather than an outsider’s view (an etic perspective), of how members of a particular sociocultural group understand their world ▪ Ethnographers often use participant observation methods to understand a group’s collective experiences, values, beliefs, and behaviors Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Ethnography is the systematic study of people and cultures in their natural environments 13.4 Case Study – A case study approach may be used when preparing a case report or a case series, or it may be applied to understanding an event, process, or program ▪ The goal is not to develop generalizable knowledge, but to understand one event well ▪ Multiple data sources may be used as part of a holistic examination of the case, including observations, interviews, and reviews of historic documents Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ A case study is a qualitative research approach that uses multiple data sources to examine one person, group, event, or other situation in detail 13.5 Mixed Methods Research – Some mixed methods projects use a convergent parallel design to collect quantitative and qualitative data concurrently and then compare the results and interpret them – Some studies collect the data sequentially, completing one type of study first and then designing and implementing the other type of study – Some qualitative studies are embedded within a quantitative study Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Mixed methods projects use of both quantitative and qualitative methods in one research study 13.5 Mixed Methods Research (Cont.) – Exploratory research aims to discover new ideas and develop hypothesis – Descriptive research seeks to understand key characteristics of a group – Explanatory research tests hypotheses about causal relationships Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Social science research can often be classified as being exploratory, descriptive, or explanatory 13.5 Mixed Methods Research (Cont.) ▪ A mixed-methods explanatory study might collect quantitative data first, and then use a qualitative study to assist with interpretation of the results Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ A mixed-methods exploratory study might collect qualitative data first, and then use the insights from that study to design and implement a quantitative study 13.5 Mixed Methods Research (Cont.) – Some research protocols do not consider the interface of the qualitative and quantitative results until the very end of the project when the findings are being interpreted – Other protocols weave both strands of the study together throughout the research process from the design stage through data collection, data analysis, and interpretation Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Integration of the two strands of a mixed methods study may occur at various times during a research project CHAPTER 23 Collecting Qualitative Data Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com. 23.1 Overview ▪ Because qualitative researchers are so closely engaged with participants, researchers need to reflect on how their backgrounds might bias their observations, and they need to be transparent about these potential biases when designing rigorous studies and reporting findings Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Qualitative data collection in the health sciences usually involves in-depth interviews, focus groups, or other specialized data collection methods 23.2 In-Depth Interviews ▪ In a semi-structured interview, the interviewer starts with a list of open-ended questions that will be asked of each participant, but these questions or lists of topics are merely starting points for eliciting responses from participants – Probing is an interviewing technique that prompts an interviewee to provide a more complete or specific response ▪ Interviewers can also record their observations of the body language and other nonverbal communication conveyed by interviewers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ In-depth interview: an interviewer spends 1 or 2 hours interviewing a key informant using open-ended questions 23.3 Focus Group Discussions – Interaction among participants stimulates richer responses and clarifies opinions, so focus groups often use homogeneous sampling to recruit participants with similar backgrounds, experiences, or perspectives – Focus groups are audio- or video-recorded so that complete transcripts can be created Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Focus group: approximately 8 to 10 people spend 1 or 2 hours participating in a moderated discussion 23.3 Focus Group Discussions (Cont.) – Participants are encouraged to interact with one another – The moderator ensures that everyone has an opportunity to speak and that no one dominates the conversation Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ The facilitator poses questions to the group, carefully keeping the conversation focused on the core discussion items and moving forward at an appropriate pace 23.4 Observational Methods – Naturalistic observation: the researcher unobtrusively observes study subjects in a natural setting, typically without the knowledge of the subjects – Controlled observation: study participants are observed in a laboratory setting and know that they are being observed Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Observational methods involve systematic observations of human actions and interactions 23.4 Observational Methods (Cont.) ▪ Field notes: observation records, interview transcripts, and other documents compiled during the qualitative research process Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Participant–observation: a trained investigator seeks to understand a community by engaging with its members and immersing in its practices 23.4 Observational Methods (Cont.) – People who know they are being observed may change their behaviors ▪ Covert observation: a researcher does not inform study subjects that they are being investigated – The lack of informed consent can raise serious ethical concerns, especially when the studies are conducted in places where people have a reasonable expectation of privacy Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Overt observation: participants are aware that they are being observed and the researcher is transparent about the goals and methods of the study 23.5 Other Techniques ▪ Oral history is the audiovisual recording of historical information about individuals, families, groups, or events ▪ Narrative inquiry examines autobiographies, personal letters, family stories, interview tapes, and other records to understand how people frame their identities and social relationships ▪ Triangulation is the process of using multiple different types of data, methods, and theories to better understand a phenomenon Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Additional techniques that move beyond traditional interviews and observations may be used to ensure the comprehensiveness of information collected during qualitative studies 23.5 Other Techniques (Cont.) ▪ Some studies use the visual and performing arts as part of their inquiries Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Photovoice is a technique in which participants take photographs that they feel represent their communities and then they share what aspects of their lived experiences they intended to capture in those images 23.5 Other Techniques (Cont.) ▪ In a think-aloud protocol or talk-aloud protocol, participants are asked to describe their thoughts and actions while they complete a task Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ A vignette is a brief written or pictorial scenario that is designed to elicit a response from participants in a qualitative study 23.6 CBPR ▪ CBPR projects often use mixed methods approaches Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ Community-Based Participatory Research (CBPR): partnerships link academicians with community representatives, who together identify research priorities for the community, design and implement appropriate data gathering and analysis activities, and then apply those findings to the development of new policies and programs in the community 23.7 Consensus Methods ▪ The Delphi method is a structured decision making and forecasting process in which experts complete questionnaires, a facilitator summarizes and shares the responses, and panelists reconsider their perspectives after reflecting on the opinions expressed by others Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com ▪ The goal of some studies is to identify areas of consensus and areas of contention among individuals who are experts on a particular topic and/or a particular community or organizations