week 12
Please answer these three discussions:
1- SY
The article presented a solid defense of the quality of the data and analysis and did a good job laying out their methods. I especially thought their sapling methods were adequate to objectively approach the topic. Specifically, a diverse group of health care workers with differing views and morals were selected for the study (Mathews et al., 2021). I find that to be especially prudent when studying the topic of medical aid in dying because the practice itself can be so divisive and people have strong moral and ethical opinions on both sides of the debate. Polit & Beck (2021) discuss person triangulation to increase validity through data collection from different perspectives of phenomena. Additionally, purposeful sampling provides for more accurate and detailed data collection is qualitative studies (Polit & Beck, 2021).
In terms of study design and data collection, I like how the authors specifically highlight their use of a qualitative descriptive design rather than grounded theory to enhance the credibility of their research. The conclusions are more closely defined by the direct data collected rather than the interpretation of the responses collected from the participants. I also find the prolonged engagement between the researchers and the participants, as you pointed out, increases the dependability of the study. Polit & Beck (2021) highlight how prolonged engagement increases rapport with informants, which can lead to rich and more detailed data. I would think this is especially important because people have strong and sometimes very personal beliefs about the topic.
Lastly, the authors do note some limitations of the study. The participants mostly came from large urban areas with considerably higher resources, limiting the transferability to lower access, rural areas (Mathews et al., 2021). However, I do think the design of their study could be repeated in rural areas to test the transferability of the study. Even if the results are different, I think it would be beneficial to then repeat the study in other similar setting to see if the implications are similar among those specific settings.
References
Mathews, J. J., Hausner, D., Avery, J., Hannon, B., Zimmermann, C., & al-Awamer, A. (2021). Impact of medical assistance in dying on palliative care: A qualitative study. Palliative Medicine, 35(2), 447-454. https://doi.org/10.1177/0269216320968517 (Links to an external site.)
Polit, D. F., & Beck, C. T. (2021). Nursing research: Generating and assessing evidence for nursing practice. Wolters Kluwer.
2- LB made a comment for AA
What an interesting read! I found it notable that Mathews et al. (2021) included their rationale for not selecting a theoretical framework to guide their research. They explained that the use of qualitative descriptive methodology does not require that the researchers go beyond the descriptions provided by the participants. According to Mathews et al. (2021), without the interpretative step found in other methodologies, such as grounded theory, the guidance that would be provided by a theoretical framework is less necessary. Although we have discussed in both this course and our accompanying philosophy course the value that can be added by the inclusion of a conceptual framework in research design and interpretation of results, this may not be paramount in descriptive research studies, as opposed to intervention or cause-probing research studies, where the study design does not include selection of variables of interest or meaningful outcome measures. I do still find great value in the inclusion of conceptual frameworks when interpreting results, making recommendations for future research, and identifying implications for clinical practice.
I would have preferred if Mathews et al. (2021) shared with us how they defined conceptual saturation. They ended recruitment when saturation was attained, which was after only 23 participants. As Nelson (2016) describes, conceptual saturation is not an objective definition with standardized criteria. The trustworthiness of qualitative data is determined not only by the use of logical and reliable methodologies but by detailing the evidence behind research design judgments. Without the raw data and statistical analyses of quantitative research to follow, presentations of qualitative research must provide the rationale for research design decisions in order to provide evidence of the validity of their claims.
Of note, the researchers claimed that the results of their research support increased communication training regarding ethical decision making and changes to resource allocation so that Medical Aid in Dying care is provided in parallel to palliative care (and not necessarily by the already stretched-thin providers) (Mathews et al., 2021). However, these educational programs and policy changes have not yet occurred, as far as I could tell.
References
Mathews, J. J., Hausner, D., Avery, J., Hannon, B., Zimmermann, C., & Al-Awamer, A. (2021). Impact of Medical Assistance in Dying on palliative care: A qualitative study. Palliative medicine, 35(2), 447454. https://doi.org/10.1177/0269216320968517
Nelson, J. (2016). Using conceptual depth criteria: Addressing the challenge of reaching saturation in qualitative research. Qualitative Research, 17(5), 554570. https://doi.org/10.1177/1468794116679873
3- LB made a comment on SY
Cool study that you referenced! I appreciate that Herwell et al. (2017) chose as part of the inclusion criteria that the participants had been impacted by medication-assisted therapy (MAT) in any way. This allowed for the inclusion of participants who were in various stages of recovery from their opioid use disorder and had a variety of experiences with MAT, including denial and/or avoidance of services. Herwell et al.s (2017) investigation of the perceptions of MAT was enhanced by the inclusion of participants who had merely considered but not sought or secured MAT.
While snowball sampling used by Herwell et al. (2017) reduces the transferability of the conclusions of qualitative research, it does also have some strengths. This recruitment measure may enhance the authenticity of participants responses during focus groups and interviews, as they may be more likely to trust the research team (Polit & Beck, 2021).
The authenticity of Herwell at al.s (2017) research was also strengthened by the on-going re-evaluation of focus group and individual interview prompts. Allowing the already collected data to guide the collection of new data in an on-going process incorporates the worldviews and perspectives of the participants (and hopefully, by extension, the population being examined) in the research design (Johnson & Rasulova, 2016). Without this, the prompts posed to the participants would have only been guided by the researchers perspectives and assumptions about that population.
The inclusion of many of the limitations of Herwell et al.s (2017) findings by the studys authors is an important factor to highlight. Transferability in qualitative studies is not achieved nor evaluated by the same criteria as quantitative studies which may be more focused on the randomness of the sample and probabilistic analyses (Johnson & Rasulova, 2016). Instead, the research needs to be presented in a way that allows the reader to evaluate how relevant the findings are to their own settings and practices. This requires detailed descriptions of research methods, especially the sampling and interview techniques. These descriptions allow the reader to assess for themselves whether the meaningfulness of the findings transfers into their realms. Acknowledging the limitations of a study further aids the reader to understand how to evaluate a studys transferability.
References
Hewell, V. M., Vasquez, A. R., & Rivkin, I. D. (2017). Systemic and individual factors in the buprenorphine treatment-seeking process: A qualitative study. Substance Abuse Treatment, Prevention and Policy, 12(1), 3-3. https://doi.org/10.1186/s13011-016-0085-y (Links to an external site.)
Johnson, S., & Rasulova, S. (2017). Qualitative research and the evaluation of development impact: Incorporating authenticity into the assessment of rigour. Journal of Development Effectiveness, 9(2), 263276. https://doi.org/10.1080/19439342.2017.1306577
Polit, D. F., & Beck, C. T. (2021). Nursing research: Generating and assessing evidence for nursing practice. Wolters Kluwer.
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Week 13: Weekly Discussion: initial post by Wednesday, November 17 and response posts due by November 21.
3. Based on your area of interest, propose a research question that could be used for a qualitative research study. Discuss whether you think it would be suited for phenomenology, grounded theory, ethnography, or historical methodology and why.
4. Propose how this research could be developed in a mixed-methods research design.
See the discussion question rubric for further grading.
Please answer these three discussions
1) SY
My interests continue to grow in the psychiatry and behavioral health as I gain experience in the field and continue to study the fields in school. One topic that consistently intrigues me is addiction medicine and associated behavioral therapies. The epidemic of overdose deaths has continually grown over the years and remains one of the most difficult problems facing the United States. Therefore, multiple studies have been conducted and more are needed to understand and address the issue. One qualitative research question that comes to mind is:
What are your triggers for relapse and what coping mechanisms do you use to overcome them to remain abstinent from opioids?
The study is best suited for phenomenology methodology because the question seeks to explore the lived experience of the subjects. Polit & Beck (2021) describe phenomenology as the exploration of lived experiences of people to discover critical truths about reality. The data is usually gathered through in-depth conversations that allow the subject to describe their lived experiences with the guidance, not influence, of the researcher (Polit & Beck, 2021). Tu truly understand the experience of the subjects, it is important for rich qualitative to be collected to understand the phenomena.
Because relapse and associated overdose death are of grave concern, it may be useful to use the qualitative data in the creation of a risk assessment instrument to gauge likelihood of the subject to relapse based on presenting factors. Researchers generally utilize qualitative data to construct assessment instruments and wording of such, and then create quantitative instruments that are statistically scrutinized (Polit & Beck, 2021). Thus, once the phenomena of triggering factors and relapse are better understood, a quantitative tool can be constructed and subjected to statistical analysis.
Reference
Polit, D. F., & Beck, C. T. (2021). Nursing research: Generating and assessing evidence for nursing practice. Wolters Kluwer
2) LB
Working for several years in the medical stabilization of patients with severe malnutrition due to their eating disorders had led me to many questions in terms of the catalysts in their disease processes. I often wonder about our patients after they have left our care mostly going to a residential treatment facility, and then hopefully to home. Mostly, we dont get to know about our patients and whether or not they have successfully recovered unless they re-admit to our unit in the future. Occasionally, we get updates that provide a glimpse of patients lives months after they have left our care. Patients will mention what kinds of support they continue to use, such as a partial hospital problem or outpatient therapist. Sometimes they mention sort of catalyzing factors to their recovery, such as attending a yoga class that made them realize that they wanted to value the strength of their body, cutting off contact with a friend who cannot stop making self-deprecating comments about their own body, or switching careers to one that makes them feel more connected to their communities.
A qualitative research question could ask patients who both meet certain criteria of and self-identify with recovery from their eating disorder if they believed there was a catalyst to their recovery that set in motion meaningful change and what it was. This would be phenomenological research, as it starts with a particular research question (Polit & Beck, 2021). If this research were to occur without the assumption of catalyzing events or factors, it would be conducted with a grounded theory methodology (Chen & Boore, 2009).
It has seemed to me that meaningful, enduring recovery is often associated with some kind of catalyzing factor, but the quantitative arm of a mixed-methods approach would evaluate whether or not that association is verified by the data. Data could first be collected on years in recovery, number of treatment attempts prior to recovery, and whether or not and how often several typical eating disorder behaviors are occurring. The qualitative interviews would follow quantitative data collection. This would be sequential explanatory mixed-method research, using the qualitative data to explain trends and differences in the quantitative data (Bressan et al., 2016).
References
Bressan, V., Bagnasco, A., Aleo, G., Timmins, F., Barisone, M., Bianchi, M., Pellegrini, R., & Sasso, L. (2017). Mixed-methods research in nursing a critical review. Journal of Clinical Nursing, 26(1920), 28782890. https://doi.org/10.1111/jocn.13631
Chen, H. Y., & Boore, J. R. (2009). Using a synthesised technique for grounded theory in nursing research. Journal of Clinical Nursing, 18(16), 22512260. https://doi.org/10.1111/j.1365-2702.2008.02684.x
Polit, D. F., & Beck, C. T. (2021). Nursing research: Generating and assessing evidence for nursing practice. Wolters Kluwer.
3) AA
Medical Aid in Dying (MAID) has been an area of interest for me not only for this course, but personally as a hospice nurse. Many of my hospice cohorts will support their patients who choose to pursue Medical Aid in Dying and many even choose to be in attendance when the lethal drug is ingested. A research question that sparked my attention would focus on the conscientious objections to Medical Aid in Dying amongst providers.
What number of providers conscientiously object to Medical Aid in Dying in a given hospice company and what are their feelings behind this decision?
This study would be suited for phenomenology as the idea explores what providers have experienced and their perspective on Medical Aid in Dying (Polit & Beck, 2021). Medical Aid in Dying is legal in the state of Colorado and many hospice providers have cared for a patient who has pursued MAID. These providers have lived a variety of experiences that could be shared in this mixed-method research design. According to Starks & Trinidad, 2007, phenomenology begins with a research question, whereas grounded theory is organized to discover a research question for testing. These lived experiences of providers can be used to gather subjective understandings of their own experiences. Ethnographic research would not be used as the researchers would not be observing or interacting directly with the study participants in their real-life environments (Reeves et al., 2008).
This research could be developed in a mixed-method research design by first focusing on the quantitative data looking at the number of hospice providers who conscientiously objected to caring for a patient who pursued or is pursuing Medical Aid in Dying. An exploratory qualitative study based on semi-structured interviews with the hospice providers could be conducted to explore the motives and experiences behind their choice to conscientiously object to care for a patient who pursued MAID.
Reference:
Polit, D. F., & Beck, C. T. (2021). Nursing research: Generating and assessing evidence for nursing practice. Wolters Kluwer.
Reeves, S., Kuper, A., & Hodges, B. D. (2008, August 7). Qualitative research methodologies: Ethnography. The BMJ. Retrieved November 16, 2021, from https://www.bmj.com/content/337/bmj.a1020.full.
Starks, H., & Trinidad, S. B. (2007). Choose your method: a comparison of phenomenology, discourse analysis, and grounded theory. Qualitative health research, 17(10), 13721380. https://doi.org/10.1177/1049732307307031
