Qualitative Study
With reference to the acceptable guidelines of quantitative and qualitative research, this study reviews the use of these guidelines in the article “Older Rural Women Moving Up and Moving on in Cardiac Rehabilitation’ in the 2013 Online Journal of Rural Nursing and Health Care, volume 13, issue 2 by Elizabeth N. Austin. Taking a qualitative analysis of Austin’s artcle, the author identifies the purpose of her research as thus of the importance of cardiac rehabilitation (CR) in the process of recovering from a cardiac disease . The study empasizes the need to give a keen consideration on cardiac rehabilitation in women argiuing that it is an area that has received little attention . The study says that this is so especially for older women in the rural areas . Austin (2013) presents the significance of her cardiac rehabilitataion research findings in nursing practice as a bridging process for those who have suffered from a cadiac disease.
Research in nursing and health practice in general may take the form of either a qualitative approach or a quantitative approach . In other cases, researchers may combine the application of both qualitative and qualitative parameters in the course of their research work (Ryan et al., 2007). Use of any of either qualitative or quantitative approach at research must concisely fall within acceptable guidelines in order for the research results to be comprehensive. Unfortunately, in some cases researchers fail to observe these guidelines and as result end up conducting substandard research work and consequently generating substandard research reports. When carrying out a critical analysis of the correct use of the qualitative and quantitative methodologies, it is fundamental to note that these two methodologies are not the same and thus their guidelines thus vary (Ryan et al., 2007). To ensure the believability of a research work as presented in the research report, the research title has to be very clear and void of ambiguity (Ryan et al., 2007). The instruments of articulate writing such as correct grammar, use of language that is easy to understand, and proper paper formatting and idea arrangement and flow are fundamental (Ryan et al., 2007). Finally, the author’s qualification has to prove that the author is well versed with the subject matter of the research (Ryan et al., 2007).
For instance, in this particular report, unless you are able to locate the report online in the scholarly database, you may never know who the author is and as a result may never know what his or her qualifications are. In this way, it is a bit challenging to establish the believability of such a report or in the first instance the associated research work. The title itself is also somehow ambiguous and does not tell the reader directly what the article is about will initial clarity. The report also lacks the robustness that a proper research pare should have. For example, a robust research paper should clearly indicate elements such as the purpose guiding the research, a thesis statement and a clear literature review (Ryan et al., 2007). Other elements include; the theoretical framework used, research methodology, research sample, consideration of ethical framework, mode and credibility of data collection and analysis, discussion of findings and a summary of the research such as conclusion and or recommendation (Ryan et al., 2007). Finally, the report should clearly portray the correct use of cited materials in the research report within the article as in-text citations and the availing of a bibliography / reference list at the end of the article (Ryan et al., 2007).
In a properly done qualitataive reasearch study, the sample being studied and the sample study method should clearly be a sufficient representative of the population being studied . This way, the sample used may enhance the credibility of the study as being trully representataive and thus avoid possible dispute and discrediting of the research findings (Caldwell et al., 2005). Austin’s research work was designed on the basis of recording the life experiences through interviwes of each of the women that were part of the study . The interviews were carried out within a span of two weeks through priorly prepared transcripts . The reaserch sample comprised of 10 womwn aged between 60 and 83 years old . A sample of 10 representatives out of a perceived possible population of 500 people for a rural population was slightly small. A sample size of at leat 10%, that is 50 represenatatives would be appropirate. The study also based its findings on reespresenataatives who had been diagnosed with different kinds of cardiac diseases . To comply with ethical gudelnes, th study protected the privacy of the sample represenatatives including the facilities in which theoir diagnoses were done .
In every research study report, it is important to ensure that when reference source material are used in developing research work, the relevance of these sources should be in tandem with the proposed research intentions. The use of these source materials should also be well articulated in the specific research report or article and their correlation with subject of discussion clearly delineated. Vague use of in-text citations for example, using an in-text citation with incorrect or minimal discussion on its relationship with the subject of discussion may result to a substandard research report. A review of in-text citation in the article shows commendable use of the certain sources. One such source is (Spencer et al., 2001) in which the author states the susceptibility of women to subsequent illnesses despite the fact that a very few of them are referred to a cardiac rehabilitation program . A second source that is well used is (AACVPR, 2004) from which the author reiterates that the virtue of the female gender influences the etiology and susceptibility of women to cardiac diseases highly than men . Third source is (Lee, 1998) and (Lee & Winters, 2006) from which the author reminiscent the rural environment as having a role-play in the attitude and perception of women in regards to their health and thus acts a predisposing factor to poor referral to a cardiac rehabilitation program . Fourthly, the author quotes the definition or a rural place as described (United States Census Bureau, 2002) to identify her appropriate site from which her sample is derived . Finally, the reference of (Whitehead, 2004) one question model in approaching an interview process is commendable. The question used by the author was that of knowing the samples representatives’ experience with their cardiac health .
The use of cited sources such as those by (Barnett, Braham, & Halverson, 1998), (Morgan, Fahs, & Klesh, 2007), (Truglio-Londrigan, Gallagher, Sosanya, & Hendrickson-Slack, 2006), were irrelevant and inconsistent with the topic of discussion. For example, the use of (Barnett, Braham, & Halverson, 1998), (Morgan, Fahs, & Klesh, 2007) to describe an action undertaken by the Centre for Disease Control (CDC) is not clearly correlated to the subject of the research study. Again the use of (Marshall & Rossman, 2006) and (Truglio-Londrigan, Gallagher, Sosanya, & Hendrickson-Slack, 2006) do not show a relationship that is consistent to the topic of discussion. Sources such as (Gulanick, Gavic, Kramer, & Rey, 2002), (Josephson, Casey, Waechter, Rosneck, & Hughes, 2006; Todaro, Shen, Niaura, & Tikemeier, 2005) were not used with the correct citation guidelines though they were used to describe and justify why the quality of life for women being different from that of men made them more susceptible to cardiac diseases than men . However, the author did not discuss how the difference in quality of life between men and women contributed to the vulnerability of women to cardiac diseases more than men are. Certain sources are mentioned though with minimal discussion of how they relate to the research topic. For example, (Ayala et al., 2003) has been referred to indicate recommendation of lifestyle modifications in cardiac rehabilitation program although the specific lifestyle modifications have not been mentioned nor how they contribute to the cardiac rehabilitation program or the life of the individual have not been stated. The mentioning of (Moore, Dolansky, Ruland, Pashkow, & Blackburn, 2003) on the minimal involvement of women in cardiac rehabilitation research programs does not further explain the repercussions or the impacts of such an occurrence and thus vaguely used.
Finally, there are sources that have been cited even though unaccompanied with discussions correlating them to the subject of discussion of the research work. An example includes (Gulanick, Gavic, Kramer, & Rey, 2002) for which only quality of life is mentioned. Another reference is made on (Josephson, Casey, Waechter, Rosneck, & Hughes, 2006) and (Todaro, Shen, Niaura, & Tikemeier, 2005) for which depressive symptomatology is mentioned. A similar case is made on (Plager, 1994), in which the reference is cited in the middle of a statement discussing hermeneutic phenomenology.
The article describes the methodology used to carry out the research with specific activities that accompanied the methodologies. For example, the methodology was designed to apply the use of phenomenological study in which sample representatives were interviewed on their experiences relating to the subject of the research . The study also clearly states that the research work was carried out in the rural areas of Pennsylvania and New York . the rationale given by the author of the study for choice of these specific sites was that the coronary heart disease (CHD) related deaths recorded amongst rural women in the Appalachia region in which Pennsylvania and New York were higher than any other region in the United States of America . The study also describes the process in which the sample representatives were enrolled in the research. The sample representatives consisted of ten women aged between 60 and 80 . Some of these women lived with their spouses while some lived independently . There were those who were employed full time while others worked part-time .The criteria allowed only women who had previously suffered from cardiac diseases and had been discharged after completing phase two of the cardiac rehabilitation program .
Quantitative Study
Olivia (2010) in her paper titled “A Closer Look at Nurse Case Management of Community-Dwelling Older Adults,” conducts an exploratory study on certain Registered Nurse (RN) characteristics using longitudinal data from Center for Medicare & Medicaid Services (CMS). The paper is motivated by the prevalence of chronic diseases in the USA. According to the Center for Disease Control and Prevention CDC, chronic diseases was the leading cause of both disability and death in the USA. The most common chronic diseases are heart disease, cancer, stroke, arthritis and type 2 diabetes. Data by CDC reveals that as at 2012, approximately half of the US adult population (around 117 million) were suffering from at least one chronic condition and one in every four adult had at least two chronic conditions simultaneously. Heart diseases and cancer were the leading causes of death; accounting for 48 percent of all deaths. Similarly, arthritis was the leading cause of disability with almost have of arthritis patients suffering from disability. The situation is aggravated for senior citizens because they have low immunity and failing muscles. Olivia (2010) points out that beneficiaries of Medicare who suffer from chronic diseases often require an average of eleven physicians a year to manage their conditions. Consequently, it elevates the costs of healthcare. Given that the worrying trend of chronic diseases in unlikely to reverse soon, there is consensus on the need for case management and evidence based disease management to cater for old patients with chronic diseases as a means of providing quality care and substantially reducing healthcare costs. The research sought to assess the impact of the role that RN play in management of chronically ill patients. Therefore, the primary research question was:
Are Nurse-led Care Management (NCM) activities, type, time and timing associated with readmission frequency in older adults with primary diagnosis of congestive heart failure?
The independent variables are Nurse-led Care Management (NCM) activities. Olivia (2010) used 20 categories of NCMs. Therefore, there were 20 independent variables. The dependent variable was health outcomes of older adult patients. The researcher was interested in only one outcome: readmission frequency.
The study purposes to identify evidence of the outcomes of NCM in older adults suffering from chronic diseases with emphasis to cognitive heart failure. The specific outcome that the research sought to assess was readmission frequency. The study findings are significant in deducing evidence or lack of it for NCM. NCM can significantly reduce disease management costs and save taxpayers in terms of Medicare reimbursement costs. This is because NCM are cheaper compared to regular visits to physicians and readmissions.
Olivia (2010) discusses extensively literature on the topic and uses the finding to refine the methodology of the study and support the need for an additional paper on the topic. Hamner (2005) assesses the impact of nursing intervention on the outcomes of CHF patients. Hamner assesses four models of nursing intervention: multi-disciplinary intervention, home-based intervention, technology based and heart failure clinics. Hamner reveals that all the four models have positive outcomes on CHF patients in terms of mortality. Similarly, Naylor (2000) evaluates programs aimed at improving discharge outcomes among older patients. The study revealed that evidence based management significantly improved post-discharge outcomes of senior citizens who were admitted with chronic cardio vascular diseases. Besides, it also significantly reduced the cost healthcare. The study recommended adoption of care management models based on care givers and registered nurses.
Olivia (2010) employs an exploratory secondary analysis that is based on longitudinal data generated from randomized control trials (RCT) over a period of 5 years for RN case management of beneficiaries of Medicare who suffer from chronic diseases who are at least 65 years old. The data was collected from one of the fifteen NCM that are financed by Centers for Medicare & Medicaid Services (CMC) which was referred to as Medicare Coordinated Care Demonstration (MCCD). The data comprised of a treatment group of 1,500 as well as a control group of 1,500 patients. Olivia (2010) selected the data because it directly addresses the primary question. The target population is also similar to what the researcher was interested in evaluating. MCCD intended to test coordination effects of senior Medicare beneficiaries. The study participants had one or more of the following chronic conditions: congestive heart failure, atrial fibrillation, coronary artery disease, diabetes mellitus or asthma. The researcher was only interested in patients who suffered from congestive heart failure. Olivia (2010) analyzed the relationship between type, timing and time of twenty Nursing Intervention Categories (NIC) of older adults CHF patients and readmission rates. The data was analyzed using various software. Microsoft Excel was used to conduct a descriptive analysis. SPSS and SAS were used for ANOVA, Wilcoxon ranking and for multiple logistic regression. Descriptive statistics revealed that NCMs attend to patients for an average of 26 minutes in a month in documenting NCMs activities and 34 minutes for the other 19 intervention categories. RN spends at least 25 percent of their time on educating patients on various aspects of managing chronic diseases. Wilcoxon ranking revealed that patients that did not have inpatient readmission received a significantly higher NCM based on time allocation compared to those who were readmitted at 5 percent significance level. ANOVA analysis revealed that the difference in the mean case management time for CHF patients by NCM compared to all inclusion patients was not statistically significant at 5 percent. A multiple logistic regression analysis revealed that NCM reduced the odds of readmission of CHF patients.
The study sought to assess evidence of the outcomes of NCM in older adults suffering from chronic diseases with emphasis to cognitive heart failure using longitudinal data. The study revealed that patients that had zero inpatient readmission received a significantly higher NCM based on time allocation compared to those who had positive readmission rates at 5 percent significance level. Similarly, the chances of readmission of CHF older patients is lower among patients who received NCM. Therefore, it can be concluded that NCM results in positive outcomes for CHF patients. The study recommends adoption of NCM as a way of improving management of chronic illnesses among older patients. Given the prevalence of chronic illness, it will save the government substantial costs that is spend in treating those diseases. Besides, patient will receive better quality healthcare resulting in better outcomes for the patients.
However, Olivia (2010) acknowledges some limitations that maybe useful in refining future studies. First, the study did not use data from the control group. Therefore, causal relationship could not be identified. Secondly, classification information for the CHF patients was not available. Hence, the study made an unrealistic assumption that all patients had the same disease severity. Lastly, the study ignored the role played by other healthcare professional. Care management is provided by RN in collaboration with other healthcare professionals such as counselors, social workers and therapists.
Comparison of the two studies
The two studies have their own unique strengths and weakness. The strengths of the qualitative study happen to be the weakness of the quantitative study and the contrary is also true.
Firstly, the qualitative study allows for variation in responses. It is more accommodative as it is flexible. For instance, Austin (2013) clearly evaluates the diversity of experiences. On the contrary, the quantitative study is restricted and assumes uniformity. Olivia (2010) acknowledges that study assumed equal disease severity which is not the case. Quantitative studies have to make simplifying assumptions to facilitate computations. Secondly, qualitative studies allow measurement of outcomes from patients’ perspective. Austin (2013) documents the experiences of patients. It is the patients’ welfare that the research is intended in addressing. On the contrary, quantitative research assumes it knows what is best for patients and does not incorporate their perceptions, feelings or desires. Olivia (2010) only considers readmission rates.
The quantitative, on other hand, is objective. It relies on a measure that can be quantified and assessed. However, qualitative studies document patients’ experiences which can easily be manipulated. Besides, study participants can lie to achieve certain personal goals. Secondly, quantitative studies ensure certainty in results as they employ simplifying assumptions. Qualitative studies do not have parameters result in broad results that are difficult to interpret or generalize.
References
Austin, E. N. (2013). Older rural women moving up and moving on in cardiac rehabilitation. Online Journal of Rural Nursing and Health Care, 13(2), 23-55.
Caldwell, K., Henshaw, L., & Taylor, G. (2005). Developing a framework for critiquing health research. Journal of Health, Social and Environmental Issues , 6(1), 45-54.
CDC. (2013). Chronic Diseases: The Leading Causes of Death and Disability in the United States. Retrieved from http://www.cdc.gov: http://www.cdc.gov/chronicdisease/overview/
Hamner, J. (2005). State of the science: posthospitalization nursing interventions in congestive heart failure. Advances in Nursing Science, 175-190.
Naylor, M. (2000). A decade of transitional care research with vulnarable elders. Journal of Cardiovascular Diseases, 1-14.
Olivia, N. (2010). A Closer Look at Nurse Case Management of Community-Dwelling Older Adults. Professional Case Management, 90-100.
Ryan, F., Coughlan, M., & Cronin, P. (2007). Step-by-step guide to critiquing research. Part 2: qualitative research. British Journal of Nursing, 16(12), 738-744.
