Integración metodológica en la investigación de fenómenos complejos en Enfermería / Methodological integration in complex phenomena in Nursing research

El presente artículo pretende analizar y reflexionar en torno a la integración metodológica. Se exponen algunos antecedentes para dar a conocer ciertos aspectos que hicieron posible este binomio en el quehacer investigativo, sin pretender dar cuenta histórica del debate. Se desarrolla una aproximación sobre la integración metodológica, los principios que subyacen su uso, su potencialidad, alcances, limitaciones y desventajas, junto con los aspectos necesarios para la construcción de su diseño. Finalmente, se considera que esta metodología permitiría desarrollar e impulsar el conocimiento de Enfermería hacia una perspectiva más holística e integral, favoreciendo el trabajo trans e interdisciplinario en el quehacer investigativo de enfermería

This article aims to analyze and reflect about methodological integration. Background information introduces certain aspects that made this binomial possible in this research, without providing the historical account of the debate. An approximation about the methodological integration, principles underlying to is use, its potential, scope, limitations and disadvantages, along with the necessary features for building design are developed. Finally, it is considered that this methodology would develop and promote nursing knowledge toward a more holistic and comprehensive perspective, promoting trans and interdisciplinary work in nursing research

Breaking from binaries - using a sequential mixed methods design.

AIM: To outline the traditional worldviews of healthcare research and discuss the benefits and challenges of using mixed methods approaches in contributing to the development of nursing and midwifery knowledge. BACKGROUND: There has been much debate about the contribution of mixed methods research to nursing and midwifery knowledge in recent years. DATA SOURCES: A sequential exploratory design is used as an exemplar of a mixed methods approach. The study discussed used a combination of focus-group interviews and a quantitative instrument to obtain a fuller understanding of women's experiences of childbirth. REVIEW METHODS: In the mixed methods study example, qualitative data were analysed using thematic analysis and quantitative data using regression analysis. DISCUSSION: Polarised debates about the veracity, philosophical integrity and motivation for conducting mixed methods research have largely abated. A mixed methods approach can contribute to a deeper, more contextual understanding of a variety of subjects and experiences; as a result, it furthers knowledge that can be used in clinical practice. CONCLUSION: The purpose of the research study should be the main instigator when choosing from an array of mixed methods research designs. Mixed methods research offers a variety of models that can augment investigative capabilities and provide richer data than can a discrete method alone. IMPLICATIONS FOR PRACTICE/RESEARCH: This paper offers an example of an exploratory, sequential approach to investigating women's childbirth experiences. A clear framework for the conduct and integration of the different phases of the mixed methods research process is provided. This approach can be used by practitioners and policy makers to improve practice.

Children's lived experiences of hematopoietic stem cell transplantation.

Although hematopoietic stem cell transplantation is a valuable treatment in many life-threatening pediatric disorders, a large number of children who receive hematopoietic stem cell transplantation are faced with a variety of physical and psychological problems throughout this process. In this study, we explored the lived experiences of these children during their treatment to provide a better understanding of their main concerns, emotions, and expectations. The participants were six children, aged between 6 and 17 years, who underwent hematopoietic stem cell transplantation. Data were collected through individual, in-depth, and semistructured interviews. Using interpretive phenomenological analysis, the findings revealed that the children experienced "transplantation rejoicing" in this "difficult passage", which was associated with "deepening of family ties". Awareness of these experiences, feelings, and concerns can help in the development of more professional interventions to provide children with holistic care during their hospitalization.

Exploring Heideggerian hermeneutic phenomenology: a perfect fit for midwifery research.

BACKGROUND: Heideggerian hermeneutic phenomenology has been used widely to understand the meaning of lived experiences in health research. For midwifery scholars this approach enables deep understanding of women's and midwives' lived experiences of specific phenomena. However, for beginning researchers this is not a methodology for the faint hearted. It requires a period of deep immersion to come to terms with at times impenetrable language and perplexing concepts. OBJECTIVES: This paper aims to assist midwives to untangle and examine some of the choices they face when they first come to terms with an understanding of this methodology and highlights the methodology's capacity to reveal midwifery authenticity and holistic practice. DISCUSSION: The illumination of a selection of various concepts underpinning hermeneutic phenomenology will inform midwives considering this methodology as suitable framework for exploring contemporary midwifery phenomena.

Fenomenología como método de investigación: Una opción para el profesional de enfermería / Phenomenology as a research method: an option for the nurse

El profesional de enfermería necesita métodos de estudio que le permitan observar al ser humano como un ente indivisible, singular y único en el mundo, que vive, siente y percibe de manera individual y propia. El objetivo de este artículo es analizar la fenomenología como método de investigación (una opción para el profesional de enfermería desde el punto de vista filosófico) y proporcionar elementos que le permitan realizar estudios de tipo cualitativo, ofreciendo una óptica diferente. Se explica cómo surge la fenomenología, sus preceptos, precursores, la visión que tuvieron para analizar las cosas (fenómenos) y el método de estudio que se desarrolló para enfocar su teoría y cómo ésta se fue adaptando a una nueva forma para llevar a cabo la investigación. Asimismo, se desarrolla este método para que los profesionales de la salud puedan comprender el comportamiento humano, aprovechando todos los recursos que se tienen para ofrecer un cuidado holístico.

The nurse needs to study methods that allow you to see the human being as a indivisible, singular, unique in the world you live in, feel and perceive individually and own. The objective of this article is to analyze the phenomenology as a research method: an option for the nurse, from the philosophical point of view and provide elements that allow qualitative studies, offering a different perspective. It describes as phenomenology arises, its precepts, precursors, had the vision to analyze things (phenomena), and the method of study to focus on developing its ideology and how it was adapted to a new way to bring out research. Also this method is developed for health professionals to understand human behavior using all the resources they have to offer holistic care.

Using an auto/biographical approach to investigate nurses' learning.

AIM: To develop methodological discussion about an 'auto/biographical' approach used to research nurses' learning. BACKGROUND: Structuring processes involved in auto/biographical approaches can reinterpret knowledge in different ways and help to examine the boundaries of experience, particularly when exploring what might be marginal spaces in cultures and institutions. The PhD study on which the paper is based explored the learning of registered nurses from two NHS trusts in the south of England. DATA SOURCES: Purposive focus groups and biographical interviews were used as a data collection method. REVIEW METHODS: This is a methodology paper that discusses the auto/biographical approach used in the study to examine people's experiences. DISCUSSION: The focus is on auto/biographical moments as sites of meaning-making in an interconnected analysis frame and on developing a pen portrait to view research processes in more holistic terms. The prevailing argument is that biography offers a way of enabling participants to find a voice through their history. This is about using a personal life story to enter a wider debate of how human activity is directed and organised and assumptions inherent in these processes. CONCLUSION: Auto/biographical methods can offer more holistic approaches to examining experiences by drawing together researcher and participant experiences in wholesome ways that are respectful. The interconnectedness avoids the abstractions that some other methods can sometimes impose, enabling fuller participant involvement in the research processes. IMPLICATIONS FOR PRACTICE/RESEARCH: Auto/biographical approaches appear particularly relevant for researching nursing because of their holistic nature. Implications for practice and research are found in the potential for developing personal and professional knowledge.

Conceptual, holistic, and pragmatic considerations for interviewing research participants.

Interviews are commonly used as data collection method in many types of studies. Interviewers and researchers may be challenged to take a holistic view of the interviewing process and to acknowledge participants' perspectives and experiences, understand the implications of dialogue between interviewers and participants, guide data collection to address research questions and aims of a study, and ensure that high-quality data is collected for analysis. This article addresses the need to integrate a holistic perspective into data collection and reviews general and specific interviewing considerations, including assessment and conceptualization of potential research vulnerability of participants, factors that may influence the quality of data collected through interviews, interviewing strategies, interview facilitation, and specific strategies to acknowledge a specialized population in terms of vulnerability, dialogue, power, and study rigor. Data and exemplars from a grounded theory study of mothers of medically fragile infants are used to illustrate some of the challenges inherent in the use of interviews for data collection.

Having faith: a Parse research method study.

In this article the author reports details of a Parse research study on the lived experience of having faith with 10 participants living in community. The central finding of this study is the structure: The lived experience of having faith is discerning conviction with perpetual alliances arising with fortitude amid adversity . The findings are discussed in relation to the human becoming school of thought and related literature.

Event-oriented data integration: a qualitative strategy in studying professional practice.

The purpose of this article is to present a qualitative mixed-method strategy that uncovers the compound reality in professional practice and the inner aspects of actions, feelings, values, and thoughts embedded therein. The authors developed a systematic strategy for collecting and handling data from different sources. This strategy, called event-oriented data integration represents within-method triangulation as well as triangulation during data analysis. The analysis involves 2 distinctive new steps for structuring of data--the braiding of data threads and the braiding of data ropes. We found that the process of weaving together different data created an inclusive text that allowed the researcher to undertake a holistic, coherent, and consistent analysis and to attain a more complete picture of professional practice.

Evaluating Mindfulness-Based Stress Reduction: analyzing stories of stress to formulate focus group questions.

The primary purpose of this analysis was to learn how therapeutic community (TC) residents describe Mindfulness-Based Stress Reduction (MBSR) delivered as part of their substance use recovery experience. A secondary purpose was to develop focus group questions guided by TC residents' descriptions. Two researchers independently analyzed 38 written stories about stress in the TC. The researchers used conventional content analysis; independent analysis was followed by consensus dialogue to identify key words and code definitions. Three themes emerged from the content analysis: utility, portability, and sustainability. Participants talked about MBSR as a tool which helped them "manage" their recovery, noting that they used MBSR techniques in the TC and off-site. They believed they could use MBSR even after exiting the TC. Three focus group questions were formulated, one for each theme. Content analysis of stories of stress provided substantive guidance for formulating focus group questions which incorporated the voice of participants through familiar terms and friendly language.

Using puppetry to elicit children's talk for research.

Although puppets have been employed by various disciplines in clinical and community (e.g. homes and schools) environments, little has been written about their use as a communication tool in research. In this article, a critical review of the literature is undertaken integrating the use of puppets in a qualitative research study exploring children's perspectives on and responses to a camp for children with cancer. Methodological considerations and ethical issues of using puppets as a data collection technique are discussed. Although some limitations exist, using puppets in interviews with children appear to help them to identify, clarify and verbalize their feelings.

Impact of nurse prescribing: a qualitative study.

AIM: This paper is a report of an investigation of the impact of prescribing on a group of recently qualified nurse prescribers in the United Kingdom. BACKGROUND: The creation of advanced nursing roles, and specific skills such as nurse prescribing, has resulted in nurses taking on roles that have traditionally been associated with doctors. The non-doctor prescribing initiative is continually developing and many nurses are now able to prescribe independently from almost the same range of medicines as doctors. Despite the advantages that appear to stem from nurses prescribing, some nurse researchers have been cautious about the impact that prescribing may have on the nursing profession. METHOD: Interviews were conducted during 2005 and 2006 with 45 nurse prescribers. All nurses had successfully qualified and registered as prescribers. Interviews were analysed thematically in line with the principles of grounded theory. FINDINGS: Prescribing allows nurses to overcome difficulties in the healthcare system that previously delayed patients' access to medicines. Prescribing is viewed as more than an 'add on' to current roles, it complements many aspects of nursing and integrates previously diffuse aspects of the nursing role. This enables nurses to adopt a more holistic approach to patient care and prescribing. Prescribing has the potential to increase job satisfaction and autonomous working, with the result that nurses are more likely to involve patients in decision-making about their care. CONCLUSIONS: Prescribing enhances nurses' knowledge about medication and increases their confidence to engage in prescribing decisions across the healthcare team. Nurse prescribing has the potential to improve service-user care, enhance collaboration and widen discussions about medicines. However, team members need to be prepared for the impact nurse prescribing could have on the dynamics of the multidisciplinary team. Preparatory information about nurse prescribing should be provided to all team members by trainee nurse prescribers. Information could include details about the proposed scope of future prescribing roles, allowing team members to consider how their roles could develop.

A unitary healing praxis model for women in despair.

The evolution of a unitary healing praxis model derived from three unitary appreciative inquiries of despair is described. Explication of unitary appreciative inquiry and how it informed and contributed to the development of the model is provided. The model is based on a conceptualization of healing as appreciating the inherent wholeness of life and provides knowledge specific to the individual lives of women in despair. The process of generative theorizing that led to the creation of the model is explicated. Unitary, appreciative, and participatory responses to despair are integrated in the model, praxis modalities are delineated, key concerns and perspectives of women in despair are addressed, and potentialities for healing are illustrated.

The sonata form of musical composition as a framework for thesis writing.

In response to Watson's challenge to view the usual in new ways, this article introduces an innovation in writing Master's research and suggests that other structures may offer new and different frameworks for reporting nursing research. This is exemplified by reference to an example of nursing research which adopted the sonata-form of musical composition as the framework for presentation of the thesis.

Narrative inquiry: Locating Aboriginal epistemology in a relational methodology.

BACKGROUND: This methodology utilizes narrative analysis and the elicitation of life stories as understood through dimensions of interaction, continuity, and situation. It is congruent with Aboriginal epistemology formulated by oral narratives through representation, connection, storytelling and art. Needed for culturally competent scholarship is an experience of research whereby inquiry into epiphanies, ritual, routines, metaphors and everyday experience creates a process of reflexive thinking for multiple ways of knowing. Based on the sharing of perspectives, narrative inquiry allows for experimentation into creating new forms of knowledge by contextualizing diabetes from the experience of a researcher overlapped with experiences of participants--a reflective practice in itself. AIM: The aim of this paper is to present narrative inquiry as a relational methodology and to analyse critically its appropriateness as an innovative research approach for exploring Aboriginal people's experience living with diabetes. NURSING APPLICATION: Narrative inquiry represents an alternative culture of research for nursing science to generate understanding and explanation of Aboriginal people's 'diabetic self' stories, and to coax open a window for co-constructing a narrative about diabetes as a chronic illness. The ability to adapt a methodology for use in a cultural context, preserve the perspectives of Aboriginal peoples, maintain the holistic nature of social problems, and value co-participation in respectful ways are strengths of an inquiry partial to a responsive and embodied scholarship.

Methodological issues and complementary therapies: researching intangibles?

The increasing drive to adopt evidence-based practice within the mainstream health service creates a sense of urgency for high quality, rigorous research to support CAM. The RCT is seen as the gold standard for allopathic research. However, the tenets of the RCT cannot simply be just picked up and applied to CAM research. Critics of the RCT propose that it fractures and fragments the essence of many complementary therapies. Challenges including standardisation, blinding, randomisation, practitioner influence, placebos, and controls are explored and some possible solutions are presented. CAM researchers need to be creative so that they capture some of the intangibles that currently slip through the reductionist net of the RCT.

Spirituality and life-threatening illness: a phenomenologic study.

PURPOSE/OBJECTIVES: To examine the lived experience of individuals when confronted with a life-threatening disease. RESEARCH APPROACH: Qualitative, phenomenologic using Giorgi's approach. SETTING: Patients' homes in the Midwest. PARTICIPANTS: Five women and two men, aged 44-74 years, who had a variety of diagnoses, including breast cancer, colorectal cancer, prostate cancer, pulmonary fibrosis, and myocardial infarction. METHODOLOGIC APPROACH: Subjects were recruited through flyers posted at support groups and religious establishments and by word of mouth. MAIN RESEARCH VARIABLES: Willingness to volunteer to share their stories. FINDINGS: Participants described how their spirituality provided comfort throughout their journey, strength in facing the life-threatening illness, many blessings despite the hardship of the illness, and trust in a higher power to see them through the journey. All participants described a sense of meaning in their lives throughout their experience. CONCLUSIONS: Spirituality greatly affected patients' journeys through a life-threatening illness and provided a sense of meaning despite the illness. INTERPRETATION: Nurses need to acknowledge patients' spirituality and, in turn, assist patients in meeting their spiritual needs. By understanding the study participants' experiences, nurses can better support their patients, provide time and space for spiritual practices, and honor patients' spiritual journeys.

Research interviews in midwifery.

This third paper in a series on research emphasises the importance of interviews in both qualitative and quantitative research. It explores the key aspects of conducting effective interviews.