The Importance of Qualitative Research to EBP

Abstract

Contemporary psychiatric mental health care incorporates several major elements: (a) assessing growth and developmental processes influencing mental health throughout the lifespan, (b) assessing interpersonal and environmental stressors influencing mental health, (c) assessing and intervening with biologically based pathophysiological conditions, and (d) assessing and intervening with patients’ subjective definitions of their experiences. The symptomatic convergence of these factors is the starting point for the delivery of psychiatric mental health care. Experienced clinicians acknowledge that focusing on these factors is the nexus of beginning to address mental care. The complexity of effective treatment requires defining a plan of care that integrates developmental states, management of life stressors, biologically based treatments, and subjective elements of perceptions, culture, and life experiences. Evidence-based practice (EBP) interventions directed toward interventions on developmental processes, stressors, and pathophysiological conditions have made significant gains over the past two decades. Discoveries in the areas of physiological functions of the developmental, stress response, and neurochemical functions provide new insights into understanding mental illness. The power of these interventions is impressive and facilitates recovery from debilitating conditions. Yet recovery is not complete until patients subjectively make sense of their experiences and integrate an understanding of the events within their lives. Evidence-based interventions on these subjective elements encompassing patients’ lived experiences, such as cognitive difficulties, suffering, and the life impact of trauma on perceptions and relationships, have not progressed as quickly. The absence of studies and interventions related to the subjective elements of psychiatric care is ironic given the psychophenomenological origins of the specialty. Psychiatric mental health care was strongly influenced by the “interpretive psychoanalytic” research model couched in qualitative descriptions of the human experience of mental illness. Although the interpretive aspects of the original psychoanalytic model are often criticized, there can be no debate that the qualitative methodology used to identify patient’s lived experience gave rise to many of the principles still used as a basis for providing psychiatric mental health care. The absence of interventions on the subjective aspects of mental illness is the result of the failed attempts of the dominant quantitative research methodology to address the subjectivity of the human condition. The inability of quantitative research methodologies to effectively capture the “subjectivity” of the human experience is not a criticism of the methodology but an inherent limitation! As a result, EBP interventions for dimensions of the lived human experience are not commonplace. EBP interventions addressing dimensions of “the lived human experience” may be more effectively examined using qualitative research methodologies. The application of qualitative approaches is not contraindicated in EBP. EBP advocates recognize and advocate for the incorporation of qualitative findings (Fineout-Overholt, Melnyk, & Schultz, 2005). Rigor ous scientific applications of qualitative research findings demonstrate an ability to produce some of the most significant EBP interventions for improving mental health and altering the patients’ lived experience. The interventions of Sandelowski, Trimble, Woodard, and Barroso (2006) to reduce the response to stigma associated with human immunodeficiency virus is an exemplary model of an intervention based on qualitative findings. The use of qualitative findings for EBP interventions addressing the patients’ experiences cannot