Concurrent Mixed Methods Study Research Articles

Nursing leadership and quality of care in a hospital setting: mixed methods research

Objective: to examine and describe the relationship between nursing leadership and the quality of care in the hospital environment. Methods: this concurrent convergent mixed methods study incorporated cross-sectional correlational design and grounded theory. Data were collected among staff nurses at a hospital. Quantitative data were collected using the Brazilian Nursing Work Index-Revised/Leadership subscale with 105 nurses and analyzed by descriptive and inferential statistics. Qualitative data were collected through intensive interviews with 64 participants and analyzed by Charmaz’s method. Subsequently, results from both arms were integrated to generate mixed methods findings. Results: better nursing leadership resulted in better quality of care. Qualitative results supported quantitative results and showed that effective nursing leadership yielded quality of care through different processes: collaborating with nursing staff, encouraging patient advocacy, and enhancing care through research. Conclusion: through mixed methods, the findings can be generalized with a deeper understanding about the phenomenon. Implications are also discussed.

Describing the Health Service Delivery Network of an Urban Poor Area and a Rural Poor Area

Objectives. This study aimed to assess the health workforce’s service capacities within a health Service Delivery Network (SDN) of an urban poor and a rural poor setting.
 Methods. This is a concurrent mixed-methods study implemented in Navotas and Masbate, an urban poor and a rural poor area, respectively. Health needs of the residents were assessed through records review, qualitative methods and a household survey. Health facilities in the identified SDN were assessed using the Service Availability and Readiness Assessment (SARA) tool. Training data of Human Resource for Health (HRH) were also obtained.
 Results. SDN in the two areas are different in terms of formality where memoranda of agreement were prepared between Masbate facilities but not in Navotas. Health worker to population ratios were 12.1 per 10,000 in Navotas and 2.7 in Masbate, respectively. The primary care facilities in the two sites met the recommended level of trainings for health workers in obstetric care, immunization, childhood nutrition and tuberculosis. There was a lack of post-graduate training in non-communicable diseases in all facilities. Poverty and geography were significant factors affecting health service delivery.
 Conclusion. In terms of human resources, both sites have limited number of health workers and the ratios fall far below WHO guideline. Recommendations include: Primary health care staff complement should be increased in the two SDNs. HHRDB should conduct a study to settle the issue of continuing medical education requirements that are not congruent with WHO recommendations. The SDNs should include the access of medicines and commodities by poor patients in private facilities during times of stock outs. Also, during stock outs or unavailability of government health personnel, transportation should be made available via the SDN to transport poor patients to private or nongovernment facilities with the needed personnel. The DOH and HHRDB should investigate innovative strategies for telehealth services that do not require continuous electricity, nor telephone or cellphone signal.

Providers' assessment of a novel interactive health information technology in a pediatric intensive care unit.

ObjectiveTo explore perceptions of critical care providers about a novel collaborative inpatient health information technology (HIT) in a pediatric intensive care unit (PICU) setting.MethodsThis cross-sectional, concurrent mixed methods study was conducted in the PICU of a large midwestern children’s hospital. The technology, the Large Customizable Interactive Monitor (LCIM), is a flat panel touch screen monitor that displays validated patient information from the electronic health record. It does not require a password to login and is available in each patient’s room for viewing and interactive use by physicians, nurses, and families. Quantitative data were collected via self-administered, standardized surveys, and qualitative data via in-person, semistructured interviews between January and April 2015. Data were analyzed using descriptive statistics and inductive thematic analysis.ResultsThe qualitative analysis showed positive impacts of the LCIM on providers’ workflow, team interactions, and interactions with families. Providers reported concerns regarding perceived patient information overload and associated anxiety and burden for families. Sixty percent of providers thought that LCIM was useful for their jobs at different levels, and almost 70% of providers reported that LCIM improved information sharing and communication with families. The average overall satisfaction score was 3.4 on a 0 to 6 scale, between “a moderate amount” and “pretty much.”Discussion and ConclusionThis study provides new insight into collaborative HIT in the inpatient pediatric setting and demonstrates that using such technology has the potential to improve providers’ experiences with families and just-in-time access to EHR information in a format more easily shared with families.

The acceptability, effectiveness, and impact of different models of care for pediatric weight management services: protocol for a concurrent mixed-methods study

BackgroundPediatric obesity is a serious, but clinically neglected, chronic health problem. Despite the high prevalence, excess weight problems are rarely managed when children attend clinical services. It is recommended that obesity treatment uses a “chronic-care” approach to management, with different types and intensity of treatment dependent upon severity of obesity. There are several new secondary and tertiary weight management services being implemented within New South Wales (NSW), Australia in 2017/2018 with differing models of care. This study will ascertain what factors affect acceptability, reach, and participation, as well as measure the clinical effectiveness of these services.MethodsThis is a acceptability and effectiveness study building upon existing and planned secondary and tertiary level service delivery in several health districts. This study will recruit participants from seven different pediatric weight management services (PWMS) across five Local Health Districts in NSW, Australia. Using a mixed-methods approach we will document a range of process, impact and clinical outcome measures in order to better understand the context and the effectiveness of each PWMS model. The project development and implementation is guided by the Theoretical Domains Framework. Participants will include parents of children less than 18 years of age attending PWMS, clinicians working as part of PWMS and health service managers. Data will be captured using a combination of anthropometric measures, questionnaires, one-on-one semi-structured interviews and focus groups.DiscussionResults from this study will assess the acceptability and effectiveness of different models of care for pediatric weight management. Such information is required to inform long-term sustainability and scalability of secondary and tertiary care services to the large number of families with children above a healthy weight.

Liderança em enfermagem e qualidade do cuidado em ambiente hospitalar: pesquisa de métodos mistos

Objetivo: examinar e descrever a relação entre liderança em enfermagem e qualidade do cuidado no ambiente hospitalar. Métodos: estudo concomitante e convergente de métodos mistos que incorporou um delineamento correlacional transversal e teoria fundamentada. Os dados quantitativos foram coletados por meio da subescala Liderança do Brazilian Nursing Work Index-Revised, com 105 enfermeiros de um hospital e analisados por meio de estatística descritiva e inferencial. Os dados qualitativos foram coletados por meio de entrevistas com 64 participantes e analisados pelo método de Charmaz. Posteriormente, os achados foram integrados para gerar os resultados dos métodos mistos. Resultados: os resultados qualitativos apoiaram os quantitativos e mostraram que a liderança de enfermagem eficaz gerou qualidade de atendimento por meio de colaboração com a equipe de enfermagem, incentivo à advocacia do paciente e melhoria do atendimento. Conclusão: o uso de métodos mistos possibilita uma compreensão mais profunda do fenômeno. As implicações também são discutidas.

Deployment communication: Underlying processes and outcomes.

This concurrent embedded mixed methods study explored important aspects of communication occurring between military service members and their intimate partners during a combat deployment to Iraq or Afghanistan. Fifty-eight participants (32 military veterans and 26 non-veteran partners) participated in an interview using standardized self-report measures assessing the current level of relationship satisfaction, trauma symptoms of the veteran, and the veterans' trauma exposure. Participants also participated in a semistructured interview focused on combat deployment and reintegration experiences. The findings suggested that communication between service members and their intimate partners during deployment is important to maintaining an emotional connection, preventing distancing to ease the transition back, obtaining assurance regarding the safety of the deployed partner, and meeting current needs to be emotionally engaged with their partner. Access to the methods of deployment communication, however, was reported to be highly variable within and across deployments. Planned withholding of unpleasant or distressing information from one's partner appeared to be common and may represent a choice by participants to improve their well-being and outcomes. Recommendations for clinical interventions include preventive programs to help couples discuss their expectations for communication during the deployment. Future research might focus on the development of measures of preferences in deployment communication, as well as the degree of impact of communication on service member duty performance, individual psychological outcomes, and couple-based outcomes. (PsycINFO Database Record

Education Research: Difficult conversations in neurology: Lessons learned from medical students.

To characterize features of medical student exposure to difficult conversations during a neurology core clerkship. This was a cross-sectional concurrent nested mixed methods study, and all students rotating through a required neurology clerkship between 2014 and 2015 were enrolled. Data collection included an electronic communication tracker, baseline and end-of-clerkship surveys, and 4 facilitated focus groups. Students were asked to log exposure to patient-clinician conversations about (1) new disability, (2) poor prognosis, (3) prognostic uncertainty (4), terminal diagnosis, and (5) end-of-life care. A total of 159 students were enrolled and 276 conversations were tracked. Most (70%) students observed at least 1 difficult conversation, and conversations about poor prognosis, new disability, and prognostic uncertainty were most commonly logged. At clerkship end, most students (87%) desired additional bedside training in communication skills. Exposure to one of the predefined conversation types did not improve student perceived preparedness to lead difficult conversations in the future. In focus groups, students noted that the educational value of observation of a difficult conversation could be optimized with preconversation planning and postconversation debriefing. Difficult conversations are common in neurology, and represent a valuable opportunity to provide communication skills training on the wards. Future curricula should consider ways to leverage these existing opportunities to enhance communication skills training.

Emerging HIV Epidemic in the North-Eastern State of Assam, India: An Exploratory Study Using Mixed-Methods Approach

Background: The national HIV scenario in India has improved impressively during past two decades. Contrastingly, the State-level HIV sentinel surveil-lance and routine programme data from various testing facilities indicated an increasing HIV prevalence among antenatal clinic attendees and female sex workers (FSWs) in three districts of Assam. Objectives: 1) To explore the reasons behind increasing adult HIV prevalence and 2) To understand the role of FSW and Migrants/long distance truckers as drivers of the HIV epi-demic in these districts. Methodology: Three sources of data were utilized in this concurrent mixed methods study—1) existing programme data for past three years; 2) questionnaire-based data for a case-control study, where dur-ing past six months at designated testing facilities HIV(+) married women were “cases” and age-matched HIV(?) women from the same district were “controls”. Spouses of these women were also interviewed separately; and 3) a qualitative study, where focus group discussions were conducted among FSWs, outgoing male migrant labourers and long-distance truckers. Results: The study revealed high levels of unsafe sexual practices among the FSWs. Sometimes in poverty-struck areas, women, not identifying themselves as sex workers, sold sex on a part-time basis to earn extra money for financial sup-port and often remained invisible to the programme. The clients of the sex workers, male migrants and truckers also revealed various risk behaviours for contracting and transmitting HIV infection. Conclusion: Population and context specific programme strategies are required to halt the rising trend of HIV infection in the general population in Assam.

American Muslims and vicarious trauma: An explanatory concurrent mixed-methods study.

This explanatory concurrent mixed-methods study aimed to explore vicarious trauma (VT) among American Muslims; whether they are experiencing it, what factors may be contributing, and how they are experiencing VT. VT and religious identity were the main variables of interest for the quantitative data; qualitative questions provided greater insight into participants' personal experiences. Religious identity and ethnicity were found to be significant in the multivariate analysis of variance (MANOVA) model and collectively explained 21% of the variance in VT scores. Phenomenological qualitative analysis of the qualitative responses revealed 9 themes, including humanity (being seen as less than human) and exposure (to trauma material). This study suggests that American Muslims are experiencing VT; in combination with qualitative responses, important policy changes can be recommended: policies addressing hate crimes should be strengthened, individuals in key professions need to be trained in Islam and Muslims, and further media guidelines and training must be conducted. (PsycINFO Database Record

Nurses' perception of knowledge, attitudes and reported practice towards patients with eating disorders: A concurrent mixed-methods study

Eating disorders are complex disorders requiring specialised care, thus knowledge and attitudes are crucial for management. This study aims to examine nurses' knowledge, attitudes, reported practice, and perceptions towards patients with eating disorders in Singapore. A concurrent mixed-methods study was carried out in Southeast Asia's only psychiatric unit with eating disorders programme. Twenty nurses were recruited using census sampling. Quantitative data were analysed with descriptive and inferential statistics, while qualitative data were analysed with content and thematic analysis. Certain personal factors were associated with nurses' levels of perceived knowledge. Different attitudes towards managing these patients were identified during interview sessions.

Developing a positive patient experience with nurses in general practice: An integrated model of patient satisfaction and enablement.

To develop a conceptual model that provides a comprehensive understanding of the structures and processes underpinning patient enablement and satisfaction in general practice nurse consultations. Current evidence regarding patient satisfaction and enablement arising from general practice nursing care is either quantitative or qualitative. To date, no studies have integrated the results of mixed methods research to provide a deeper understanding of processes that facilitate their achievement. A concurrent mixed methods study. Our 2013-2014 concurrent mixed methods study comprised a quantitative study that analysed variables identified in interviews with general practice nurses, patients and practice managers with data from a cross-sectional survey of 678 patients receiving nursing care in 21 general practices; and a qualitative study that used a grounded theory approach to in-depth interviews with nurses and patients from these same practices. Using joint displays, we compared and integrated the results of the multilevel analyses and the grounded theory model derived from these studies. We conceptualized a model-'developing a positive patient experience with nurses in general practice'-in which time, continuity of care, nursing scope of practice and autonomy, and patients' health conditions provide platforms for the processes of triggering healthcare partnerships and tailoring care in nurse consultations. This model builds on previous evidence describing processes and characteristics that optimize the quality of care in general practice nurse consultations. It provides a practical tool to inform education and training for general practice nurses and other clinicians.

Strategies for research engagement of clinicians in allied health (STRETCH): a mixed methods research protocol

IntroductionAllied health professionals (AHPs) report positive attitudes to using research evidence in clinical practice, yet often lack time, confidence and skills to use, participate in and conduct research. A range...

Development of an Assistive Technology Intervention for Community Older Adults

ABSTRACTAim: To explore the use of the Ecological Validity Model as a guiding framework in the provision of a culturally sensitive assistive technology (AT) intervention for community older people. Methods: Twenty-seven Hispanic adults aged 70 years and older and four individuals with expertise in AT participated in a concurrent nested mixed method study where the quantitative method (content validity ratio exercise) was embedded in the dominant qualitative method (focus groups). Results: Findings informed the development of the Assistive Technology Life Enhancement Program (ATLEP), an intervention consisting of seven modules addressing AT devices with culturally sensitive elements. Conclusions: The Ecological Validity Model, as well as the input from older adults, were both effective methodological strategies in tailoring the ATLEP intervention to the needs and circumstances of community-living older people living in Puerto Rico.

The Cross-Cultural Societal Response to SCI: Health and Related Systems.

The Learning Health System for Spinal Cord Injury (LHS-SCI) is an initiative aligned with the World Health Organization's (WHO) Global Disability Action Plan. Based on the outcomes of this initiative, countries will be able to shape their health systems to better respond to the needs of persons with SCI. This paper describes and compares the macroeconomic situation and societal response to SCI across 27 countries from all 6 WHO regions that will participate in the LHS-SCI initiative. A concurrent mixed-methods study was conducted to identify key indicators that describe the situation of persons with SCI, the general societal response, the health and rehabilitation system, and the experience for a SCI person after discharge from inpatient rehabilitation. A strong correlation was found between the efficiency of a healthcare system and the amount a country invests in health. Higher availability of resources does not necessarily imply that unrestricted access to the healthcare system is warranted. Variations in the health systems were found for various domains of the health and rehabilitation systems. The evaluation and comparative analysis of the societal response to SCI raise the awareness of the need of more standardized data to identify current needs and gaps in the quality and access to SCI-specific health system.

Brief mindfulness training in the social work practice classroom

Social Work educators are increasingly concerned with discerning how to help students develop the affective, relational, and meta-cognitive skills needed for effective, resilient, and sustainable social work practice. A small but growing literature supports mindfulness training as a path to those ends. However, most mindfulness intervention studies, even those mentioning ‘brief intervention,’ have typically used fairly lengthy training programs, often 2–3 h per week for 6–8 weeks. It is unlikely that already over-committed social work practice classes would devote this amount of class time to these strategies. This concurrent mixed methods study examined whether very brief mindfulness training in undergraduate social work practice classes (100 min over the course of a 3.0 semester credit hour course) would influence outcomes on measures of mindfulness, emotional regulation, and empathy, as well as student perceptions of helpfulness in managing stress and meeting course goals. No significant differences were found on quantitative measures at post-test. However, results of the qualitative analysis suggest that even brief mindfulness exercises in social work practice classes are perceived by students as helpful for managing anxiety, staying present-focused with clients, reducing premature judgment, and feeling safe and connected in the classroom. Implications for social work education are discussed.

Informing a Canadian paramedic profile: framing concepts, roles and crosscutting themes.

BackgroundParamedicine is a rapidly evolving health profession with increasing responsibilities and contributions to healthcare. This rapid growth has left the profession with unclear professional and clinical boundaries. Existing defining frameworks may no longer align with the practice of paramedicine or expectations of the public. The purpose of this study was to explore the roles paramedics in Canada are to embody and that align with or support the rapid and ongoing evolution of the profession.MethodsWe used a concurrent mixed methods study design involving a focused discourse analysis (i.e., analysis of language used to describe paramedics and paramedicine) of peer reviewed and grey literature (Phase 1) and in-depth one-on-one semi-structured interviews with key informants in Canadian paramedicine (Phase 2). Data from both methods were analyzed simultaneously throughout and after being merged using inductive thematic analysis.ResultsSaturation was reached after 99 national and international grey and peer reviewed publications and 20 in depth interviews with stakeholders representing six provinces, seven different service/agency types, 11 operational roles and seven provider roles. After merging both data sets three framing concepts, six roles and four crosscutting themes emerged that may be significant to both present-day practice and aspirational. Framing concepts, which provide context, include variable contexts or practice, embedded relationships and a health and social continuum. Roles include clinician, health and social advocate, team member, educator, professional and reflective practitioner. Crosscutting themes including patient safety, adaptability, compassion and communication appear to exist in all roles.ConclusionsThe paramedic profession is experiencing a shift that appears to deviate or at least place a tension on traditional views or models of practice. Underlying and evolving notions of practice are resulting in intended or actual clinical and professional boundaries that may require the profession to re-think how it is defined and/or shaped. Until these framing concepts, roles and crosscutting themes are fully understood, tested and operationalized, tensions between guiding frameworks and actual or intended practice may persist.

Athletic Trainer Services in US Private Secondary Schools.

Availability of athletic trainer (AT) services in US secondary schools has recently been reported to be as high as 70%, but this only describes the public sector. The extent of AT coverage in private secondary school settings has yet to be investigated and may differ from the public secondary school setting for several reasons, including differences in funding sources. To determine the level of AT services in US private secondary schools and identify the reasons why some schools did not employ ATs. Concurrent mixed-methods study. Private secondary schools in the United States. Of 5414 private secondary schools, 2044 (38%) responded to the survey. School administrators responded to the survey via telephone or e-mail. This instrument was previously used in a study examining AT services among public secondary schools. Descriptive statistics provided national data. Open-ended questions were evaluated through content analysis. Of the 2044 schools that responded, 58% (1176/2044) offered AT services, including 28% (574/2040) full time, 25% (501/2042) part time, 4% (78/1918) per diem, and 20% (409/2042) from a hospital or clinic. A total of 84% (281 285/336 165) of athletes had access to AT services. Larger private secondary schools were more likely to have AT services available. Barriers to providing AT services in the private sector were budgetary constraints, school size and sports, and lack of awareness of the role of an AT. More than half of the surveyed private secondary schools in the United States had AT services available; however, only 28% had a full-time AT. This demonstrates the need for increased medical coverage to provide athletes in this setting the appropriate level of care. Budgetary concerns, size of the school and sport offerings, and lack of awareness of the role of the AT continued to be barriers in the secondary school setting.

Assessment of cultural competence in Texas nursing faculty

BackgroundCultural competence [CC] is an essential component of nursing education and nursing practice yet there is a gap in the research evaluating CC in faculty and how to practically develop this skillset for faculty members. ObjectivesTo explore CC in faculty as evaluated with the Nurses' Cultural Competence Scale [NCCS] and apply the findings to the Purnell Model of Cultural Competence [PMCC] to guide professional development opportunities for faculty members. DesignThis was a concurrent mixed-methods study. SettingFaculty members teaching in Texas nursing programs were recruited for the study. Quantitative data was collected using an online survey tool and qualitative data was collected over the phone. Participants89 Texas faculty members completed the quantitative strand and a subset of 10 faculty members completed the qualitative strand. MethodsDescriptive statistics were used to examine the quantitative data and Strauss and Corbin's methodology guided the evaluation of the qualitative data. These two strands were used to support the results. ResultsFaculty in Texas are moderately culturally competent. The qualitative findings support the application of the PMCC to the areas identified by the NCCS. ConclusionThe PMCC may be applied to the application of culture and values in nursing professional education as supported by the NCCS. Recommendations are to include the PMCC as a structure for the creation of professional development opportunities for faculty.

Exploratory Study of Breast Cancer Survivors’ Lived Experience: Activity Engagement During and After Breast Cancer Treatment

Abstract Date Presented 4/7/2016 A concurrent mixed-method study of 10 breast cancer survivors showed that extrinsic factors seem to influence participation in important activities more than do intrinsic factors. Instrumental and social activities were 75% of important activities. Survivors retained more instrumental and low-demand activities. Primary Author and Speaker: Anne Fleischer Contributing Author: Max Ito

Evaluation of the effectiveness of robotic gait training and gait-focused physical therapy programs for children and youth with cerebral palsy: a mixed methods RCT.

BackgroundRobot assisted gait training (RAGT) is considered to be a promising approach for improving gait-related gross motor function of children and youth with cerebral palsy. However, RAGT has yet to be empirically demonstrated to be effective. This knowledge gap is particularly salient given the strong interest in this intensive therapy, the high cost of the technology, and the requirement for specialized rehabilitation centre resources.MethodsThis is a research protocol describing a prospective, multi-centre, concurrent mixed methods study comprised of a randomized controlled trial (RCT) and an interpretive descriptive qualitative design. It is a mixed methods study designed to determine the relative effectiveness of three physical therapy treatment conditions (i.e., RAGT, a functional physical therapy program conducted over-ground (fPT), and RAGT + fPT) on gait related motor skills of ambulatory children with cerebral palsy. Children with cerebral palsy aged 5–18 years who are ambulatory (Gross Motor Function Classification System Levels II and III) will be randomly allocated to one of four treatment conditions: 1) RAGT, 2) fPT, 3) RAGT and fPT combined, or 4) a maintenance therapy only control group. The qualitative component will explicate child and parent experiences with the interventions, provide insight into the values that underlie their therapy goals, and assist with interpretation of the results of the RCT.Discussionn/a.Trial RegistrationNCT02391324 Registered March 12, 2015.