qualitative and quantitative nursing research topics

Best Nursing Research Topics for Students

What is a nursing research paper.

• What They Include
• Choosing a Topic
• Best Nursing Research Topics
• Research Paper Writing Tips

Writing a research paper is a massive task that involves careful organization, critical analysis, and a lot of time. Some nursing students are natural writers, while others struggle to select a nursing research topic, let alone write about it.

If you're a nursing student who dreads writing research papers, this article may help ease your anxiety. We'll cover everything you need to know about writing nursing school research papers and the top topics for nursing research.  

Continue reading to make your paper-writing jitters a thing of the past.

A nursing research paper is a work of academic writing composed by a nurse or nursing student. The paper may present information on a specific topic or answer a question.

During LPN/LVN and RN programs, most papers you write focus on learning to use research databases, evaluate appropriate resources, and format your writing with APA style. You'll then synthesize your research information to answer a question or analyze a topic.

BSN , MSN , Ph.D., and DNP programs also write nursing research papers. Students in these programs may also participate in conducting original research studies.

Writing papers during your academic program improves and develops many skills, including the ability to:

• Select nursing topics for research
• Conduct effective research
• Analyze published academic literature
• Format and cite sources
• Synthesize data
• Organize and articulate findings

About Nursing Research Papers

When do nursing students write research papers.

You may need to write a research paper for any of the nursing courses you take. Research papers help develop critical thinking and communication skills. They allow you to learn how to conduct research and critically review publications.

That said, not every class will require in-depth, 10-20-page papers. The more advanced your degree path, the more you can expect to write and conduct research. If you're in an associate or bachelor's program, you'll probably write a few papers each semester or term.

Do Nursing Students Conduct Original Research?

Most of the time, you won't be designing, conducting, and evaluating new research. Instead, your projects will focus on learning the research process and the scientific method. You'll achieve these objectives by evaluating existing nursing literature and sources and defending a thesis.

However, many nursing faculty members do conduct original research. So, you may get opportunities to participate in, and publish, research articles.

Example Research Project Scenario:

In your maternal child nursing class, the professor assigns the class a research paper regarding developmentally appropriate nursing interventions for the pediatric population. While that may sound specific, you have almost endless opportunities to narrow down the focus of your writing. 

You could choose pain intervention measures in toddlers. Conversely, you can research the effects of prolonged hospitalization on adolescents' social-emotional development.

What Does a Nursing Research Paper Include?

Your professor should provide a thorough guideline of the scope of the paper. In general, an undergraduate nursing research paper will consist of:

Introduction : A brief overview of the research question/thesis statement your paper will discuss. You can include why the topic is relevant.

Body : This section presents your research findings and allows you to synthesize the information and data you collected. You'll have a chance to articulate your evaluation and answer your research question. The length of this section depends on your assignment.

Conclusion : A brief review of the information and analysis you presented throughout the body of the paper. This section is a recap of your paper and another chance to reassert your thesis.

The best advice is to follow your instructor's rubric and guidelines. Remember to ask for help whenever needed, and avoid overcomplicating the assignment!

How to Choose a Nursing Research Topic

The sheer volume of prospective nursing research topics can become overwhelming for students. Additionally, you may get the misconception that all the 'good' research ideas are exhausted. However, a personal approach may help you narrow down a research topic and find a unique angle.

Writing your research paper about a topic you value or connect with makes the task easier. Additionally, you should consider the material's breadth. Topics with plenty of existing literature will make developing a research question and thesis smoother.

Finally, feel free to shift gears if necessary, especially if you're still early in the research process. If you start down one path and have trouble finding published information, ask your professor if you can choose another topic.

The Best Research Topics for Nursing Students

You have endless subject choices for nursing research papers. This non-exhaustive list just scratches the surface of some of the best nursing research topics.

1. Clinical Nursing Research Topics

• Analyze the use of telehealth/virtual nursing to reduce inpatient nurse duties.
• Discuss the impact of evidence-based respiratory interventions on patient outcomes in critical care settings.
• Explore the effectiveness of pain management protocols in pediatric patients.

2. Community Health Nursing Research Topics

• Assess the impact of nurse-led diabetes education in Type II Diabetics.
• Analyze the relationship between socioeconomic status and access to healthcare services.

3. Nurse Education Research Topics

• Review the effectiveness of simulation-based learning to improve nursing students' clinical skills.
• Identify methods that best prepare pre-licensure students for clinical practice.
• Investigate factors that influence nurses to pursue advanced degrees.
• Evaluate education methods that enhance cultural competence among nurses.
• Describe the role of mindfulness interventions in reducing stress and burnout among nurses.

4. Mental Health Nursing Research Topics

• Explore patient outcomes related to nurse staffing levels in acute behavioral health settings.
• Assess the effectiveness of mental health education among emergency room nurses .
• Explore de-escalation techniques that result in improved patient outcomes.
• Review the effectiveness of therapeutic communication in improving patient outcomes.

5. Pediatric Nursing Research Topics

• Assess the impact of parental involvement in pediatric asthma treatment adherence.
• Explore challenges related to chronic illness management in pediatric patients.
• Review the role of play therapy and other therapeutic interventions that alleviate anxiety among hospitalized children.

6. The Nursing Profession Research Topics

• Analyze the effects of short staffing on nurse burnout .
• Evaluate factors that facilitate resiliency among nursing professionals.
• Examine predictors of nurse dissatisfaction and burnout.
• Posit how nursing theories influence modern nursing practice.

Tips for Writing a Nursing Research Paper

The best nursing research advice we can provide is to follow your professor's rubric and instructions. However, here are a few study tips for nursing students to make paper writing less painful:

Avoid procrastination: Everyone says it, but few follow this advice. You can significantly lower your stress levels if you avoid procrastinating and start working on your project immediately.

Plan Ahead: Break down the writing process into smaller sections, especially if it seems overwhelming. Give yourself time for each step in the process.

Research: Use your resources and ask for help from the librarian or instructor. The rest should come together quickly once you find high-quality studies to analyze.

Outline: Create an outline to help you organize your thoughts. Then, you can plug in information throughout the research process. 

Clear Language: Use plain language as much as possible to get your point across. Jargon is inevitable when writing academic nursing papers, but keep it to a minimum.

Cite Properly: Accurately cite all sources using the appropriate citation style. Nursing research papers will almost always implement APA style. Check out the resources below for some excellent reference management options.

Revise and Edit: Once you finish your first draft, put it away for one to two hours or, preferably, a whole day. Once you've placed some space between you and your paper, read through and edit for clarity, coherence, and grammatical errors. Reading your essay out loud is an excellent way to check for the 'flow' of the paper.

Helpful Nursing Research Writing Resources:

Purdue OWL (Online writing lab) has a robust APA guide covering everything you need about APA style and rules.

Grammarly helps you edit grammar, spelling, and punctuation. Upgrading to a paid plan will get you plagiarism detection, formatting, and engagement suggestions. This tool is excellent to help you simplify complicated sentences.

Mendeley is a free reference management software. It stores, organizes, and cites references. It has a Microsoft plug-in that inserts and correctly formats APA citations.

Don't let nursing research papers scare you away from starting nursing school or furthering your education. Their purpose is to develop skills you'll need to be an effective nurse: critical thinking, communication, and the ability to review published information critically.

Choose a great topic and follow your teacher's instructions; you'll finish that paper in no time.

Joleen Sams is a certified Family Nurse Practitioner based in the Kansas City metro area. During her 10-year RN career, Joleen worked in NICU, inpatient pediatrics, and regulatory compliance. Since graduating with her MSN-FNP in 2019, she has worked in urgent care and nursing administration. Connect with Joleen on LinkedIn or see more of her writing on her website.

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150 Qualitative and Quantitative Nursing Research Topics for Students

Do not be lazy to spend some time researching and brainstorming. You can either lookup for the popular nursing research topics on social media networks or news or ask a professional writer online to take care of your assignment. What you should not do for sure is refuse to complete any of your course projects. You need every single task to be done if you wish to earn the highest score by the end of a semester.

In this article, we will share 150 excellent nursing research topics with you. Choose one of them or come up with your own idea based on our tips, and you’ll succeed for sure!

Table of Contents

Selecting the Top Ideas for Your Essays in Healthcare & Medicine

Would you like to learn how to pick research paper topics for nursing students? We will share some tips before offering lists of ideas.

Start with the preliminary research. You can get inspired on various websites offering ideas for students as well as academic help. Gather with your classmates and brainstorm by putting down different themes that you can cover. You should take your interests into consideration, but still, remember that ideas must relate to your lessons recently covered in class. You have to highlight keywords and main phrases to use in your text.

Before deciding on one of the numerous nursing school research topics, you should consult your tutor. Make sure that he or she approves the idea. Start writing only after that.

50 Popular Nursing Research Topics

Are you here to find the most popular research topics? They change with each new year as the innovations and technologies move on. We have collected the top discussed themes in healthcare for you.

• Problems Encountered by the Spouses of the Patients with Dyslexia
• Ethics in Geriatrics
• Checklist for the Delivery Room Behavior
• Parkinson Disease: Causes and Development
• Exercises Used to Improve Mental Health
• Effective Tips for Antenatal Treatment
• Syndrome of the Restless Legs: How to Treat It
• Behavior Assessment in Pediatric Primary Care
• Why Can Mother’s Health Be under the Threat During the Child Birth?
• Recommendations for Creating Strong Nursing Communities
• Alzheimer’s Disease and Proper Treatment
• Pre-Term Labor Threats
• Music Therapy and Lactation
• Influence of Ageism on Mental Health
• Newborn Resuscitation Practices
• Effective Therapy for Bladder Cancer
• Approaches to Improving Emotional Health of Nurses
• Skin-to-skin Contact by mothers and Its Consequences
• Does a Nurse Have a Right to Prescribe Drugs?
• Research on Atrial Fibrillation
• Pros & Cons of Water Birth
• Prevention Measures for Those Who Have to Contact Infectious Diseases
• Stroke Disease and Ways to Cure It
• The Role of Governmental Policies on the Hiring of Healthcare Professionals
• Demands for the Critical Care
• Joint Issue Research in Elderly Population
• Why Should Nurses and Healthcare Workers Cooperate?
• The Role of Good Leadership Skills in Nursing Profession
• How to Minimize the Threat of Cardiovascular Problems
• What Should a Nurse Do When an Elderly Refuses to Eat?
• Main Reasons for the Depression to Occur
• Methods Used to Detect an Abused Elderly Patient
• Treatment and Prevention of Acne and Other Skin Problems
• Consequences of the So-Called “Cold Therapy”
• End-of-Life Care Interventions That Work
• Risk factors for Osteoporosis in Female Population
• Alcohol Addiction and How to Get Rid of It
• Emerging Ethical Problems in Pain Management
• Psychiatric Patient Ethics
• How to Teach Female Population about Menopause Management
• Reasons for Aged Patients to Use Alcohol in Nursing Homes
• Family Engagement in Primary Healthcare
• Do the Race and Gender of a Patient Play a Role in Pain Management?
• PTSD in the Veterans of the United States Army
• How to Prepare a Nurse for Primary Healthcare
• The Correlation between Teen Aggression and Video Games
• Outcomes of Abdominal Massage in Critically Sick Population
• Developing an Effective Weight Loss Program: Case Study
• Comparing and Contrasting Public Health Nursing Models in Various Regions
• Mirror Therapy for Stroke Patients Who Are Partially Paralyzed

50 Interesting Nursing Research Topics

Do you wish to impress the target audience? Are you looking for the most interesting nursing research topics? It is important to consider time and recently covered themes. People tend to consider a topic an interesting one only if it is relevant. We have prepared the list of curious ideas for your project.

• Reasons for Hypertensive Diseases
• Self-Care Management and Sickle Cell Grown-Up Patients
• Schizophrenia Symptoms, Treatment, and Diagnostics
• Acute Coronary Syndrome Care
• Getting Ready with Caesarean Section
• What Are Some of the Cold and Cough Medicines?
• Why Do Patients Suffer from Anxiety Disorders?
• Use of the Forbidden Substances in Medicine
• How to Make Wise and Safe Medical Decisions
• CV Imaging Procedure
• Complementary vs. Alternative Therapy
• Can Some Types of Grains Prevent Cardiovascular Diseases?
• Restrictions of Medical Contracts
• How to Cope with High Levels of Stress
• Legal Threats with Non-English Patients
• The Basics of Palliative Care
• Clinical Cardiology Innovations
• How to Reduce Body Temperature in Household Conditions
• What Causes Type II Diabetes?
• Ways to Control Blood Pressure at Home
• Dental/Oral Health in the US
• Is There a Gender Bias in Nursing Profession?
• Gyno Education for the Young Girls
• Bipolar Disorder and Its Main Symptoms
• Methods Used to Recover after Physical Traumas
• The Principles of Sports Medicine
• The Gap between Female and Male Healthcare Professionals
• Increasing the Efficiency of Asthma Management in Educational Establishments
• Different Roles of Clinical Nurses
• Case Study: Successful Treatment of Migraine
• In-depth Analysis of the Ovarian Disorder
• Distant Intensive Treatment Until Questions
• Proper Treatment of Sleep Disorders
• How to Overcome Stressful Situations during Night Shifts
• Effective Methods to Prevent Breast Cancer
• Future of Healthcare & Medicine (Based on Modern Innovations)
• Approaches to Treating Insomnia
• Reproductive Endocrinology
• Diversity in the Field of Medicine
• Issues Associated with Menopause
• Causes and Effects of the Vaginal Atrophy
• Is Child’s Health Insurance a Right or a Privilege?
• Best Practices for Nursing Practitioners
• What Does the Phenomenon of Phantom Pains Stand for?
• Ethical Aspects of Infertility
• Protocol for Headache Treatment
• Moral Aspects of Euthanasia
• Treatment of Homeless People
• Why Should Healthcare System Be Made Free Everywhere in the World?
• Pain Restrictions Evaluation

50 Good Nursing Research Topics

Here is one more list of the nursing topics for research paper. We hope that at least one of these ideas will inspire you or give a clue.

• Advantages of Pet Therapy in Kids with the Autism Disorder
• Contemporary Approaches to Vaccinating Teenagers
• eHealth: The Effectiveness of Telecare and eCare
• Burn-Out in the Nursing Profession: Effective Ways to Handle Stress
• Healing of Bone Injuries
• Providing Spiritual Care: Does It Make Sense?
• Rheumatoid Arthritis: Opioid Usage
• Symptoms in ER That Cannot Be Explained by Medicine
• Contemporary Neonatal Practices
• Disorders with the Sexual Heath of an Average Woman
• Typical Causes of Headache
• Top Measures Used to Prevent Pregnancy
• Strategies Used by Government to Finance Healthcare System
• The Possible Consequences of Abortion for Women
• Evaluation of Childbirth Efficacy
• Quality Evaluation Techniques in Healthcare & Medicine
• Maternal Practices in Urban Areas
• Childcare Services Integration in Primary Medicine
• Rules for Pregnant Women Who Suffer from Obesity
• Mental Causes of Anorexia Nervosa
• Self-Instruction Kits
• Post-Natal Period Recommendations
• Midwifery Continuous Treatment & Care
• Case Study: Analyzing Positive Birth Experience
• Issues Related to the Gestational Weight Gain
• The Importance of Healthy Nutrition and Hydration
• What Are the Obligations of Every Nurse in Any Situation?
• Causes, Symptoms, and Treatment of ADHD
• Management of Disease and Prevention Methods
• The Importance of Kid and Teen Vaccination
• Termination of Pregnancy: Risks for Female Health
• Obligations of Every Pharmacist
• How to Prevent Child Obesity
• How to Stick to the Safe Sex Culture
• What Are the Main Symptoms of Autism?
• Ethics of the Healthcare Sales Promotion Campaigns
• Pros and Cons of Telemedicine
• Ethics in Pediatric Care
• Therapies Used to Treat Speech Disorders
• Medical Uniform Code Principles
• Psychological Sides of Infant Treatment
• Reasons for Seizures to Happen in Young Adolescents
• Healthcare Home Service and Self-Medicine
• How to Deal with Various Types of Eating Disorders
• Treatment of Patients in Prison
• Patient Security and Human Factors
• Bad Habits and Illnesses Impacted by Social Media and Pop Culture
• Apology Legislation and Regulations
• Antibiotic Resistance in Small Kids
• Nursing Marijuana Management & Control

You should also know that there are qualitative and quantitative nursing research topics. If you decide to base your study on numbers and figures, you should think about the second category. In quantitative research papers, writers must provide statistical data and interpret it to defend a thesis statement or find a solution to the existing problem.

Keep in mind that you can always count on the help of our professional essay writers. They will come up with the good nursing research topics and even compose the whole paper for you if you want.

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Introduction to qualitative nursing research

This type of research can reveal important information that quantitative research can’t.

• Qualitative research is valuable because it approaches a phenomenon, such as a clinical problem, about which little is known by trying to understand its many facets.
• Most qualitative research is emergent, holistic, detailed, and uses many strategies to collect data.
• Qualitative research generates evidence and helps nurses determine patient preferences.

Research 101: Descriptive statistics

Differentiating research, evidence-based practice, and quality improvement

How to appraise quantitative research articles

All nurses are expected to understand and apply evidence to their professional practice. Some of the evidence should be in the form of research, which fills gaps in knowledge, developing and expanding on current understanding. Both quantitative and qualitative research methods inform nursing practice, but quantitative research tends to be more emphasized. In addition, many nurses don’t feel comfortable conducting or evaluating qualitative research. But once you understand qualitative research, you can more easily apply it to your nursing practice.

What is qualitative research?

Defining qualitative research can be challenging. In fact, some authors suggest that providing a simple definition is contrary to the method’s philosophy. Qualitative research approaches a phenomenon, such as a clinical problem, from a place of unknowing and attempts to understand its many facets. This makes qualitative research particularly useful when little is known about a phenomenon because the research helps identify key concepts and constructs. Qualitative research sets the foundation for future quantitative or qualitative research. Qualitative research also can stand alone without quantitative research.

Although qualitative research is diverse, certain characteristics—holism, subjectivity, intersubjectivity, and situated contexts—guide its methodology. This type of research stresses the importance of studying each individual as a holistic system (holism) influenced by surroundings (situated contexts); each person develops his or her own subjective world (subjectivity) that’s influenced by interactions with others (intersubjectivity) and surroundings (situated contexts). Think of it this way: Each person experiences and interprets the world differently based on many factors, including his or her history and interactions. The truth is a composite of realities.

Qualitative research designs

Because qualitative research explores diverse topics and examines phenomena where little is known, designs and methodologies vary. Despite this variation, most qualitative research designs are emergent and holistic. In addition, they require merging data collection strategies and an intensely involved researcher. (See Research design characteristics .)

Although qualitative research designs are emergent, advanced planning and careful consideration should include identifying a phenomenon of interest, selecting a research design, indicating broad data collection strategies and opportunities to enhance study quality, and considering and/or setting aside (bracketing) personal biases, views, and assumptions.

Many qualitative research designs are used in nursing. Most originated in other disciplines, while some claim no link to a particular disciplinary tradition. Designs that aren’t linked to a discipline, such as descriptive designs, may borrow techniques from other methodologies; some authors don’t consider them to be rigorous (high-quality and trustworthy). (See Common qualitative research designs .)

Sampling approaches

Sampling approaches depend on the qualitative research design selected. However, in general, qualitative samples are small, nonrandom, emergently selected, and intensely studied. Qualitative research sampling is concerned with accurately representing and discovering meaning in experience, rather than generalizability. For this reason, researchers tend to look for participants or informants who are considered “information rich” because they maximize understanding by representing varying demographics and/or ranges of experiences. As a study progresses, researchers look for participants who confirm, challenge, modify, or enrich understanding of the phenomenon of interest. Many authors argue that the concepts and constructs discovered in qualitative research transcend a particular study, however, and find applicability to others. For example, consider a qualitative study about the lived experience of minority nursing faculty and the incivility they endure. The concepts learned in this study may transcend nursing or minority faculty members and also apply to other populations, such as foreign-born students, nurses, or faculty.

Qualitative nursing research can take many forms. The design you choose will depend on the question you’re trying to answer.

A sample size is estimated before a qualitative study begins, but the final sample size depends on the study scope, data quality, sensitivity of the research topic or phenomenon of interest, and researchers’ skills. For example, a study with a narrow scope, skilled researchers, and a nonsensitive topic likely will require a smaller sample. Data saturation frequently is a key consideration in final sample size. When no new insights or information are obtained, data saturation is attained and sampling stops, although researchers may analyze one or two more cases to be certain. (See Sampling types .)

Some controversy exists around the concept of saturation in qualitative nursing research. Thorne argues that saturation is a concept appropriate for grounded theory studies and not other study types. She suggests that “information power” is perhaps more appropriate terminology for qualitative nursing research sampling and sample size.

Data collection and analysis

Researchers are guided by their study design when choosing data collection and analysis methods. Common types of data collection include interviews (unstructured, semistructured, focus groups); observations of people, environments, or contexts; documents; records; artifacts; photographs; or journals. When collecting data, researchers must be mindful of gaining participant trust while also guarding against too much emotional involvement, ensuring comprehensive data collection and analysis, conducting appropriate data management, and engaging in reflexivity.

Data usually are recorded in detailed notes, memos, and audio or visual recordings, which frequently are transcribed verbatim and analyzed manually or using software programs, such as ATLAS.ti, HyperRESEARCH, MAXQDA, or NVivo. Analyzing qualitative data is complex work. Researchers act as reductionists, distilling enormous amounts of data into concise yet rich and valuable knowledge. They code or identify themes, translating abstract ideas into meaningful information. The good news is that qualitative research typically is easy to understand because it’s reported in stories told in everyday language.

Evaluating a qualitative study

Evaluating qualitative research studies can be challenging. Many terms—rigor, validity, integrity, and trustworthiness—can describe study quality, but in the end you want to know whether the study’s findings accurately and comprehensively represent the phenomenon of interest. Many researchers identify a quality framework when discussing quality-enhancement strategies. Example frameworks include:

• Trustworthiness criteria framework, which enhances credibility, dependability, confirmability, transferability, and authenticity
• Validity in qualitative research framework, which enhances credibility, authenticity, criticality, integrity, explicitness, vividness, creativity, thoroughness, congruence, and sensitivity.

With all frameworks, many strategies can be used to help meet identified criteria and enhance quality. (See Research quality enhancement ). And considering the study as a whole is important to evaluating its quality and rigor. For example, when looking for evidence of rigor, look for a clear and concise report title that describes the research topic and design and an abstract that summarizes key points (background, purpose, methods, results, conclusions).

Application to nursing practice

Qualitative research not only generates evidence but also can help nurses determine patient preferences. Without qualitative research, we can’t truly understand others, including their interpretations, meanings, needs, and wants. Qualitative research isn’t generalizable in the traditional sense, but it helps nurses open their minds to others’ experiences. For example, nurses can protect patient autonomy by understanding them and not reducing them to universal protocols or plans. As Munhall states, “Each person we encounter help[s] us discover what is best for [him or her]. The other person, not us, is truly the expert knower of [him- or herself].” Qualitative nursing research helps us understand the complexity and many facets of a problem and gives us insights as we encourage others’ voices and searches for meaning.

When paired with clinical judgment and other evidence, qualitative research helps us implement evidence-based practice successfully. For example, a phenomenological inquiry into the lived experience of disaster workers might help expose strengths and weaknesses of individuals, populations, and systems, providing areas of focused intervention. Or a phenomenological study of the lived experience of critical-care patients might expose factors (such dark rooms or no visible clocks) that contribute to delirium.

Successful implementation

Qualitative nursing research guides understanding in practice and sets the foundation for future quantitative and qualitative research. Knowing how to conduct and evaluate qualitative research can help nurses implement evidence-based practice successfully.

When evaluating a qualitative study, you should consider it as a whole. The following questions to consider when examining study quality and evidence of rigor are adapted from the Standards for Reporting Qualitative Research.

Jennifer Chicca is a PhD candidate at the Indiana University of Pennsylvania in Indiana, Pennsylvania, and a part-time faculty member at the University of North Carolina Wilmington.

Amankwaa L. Creating protocols for trustworthiness in qualitative research. J Cult Divers. 2016;23(3):121-7.

Cuthbert CA, Moules N. The application of qualitative research findings to oncology nursing practice. Oncol Nurs Forum . 2014;41(6):683-5.

Guba E, Lincoln Y. Competing paradigms in qualitative research . In: Denzin NK, Lincoln YS, eds. Handbook of Qualitative Research. Thousand Oaks, CA: SAGE Publications, Inc.;1994: 105-17.

Lincoln YS, Guba EG. Naturalistic Inquiry . Thousand Oaks, CA: SAGE Publications, Inc.; 1985.

Munhall PL. Nursing Research: A Qualitative Perspective . 5th ed. Sudbury, MA: Jones & Bartlett Learning; 2012.

Nicholls D. Qualitative research. Part 1: Philosophies. Int J Ther Rehabil . 2017;24(1):26-33.

Nicholls D. Qualitative research. Part 2: Methodology. Int J Ther Rehabil . 2017;24(2):71-7.

Nicholls D. Qualitative research. Part 3: Methods. Int J Ther Rehabil . 2017;24(3):114-21.

O’Brien BC, Harris IB, Beckman TJ, Reed DA, Cook DA. Standards for reporting qualitative research: A synthesis of recommendations. Acad Med . 2014;89(9):1245-51.

Polit DF, Beck CT. Nursing Research: Generating and Assessing Evidence for Nursing Practice . 10th ed. Philadelphia, PA: Wolters Kluwer; 2017.

Thorne S. Saturation in qualitative nursing studies: Untangling the misleading message around saturation in qualitative nursing studies. Nurse Auth Ed. 2020;30(1):5. naepub.com/reporting-research/2020-30-1-5

Whittemore R, Chase SK, Mandle CL. Validity in qualitative research. Qual Health Res . 2001;11(4):522-37.

Williams B. Understanding qualitative research. Am Nurse Today . 2015;10(7):40-2.

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What is Qualitative Research?

Qualitative research  is research that seeks to provide understanding of human experience , perceptions, motivations, intentions, and behaviors based on description and observation , utilizing a naturalistic interpretative approach to a subject and its contextual setting. Observations in qualitative research are described in words .

Qualitative research starts with a situation the researcher can observe. One of the goals of qualitative research design is that participants are comfortable with the researcher and can be honest and forthcoming, allowing the researcher to make robust observations. Some examples of qualitative research methods include open-ended interviews, focus groups, and participant observation.

Adapted from  Finding Quantitative or Qualitative Nursing Research Articles (Simmons University)

Types of Qualitative Research

The following are the most common types of qualitative research methods:

Case Study  - Describes in-depth the experience of one person, family, group, community, or institution. Data is collected through direct observation and interaction with the subject.

Ethnography  - Describes a culture's characteristics. The researcher identifies the culture, variables, and review literature, then collects data through immersion into the culture, informants, direct observation, and interaction with subjects.

Grounded Theory  - The purpose of this research is theory development. Grounded theory is used in discovering what problems exist in a social scene and how persons handle them. It involves formulation, testing, and redevelopment of propositions until a theory is developed. Data is collected through interview, observation, record review, or a combination.

Historical Research  - Used to describe and examine events of the past to understand the present and anticipate potential future effects. An idea is formulated after reading related literature, followed by the development of a research question and an inventory of sources. The researcher clarifies the validity and reliability of data from primary sources, then develops a research outline and collects data.

Phenomenology  - Describes experiences as they are lived. The researcher examines the uniqueness of individuals' lived situations and develops research questions from these observations. There is no clearly defined method of data collection to avoid limiting the creativity of the researcher.

Adapted from Qualitative Research Designs

Selected eBooks (Qualitative Designs and Methods Series)

Video Resources

An Introduction to Qualitative Research  (1 hour, 20 mins) From Academic Videos Online, this video presented by Jaime Dyce covers six areas: an introduction to qualitative research, qualitative data collection, qualitative data analysis, qualitative research in action, writing a qualitative research report, and ethics.

Fundamentals of Qualitative Research Methods: What is Qualitative Research? (YouTube) Qualitative research is a strategy for systematic collection, organization, and interpretation of phenomena that are difficulty to measure quantitatively. Dr. Leslie Curry from Yale University leads us through six modules covering essential topics in qualitative research, including what is qualitative research and how to use the most common methods, in-depth interviews and focus groups.

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What is qualitative research?

Qualitative research  in Nursing approaches a clinical question from a place of unknowing in an attempt to understand the complexity, depth, and richness of a particular situation from the perspective of the person or persons impacted by the situation (i.e., the subjects of the study).

Study subjects may include the patient(s), the patient's caregivers, the patient's family members, etc. Qualitative research may also include information gleaned from the investigator's or researcher's observations.

While typically more subjective than quantitative research (which focuses on measurements and numbers), qualitative research still employs a systematic approach.

Qualitative research  is generally preferred over quantitative research (which on measurements and numbers) when the clinical question centers around life experiences or meaning.

Adapted from:

• Wilson, B., Austria, M.J., & Casucci, T. (2021 March 21).  Understanding Quantitative and Qualitative Approaches  
• Chicca, J. (2020 June 5).  Introduction to qualitative nursing research.   American Nurse Journal.

Where can I find qualitative research?

Qualitative research can be found in numerous databases. Some good starting options are:

• CINAHL Ultimate Journal articles and eBooks in nursing and allied health.
• MEDLINE (EBSCOhost Web) Journal articles in medicine, life sciences, health care, and biomedical research.
• APA PsycINFO Articles from journals, newspapers, and magazines, along with eBooks in nearly every social science subject area.
• PubMed Citation search of journal articles and books in health and life sciences.

How can I find qualitative research?

Cinahl and/or  medline.

• Start at the Advanced Search  screen.
• Add a search term that represents the topic you are interested in into one (or more) of the search boxes.
• Scroll down until you see the Limit your results  section.
• Qualitative - High Sensitivity (broadest category/broad search)
• Qualitative - High Specificity (narrowest category/specific search)
• Qualitative - Best Balance (somewhere in between)
• Select or click the search button.

APA PsycINFO

• Start at the Advanced Search  screen.
• Use the  Methodology menu to select  Qualitative .

• Use the drop-down menu next the Enter search term  box to set the search to MeSH Terms
• Qualitative Research
• Nursing Methodology Research

How can I use keywords to search for qualitative research?

Try adding adding a keyword that might specifically identify qualitative research. You could add the term qualitative  to your search and/or your could add different types of qualitative research according to your specific needs and/or research assignment.

For example, consider the following types of qualitative research in light of the types of questions a researcher might be trying to answer with each qualitative research type: 

•   Clinical question: What happens to the quality of nursing practice when we implement a peer-mentoring system?
• Clinical question: How is patient autonomy promoted by a unit?
• Clinical question: What is the nursing role in end-of-life decisions?
• Clinical question: What discourses are used in nursing practice and how do they shape practice?
• Clinical question: How does Filipino culture influence childbirth experiences?
• Clinical question: What are the immediate underlying psychological and environmental causes of incivility in nursing?
• Clinical question: How does the basic social process of role transition happen within the context of advanced practice nursing transitions?
• Clinical question: When and why did nurses become researchers?
• Clinical question: How does one live with a diagnosis of scleroderma?
• Clinical question:  What is the lived experience of nurses who were admitted as patients on their home practice units?

Adapted from: Chicca, J. (2020 June 5).  Introduction to qualitative nursing research . American Nurse Journal.

Need more help?

Finding relevant qualitative research can be both difficult and time consuming. Once you conduct a search, you will need to review your search results and look at individual articles, their subject terms, and abstracts to determine if they are truly qualitative research articles. And that's a determination that only you can make.

If you still need help after trying the search strategies and tips suggested on this research guide, we encourage you to schedule an in-person or Zoom research appointment . Health Services librarian Rachel Riffe-Albright is a great bet, but any librarian would be happy to help!

Additonal resources on qualitative research

The following are research guides created by other academic libraries. While you likely will not have access to any of their linked resources, the tips and tricks shared may be useful to you as you search for qualitative research:

• What is Qualitative Research? from UTA Libraries at University of Texas Arlington
• Finding Qualitative Research Articles from Ashland University Library
• Finding Qualitative Research Articles from the Health Sciences Library at University of Washington
• Advanced Search Guide: Qualitative and Quantitative Studies from Southern Connecticut State University Library
• Finding Qualitative and Quantitative Studies in CINAHL from Southern Connecticut State University Library
• << Previous: Searching by Author & Theory
• Next: Searching for Systematic Reviews & Controlled Trials >>
• Last Updated: Apr 22, 2024 2:39 PM
• URL: https://libguides.eku.edu/nursing

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Library Research Guides - University of Wisconsin Ebling Library

Uw-madison libraries research guides.

• Course Guides
• Subject Guides
• University of Wisconsin-Madison
• Research Guides
• Nursing Resources
• Types of Research within Qualitative and Quantitative

Nursing Resources : Types of Research within Qualitative and Quantitative

• Definitions of
• Professional Organizations
• Nursing Informatics
• Nursing Related Apps
• EBP Resources
• PICO-Clinical Question
• Types of PICO Question (D, T, P, E)
• Secondary & Guidelines
• Bedside--Point of Care
• Pre-processed Evidence
• Measurement Tools, Surveys, Scales
• Types of Studies
• Table of Evidence
• Qualitative vs Quantitative
• Cohort vs Case studies
• Independent Variable VS Dependent Variable
• Sampling Methods and Statistics
• Systematic Reviews
• Review vs Systematic Review vs ETC...
• Standard, Guideline, Protocol, Policy
• Additional Guidelines Sources
• Peer Reviewed Articles
• Conducting a Literature Review
• Systematic Reviews and Meta-Analysis
• Writing a Research Paper or Poster
• Annotated Bibliographies
• Levels of Evidence (I-VII)
• Reliability
• Validity Threats
• Threats to Validity of Research Designs
• Nursing Theory
• Nursing Models
• PRISMA, RevMan, & GRADEPro
• ORCiD & NIH Submission System
• Understanding Predatory Journals
• Nursing Scope & Standards of Practice, 4th Ed
• Distance Ed & Scholarships
• Assess A Quantitative Study?
• Assess A Qualitative Study?
• Find Health Statistics?
• Choose A Citation Manager?
• Find Instruments, Measurements, and Tools
• Write a CV for a DNP or PhD?
• Find information about graduate programs?
• Learn more about Predatory Journals
• Get writing help?
• Choose a Citation Manager?
• Other questions you may have
• Search the Databases?
• Get Grad School information?

Aspects of Quantative (Empirical) Research

♦   Statement of purpose—what was studied and why.

  ♦   Description of the methodology (experimental group, control group, variables, test conditions, test subjects, etc.).

  ♦   Results (usually numeric in form presented in tables or graphs, often with statistical analysis).

♦   Conclusions drawn from the results.

  ♦   Footnotes, a bibliography, author credentials.

Hint: the abstract (summary) of an article is the first place to check for most of the above features.  The abstract appears both in the database you search and at the top of the actual article.

Types of Quantitative Research

There are four (4) main types of quantitative designs: descriptive, correlational, quasi-experimental, and experimental.

samples.jbpub.com/9780763780586/80586_CH03_Keele.pdf

Types of Qualitative Research

http://wilderdom.com/OEcourses/PROFLIT/Class6Qualitative1.htm

• << Previous: Qualitative vs Quantitative
• Next: Cohort vs Case studies >>
• Last Updated: Mar 19, 2024 10:39 AM
• URL: https://researchguides.library.wisc.edu/nursing

• Library Basics
• Searching Databases
• Finding Full Text
• Overview Quantitative vs Qualitative
• Steps for Conducting a Literature Review
• Organizing a Literature Review
• Synthesizing Information for a Literature Review
• NoodleTools

Qualitative and Quantitative Research

In general, quantitative research seeks to understand the causal or correlational relationship between variables through testing hypotheses, whereas qualitative research seeks to understand a phenomenon within a real-world context through the use of interviews and observation. Both types of research are valid, and certain research topics are better suited to one approach or the other. However, it is important to understand the differences between qualitative and quantitative research so that you will be able to conduct an informed critique and analysis of any articles that you read, because you will understand the different advantages, disadvantages, and influencing factors for each approach. 

The table below illustrates the main differences between qualitative and quantitative research. Be aware that these are generalizations, and that not every research study or article will fit neatly into these categories. 

Systematic reviews, meta-analyses, and integrative reviews are not exactly designs, but they synthesize, analyze, and compare the results from many research studies and are somewhat quantitative in nature. However, they are not truly quantitative or qualitative studies.

References:

LoBiondo-Wood, G., & Haber, J. (2010). Nursing research: Methods and critical appraisal for evidence-based practice (7 th ed.). St. Louis, MO: Mosby Elsevier

Mertens, D. M. (2010). Research and evaluation in education and psychology (3 rd ed.). Los Angeles: SAGE

Quick Overview

This 2-minute video provides a simplified overview of the primary distinctions between quantitative and qualitative research.

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• Last Updated: Apr 11, 2024 11:37 AM
• URL: https://stevenson.libguides.com/NURS520

• Research article
• Open access
• Published: 14 June 2021

Nurses in the lead: a qualitative study on the development of distinct nursing roles in daily nursing practice

• Jannine van Schothorst–van Roekel 1 ,
• Anne Marie J.W.M. Weggelaar-Jansen 1 ,
• Carina C.G.J.M. Hilders 1 ,
• Antoinette A. De Bont 1 &
• Iris Wallenburg 1  

BMC Nursing volume  20 , Article number:  97 ( 2021 ) Cite this article

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Transitions in healthcare delivery, such as the rapidly growing numbers of older people and increasing social and healthcare needs, combined with nursing shortages has sparked renewed interest in differentiations in nursing staff and skill mix. Policy attempts to implement new competency frameworks and job profiles often fails for not serving existing nursing practices. This study is aimed to understand how licensed vocational nurses (VNs) and nurses with a Bachelor of Science degree (BNs) shape distinct nursing roles in daily practice.

A qualitative study was conducted in four wards (neurology, oncology, pneumatology and surgery) of a Dutch teaching hospital. Various ethnographic methods were used: shadowing nurses in daily practice (65h), observations and participation in relevant meetings (n=56), informal conversations (up to 15 h), 22 semi-structured interviews and member-checking with four focus groups (19 nurses in total). Data was analyzed using thematic analysis.

Hospital nurses developed new role distinctions in a series of small-change experiments, based on action and appraisal. Our findings show that: (1) this developmental approach incorporated the nurses’ invisible work; (2) nurses’ roles evolved through the accumulation of small changes that included embedding the new routines in organizational structures; (3) the experimental approach supported the professionalization of nurses, enabling them to translate national legislation into hospital policies and supporting the nurses’ (bottom-up) evolution of practices. The new roles required the special knowledge and skills of Bachelor-trained nurses to support healthcare quality improvement and connect the patients’ needs to organizational capacity.

Conclusions

Conducting small-change experiments, anchored by action and appraisal rather than by design , clarified the distinctions between vocational and Bachelor-trained nurses. The process stimulated personal leadership and boosted the responsibility nurses feel for their own development and the nursing profession in general. This study indicates that experimental nursing role development provides opportunities for nursing professionalization and gives nurses, managers and policymakers the opportunity of a ‘two-way-window’ in nursing role development, aligning policy initiatives with daily nursing practices.

Peer Review reports

The aging population and mounting social and healthcare needs are challenging both healthcare delivery and the financial sustainability of healthcare systems [ 1 , 2 ]. Nurses play an important role in facing these contemporary challenges [ 3 , 4 ]. However, nursing shortages increase the workload which, in turn, boosts resignation numbers of nurses [ 5 , 6 ]. Research shows that nurses resign because they feel undervalued and have insufficient control over their professional practice and organization [ 7 , 8 ]. This issue has sparked renewed interest in nursing role development [ 9 , 10 , 11 ]. A role can be defined by the activities assumed by one person, based on knowledge, modulated by professional norms, a legislative framework, the scope of practice and a social system [ 12 , 9 ].

New nursing roles usually arise through task specialization [ 13 , 14 ] and the development of advanced nursing roles [ 15 , 16 ]. Increasing attention is drawn to role distinction within nursing teams by differentiating the staff and skill mix to meet the challenges of nursing shortages, quality of care and low job satisfaction [ 17 , 18 ]. The staff and skill mix include the roles of enrolled nurses, registered nurses, and nurse assistants [ 19 , 20 ]. Studies on differentiation in staff and skill mix reveal that several countries struggle with the composition of nursing teams [ 21 , 22 , 23 ].

Role distinctions between licensed vocational-trained nurses (VNs) and Bachelor of Science-trained nurses (BNs) has been heavily debated since the introduction of the higher nurse education in the early 1970s, not only in the Netherlands [ 24 , 25 ] but also in Australia [ 26 , 27 ], Singapore [ 20 ] and the United States of America [ 28 , 29 ]. Current debates have focused on the difficulty of designing distinct nursing roles. For example, Gardner et al., revealed that registered nursing roles are not well defined and that job profiles focus on direct patient care [ 30 ]. Even when distinct nursing roles are described, there are no proper guidelines on how these roles should be differentiated and integrated into daily practice. Although the value of differentiating nursing roles has been recognized, it is still not clear how this should be done or how new nursing roles should be embedded in daily nursing practice. Furthermore, the consequences of these roles on nursing work has been insufficiently investigated [ 31 ].

This study reports on a study of nursing teams developing new roles in daily nursing hospital practice. In 2010, the Dutch Ministry of Health announced a law amendment (the Individual Health Care Professions Act) to formalize the distinction between VNs and BNs. The law amendment made a distinction in responsibilities regarding complexity of care, coordination of care, and quality improvement. Professional roles are usually developed top-down at policy level, through competency frameworks and job profiles that are subsequently implemented in nursing practice. In the Dutch case, a national expert committee made two distinct job profiles [ 32 ]. Instead of prescribing role implementation, however, healthcare organizations were granted the opportunity to develop these new nursing roles in practice, aiming for a more practice-based approach to reforming the nursing workforce. This study investigates a Dutch teaching hospital that used an experimental development process in which the nurses developed role distinctions by ‘doing and appraising’. This iterative process evolved in small changes [ 33 , 34 , 35 , 36 ], based on nurses’ thorough knowledge of professional practices [ 37 ] and leadership role [ 38 , 39 , 40 ].

According to Abbott, the constitution of a new role is a competitive action, as it always leads to negotiation of new openings for one profession and/or degradation of adjacent professions [ 41 ]. Additionally, role differentiation requires negotiation between different professionals, which always takes place in the background of historical professionalization processes and vested interests resulting in power-related issues [ 42 , 43 , 44 ]. Recent studies have described the differentiation of nursing roles to other professionals, such as nurse practitioners and nurse assistants, but have focused on evaluating shifts in nursing tasks and roles [ 31 ]. Limited research has been conducted on differentiating between the different roles of registered nurses and the involvement of nurses themselves in developing new nursing roles. An ethnographic study was conducted to shed light on the nurses’ work of seeking openings and negotiating roles and responsibilities and the consequences of role distinctions, against a background of historically shaped relationships and patterns.

The study aimed to understand the formulation of nursing role distinctions between different educational levels in a development process involving experimental action (doing) and appraisal.

We conducted an ethnographic case study. This design was commonly used in nursing studies in researching changing professional practices [ 45 , 46 ]. The researchers gained detailed insights into the nurses’ actions and into the finetuning of their new roles in daily practice, including the meanings, beliefs and values nurses give to their roles [ 47 , 48 ]. This study complied with the consolidated criteria for reporting qualitative research (COREQ) checklist.

Setting and participants

Our study took place in a purposefully selected Dutch teaching hospital (481 beds, 2,600 employees including 800 nurses). Historically, nurses in Dutch hospitals have vocational training. The introduction of higher nursing education in 1972 prompted debates about distinguishing between vocational-trained nurses (VNs) and bachelor-trained nurses (BNs). For a long time, VNs resisted a role distinction, arguing that their work experience rendered them equally capable to take care of patients and deal with complex needs. As a result, VNs and BNs carry out the same duties and bear equal responsibility. To experiment with role distinctions in daily practice, the hospital management and project team selected a convenience but representative sample of wards. Two general (neurology and surgery) and two specific care (oncology and pneumatology) wards were selected as they represent the different compositions of nursing educational levels (VN, BN and additional specialized training). The demographic profile for the nursing teams is shown in Table  1 . The project team, comprising nursing policy staff, coaches and HR staff ( N  = 7), supported the four (nursing) teams of the wards in their experimental development process (131 nurses; 32 % BNs and 68 % VNs, including seven senior nurses with an organizational role). We also studied the interactions between nurses and team managers ( N  = 4), and the CEO ( N  = 1) in the meetings.

Data collection

Data was collected between July 2017 and January 2019. A broad selection of respondents was made based on the different roles they performed. Respondents were personally approached by the first author, after close consultation with the team managers. Four qualitative research methods were used iteratively combining collection and analysis, as is common in ethnographic studies [ 45 ] (see Table  2 ).

Shadowing nurses (i.e. observations and questioning nurses about their work) on shift (65 h in total) was conducted to observe behavior in detail in the nurses’ organizational and social setting [ 49 , 50 ], both in existing practices and in the messy fragmented process of developing distinct nursing roles. The notes taken during shadowing were worked up in thick descriptions [ 46 ].

Observation and participation in four types of meetings. The first and second authors attended: (1) kick-off meetings for the nursing teams ( n  = 2); (2) bi-monthly meetings ( n  = 10) between BNs and the project team to share experiences and reflect on the challenges, successes and failures; and (3) project group meetings at which the nursing role developmental processes was discussed ( n  = 20). Additionally, the first author observed nurses in ward meetings discussing the nursing role distinctions in daily practice ( n  = 15). Minutes and detailed notes also produced thick descriptions [ 51 ]. This fieldwork provided a clear understanding of the experimental development process and how the respondents made sense of the challenges/problems, the chosen solutions and the changes to their work routines and organizational structures. During the fieldwork, informal conversations took place with nurses, nursing managers, project group members and the CEO (app. 15 h), which enabled us to reflect on the daily experiences and thus gain in-depth insights into practices and their meanings. The notes taken during the conversations were also written up in the thick description reports, shortly after, to ensure data validity [ 52 ]. These were completed with organizational documents, such as policy documents, activity plans, communication bulletins, formal minutes and in-house presentations.

Semi-structured interviews lasting 60–90 min were held by the first author with 22 respondents: the CEO ( n  = 1), middle managers ( n  = 4), VNs ( n  = 6), BNs ( n  = 9, including four senior nurses), paramedics ( n  = 2) using a predefined topic list based on the shadowing, observations and informal conversations findings. In the interviews, questions were asked about task distinctions, different stakeholder roles (i.e., nurses, managers, project group), experimental approach, and added value of the different roles and how they influence other roles. General open questions were asked, including: “How do you distinguish between tasks in daily practice?”. As the conversation proceeded, the researcher asked more specific questions about what role differentiation meant to the respondent and their opinions and feelings. For example: “what does differentiation mean for you as a professional?”, and “what does it mean for you daily work?”, and “what does role distinction mean for collaboration in your team?” The interviews were tape-recorded (with permission), transcribed verbatim and anonymized.

The fieldwork period ended with four focus groups held by the first author on each of the four nursing wards ( N  = 19 nurses in total: nine BNs, eight VNs, and two senior nurses). The groups discussed the findings, such as (nurses’ perceptions on) the emergence of role distinctions, the consequences of these role distinctions for nursing, experimenting as a strategy, the elements of a supportive environment and leadership. Questions were discussed like: “which distinctions are made between VN and BN roles?”, and “what does it mean for VNs, BNs and senior nurses?”. During these meetings, statements were also used to provoke opinions and discussion, e.g., “The role of the manager in developing distinct nursing roles is…”. With permission, all focus groups were audio recorded and the recordings were transcribed verbatim. The focus groups also served for member-checking and enriched data collection, together with the reflection meetings, in which the researchers reflected with the leader and a member of the project group members on program, progress, roles of actors and project outcomes. Finally, the researchers shared a report of the findings with all participants to check the credibility of the analysis.

Data analysis

Data collection and inductive thematic analysis took place iteratively [ 45 , 53 ]. The first author coded the data (i.e. observation reports, interview and focus group transcripts), basing the codes on the research question and theoretical notions on nursing role development and distinctions. In the next step, the research team discussed the codes until consensus was reached. Next, the first author did the thematic coding, based on actions and interactions in the nursing teams, the organizational consequences of their experimental development process, and relevant opinions that steered the development of nurse role distinctions (see Additional file ). Iteratively, the research team developed preliminary findings, which were fed back to the respondents to validate our analysis and deepen our insights [ 54 ]. After the analysis of the additional data gained in these validating discussions, codes were organized and re-organized until we had a coherent view.

Ethnography acknowledges the influence of the researcher, whose own (expert) knowledge, beliefs and values form part of the research process [ 48 ]. The first author was involved in the teams and meetings as an observer-as-participant, to gain in-depth insight, but remained research-oriented [ 55 ]. The focus was on the study of nursing actions, routines and accounts, asking questions to obtain insights into underlying assumptions, which the whole research group discussed to prevent ‘going native’ [ 56 , 57 ]. Rigor was further ensured by triangulating the various data resources (i.e. participants and research methods), purposefully gathered over time to secure consistency of findings and until saturation on a specific topic was reached [ 54 ]. The meetings in which the researchers shared the preliminary findings enabled nurses to make explicit their understanding of what works and why, how they perceived the nursing role distinctions and their views on experimental development processes.

Ethical considerations

All participants received verbal and written information, ensuring that they understood the study goals and role of the researcher [ 48 ]. Participants were informed about their voluntary participation and their right to end their contribution to the study. All gave informed consent. The study was performed in accordance with the Declaration of Helsinki and was approved by the Erasmus Medical Ethical Assessment Committee in Rotterdam (MEC-2019-0215), which also assessed the compliance with GDPR.

Our findings reveal how nurses gradually shaped new nursing role distinctions in an experimental process of action and appraisal and how the new BN nursing roles became embedded in new nursing routines, organizational routines and structures. Three empirical appeared from the systematic coding: (1) distinction based on complexity of care; (2) organizing hospital care; and (3) evidence-based practices (EBP) in quality improvement work.

Distinction based on complexity of care

Initially, nurses distinguished the VN and BN roles based on the complexity of patient care, as stated in national job profiles [ 32 ]. BNs were supposed to take care of clinically complex patients, rather than VNs, although both VNs and BNs had been equally taking care of every patient category. To distinguish between highly and less complex patient care, nurses developed a complexity measurement tool. This tool enabled classification of the predictability of care, patient’s degree of self-reliance, care intensity, technical nursing procedures and involvement of other disciplines. However, in practice, BNs questioned the validity of assessing a patient’s care complexity, because the assessments of different nurses often led to different outcomes. Furthermore, allocating complex patient care to BNs impacted negatively on the nurses’ job satisfaction, organizational routines and ultimately the quality of care. VNs experienced the shift of complex patient care to BNs as a diminution of their professional expertise. They continuously stressed their competencies and questioned the assigned levels of complexity, aiming to prevent losses to their professional tasks:

‘Now we’re only allowed to take care of COPD patients and people with pneumonia, so no more young boys with a pneumothorax drain. Suddenly we are not allowed to do that. (…) So, your [professional] world is getting smaller. We don’t like that at all. So, we said: We used to be competent, so why aren’t we anymore?’ (Interview VN1, in-service trained nurse).

In discussing complexity of care, both VNs and BNs (re)discovered the competencies VNs possess in providing complex daily care. BNs acknowledged the contestability of the distinction between VN and BN roles related to patient care complexity, as the next quote shows:

‘Complexity, they always make such a fuss about it. (…) At a given moment you’re an expert in just one certain area; try then to stand out on your ward. (…) When I go to GE [gastroenterology] I think how complex care is in here! (…) But it’s also the other way around, when I’m the expert and know what to expect after an angioplasty, or a bypass, or a laparoscopic cholecystectomy (…) When I’ve mastered it, then I no longer think it’s complex, because I know what to expect!’ (Interview BN1, 19-07-2017).

This quote illustrates how complexity was shaped through clinical experience. What complex care is , is influenced by the years of doing nursing work and hence is individual and remains invisible. It is not formally valued [ 58 ] because it is not included in the BN-VN competency model. This caused dissatisfaction and feelings of demotion among VNs. The distinction in complexities of care was also problematic for BNs. Following the complexity tool, recently graduated BNs were supposed to look after highly complex patients. However, they often felt insecure and needed the support of more experienced (VN) colleagues – which the VNs perceived as a recognition of their added value and evidence of the failure of the complexity tool to guide division of tasks. Also, mundane issues like holidays, sickness or pregnancy leave further complicated the use of the complexity tool as a way of allocating patients, as it decreased flexibility in taking over and swapping shifts, causing dissatisfaction with the work schedule and leading to problems in the continuity of care during evening, night and weekend shifts. Hence, the complexity tool disturbed the flexibility in organizing the ward and held possible consequences for the quality and safety of care (e.g. inexperienced BNs providing complex care), Ultimately, the complexity tool upset traditional teamwork, in which nurses more implicitly complemented each other’s competencies and ability to ‘get the work done’ [ 59 ]. As a result, role distinction based on ‘quantifiable’ complexity of care was abolished. Attention shifted to the development of an organizational and quality-enhancing role, seeking to highlight the added value of BNs – which we will elaborate on in the next section.

Organizing hospital care

Nurses increasingly fulfill a coordinating role in healthcare, making connections across occupational, departmental and organizational boundaries, and ‘mediating’ individual patient needs, which Allen describes as organizing work [ 49 ]. Attempting to make a valuable distinction between nursing roles, BNs adopted coordinating management tasks at the ward level, taking over this task from senior nurses and team managers. BNs sought to connect the coordinating management tasks with their clinical role and expertise. An example is bed management, which involves comparing a ward’s bed capacity with nursing staff capacity [ 1 , 60 ]. At first, BNs accompanied middle managers to the hospital bed review meeting to discuss and assess patient transfers. On the wards where this coordination task used to be assigned to senior nurses, the process of transferring this task to BNs was complicated. Senior nurses were reluctant to hand over coordinating tasks as this might undermine their position in the near future. Initially, BNs were hesitant to take over this task, but found a strategy to overcome their uncertainty. This is reflected in the next excerpt from fieldnotes:

Senior nurse: ‘First we have to figure out if it will work, don’t we? I mean, all three of us [middle manager, senior nurse, BN] can’t just turn up at the bed review meeting, can we? The BN has to know what to do first, otherwise she won’t be able to coordinate properly. We can’t just do it.’ BN: ‘I think we should keep things small, just start doing it, step by step. (…) If we don’t try it out, we don’t know if it works.’ (Field notes, 24-05-2018).

This excerpt shows that nurses gradually developed new roles as a series of matching tasks. Trying out and evaluating each step of development in the process overcame the uncertainty and discomfort all parties held [ 61 ]. Moreover, carrying out the new tasks made the role distinctions become apparent. The coordinating role in bed management, for instance, became increasingly embedded in the new BN nursing role. Experimenting with coordination allowed BNs prove their added value [ 62 ] and contributed to overall hospital performance as it combined daily working routines with their ability to manage bed occupancy, patient flow, staffing issues and workload. This was not an easy task. The next quote shows the complexity of creating room for this organizing role:

The BNs decide to let the VNs help coordinate the daily care, as some VNs want to do this task. One BN explains: ‘It’s very hard to say, you’re not allowed.’ The middle manager looks surprised and says that daily coordination is a chance to draw a clear distinction and further shape the role of BNs. The project group leader replies: ‘Being a BN means that you dare to make a difference [in distinctive roles]. We’re all newbies in this field, but we can use our shared knowledge. You can derive support from this task for your new role.’ (Field notes, 09-01-2018).

This excerpt reveals the BNs’ thinking on crafting their organizational role, turning down the VNs wishes to bear equal responsibility for coordinating tasks. Taking up this role touched on nurse identity as BNs had to overcome the delicate issue of equity [ 63 ], which has long been a core element of the Dutch nursing profession. Taking over an organization role caused discomfort among BNs, but at the same time provided legitimation for a role distinction.

Legitimation for this task was also gained from external sources, as the law amendment and the expert committee’s job descriptions both mentioned coordinating tasks. However, taking over coordinating tasks and having an organizing role in hospital care was not done as an ‘implementation’; rather it required a process of actively crafting and carving out this new role. We observed BNs choosing not to disclose that they were experimenting with taking over the coordinating tasks as they anticipated a lack of support from VNs:

BN: ‘We shouldn’t tell the VNs everything. We just need this time to give shape to our new role. And we all know who [of the colleagues] won’t agree with it. In my opinion, we’d be better off hinting at it at lunchtime, for example, to figure out what colleagues think about it. And then go on as usual.’ (Field notes, 12-06-2018).

BNs stayed ‘under the radar’, not talking explicitly about their fragile new role to protect the small coordination tasks they had already gained. By deliberately keeping the evaluation of their new task to themselves, they protected the transition they had set into motion. Thus, nurses collected small changes in their daily routines, developing a new role distinction step by step. Changes to single tasks accumulated in a new role distinction between BNs, VNs and senior nurses, and gave BNs a more hybrid nursing management role.

Evidence-based practices in quality improvement work

Quality improvement appeared to be another key concern in the development of the new BN role. Quality improvement work used to be carried out by groups of senior nurses, middle managers and quality advisory staff. Not involved in daily routines, the working group focused on nursing procedures (e.g. changing infusion system and wound treatment protocols). In taking on this new role BNs tried different ways of incorporating EBP in their routines, an aspect that had long been neglected in the Netherlands. As a first step, BNs rearranged the routines of the working group. For example, a team of BNs conducted a quality improvement investigation of a patient’s formal’s complaint:

Twenty-two patients registered a pain score of seven or higher and were still discharged. The question for BNs was: how and why did this bad care happen? The BNs used electronic patient record to study data on the relations between pain, medication and treatment. Their investigation concluded: nurses do not always follow the protocols for high pain scores. Their improvement plan covered standard medication policy, clinical lessons on pain management and revisions to the patient information folder. One BN said: ‘I really loved investigating this improvement.’ (Field notes, 28-05-2018).

This fieldnote shows the joy quality improvement work can bring. During interviews, nurses said that it had given them a better grip on the outcome of nursing work. BNs felt the need to enhance their quality improvement tasks with their EBP skills, e.g. using clinical reasoning in bedside teaching, formulating and answering research questions in clinical lessons and in multi-disciplinary patient rounds to render nursing work more evidence based. The BNs blended EBP-related education into shift handovers and ward meetings, to show VNs the value of doing EBP [ 64 ]. In doing so, they integrated and fostered an EBP infrastructure of care provision, reflecting a new sense of professionalism and responsibility for quality of care.

However, learning how to blend EPB quality work in daily routines – ‘learning in practice’ –requires attention and steering. Although the BNs had a Bachelor’s degree, they had no experience of a quality-enhancing role in hospital practice [ 65 ]. In our case, the interplay between team members’ previous education and experienced shortcomings in knowledge and skills uncovered the need for further EBP training. This training established the BNs’ role as quality improvers in daily work and at the same time supported the further professionalization of both BNs and VNs. Although introducing the EBP approach was initially restricted to the BNs, it was soon realized that VNs should be involved as well, as nursing is a collaborative endeavor [ 1 ], as one team member (the trainer) put it:

‘I think that collaboration between BNs and VNs would add lots of value, because both add something different to quality work. I’d suggest that BNs could introduce the process-oriented, theoretical scope, while VNs could maybe focus on the patients’ interest.’ (Fieldnote, informal conversation, 11-06-2018).

During reflection sessions on the ward level and in the project team meetings BNs, informed by their previous experience with the complexity tool, revealed that they found it a struggle to do justice to everyone’s competencies. They wanted to use everyone’s expertise to improve the quality of patient care. They were for VNs being involved in the quality work, e.g. in preparing a clinical lesson, conducting small surveys, asking VNs to pose EBP questions and encourage VNs to write down their thoughts on flip over charts as means of engaging all team members.

These findings show that applying EPB in quality improvement is a relational practice driven by mutual recognition of one another’s competencies. This relational practice blended the BNs’ theoretical competence in EBP [ 66 ] with the VNs’ practical approach to the improvement work they did together. As a result, the blend enhanced the quality of daily nursing work and thus improved the quality of patient care and the further professionalization of the whole nursing team.

This study aimed to understand how an experimental approach enables differently educated nurses to develop new, distinct professional roles. Our findings show that roles cannot be distinguished by complexity of care; VNs and BNs are both able to provide care to patients with complex healthcare needs based on their knowledge and experience. However, role distinctions can be made on organizing care and quality improvement. BNs have an important role organizing care, for example arranging the patient flow on and across wards at bed management meetings, while VNs contribute more to organizing at the individual patient level. BNs play a key role in starting and steering quality improvement work, especially blending EBP in with daily nursing tasks, while VNs are involved but not in the lead. Working together on quality improvement boosts nursing professionalization and team development.

Our findings also show that the role development process is greatly supported by a series of small-change experiments, based on action and appraisal. This experimental approach supported role development in three ways. First, it incorporates both formal tasks and the invisible, unconscious elements of nursing work [ 49 ]. Usually, invisible work gets no formal recognition, for example in policy documents [ 55 ], whereas it is crucial in daily routines and organizational structures [ 49 , 60 ]. Second, experimenting triggers an accumulation of small changes [ 33 , 35 ] leading to the embeddedness of role distinctions in new nursing routines, allowing nurses to influence the organization of care. This finding confirms the observations of Reay et al. that nurses can create small changes in daily activities to craft a new nursing role, based on their thorough knowledge of their own practice and that of the other involved professional groups [ 37 ]. Although these changes are accompanied by tension and uncertainty, the process of developing roles generates a certain joy. Third, experimenting stimulated nursing professionalization, enabling the nurses to translate national legislation into hospital policy and supporting the nurses’ own (bottom-up) evolution of practices. Historically, nursing professionalization is strongly influenced by gender and education level [ 43 ] resulting in a subordinate position, power inequity and lack of autonomy [ 44 ]. Giving nurses the lead in developing distinct roles enables them to ‘engage in acts of power’ and obtain more control over their work. Fourth, experimenting contributes to role definition and clarification. In line with Poitras et al. [ 12 ] we showed that identifying and differentiating daily nursing tasks led to the development of two distinct and complementary roles. We have also shown that the knowledge base of roles and tasks includes both previous and additional education, as well as nursing experience.

Our study contributes to the literature on the development of distinct nursing roles [ 9 , 10 , 11 ] by showing that delineating new roles in formal job descriptions is not enough. Evidence shows that this formal distinction led particularly to the non-recognition, non-use and degradation [ 41 ] of VN competencies and discomforted recently graduated BNs. The workplace-based experimental approach in the hospital includes negotiation between professionals, the adoption process of distinct roles and the way nurses handle formal policy boundaries stipulated by legislation, national job profiles, and hospital documents, leading to clear role distinctions. In addition to Hughes [ 42 ] and Abbott [ 67 ] who showed that the delineation of formal work boundaries does not fit the blurred professional practices or individual differences in the profession, we show how the experimental approach leads to the clarification and shape of distinct professional practices.

Thus, an important implication of our study is that the professionals concerned should be given a key role in creating change [ 37 , 39 , 40 ]. Adding to Mannix et al. [ 38 ], our study showed that BNs fulfill a leadership role, which allows them to build on their professional role and identity. Through the experiments, BNs and VNs filled the gap between what they had learned in formal education, and what they do in daily practice [ 64 , 65 ]. Experimenting integrates learning, appraising and doing much like going on ‘a journey with no fixed routes’ [ 34 , 68 ] and no fixed job description, resulting in the enlargement of their roles.

Our study suggests that role development should involve professionalization at different educational levels, highlighting and valuing specific roles rather than distinguishing higher and lower level skills and competencies. Further research is needed to investigate what experimenting can yield for nurses trained at different educational levels in the context of changing healthcare practices, and which interventions (e.g., in process planning, leadership, or ownership) are needed to keep the development of nursing roles moving ahead. Furthermore, more attention should be paid to how role distinction and role differentiation influence nurse capacity, quality of care (e.g., patient-centered care and patient satisfaction), and nurses’ job satisfaction.

Limitations

Our study was conducted on four wards of one teaching hospital in the Netherlands. This might limit the potential of generalizing our findings to other contexts. However, the ethnographic nature of our study gave us unique understanding and in-depth knowledge of nurses’ role development and distinctions, both of which have broader relevance. As always in ethnographic studies, the chances of ‘going native’ were apparent, and we tried to prevent this with ongoing reflection in the research team. Also, the interpretation of research findings within the Dutch context of nurse professionalization contributed to a more in-depth understanding of how nursing roles develop, as well as the importance of involving nurses themselves in the development of these roles to foster and support professional development.

We focused on role distinctions between VNs and BNs and paid less attention to (the collaboration with) other professionals or management. Further research is needed to investigate how nursing role development takes place in a broader professional and managerial constellation and what the consequences are on role development and healthcare delivery.

This paper described how nurses crafted and shaped new roles with an experimental process. It revealed the implications of developing a distinct VN role and the possibility to enhance the BN role in coordination tasks and in steering and supporting EBP quality improvement work. Embedding the new roles in daily practice occurred through an accumulation of small changes. Anchored by action and appraisal rather than by design , the changes fostered by experiments have led to a distinction between BNs and VNs in the Netherlands. Furthermore, experimenting with nursing role development has also fostered the professionalization of nurses, encouraging nurses to translate knowledge into practice, educating the team and stimulating collaborative quality improvement activities.

This paper addressed the enduring challenge of developing distinct nursing roles at both the vocational and Bachelor’s educational level. It shows the importance of experimental nursing role development as it provides opportunities for the professionalization of nurses at different educational levels, valuing specific roles and tasks rather than distinguishing between higher and lower levels of skills and competencies. Besides, nurses, managers and policymakers can embrace the opportunity of a ‘two-way window’ in (nursing) role development, whereby distinct roles are outlined in general at policy levels, and finetuned in daily practice in a process of small experiments to determine the best way to collaborate in diverse contexts.

Availability of data and materials

The data generated and analyzed during the current study is not publicly available to ensure data confidentiality but is available from the corresponding author on reasonable request and with the consent of the research participants.

Abbreviations

Bachelor-trained nurse

Vocational-trained nurse

Evidence-based Practices

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Acknowledgements

The authors would like to thank all participants for their contribution to this study.

The Reinier de Graaf hospital in Delft, who was central to this study provided financial support for this research.

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Jannine van Schothorst–van Roekel, Anne Marie J.W.M. Weggelaar-Jansen, Carina C.G.J.M. Hilders, Antoinette A. De Bont & Iris Wallenburg

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A.W. and I.W. developed the study design. J.S. and A.W. were responsible for data collection, enhanced by I.W. for data analysis and drafting the manuscript. C.H. and A.B. critically revised the paper. All authors have read and approved the manuscript.

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van Schothorst–van Roekel, J., Weggelaar-Jansen, A.M.J., Hilders, C.C. et al. Nurses in the lead: a qualitative study on the development of distinct nursing roles in daily nursing practice. BMC Nurs 20 , 97 (2021). https://doi.org/10.1186/s12912-021-00613-3

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• nursing research
• qualitative research

Readers of Evidence-Based Nursing will be familiar with “review articles.” They are among the most common types of research abstracted for the journal, and although systematic reviews of randomised controlled trials (RCTs) predominantly feature in the Treatment section, reviews that address questions of assessment, causation, quality improvement, prognosis, and quality assessment have also been abstracted. Reviews of qualitative research have been abstracted less frequently—7 times since the journal began in 1998.

Systematic reviews and meta-analyses of RCTs are at the top of the hierarchy for providing evidence of the effectiveness of interventions. This is because all individual trials have limitations, such as low statistical power, researcher or expert bias, and contextual variability. 2 Similarly, single qualitative studies can be heavily influenced by specific issues of context and generalisability. By synthesising qualitative research, these difficulties can potentially be overcome.

THE DEVELOPMENT OF THE SCIENCE OF THE SYNTHESIS OF QUALITATIVE RESEARCH

Several methodological approaches have been developed to synthesise qualitative research over the past 2 decades. Some have been adapted from methods used to analyse primary qualitative research, whereas others have been specifically developed for this purpose. 3

Qualitative synthesis is being promoted by a number of organisations based on the recognition that providing health care involves complex, multifactorial decisions that require a range of evidence. Qualitative synthesis complements the “rationalist” model of synthesis provided by traditional systematic review methods. 4 One such organisation is the Cochrane Qualitative Methods group ( http://www.joannabriggs.edu.au/cqrmg/about.html ), which was founded in 1998 with an aim to develop methods for including and incorporating synthesised findings from qualitative research into systematic reviews on the effectiveness of healthcare interventions. Looking more broadly at social care, the Campbell Collaboration ( http://www.campbellcollaboration.org/MG/index.asp ) was established in 1999 to prepare, maintain, and disseminate systematic reviews of studies of social interventions, which, by their nature, require the synthesis of complex forms of evidence. The Joanna Briggs Institute ( http://www.joannabriggs.edu.au/about/home.php ) in Australia has developed an approach to the synthesis of qualitative research (with supporting computer software) that enables the synthesis of qualitative research and its integration with quantitative reviews. 5

Since the late 1990s, the efforts of specific research groups have resulted in an increase in publications reporting methods and findings of qualitative syntheses. 6, 7, 8, 9, 10, 11, 12 Many of these syntheses addressed topics relevant to nursing and health care, such as the lay meanings of medicines, experiences of diabetes care, and factors influencing healthy eating among children.

Several different approaches can be used to synthesise qualitative research, each producing different types of review. Noblit and Hare developed the methodology of meta-ethnography specifically to synthesise qualitative research. 13 They distinguish between integrative and interpretative reviews. Integrative reviews aggregate quantitative data and use statistical analysis to generate new findings, whereas i nterpretative reviews create understanding from multiple cases, accounts, narratives, or studies derived from qualitative research. Concepts identified in these studies are pulled together to create “higher-order” theoretical structures.

Dixon-Woods et al 3 focus on different ways of synthesising evidence. Rather than focusing on different forms of evidence, they propose that integrative syntheses summarise data through pooling, meta-analysis, or description. Interpretative synthesis, however, is best viewed as the development of concepts and theories that integrate these concepts, grounded in data from primary studies. Interpretative syntheses can incorporate both quantitative and qualitative evidence. Both types of syntheses exist on a continuum in which integrative reviews interpret data and interpretative reviews aggregate data. What drives the method of synthesis is the nature of the research question asked. 3 Although the interpretative end of the synthesis continuum is mainly populated with methodologies synthesising qualitative research, in reality, many syntheses include elements of both interpretation and integration. Indeed, combining interpretation and integration is an underlying principle of good syntheses.

METHODS OF SYNTHESISING QUALITATIVE RESEARCH

Many of the methods associated with the linear process of conventional systematic reviews (eg, question formulation, searching, quality appraisal, and methods of pooling data) are still being developed or evaluated for their application to synthesis of qualitative research. Qualitative synthesis will probably never evolve into the relatively standardised process of producing a systematic review of clinical trials or diagnostic studies. More likely, the vision of qualitative synthesis will include a reviewer drawing on a “methodological palette,” in which the review processes are defined by the question and nature of the research to be included in the review.

This does not mean that syntheses of qualitative research are not being done. One of the most frequently used methods is meta-ethnography. 13 Meta-ethnography uses techniques familiar to primary qualitative researchers to synthesise qualitative research reports and is not limited, as its name might suggest, to ethnographic studies. It is an interpretative approach, with the findings of studies being “translated” into one another. Meta-ethnography was the method used in 3 of the 7 syntheses of qualitative research that were abstracted in Evidence-Based Nursing . The clinical questions of these syntheses were

How have healthcare relationships in chronic illness changed over the past 15 years? 14

What are patients’ experiences of recognising symptoms of cancer and seeking help? 15

How do people with diabetes mellitus describe their lived experience? 16

Meta-ethnography is a methodology capable of answering clinical questions and is one of the few areas in qualitative synthesis with an active programme of funded methodological work. 1 Other methods for synthesising qualitative research include meta-synthesis, meta-summary, meta-study, meta-narrative mapping, cross-case analysis, narrative summary, thematic analysis, content analysis, case survey and the qualitative comparative analysis method. 1, 3 The volume of methods available indicates why underdevelopment and underevaluation are so common.

HOW CAN SYNTHESISING QUALITATIVE RESEARCH CONTRIBUTE TO EVIDENCE-BASED NURSING?

The development of the synthesis of qualitative research has created a “new” form of research evidence, which impacts on the evidence available for clinical decision making. The number of completed qualitative syntheses is small, but growing. Just as it has taken time for the repository of systematic reviews of effectiveness to build up to a useful mass whereby fruitful searching occurs, it will take time for the number of syntheses of qualitative studies to grow to a practical number so as to enhance clinical decision making. However, syntheses of qualitative research that have already been done address many topics of interest to nurses, including

what constitutes quality end-of-life care 17

adapting to and managing diabetes 8

patients’ help-seeking experiences and delay in cancer presentation 18

the experience of physical restraint 19

development of a user focused stroke service in primary care 20

The synthesis of qualitative research can contribute to the evidence base for nursing in ways that are relevant to practitioners and researchers (table ⇓ ).

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Contribution of qualitative research to practice and research

Development of theory

One of the primary arguments for synthesising qualitative research is that relevant theories for clinical practice and research can be made stronger. 21, 22 An example is found in the area of end-of-life care. From a synthesis of primary qualitative explorations of patient and family perspectives and narratives, a shared conceptual framework of the constituents of quality end-of-life care was developed. 17 The review determined that quality of life and quality of dying are intertwined with quality of care from the perspectives of patients and their families. Before the synthesis, these 3 concepts had been identified and measured separately. Practice applications arising from these findings included development of clear outcome measures to evaluate quality end-of-life care and prioritisation of strategies for improving quality of care at this time.

New insights from primary research

The synthesis of qualitative research may improve the use of primary research findings, particularly those that relate to rare or infrequent events that are often under-represented in single studies. 23 By systematically examining primary studies, similarities that were not individually recognised as major themes can be integrated and re-examined, and new insights can be gained. A review on adapting to and managing diabetes combined a series of qualitative research studies that had focused on specific concepts of diabetes management, rather than the totality of the experience. 8 Synthesising the findings highlighted the connections between key concepts in diabetes management. Of particular note were the divergent views of healthcare professionals and people with diabetes regarding the focus of management. Healthcare professionals favoured managing and controlling diabetes through compliance with prescribed regimens. People with diabetes, however, sought to balance self care and striving for a normal life.

Because one of the key advantages of qualitative research generally is the ability to access sensitive, rare, and “difficult” phenomena, synthesising qualitative research allows maximum value to be gained from primary studies that have overcome problems in accessing and researching difficult settings. 22 Qualitative syntheses then are a useful step to consider before undertaking further research in these types of study areas.

Enhanced generalisability of primary studies

The nature and extent of the generalisability of qualitative research is heavily contested. 24, 25 Qualitative research methods do not seek to produce generalisable knowledge in the same way as statistical predictions. Single qualitative studies can produce indepth, insightful, and rich descriptions of phenomena, which can be difficult to generalise beyond the original sample. Such studies can end up isolated and used little in practice. Synthesising qualitative research addresses this limitation by drawing single studies together and providing new cumulative knowledge with broader applicability. 1

In a qualitative review of 32 studies of patients’ help-seeking experiences and delays in cancer presentation, Smith et al 18 developed 2 higher order categories that had direct implications for nursing practice: the influence of gender on help seeking and the influence of sanctioning on help seeking. These findings were shown to hold true across patients with different types of cancers, generalisability that would not have been apparent if only the individual studies had been considered. The synthesis also revealed the difficulties faced by patients with cancer when attempting to communicate what might be perceived as trivial symptoms to healthcare professionals.

Providing context for systematic reviews of effectiveness

When combined with systematic reviews of effectiveness, qualitative syntheses can provide a valuable contextual dimension. 26 Qualitative and quantitative research methods may be synthesised separately, with one method used to inform the other (combined synthesis), or they may be integrated throughout the process of synthesis itself.

Combining research syntheses is becoming more common in response to the challenge of evaluating complex interventions in health care. Such evaluations are crucial, not only in terms of applications at practice levels, but also for informing policy. 27 This is similar to the that way mixed methods research (the combination of qualitative and quantitative research methods) has been advocated for the evaluation of complex interventions in primary research. 28, 29 As awareness of the limitations of “mono-method” reviewing grows, calls for greater methodological heterogeneity in the studies included in reviews are increasing. Combining or integrating syntheses of qualitative research alongside empirical evidence may be efficient and increase the richness, relevance, and usefulness of evidence for decision makers. 2 Although underevaluated, 3 methods for undertaking “multi-method” reviews are one of the most promising areas of evidence synthesis. 2

An illustration of a combined synthesis of qualitative and quantitative research is a review by Thomas et al, which examined barriers to, and facilitators of, increased fruit and vegetable intake in children. 30 The review included a meta-analysis of intervention studies designed to increase intake and a synthesis of qualitative research into children’s views on eating fruit and vegetables. The 2 separate reviews were then combined using a matrix that matched the interventions found to be effective with children’s views of those interventions. In doing so, Thomas et al found that the promotion of fruit and vegetable intake needs to be separated or packaged in different ways within the same intervention as children see fruit and vegetables as different types of food. There needs to be less emphasis on health messages—fruit and vegetables need to be branded as “tasty” rather than “healthy”. Promotion of fruit and vegetables in educational materials needs to be accompanied by access to fruit and vegetables. Combining qualitative and quantitative syntheses in this way illustrates not only which interventions work and why, but also the impact (or lack of impact) on those they are designed to target.

Identification of new research topics

Qualitative synthesis can generate future research topics. This may be in the form of developing theory for future hypothesis testing in effectiveness research or identifying gaps in research agendas for specific content areas. For example, in synthesising qualitative studies of experiences of physical restraint, Evans and Fitzgerald found that research had only been done in acute care settings. 19 Consequently, they identified a need for research on patient experiences of restraint in residential care environments. Similarly, a synthesis of qualitative research on stroke care identified patients that were under-represented in primary care based research. 20 Only one study included in the review addressed the issues facing younger patients with stroke, and this provides an impetus for future research to address the discrepancy.

Improved quality and reporting of primary qualitative research

Syntheses of qualitative research can also help to improve the quality and reporting of primary qualitative research. Systematic reviews of RCTs led to the development of the CONSORT statement, 31 which provides explicit criteria for reporting of trials. As reviewers of qualitative research begin to grapple with similar issues of quality and reporting, an analogous initiative may be initiated.

FUTURE DEVELOPMENTS IN THE SYNTHESIS OF QUALITATIVE RESEARCH

Before addressing the future developments for qualitative research synthesis, it is useful to acknowledge the debate over whether we should be attempting to synthesise qualitative research at all. Synthesising primary qualitative studies is anathema to those who consider that each piece of qualitative research is a unique representation of multiple realities or truths. 1 In order to accept that synthesis of qualitative research is a feasible methodological option, a position of “subtle realism” 32 is required. From this position, one acknowledges that research studies attempt to describe and capture (albeit in different ways) an underlying social reality. 1 For those concerned with answering questions relevant to clinical practice and policy decision making, adopting this pragmatic stance makes the synthesis of qualitative research methodologically feasible.

Several methodological issues remain under debate among those attempting to synthesise of qualitative research, such as whether different qualitative research methodologies should be combined, whether studies included in reviews should be appraised for quality, and if so, using which methods. Further areas of debate include the need for comprehensive searching to identify all relevant studies as opposed to a sampling of papers for inclusion and methods of synthesising studies. As more qualitative syntheses are completed, so will such methods become replicated and validated. In addition to developing the methods for synthesising research, researchers are continuing to advance techniques for searching 33, 34 and critically appraising qualitative studies. 35

Readers of syntheses of qualitative research may also be looking for a quality appraisal checklist by which to judge the quality of the synthesis, such as those available for other research methods. As yet, such a tool does not exist, and it is unlikely that a single checklist could cover all qualitative syntheses. This reflects the fact that syntheses of qualitative research can be done using various methods. This is appropriate given the range of questions that may be answered using this methodology. Quality criteria that have been suggested as guidance include a clearly stated purpose for the review, an explanation of inclusion criteria, description of the sample of papers, procedures for handling and synthesising data, and rules for interpretation. 36

Further work is needed to develop the terminology associated with the synthesis of qualitative research. Readers may be baffled by the range of language used, but perhaps a more important implication of the lack of consensus on terminology is that indexing within electronic databases is haphazard, making searching for qualitative syntheses difficult. Clearly, this makes life more difficult for teachers of evidence-based nursing who instruct students on methods of searching and who wish to identify qualitative syntheses in their searches. Until some consensus is reached on indexing, the contribution of syntheses of qualitative research to evidence based nursing may be limited.

This notebook has shown that although considerable developmental work is needed to create mutually agreed upon approaches to qualitative research synthesis, the existing methodologies can produce influential findings relevant to nursing practice.

The synthesis of primary qualitative studies creates a cumulative body of evidence that builds and develops theory for practice in ways that individual studies cannot. Syntheses of qualitative research may also complement quantitative research syntheses, providing context for, and giving meaning to, evidence of the effectiveness of interventions.

Syntheses of qualitative research will increasingly become available to nurses as nursing journals become more open to publishing qualitative syntheses and related methodological papers. Such papers will add to the evidence base for nursing practice, informing clinical decision making and policy.

• ↵ Pope C, Mays N. Synthesising qualitative research. In: Pope C, Mays N, editors. Qualitative research in health care. Third edition. Oxford: Blackwell Publishing, 2006 : 142 –52.
• ↵ Sheldon TA. Making evidence synthesis more useful for management and policy-making. J Health Serv Res Policy 2005 ; 10 1 : 1 –5. OpenUrl CrossRef PubMed
• ↵ Dixon-Woods M, Agarwal S, Jones D, et al. Synthesising qualitative and quantitative evidence: a review of possible methods. J Health Serv Res Policy 2005 ; 10 : 45 –53. OpenUrl CrossRef PubMed
• ↵ Higgins JPT, Green S, editors. Cochrane handbook for systematic reviews of interventions. Version 4.2.6 (updated September 2006). In: Cochrane Library, Chichester, UK: John Wiley & Sons, Ltd.
• ↵ Pearson A. Balancing the evidence: incorporating the synthesis of qualitative data into systematic reviews. JBI Reports 2004 ; 2 : 45 –64. OpenUrl CrossRef
• ↵ Sandelowski M, Barroso J. Toward a metasynthesis of qualitative findings on motherhood in HIV-positive women. Res Nurs Health 2003 ; 26 : 153 –70. OpenUrl CrossRef PubMed Web of Science
• ↵ Sandelowski M, Barroso J. Creating metasummaries of qualitative findings. Nurs Res 2003 ; 52 : 226 –33. OpenUrl CrossRef PubMed Web of Science
• ↵ Paterson BL, Thorne S, Dewis M. Adapting to and managing diabetes. Image J Nurs Sch 1998 ; 30 : 57 –62. OpenUrl CrossRef PubMed
• ↵ Dixon-Woods M, Fitzpatrick R, Roberts K. Including qualitative research in systematic reviews: opportunities and problems. J Eval Clin Pract 2001 ; 7 : 125 –33. OpenUrl CrossRef PubMed Web of Science
• ↵ Britten N, Campbell R, Pope C, et al. Using meta-ethnography to synthesise qualitative research: a worked example. J Health Serv Res Policy 2002 ; 7 : 209 –15. OpenUrl CrossRef PubMed
• ↵ Finfgeld D. Metasynthesis: the state of the art—so far. Qual Health Res 2003 ; 13 : 893 –904. OpenUrl CrossRef PubMed Web of Science
• ↵ Thomas J, Harden A, Oakley A, et al. Integrating qualitative research with trials in systematic reviews. BMJ 2004 ; 328 : 1010 –2. OpenUrl FREE Full Text
• ↵ Noblit GW, Hare RD. Meta-ethnography: synthesizing qualitative studies. California: Sage Publications, 1988 .
• ↵ Review: research on chronic illness has shifted towards viewing the individual as empowered and a partner in the health management process. Evid Based Nurs . 1999 ; 2 : 32 . Abstract of: Thorne S, Paterson B. Shifting images of chronic illness. Image J Nurs Sch 1998; 30 :173–8. OpenUrl FREE Full Text
• ↵ Review: delays in help seeking for cancer symptoms related to recognition and interpretation of symptoms and fear of consultation and were affected by gender and sanctioning of help seeking. Evid Based Nurs . 2006 ; 9 : 62 . Abstract of: Smith LK, Pope C, Botha JL. Patients’ help-seeking experiences and delay in cancer presentation: a qualitative synthesis. Lancet 2005; 366 :825–31. OpenUrl FREE Full Text
• ↵ Review: patients living with diabetes mellitus focus on learning to balance by assuming control for the management of their illness. Evid Based Nurs . 1998 ; 1 : 132 . Abstract of: Paterson BL, Thorne S, Dewis M. Adapting to and managing diabetes. Image J Nurs Sch 1998; 30 :57–62. OpenUrl FREE Full Text
• ↵ Howell D, Brazil K. Reaching common ground: a patient–family-based conceptual framework of quality EOL care. J Palliat Care 2005 ; 21 : 19 –26. OpenUrl PubMed Web of Science
• ↵ Smith LK, Pope C, Botha JL. Patients’ help seeking experiences and delay in cancer presentation: a qualitative synthesis. Lancet 2005 ; 366 : 825 –31. OpenUrl CrossRef PubMed Web of Science
• ↵ Evans D, Fitzgerald M. The experience of physical restraint: a systematic review of qualitative research. Contemp Nurse 2002 ; 13 : 126 –35. OpenUrl PubMed
• ↵ Murray J, Ashworth R, Forster A, et al. Developing a primary care–based stroke service: a review of the qualitative literature. Br J Gen Pract 2003 ; 53 : 137 –42. OpenUrl Abstract / FREE Full Text
• ↵ Estabrooks CA, Field PA, Morse JM. Aggregating qualitative findings: an approach to theory development. Qual Health Res 1994 ; 4 : 503 –11. OpenUrl CrossRef
• ↵ Dixon-Woods M, Agarwal S, Young B, et al. Integrative approaches to qualitative and quantitative evidence . London: NHS Health Development Agency, 2004 .
• ↵ Thorne S. Secondary analysis in qualitative research: issues and implications. In: Morse JM, editor. Critical issues in qualitative research methods London: Sage Publications, 1994 .
• ↵ Field PA, Morse JM. Nursing research: the application of qualitative approaches . London: Chapman and Hall, 1985 .
• ↵ Payne G, Williams M. Generalization in qualitative research. Sociology 2005 ; 39 : 295 –314. OpenUrl CrossRef Web of Science
• ↵ Flemming KA. The knowledge base for evidence-based nursing: a role for mixed methods research? ANS Adv Nurs Sci 2007 ; 30 : 41 –51. OpenUrl CrossRef PubMed
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• ↵ Thomas J, Sutcliffe K, Harden A, et al. Children and healthy eating: a systematic review of the barriers and facilitators . London: EPPI-Centre, Social Science Research Unit, Institute of Education, University of London, 2003 .
• ↵ Moher D, Schulz KF, Altman DG. The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomised trials. Lancet 2001 ; 357 : 1191 –4. OpenUrl CrossRef PubMed Web of Science
• ↵ Hammersley M. What’s wrong with ethnography? London: Routledge, 1992 .
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Thanks to Dr Karl Atkin and Professor Trevor Sheldon for comments on an earlier draft of this paper and Laurie Gunderman for providing me with the data on the number of qualitative articles abstracted in Evidence-Based Nursing .

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500+ Qualitative Research Titles and Topics

Table of Contents

Qualitative research is a methodological approach that involves gathering and analyzing non-numerical data to understand and interpret social phenomena. Unlike quantitative research , which emphasizes the collection of numerical data through surveys and experiments, qualitative research is concerned with exploring the subjective experiences, perspectives, and meanings of individuals and groups. As such, qualitative research topics can be diverse and encompass a wide range of social issues and phenomena. From exploring the impact of culture on identity formation to examining the experiences of marginalized communities, qualitative research offers a rich and nuanced perspective on complex social issues. In this post, we will explore some of the most compelling qualitative research topics and provide some tips on how to conduct effective qualitative research.

Qualitative Research Titles

Qualitative research titles often reflect the study’s focus on understanding the depth and complexity of human behavior, experiences, or social phenomena. Here are some examples across various fields:

• “Understanding the Impact of Project-Based Learning on Student Engagement in High School Classrooms: A Qualitative Study”
• “Navigating the Transition: Experiences of International Students in American Universities”
• “The Role of Parental Involvement in Early Childhood Education: Perspectives from Teachers and Parents”
• “Exploring the Effects of Teacher Feedback on Student Motivation and Self-Efficacy in Middle Schools”
• “Digital Literacy in the Classroom: Teacher Strategies for Integrating Technology in Elementary Education”
• “Culturally Responsive Teaching Practices: A Case Study in Diverse Urban Schools”
• “The Influence of Extracurricular Activities on Academic Achievement: Student Perspectives”
• “Barriers to Implementing Inclusive Education in Public Schools: A Qualitative Inquiry”
• “Teacher Professional Development and Its Impact on Classroom Practice: A Qualitative Exploration”
• “Student-Centered Learning Environments: A Qualitative Study of Classroom Dynamics and Outcomes”
• “The Experience of First-Year Teachers: Challenges, Support Systems, and Professional Growth”
• “Exploring the Role of School Leadership in Fostering a Positive School Culture”
• “Peer Relationships and Learning Outcomes in Cooperative Learning Settings: A Qualitative Analysis”
• “The Impact of Social Media on Student Learning and Engagement: Teacher and Student Perspectives”
• “Understanding Special Education Needs: Parent and Teacher Perceptions of Support Services in Schools

Health Science

• “Living with Chronic Pain: Patient Narratives and Coping Strategies in Managing Daily Life”
• “Healthcare Professionals’ Perspectives on the Challenges of Rural Healthcare Delivery”
• “Exploring the Mental Health Impacts of COVID-19 on Frontline Healthcare Workers: A Qualitative Study”
• “Patient and Family Experiences of Palliative Care: Understanding Needs and Preferences”
• “The Role of Community Health Workers in Improving Access to Maternal Healthcare in Rural Areas”
• “Barriers to Mental Health Services Among Ethnic Minorities: A Qualitative Exploration”
• “Understanding Patient Satisfaction in Telemedicine Services: A Qualitative Study of User Experiences”
• “The Impact of Cultural Competence Training on Healthcare Provider-Patient Communication”
• “Navigating the Transition to Adult Healthcare Services: Experiences of Adolescents with Chronic Conditions”
• “Exploring the Use of Alternative Medicine Among Patients with Chronic Diseases: A Qualitative Inquiry”
• “The Role of Social Support in the Rehabilitation Process of Stroke Survivors”
• “Healthcare Decision-Making Among Elderly Patients: A Qualitative Study of Preferences and Influences”
• “Nurse Perceptions of Patient Safety Culture in Hospital Settings: A Qualitative Analysis”
• “Experiences of Women with Postpartum Depression: Barriers to Seeking Help”
• “The Impact of Nutrition Education on Eating Behaviors Among College Students: A Qualitative Approach”
• “Understanding Resilience in Survivors of Childhood Trauma: A Narrative Inquiry”
• “The Role of Mindfulness in Managing Work-Related Stress Among Corporate Employees: A Qualitative Study”
• “Coping Mechanisms Among Parents of Children with Autism Spectrum Disorder”
• “Exploring the Psychological Impact of Social Isolation in the Elderly: A Phenomenological Study”
• “Identity Formation in Adolescence: The Influence of Social Media and Peer Groups”
• “The Experience of Forgiveness in Interpersonal Relationships: A Qualitative Exploration”
• “Perceptions of Happiness and Well-Being Among University Students: A Cultural Perspective”
• “The Impact of Art Therapy on Anxiety and Depression in Adult Cancer Patients”
• “Narratives of Recovery: A Qualitative Study on the Journey Through Addiction Rehabilitation”
• “Exploring the Psychological Effects of Long-Term Unemployment: A Grounded Theory Approach”
• “Attachment Styles and Their Influence on Adult Romantic Relationships: A Qualitative Analysis”
• “The Role of Personal Values in Career Decision-Making Among Young Adults”
• “Understanding the Stigma of Mental Illness in Rural Communities: A Qualitative Inquiry”
• “Exploring the Use of Digital Mental Health Interventions Among Adolescents: A Qualitative Study”
• “The Psychological Impact of Climate Change on Young Adults: An Exploration of Anxiety and Action”
• “Navigating Identity: The Role of Social Media in Shaping Youth Culture and Self-Perception”
• “Community Resilience in the Face of Urban Gentrification: A Case Study of Neighborhood Change”
• “The Dynamics of Intergenerational Relationships in Immigrant Families: A Qualitative Analysis”
• “Social Capital and Economic Mobility in Low-Income Neighborhoods: An Ethnographic Approach”
• “Gender Roles and Career Aspirations Among Young Adults in Conservative Societies”
• “The Stigma of Mental Health in the Workplace: Employee Narratives and Organizational Culture”
• “Exploring the Intersection of Race, Class, and Education in Urban School Systems”
• “The Impact of Digital Divide on Access to Healthcare Information in Rural Communities”
• “Social Movements and Political Engagement Among Millennials: A Qualitative Study”
• “Cultural Adaptation and Identity Among Second-Generation Immigrants: A Phenomenological Inquiry”
• “The Role of Religious Institutions in Providing Community Support and Social Services”
• “Negotiating Public Space: Experiences of LGBTQ+ Individuals in Urban Environments”
• “The Sociology of Food: Exploring Eating Habits and Food Practices Across Cultures”
• “Work-Life Balance Challenges Among Dual-Career Couples: A Qualitative Exploration”
• “The Influence of Peer Networks on Substance Use Among Adolescents: A Community Study”

Business and Management

• “Navigating Organizational Change: Employee Perceptions and Adaptation Strategies in Mergers and Acquisitions”
• “Corporate Social Responsibility: Consumer Perceptions and Brand Loyalty in the Retail Sector”
• “Leadership Styles and Organizational Culture: A Comparative Study of Tech Startups”
• “Workplace Diversity and Inclusion: Best Practices and Challenges in Multinational Corporations”
• “Consumer Trust in E-commerce: A Qualitative Study of Online Shopping Behaviors”
• “The Gig Economy and Worker Satisfaction: Exploring the Experiences of Freelance Professionals”
• “Entrepreneurial Resilience: Success Stories and Lessons Learned from Failed Startups”
• “Employee Engagement and Productivity in Remote Work Settings: A Post-Pandemic Analysis”
• “Brand Storytelling: How Narrative Strategies Influence Consumer Engagement”
• “Sustainable Business Practices: Stakeholder Perspectives in the Fashion Industry”
• “Cross-Cultural Communication Challenges in Global Teams: Strategies for Effective Collaboration”
• “Innovative Workspaces: The Impact of Office Design on Creativity and Collaboration”
• “Consumer Perceptions of Artificial Intelligence in Customer Service: A Qualitative Exploration”
• “The Role of Mentoring in Career Development: Insights from Women in Leadership Positions”
• “Agile Management Practices: Adoption and Impact in Traditional Industries”

Environmental Studies

• “Community-Based Conservation Efforts in Tropical Rainforests: A Qualitative Study of Local Perspectives and Practices”
• “Urban Sustainability Initiatives: Exploring Resident Participation and Impact in Green City Projects”
• “Perceptions of Climate Change Among Indigenous Populations: Insights from Traditional Ecological Knowledge”
• “Environmental Justice and Industrial Pollution: A Case Study of Community Advocacy and Response”
• “The Role of Eco-Tourism in Promoting Conservation Awareness: Perspectives from Tour Operators and Visitors”
• “Sustainable Agriculture Practices Among Smallholder Farmers: Challenges and Opportunities”
• “Youth Engagement in Climate Action Movements: Motivations, Perceptions, and Outcomes”
• “Corporate Environmental Responsibility: A Qualitative Analysis of Stakeholder Expectations and Company Practices”
• “The Impact of Plastic Pollution on Marine Ecosystems: Community Awareness and Behavioral Change”
• “Renewable Energy Adoption in Rural Communities: Barriers, Facilitators, and Social Implications”
• “Water Scarcity and Community Adaptation Strategies in Arid Regions: A Grounded Theory Approach”
• “Urban Green Spaces: Public Perceptions and Use Patterns in Megacities”
• “Environmental Education in Schools: Teachers’ Perspectives on Integrating Sustainability into Curricula”
• “The Influence of Environmental Activism on Policy Change: Case Studies of Grassroots Campaigns”
• “Cultural Practices and Natural Resource Management: A Qualitative Study of Indigenous Stewardship Models”

Anthropology

• “Kinship and Social Organization in Matrilineal Societies: An Ethnographic Study”
• “Rituals and Beliefs Surrounding Death and Mourning in Diverse Cultures: A Comparative Analysis”
• “The Impact of Globalization on Indigenous Languages and Cultural Identity”
• “Food Sovereignty and Traditional Agricultural Practices Among Indigenous Communities”
• “Navigating Modernity: The Integration of Traditional Healing Practices in Contemporary Healthcare Systems”
• “Gender Roles and Equality in Hunter-Gatherer Societies: An Anthropological Perspective”
• “Sacred Spaces and Religious Practices: An Ethnographic Study of Pilgrimage Sites”
• “Youth Subcultures and Resistance: An Exploration of Identity and Expression in Urban Environments”
• “Cultural Constructions of Disability and Inclusion: A Cross-Cultural Analysis”
• “Interethnic Marriages and Cultural Syncretism: Case Studies from Multicultural Societies”
• “The Role of Folklore and Storytelling in Preserving Cultural Heritage”
• “Economic Anthropology of Gift-Giving and Reciprocity in Tribal Communities”
• “Digital Anthropology: The Role of Social Media in Shaping Political Movements”
• “Migration and Diaspora: Maintaining Cultural Identity in Transnational Communities”
• “Cultural Adaptations to Climate Change Among Coastal Fishing Communities”

Communication Studies

• “The Dynamics of Family Communication in the Digital Age: A Qualitative Inquiry”
• “Narratives of Identity and Belonging in Diaspora Communities Through Social Media”
• “Organizational Communication and Employee Engagement: A Case Study in the Non-Profit Sector”
• “Cultural Influences on Communication Styles in Multinational Teams: An Ethnographic Approach”
• “Media Representation of Women in Politics: A Content Analysis and Audience Perception Study”
• “The Role of Communication in Building Sustainable Community Development Projects”
• “Interpersonal Communication in Online Dating: Strategies, Challenges, and Outcomes”
• “Public Health Messaging During Pandemics: A Qualitative Study of Community Responses”
• “The Impact of Mobile Technology on Parent-Child Communication in the Digital Era”
• “Crisis Communication Strategies in the Hospitality Industry: A Case Study of Reputation Management”
• “Narrative Analysis of Personal Stories Shared on Mental Health Blogs”
• “The Influence of Podcasts on Political Engagement Among Young Adults”
• “Visual Communication and Brand Identity: A Qualitative Study of Consumer Interpretations”
• “Communication Barriers in Cross-Cultural Healthcare Settings: Patient and Provider Perspectives”
• “The Role of Internal Communication in Managing Organizational Change: Employee Experiences”

Information Technology

• “User Experience Design in Augmented Reality Applications: A Qualitative Study of Best Practices”
• “The Human Factor in Cybersecurity: Understanding Employee Behaviors and Attitudes Towards Phishing”
• “Adoption of Cloud Computing in Small and Medium Enterprises: Challenges and Success Factors”
• “Blockchain Technology in Supply Chain Management: A Qualitative Exploration of Potential Impacts”
• “The Role of Artificial Intelligence in Personalizing User Experiences on E-commerce Platforms”
• “Digital Transformation in Traditional Industries: A Case Study of Technology Adoption Challenges”
• “Ethical Considerations in the Development of Smart Home Technologies: A Stakeholder Analysis”
• “The Impact of Social Media Algorithms on News Consumption and Public Opinion”
• “Collaborative Software Development: Practices and Challenges in Open Source Projects”
• “Understanding the Digital Divide: Access to Information Technology in Rural Communities”
• “Data Privacy Concerns and User Trust in Internet of Things (IoT) Devices”
• “The Effectiveness of Gamification in Educational Software: A Qualitative Study of Engagement and Motivation”
• “Virtual Teams and Remote Work: Communication Strategies and Tools for Effectiveness”
• “User-Centered Design in Mobile Health Applications: Evaluating Usability and Accessibility”
• “The Influence of Technology on Work-Life Balance: Perspectives from IT Professionals”

Tourism and Hospitality

• “Exploring the Authenticity of Cultural Heritage Tourism in Indigenous Communities”
• “Sustainable Tourism Practices: Perceptions and Implementations in Small Island Destinations”
• “The Impact of Social Media Influencers on Destination Choice Among Millennials”
• “Gastronomy Tourism: Exploring the Culinary Experiences of International Visitors in Rural Regions”
• “Eco-Tourism and Conservation: Stakeholder Perspectives on Balancing Tourism and Environmental Protection”
• “The Role of Hospitality in Enhancing the Cultural Exchange Experience of Exchange Students”
• “Dark Tourism: Visitor Motivations and Experiences at Historical Conflict Sites”
• “Customer Satisfaction in Luxury Hotels: A Qualitative Study of Service Excellence and Personalization”
• “Adventure Tourism: Understanding the Risk Perception and Safety Measures Among Thrill-Seekers”
• “The Influence of Local Communities on Tourist Experiences in Ecotourism Sites”
• “Event Tourism: Economic Impacts and Community Perspectives on Large-Scale Music Festivals”
• “Heritage Tourism and Identity: Exploring the Connections Between Historic Sites and National Identity”
• “Tourist Perceptions of Sustainable Accommodation Practices: A Study of Green Hotels”
• “The Role of Language in Shaping the Tourist Experience in Multilingual Destinations”
• “Health and Wellness Tourism: Motivations and Experiences of Visitors to Spa and Retreat Centers”

Qualitative Research Topics

Qualitative Research Topics are as follows:

• Understanding the lived experiences of first-generation college students
• Exploring the impact of social media on self-esteem among adolescents
• Investigating the effects of mindfulness meditation on stress reduction
• Analyzing the perceptions of employees regarding organizational culture
• Examining the impact of parental involvement on academic achievement of elementary school students
• Investigating the role of music therapy in managing symptoms of depression
• Understanding the experience of women in male-dominated industries
• Exploring the factors that contribute to successful leadership in non-profit organizations
• Analyzing the effects of peer pressure on substance abuse among adolescents
• Investigating the experiences of individuals with disabilities in the workplace
• Understanding the factors that contribute to burnout among healthcare professionals
• Examining the impact of social support on mental health outcomes
• Analyzing the perceptions of parents regarding sex education in schools
• Investigating the experiences of immigrant families in the education system
• Understanding the impact of trauma on mental health outcomes
• Exploring the effectiveness of animal-assisted therapy for individuals with anxiety
• Analyzing the factors that contribute to successful intergenerational relationships
• Investigating the experiences of LGBTQ+ individuals in the workplace
• Understanding the impact of online gaming on social skills development among adolescents
• Examining the perceptions of teachers regarding technology integration in the classroom
• Analyzing the experiences of women in leadership positions
• Investigating the factors that contribute to successful marriage and long-term relationships
• Understanding the impact of social media on political participation
• Exploring the experiences of individuals with mental health disorders in the criminal justice system
• Analyzing the factors that contribute to successful community-based programs for youth development
• Investigating the experiences of veterans in accessing mental health services
• Understanding the impact of the COVID-19 pandemic on mental health outcomes
• Examining the perceptions of parents regarding childhood obesity prevention
• Analyzing the factors that contribute to successful multicultural education programs
• Investigating the experiences of individuals with chronic illnesses in the workplace
• Understanding the impact of poverty on academic achievement
• Exploring the experiences of individuals with autism spectrum disorder in the workplace
• Analyzing the factors that contribute to successful employee retention strategies
• Investigating the experiences of caregivers of individuals with Alzheimer’s disease
• Understanding the impact of parent-child communication on adolescent sexual behavior
• Examining the perceptions of college students regarding mental health services on campus
• Analyzing the factors that contribute to successful team building in the workplace
• Investigating the experiences of individuals with eating disorders in treatment programs
• Understanding the impact of mentorship on career success
• Exploring the experiences of individuals with physical disabilities in the workplace
• Analyzing the factors that contribute to successful community-based programs for mental health
• Investigating the experiences of individuals with substance use disorders in treatment programs
• Understanding the impact of social media on romantic relationships
• Examining the perceptions of parents regarding child discipline strategies
• Analyzing the factors that contribute to successful cross-cultural communication in the workplace
• Investigating the experiences of individuals with anxiety disorders in treatment programs
• Understanding the impact of cultural differences on healthcare delivery
• Exploring the experiences of individuals with hearing loss in the workplace
• Analyzing the factors that contribute to successful parent-teacher communication
• Investigating the experiences of individuals with depression in treatment programs
• Understanding the impact of childhood trauma on adult mental health outcomes
• Examining the perceptions of college students regarding alcohol and drug use on campus
• Analyzing the factors that contribute to successful mentor-mentee relationships
• Investigating the experiences of individuals with intellectual disabilities in the workplace
• Understanding the impact of work-family balance on employee satisfaction and well-being
• Exploring the experiences of individuals with autism spectrum disorder in vocational rehabilitation programs
• Analyzing the factors that contribute to successful project management in the construction industry
• Investigating the experiences of individuals with substance use disorders in peer support groups
• Understanding the impact of mindfulness meditation on stress reduction and mental health
• Examining the perceptions of parents regarding childhood nutrition
• Analyzing the factors that contribute to successful environmental sustainability initiatives in organizations
• Investigating the experiences of individuals with bipolar disorder in treatment programs
• Understanding the impact of job stress on employee burnout and turnover
• Exploring the experiences of individuals with physical disabilities in recreational activities
• Analyzing the factors that contribute to successful strategic planning in nonprofit organizations
• Investigating the experiences of individuals with hoarding disorder in treatment programs
• Understanding the impact of culture on leadership styles and effectiveness
• Examining the perceptions of college students regarding sexual health education on campus
• Analyzing the factors that contribute to successful supply chain management in the retail industry
• Investigating the experiences of individuals with personality disorders in treatment programs
• Understanding the impact of multiculturalism on group dynamics in the workplace
• Exploring the experiences of individuals with chronic pain in mindfulness-based pain management programs
• Analyzing the factors that contribute to successful employee engagement strategies in organizations
• Investigating the experiences of individuals with internet addiction disorder in treatment programs
• Understanding the impact of social comparison on body dissatisfaction and self-esteem
• Examining the perceptions of parents regarding childhood sleep habits
• Analyzing the factors that contribute to successful diversity and inclusion initiatives in organizations
• Investigating the experiences of individuals with schizophrenia in treatment programs
• Understanding the impact of job crafting on employee motivation and job satisfaction
• Exploring the experiences of individuals with vision impairments in navigating public spaces
• Analyzing the factors that contribute to successful customer relationship management strategies in the service industry
• Investigating the experiences of individuals with dissociative amnesia in treatment programs
• Understanding the impact of cultural intelligence on intercultural communication and collaboration
• Examining the perceptions of college students regarding campus diversity and inclusion efforts
• Analyzing the factors that contribute to successful supply chain sustainability initiatives in organizations
• Investigating the experiences of individuals with obsessive-compulsive disorder in treatment programs
• Understanding the impact of transformational leadership on organizational performance and employee well-being
• Exploring the experiences of individuals with mobility impairments in public transportation
• Analyzing the factors that contribute to successful talent management strategies in organizations
• Investigating the experiences of individuals with substance use disorders in harm reduction programs
• Understanding the impact of gratitude practices on well-being and resilience
• Examining the perceptions of parents regarding childhood mental health and well-being
• Analyzing the factors that contribute to successful corporate social responsibility initiatives in organizations
• Investigating the experiences of individuals with borderline personality disorder in treatment programs
• Understanding the impact of emotional labor on job stress and burnout
• Exploring the experiences of individuals with hearing impairments in healthcare settings
• Analyzing the factors that contribute to successful customer experience strategies in the hospitality industry
• Investigating the experiences of individuals with gender dysphoria in gender-affirming healthcare
• Understanding the impact of cultural differences on cross-cultural negotiation in the global marketplace
• Examining the perceptions of college students regarding academic stress and mental health
• Analyzing the factors that contribute to successful supply chain agility in organizations
• Understanding the impact of music therapy on mental health and well-being
• Exploring the experiences of individuals with dyslexia in educational settings
• Analyzing the factors that contribute to successful leadership in nonprofit organizations
• Investigating the experiences of individuals with chronic illnesses in online support groups
• Understanding the impact of exercise on mental health and well-being
• Examining the perceptions of parents regarding childhood screen time
• Analyzing the factors that contribute to successful change management strategies in organizations
• Understanding the impact of cultural differences on international business negotiations
• Exploring the experiences of individuals with hearing impairments in the workplace
• Analyzing the factors that contribute to successful team building in corporate settings
• Understanding the impact of technology on communication in romantic relationships
• Analyzing the factors that contribute to successful community engagement strategies for local governments
• Investigating the experiences of individuals with attention deficit hyperactivity disorder (ADHD) in treatment programs
• Understanding the impact of financial stress on mental health and well-being
• Analyzing the factors that contribute to successful mentorship programs in organizations
• Investigating the experiences of individuals with gambling addictions in treatment programs
• Understanding the impact of social media on body image and self-esteem
• Examining the perceptions of parents regarding childhood education
• Analyzing the factors that contribute to successful virtual team management strategies
• Investigating the experiences of individuals with dissociative identity disorder in treatment programs
• Understanding the impact of cultural differences on cross-cultural communication in healthcare settings
• Exploring the experiences of individuals with chronic pain in cognitive-behavioral therapy programs
• Analyzing the factors that contribute to successful community-building strategies in urban neighborhoods
• Investigating the experiences of individuals with alcohol use disorders in treatment programs
• Understanding the impact of personality traits on romantic relationships
• Examining the perceptions of college students regarding mental health stigma on campus
• Analyzing the factors that contribute to successful fundraising strategies for political campaigns
• Investigating the experiences of individuals with traumatic brain injuries in rehabilitation programs
• Understanding the impact of social support on mental health and well-being among the elderly
• Exploring the experiences of individuals with chronic illnesses in medical treatment decision-making processes
• Analyzing the factors that contribute to successful innovation strategies in organizations
• Investigating the experiences of individuals with dissociative disorders in treatment programs
• Understanding the impact of cultural differences on cross-cultural communication in education settings
• Examining the perceptions of parents regarding childhood physical activity
• Analyzing the factors that contribute to successful conflict resolution in family relationships
• Investigating the experiences of individuals with opioid use disorders in treatment programs
• Understanding the impact of emotional intelligence on leadership effectiveness
• Exploring the experiences of individuals with learning disabilities in the workplace
• Analyzing the factors that contribute to successful change management in educational institutions
• Investigating the experiences of individuals with eating disorders in recovery support groups
• Understanding the impact of self-compassion on mental health and well-being
• Examining the perceptions of college students regarding campus safety and security measures
• Analyzing the factors that contribute to successful marketing strategies for nonprofit organizations
• Investigating the experiences of individuals with postpartum depression in treatment programs
• Understanding the impact of ageism in the workplace
• Exploring the experiences of individuals with dyslexia in the education system
• Investigating the experiences of individuals with anxiety disorders in cognitive-behavioral therapy programs
• Understanding the impact of socioeconomic status on access to healthcare
• Examining the perceptions of parents regarding childhood screen time usage
• Analyzing the factors that contribute to successful supply chain management strategies
• Understanding the impact of parenting styles on child development
• Exploring the experiences of individuals with addiction in harm reduction programs
• Analyzing the factors that contribute to successful crisis management strategies in organizations
• Investigating the experiences of individuals with trauma in trauma-focused therapy programs
• Examining the perceptions of healthcare providers regarding patient-centered care
• Analyzing the factors that contribute to successful product development strategies
• Investigating the experiences of individuals with autism spectrum disorder in employment programs
• Understanding the impact of cultural competence on healthcare outcomes
• Exploring the experiences of individuals with chronic illnesses in healthcare navigation
• Analyzing the factors that contribute to successful community engagement strategies for non-profit organizations
• Investigating the experiences of individuals with physical disabilities in the workplace
• Understanding the impact of childhood trauma on adult mental health
• Analyzing the factors that contribute to successful supply chain sustainability strategies
• Investigating the experiences of individuals with personality disorders in dialectical behavior therapy programs
• Understanding the impact of gender identity on mental health treatment seeking behaviors
• Exploring the experiences of individuals with schizophrenia in community-based treatment programs
• Analyzing the factors that contribute to successful project team management strategies
• Investigating the experiences of individuals with obsessive-compulsive disorder in exposure and response prevention therapy programs
• Understanding the impact of cultural competence on academic achievement and success
• Examining the perceptions of college students regarding academic integrity
• Analyzing the factors that contribute to successful social media marketing strategies
• Investigating the experiences of individuals with bipolar disorder in community-based treatment programs
• Understanding the impact of mindfulness on academic achievement and success
• Exploring the experiences of individuals with substance use disorders in medication-assisted treatment programs
• Investigating the experiences of individuals with anxiety disorders in exposure therapy programs
• Understanding the impact of healthcare disparities on health outcomes
• Analyzing the factors that contribute to successful supply chain optimization strategies
• Investigating the experiences of individuals with borderline personality disorder in schema therapy programs
• Understanding the impact of culture on perceptions of mental health stigma
• Exploring the experiences of individuals with trauma in art therapy programs
• Analyzing the factors that contribute to successful digital marketing strategies
• Investigating the experiences of individuals with eating disorders in online support groups
• Understanding the impact of workplace bullying on job satisfaction and performance
• Examining the perceptions of college students regarding mental health resources on campus
• Analyzing the factors that contribute to successful supply chain risk management strategies
• Investigating the experiences of individuals with chronic pain in mindfulness-based pain management programs
• Understanding the impact of cognitive-behavioral therapy on social anxiety disorder
• Understanding the impact of COVID-19 on mental health and well-being
• Exploring the experiences of individuals with eating disorders in treatment programs
• Analyzing the factors that contribute to successful leadership in business organizations
• Investigating the experiences of individuals with chronic pain in cognitive-behavioral therapy programs
• Understanding the impact of cultural differences on intercultural communication
• Examining the perceptions of teachers regarding inclusive education for students with disabilities
• Investigating the experiences of individuals with depression in therapy programs
• Understanding the impact of workplace culture on employee retention and turnover
• Exploring the experiences of individuals with traumatic brain injuries in rehabilitation programs
• Analyzing the factors that contribute to successful crisis communication strategies in organizations
• Investigating the experiences of individuals with anxiety disorders in mindfulness-based interventions
• Investigating the experiences of individuals with chronic illnesses in healthcare settings
• Understanding the impact of technology on work-life balance
• Exploring the experiences of individuals with learning disabilities in academic settings
• Analyzing the factors that contribute to successful entrepreneurship in small businesses
• Understanding the impact of gender identity on mental health and well-being
• Examining the perceptions of individuals with disabilities regarding accessibility in public spaces
• Understanding the impact of religion on coping strategies for stress and anxiety
• Exploring the experiences of individuals with chronic illnesses in complementary and alternative medicine treatments
• Analyzing the factors that contribute to successful customer retention strategies in business organizations
• Investigating the experiences of individuals with postpartum depression in therapy programs
• Understanding the impact of ageism on older adults in healthcare settings
• Examining the perceptions of students regarding online learning during the COVID-19 pandemic
• Analyzing the factors that contribute to successful team building in virtual work environments
• Investigating the experiences of individuals with gambling disorders in treatment programs
• Exploring the experiences of individuals with chronic illnesses in peer support groups
• Analyzing the factors that contribute to successful social media marketing strategies for businesses
• Investigating the experiences of individuals with ADHD in treatment programs
• Understanding the impact of sleep on cognitive and emotional functioning
• Examining the perceptions of individuals with chronic illnesses regarding healthcare access and affordability
• Investigating the experiences of individuals with borderline personality disorder in dialectical behavior therapy programs
• Understanding the impact of social support on caregiver well-being
• Exploring the experiences of individuals with chronic illnesses in disability activism
• Analyzing the factors that contribute to successful cultural competency training programs in healthcare settings
• Understanding the impact of personality disorders on interpersonal relationships
• Examining the perceptions of healthcare providers regarding the use of telehealth services
• Investigating the experiences of individuals with dissociative disorders in therapy programs
• Understanding the impact of gender bias in hiring practices
• Exploring the experiences of individuals with visual impairments in the workplace
• Analyzing the factors that contribute to successful diversity and inclusion programs in the workplace
• Understanding the impact of online dating on romantic relationships
• Examining the perceptions of parents regarding childhood vaccination
• Analyzing the factors that contribute to successful communication in healthcare settings
• Understanding the impact of cultural stereotypes on academic achievement
• Exploring the experiences of individuals with substance use disorders in sober living programs
• Analyzing the factors that contribute to successful classroom management strategies
• Understanding the impact of social support on addiction recovery
• Examining the perceptions of college students regarding mental health stigma
• Analyzing the factors that contribute to successful conflict resolution in the workplace
• Understanding the impact of race and ethnicity on healthcare access and outcomes
• Exploring the experiences of individuals with post-traumatic stress disorder in treatment programs
• Analyzing the factors that contribute to successful project management strategies
• Understanding the impact of teacher-student relationships on academic achievement
• Analyzing the factors that contribute to successful customer service strategies
• Investigating the experiences of individuals with social anxiety disorder in treatment programs
• Understanding the impact of workplace stress on job satisfaction and performance
• Exploring the experiences of individuals with disabilities in sports and recreation
• Analyzing the factors that contribute to successful marketing strategies for small businesses
• Investigating the experiences of individuals with phobias in treatment programs
• Understanding the impact of culture on attitudes towards mental health and illness
• Examining the perceptions of college students regarding sexual assault prevention
• Analyzing the factors that contribute to successful time management strategies
• Investigating the experiences of individuals with addiction in recovery support groups
• Understanding the impact of mindfulness on emotional regulation and well-being
• Exploring the experiences of individuals with chronic pain in treatment programs
• Analyzing the factors that contribute to successful conflict resolution in romantic relationships
• Investigating the experiences of individuals with autism spectrum disorder in social skills training programs
• Understanding the impact of parent-child communication on adolescent substance use
• Examining the perceptions of parents regarding childhood mental health services
• Analyzing the factors that contribute to successful fundraising strategies for non-profit organizations
• Investigating the experiences of individuals with chronic illnesses in support groups
• Understanding the impact of personality traits on career success and satisfaction
• Exploring the experiences of individuals with disabilities in accessing public transportation
• Analyzing the factors that contribute to successful team building in sports teams
• Investigating the experiences of individuals with chronic pain in alternative medicine treatments
• Understanding the impact of stigma on mental health treatment seeking behaviors
• Examining the perceptions of college students regarding diversity and inclusion on campus.

About the author

Muhammad Hassan

Researcher, Academic Writer, Web developer

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Combining qualitative and quantitative research within mixed method research designs: A methodological review

Ulrika Östlund.

a Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden

b Institute for Applied Health Research/School of Health, Glasgow Caledonian University, United Kingdom

Yvonne Wengström

c Division of Nursing, Department or Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden

Neneh Rowa-Dewar

d Public Health Sciences, University of Edinburgh, United Kingdom

It has been argued that mixed methods research can be useful in nursing and health science because of the complexity of the phenomena studied. However, the integration of qualitative and quantitative approaches continues to be one of much debate and there is a need for a rigorous framework for designing and interpreting mixed methods research. This paper explores the analytical approaches (i.e. parallel, concurrent or sequential) used in mixed methods studies within healthcare and exemplifies the use of triangulation as a methodological metaphor for drawing inferences from qualitative and quantitative findings originating from such analyses.

This review of the literature used systematic principles in searching CINAHL, Medline and PsycINFO for healthcare research studies which employed a mixed methods approach and were published in the English language between January 1999 and September 2009.

In total, 168 studies were included in the results. Most studies originated in the United States of America (USA), the United Kingdom (UK) and Canada. The analytic approach most widely used was parallel data analysis. A number of studies used sequential data analysis; far fewer studies employed concurrent data analysis. Very few of these studies clearly articulated the purpose for using a mixed methods design. The use of the methodological metaphor of triangulation on convergent, complementary, and divergent results from mixed methods studies is exemplified and an example of developing theory from such data is provided.

A trend for conducting parallel data analysis on quantitative and qualitative data in mixed methods healthcare research has been identified in the studies included in this review. Using triangulation as a methodological metaphor can facilitate the integration of qualitative and quantitative findings, help researchers to clarify their theoretical propositions and the basis of their results. This can offer a better understanding of the links between theory and empirical findings, challenge theoretical assumptions and develop new theory.

What is already known about the topic?

• • Mixed methods research, where quantitative and qualitative methods are combined, is increasingly recognized as valuable, because it can potentially capitalize on the respective strengths of quantitative and qualitative approaches.
• • There is a lack of pragmatic guidance in the research literature as how to combine qualitative and quantitative approaches and how to integrate qualitative and quantitative findings.
• • Analytical approaches used in mixed-methods studies differ on the basis of the sequence in which the components occur and the emphasis given to each, e.g. parallel, sequential or concurrent.

What this paper adds

• • A trend for conducting parallel analysis on quantitative and qualitative data in healthcare research is apparent within the literature.
• • Using triangulation as a methodological metaphor can facilitate the integration of qualitative and quantitative findings and help researchers to clearly present both their theoretical propositions and the basis of their results.
• • Using triangulation as a methodological metaphor may also support a better understanding of the links between theory and empirical findings, challenge theoretical assumptions and aid the development of new theory.

1. Introduction

Mixed methods research has been widely used within healthcare research for a variety of reasons. The integration of qualitative and quantitative approaches is an interesting issue and continues to be one of much debate ( Bryman, 2004 , Morgan, 2007 , Onwuegbuzie and Leech, 2005 ). In particular, the different epistemological and ontological assumptions and paradigms associated with qualitative and quantitative research have had a major influence on discussions on whether the integration of the two is feasible, let alone desirable ( Morgan, 2007 , Sale et al., 2002 ). Proponents of mixed methods research suggest that the purist view, that quantitative and qualitative approaches cannot be merged, poses a threat to the advancement of science ( Onwuegbuzie and Leech, 2005 ) and that while epistemological and ontological commitments may be associated with certain research methods, the connections are not necessary deterministic ( Bryman, 2004 ). Mixed methods research can be viewed as an approach which draws upon the strengths and perspectives of each method, recognising the existence and importance of the physical, natural world as well as the importance of reality and influence of human experience ( Johnson and Onquegbuzie, 2004 ). Rather than continue these debates in this paper, we aim to explore the approaches used to integrate qualitative and quantitative data within healthcare research to date. Accordingly, this paper focuses on the practical issues of conducting mixed methods studies and the need to develop a rigorous framework for designing and interpreting mixed methods studies to advance the field. In this paper, we will attempt to offer some guidance for those interested in mixed methods research on ways to combine qualitative and quantitative methods.

The concept of mixing methods was first introduced by Jick (1979) , as a means for seeking convergence across qualitative and quantitative methods within social science research ( Creswell, 2003 ). It has been argued that mixed methods research can be particularly useful in healthcare research as only a broader range of perspectives can do justice to the complexity of the phenomena studied ( Clarke and Yaros, 1988 , Foss and Ellefsen, 2002 , Steckler et al., 1992 ). By combining qualitative and quantitative findings, an overall or negotiated account of the findings can be forged, not possible by using a singular approach ( Bryman, 2007 ). Mixed methods can also help to highlight the similarities and differences between particular aspects of a phenomenon ( Bernardi et al., 2007 ). Interest in, and expansion of, the use of mixed methods designs have most recently been fuelled by pragmatic issues: the increasing demand for cost effective research and the move away from theoretically driven research to research which meets policymakers’ and practitioners’ needs and the growing competition for research funding ( Brannen, 2009 , O’Cathain et al., 2007 ).

Tashakkori and Creswell (2007) broadly define mixed methods research as “research in which the investigator collects and analyses data, integrates the findings and draws inferences using both qualitative and quantitative approaches” (2007:3). In any mixed methods study, the purpose of mixing qualitative and quantitative methods should be clear in order to determine how the analytic techniques relate to one another and how, if at all, the findings should be integrated ( O’Cathain et al., 2008 , Onwuegbuzie and Teddlie, 2003 ). It has been argued that a characteristic of truly mixed methods studies are those which involve integration of the qualitative and quantitative findings at some stage of the research process, be that during data collection, analysis or at the interpretative stage of the research ( Kroll and Neri, 2009 ). An example of this is found in mixed methods studies which use a concurrent data analysis approach, in which each data set is integrated during the analytic stage to provide a complete picture developed from both data sets after data has been qualitised or quantitised (i.e. where both forms of data have been converted into either qualitative or quantitative data so that it can be easily merged) ( Onwuegbuzie and Teddlie, 2003 ). Other analytic approaches have been identified including; parallel data analysis, in which collection and analysis of both data sets is carried out separately and the findings are not compared or consolidated until the interpretation stage, and finally sequential data analysis, in which data are analysed in a particular sequence with the purpose of informing, rather than being integrated with, the use of, or findings from, the other method ( Onwuegbuzie and Teddlie, 2003 ). An example of sequential data analysis might be where quantitative findings are intended to lead to theoretical sampling in an in depth qualitative investigation or where qualitative data is used to generate items for the development of quantitative measures.

When qualitative and quantitative methods are mixed in a single study, one method is usually given priority over the other. In such cases, the aim of the study, the rationale for employing mixed methods, and the weighting of each method determine whether, and how, the empirical findings will be integrated. This is less challenging in sequential mixed methods studies where one approach clearly informs the other, however, guidance on combining qualitative and quantitative data of equal weight, for example, in concurrent mixed methods studies, is rather less clear ( Foss and Ellefsen, 2002 ). This is made all the more challenging by a common flaw which is to insufficiently and inexplicitly identify the relationships between the epistemological and methodological concepts in a particular study and the theoretical propositions about the nature of the phenomena under investigation ( Kelle, 2001 ).

One approach to combining different data of equal weight and which facilitate clear identification of the links between the different levels of theory, epistemology, and methodology could be to frame triangulation as a ‘methodological metaphor’, as argued by Erzberger and Kelle (2003) . This can help to; describe the logical relations between the qualitative and quantitative findings and the theoretical concepts in a study; demonstrate the way in which both qualitative and quantitative data can be combined to facilitate an improved understanding of particular phenomena; and, can also be used to help generate new theory ( Erzberger and Kelle, 2003 ) (see Fig. 1 ). The points of the triangle represent theoretical propositions and empirical findings from qualitative and quantitative data while the sides of the triangle represent the logical relationships between these propositions and findings. The nature and use of the triangle depends upon the outcome from the analysis, whether that be convergent , where qualitative and quantitative findings lead to the same conclusion; complementary, where qualitative and quantitative results can be used to supplement each other or; divergent , where the combination of qualitative and quantitative results provides different (and at times contradictory) findings. Each of these outcomes requires a different way of using the triangulation metaphor to link theoretical propositions to empirical findings ( Erzberger and Kelle, 2003 ).

Illustrating the triangulation triangle ( Erzberger and Kelle, 2003 )

1.1. Purpose of this paper

In the following paper, we identify the analytical approaches used in mixed methods healthcare research and exemplify the use of triangulation ( Erzberger and Kelle, 2003 ) as a methodological metaphor for drawing inferences from qualitative and quantitative findings. Papers reporting on mixed methods studies within healthcare research were reviewed to (i) determine the type of analysis approach used, i.e. parallel, concurrent, or sequential data analysis and, (ii) identify studies which could be used to illustrate the use of the methodological metaphor of triangulation suggested by Erzberger and Kelle (2003) . Four papers were selected to illustrate the application of the triangulation metaphor on complementary, convergent and divergent outcomes and to develop theory.

This literature review has used systematic principles ( Cochrane, 2009 , Khan, 2001 ) to search for mixed methods studies within healthcare research. The first search was conducted in September 2009 in the data bases CINAHL, Medline and PsycINFO on papers published in English language between 1999 and 2009. To identify mixed methods studies, the search terms (used as keywords and where possible as MeSH terms) were: “mixed methods”, “mixed research methods”, “mixed research”, “triangulation”, “complementary methods”, “concurrent mixed analysis” and “multi-strategy research.” These terms were searched individually and then combined (with OR). This resulted in 1896 hits in CINAHL, 1177 in Medline and 1943 in PsycINFO.

To focus on studies within, or relevant to, a healthcare context the following search terms were used (as keywords or as MeSH terms and combined with OR): “health care research”; “health services research”; and “health”. These limits applied to the initial search (terms combined with AND) resulted in 205 hits in Medline and 100 hits in PsycINFO. Since this combination in CINAHL only limited the search results to 1017; a similar search was conducted but without using the search term triangulation to capture mixed methods papers; resulting in 237 hits. In CINAHL the search result on 1017 papers was further limited by using “interventions” as a keyword resulting in 160 papers also selected to be reviewed. Moreover; in Medline the mixed methods data set was limited by the MeSH term “research” resulting in 218 hits and in PsycINFO with “intervention” as keyword or MeSH term resulting in 178 hits.

When duplicates were removed the total numbers of papers identified were 843. The abstracts were then reviewed by each author and those identified as relevant to the review were selected to be retrieved and reviewed in full text. Papers were selected based on the following inclusion criteria: empirical studies; published in peer review journals; healthcare research (for the purpose of this paper defined as any study focussing on participants in receipt, or involved in the delivery, of healthcare or a study conducted within a healthcare setting, e.g. different kinds of care, health economics, decision making, and professionals’ role development); and using mixed methods (defined as a study in which both qualitative and quantitative data were collected and analysed ( Halcomb et al., 2009b ). To maintain rigour, a random sample (10%) of the full text papers was reviewed jointly by two authors. Any disagreements or uncertainties that arose between the reviewers regarding their inclusion or in determining the type of analytic approach used were resolved through discussion between the authors.

In addition to the criteria outlined above, papers were excluded if the qualitative element constituted a few open-ended questions in a questionnaire, as we would agree with previous authors who have argued such studies do not strictly constitute a mixed methods design ( Kroll and Neri, 2009 ). Papers were also excluded if they could not be retrieved in full text via the library services at the University of Edinburgh, Glasgow Caledonian University or the Karolinska Institutet, or did not adequately or clearly describe their analytic strategy, for example, failing to report how the qualitative and quantitative data sets were analysed individually and, where relevant, how these were integrated. See Table 1 for reasons for the exclusion of subsequent papers.

Reasons for exclusion.

A second search was conducted within the databases of Medline, PsychInfo and Cinahl to identify studies which have specifically used Erzberger and Kelle's (2003) triangulation metaphor to frame the description and interpretation of their findings. The term ‘triangulation metaphor’ (as keywords) and author searches on ‘Christian Erzberger’ and ‘Udo Kelle’ were conducted. Three papers, published by Christian Erzberger and Udo Kelle, were identified in the PsychInfo databases but none of these were relevant to the purpose of this review. There were no other relevant papers identified in the other two databases.

168 Papers were included in the final review and reviewed to determine the type of mixed analysis approach used, i.e. parallel, concurrent, or sequential mixed analysis. Four of these papers (identified from the first search on mixed methods studies and healthcare research) were also used to exemplify the use of the methodological metaphor of triangulation ( Erzberger and Kelle, 2003 ). Data was extracted from included papers accordingly in relation to these purposes.

In total, 168 papers were included in our review. The majority of these studies originated in the USA ( n  = 63), the UK ( n  = 39) and Canada ( n  = 19), perhaps reflecting the considerable interest and expertise in mixed methods research within these countries. The focus of the studies included in the review varied significantly and the populations studied included both patients and healthcare professionals.

3.1. Analytic approaches

Table 2 illustrates the types of analytic approaches adopted in each of the studies included in the review. The most widely used analytic approach ( n  = 98) was parallel analysis ( Creswell and Plano Clark, 2007 ). However, very few of the studies employing parallel analysis clearly articulate their purpose for mixing qualitative and quantitative data, the weighting (or priority) given to the qualitative and quantitative data or the expected outcomes from doing so, mirroring previous research findings ( O’Cathain et al., 2008 ). The weighting, or priority, of the qualitative and quantitative data in a mixed methods study is dependent upon various factors including; the aims of the study and whether the purpose is, for example, to contextualise quantitative data using qualitative data or to use qualitative data to inform a larger quantitative approach such as a survey. Nonetheless, the omission of this statement makes it difficult to determine which data set the conclusions have been drawn from and the role of, or emphasis on, each approach. Therefore, is of importance for authors to clearly state this in their papers ( Creswell and Plano Clark, 2007 ). A number of studies had also used sequential data analysis ( n  = 46), where qualitative approaches were visibly used to inform the development of both clinical tools (e.g. Canales and Rakowski, 2006 ) and research measures and surveys (e.g. Beatty et al., 2004 ) or where quantitative surveys were supplemented by and issues further explored using qualitative approaches (e.g. Abadia and Oviedo, 2009 , Cheng, 2004 , Halcomb et al., 2008 ).

Included papers illustrating their analytical approach and country of origin.

Most notably, with only 20 included studies using a concurrent approach to data analysis, this was the least common design employed. Compared to the studies using a parallel or sequential approach, the authors of concurrent studies more commonly provided an explanation for their purpose of using a mixed methods design in their study, e.g. how it addressed a gap or would facilitate and advance the state of knowledge (e.g. Bussing et al., 2005 , Kartalova-O’Doherty and Tedstone Doherty, 2009 ). Despite this, there remained a lack of clarity within these studies about the weighting given to, and priority of, each method. Consequently, the importance and relevance of the findings produced by each approach and how these have informed their conclusions and interpretation is lacking. In four of the included papers a combination of approaches to data analysis (i.e. sequential and concurrent, parallel and concurrent, or sequential and parallel) were used. In the next section, we have selected papers to illustrate the methodological metaphor of triangulation ( Erzberger and Kelle, 2003 ).

3.2. Using the methodological metaphor of triangulation

We have selected four papers from our review ( Lukkarinen, 2005 , Midtgaard et al., 2006 , Shipman et al., 2008 , Skilbeck et al., 2005 ) to illustrate how the methodological metaphor of triangulation ( Erzberger and Kelle, 2003 ) can be applied to mixed methods studies. Each of these studies has been used to illustrate how the metaphor of triangulation can be applied to studies producing: (i) complementary findings, (ii) convergent findings, and (iii) divergent findings. In the following section, we demonstrate how the application of the metaphor can be used as a framework both to develop theory and to facilitate the interpretation of the findings from mixed methods studies and their conclusions in each of these scenarios, and how using the metaphor can help to promote greater clarity of the study's purpose, its theoretical propositions, and the links between data sets.

3.2.1. Triangulating complementary results

To exemplify the use of the methodological metaphor of triangulation ( Erzberger and Kelle, 2003 ) for drawing inferences from complementary results, we have drawn on the results of a UK based study by Shipman et al. (2008) ( Fig. 2 ). In the UK, members of district nursing teams (DNs) provide most nursing care to people at home in the last year of life. Following concerns that inadequate education might limit the confidence of some DNs to support patients and their carers’ at home, and that low home death rates may in part be related to this, the Department of Health (DH) identified good examples of palliative care educational initiatives for DNs and invested in a 3-year national education and support programme in the principles and practice of palliative care. Shipman et al.’s study evaluates whether the programme had measurable effects on DN knowledge and confidence in competency in the principles and practice of palliative care. The study had two parts, a summative (concerned with outcomes) quantitative component which included ‘before and after’ postal questionnaires which measured effects on DNs’ ( n  = 1280) knowledge, confidence and perceived competence in the principles and practice of palliative care and a formative (concerned with process) qualitative component which included semi-structured focus groups and interviews with a sub-sample of DNs ( n  = 39).

Illustrating the use of triangulation ( Erzberger and Kelle, 2003 ) on complementary results in the study by Shipman et al. (2008) .

While their theoretical proposition may not be explicitly stated by the authors, there is clearly an implicit theoretical proposition that the educational intervention would improve DNs knowledge and confidence (theoretical proposition 1, Fig. 2 ). This was supported by the quantitative findings which showed significant improvement in the district nurses confidence in their professional competence post intervention. Qualitative results supported and complemented the quantitative findings as the district nurses described several benefits from the program including greater confidence in tackling complex problems and better communication with patient and carers’ because of greater understanding of the reasons for symptoms. Thus, a complementary theoretical proposition (theoretical proposition 2, Fig. 2 ) can be deduced from the qualitative findings: the DN's better understanding of factors contributing to complex problems and underlying reasons for symptoms led to improved confidence in competence raised from district nurses increased understanding.

Fig. 2 illustrates the theoretical propositions, the empirical findings from qualitative and quantitative data and the logical relationships between these. Theoretical proposition 1 is supported by the quantitative findings. From qualitative findings, a complementary theoretical proposition (theoretical proposition 2) can be stated explaining the process that led to the DNs improved confidence in competence.

3.2.2. Triangulating convergent results

To illustrate how the methodological metaphor of triangulation can be used to draw inferences from convergent findings, we have drawn on the example of a Danish study by Midtgaard et al. (2006) ( Fig. 3 ). This study was conducted to explore experiences of group cohesion and changes in quality of life (QoL) among people ( n  = 55) who participated in a weekly physical exercise intervention (for six weeks) during treatment for cancer. The study, conducted in a Danish hospital, involved the use of structured QoL questionnaires, administered at baseline and post intervention (at six weeks) to determine changes in QoL and health status, and qualitative focus groups, conducted post intervention (at six weeks), to explore aspects of cohesion within the group. With regards to the theoretical proposition of the study ( Fig. 3 ), group cohesion was seen as essential to understand the processes within the group that facilitated the achievement of desired outcomes and the satisfaction of affective needs as well as promoting a sense of belonging to the group itself.

Illustrating the use of triangulation ( Erzberger and Kelle, 2003 ) on convergent results in the study by Midtgaard et al. (2006) .

This proposition was deductively tested in an intervention where patients exercised in mixed gender groups of seven to nine members during a nine hour weekly session over a six week period and was supported by both the empirical quantitative and qualitative findings. The quantitative data showed significant improvements in peoples’ emotional functioning, social functioning and mental health. The qualitative data showed how the group setting motivated the individuals to pursue personal endeavors beyond physical limitations, that patients used each others as role models during ‘down periods’ and how exercising in a group made individuals feel a sense of obligation to train and to do their best. This subsequently helped to improve their social functioning which in turn satisfied their affective needs, improving their improved emotional functioning and mental health.

Fig. 3 illustrates the theoretical propositions, empirical findings from qualitative and quantitative data and the logical relationships between these. Both the quantitative and qualitative findings, demonstrating improvements in participants’ emotional and social functioning and their mental health, can be attributed to the nature of group cohesion within the programme as expected.

3.2.3. Triangulating divergent results

Qualitative and quantitative results that seem to contradict each other are often explained as resulting from methodological error. However, instead of a methodological flaw, a divergent result could be a consequence of the inadequacy of the theoretical concepts used. This may indicate the need for changing or developing the theoretical concepts involved ( Erzberger and Kelle, 2003 ). The following example of using the methodological metaphor of triangulation ( Erzberger and Kelle, 2003 ) for drawing inferences from divergent results is intended as an example rather than an attempt to change the theoretical concept involved. In a study by Skilbeck et al. (2005) ( Fig. 4 ), some results were found to be divergent which was explained as resulting from the use of inadequate questionnaires. We do not wish to critique their conclusion; rather we intend to simply offer an alternative interpretation for their findings.

Illustrating the use of triangulation ( Erzberger and Kelle, 2003 ) on divergent results using the study by Skilbeck et al. (2005) .

The study aimed to explore family carers’ expectations and experiences of respite services provided by one independent hospice in North England. This hospice provides inpatient respite beds specifically for planned respite admission for a two-week period. Referrals were predominated from general practitioners and patients and their carers were offered respite care twice a year, during the study this was reduced to once a year for each patient. Data was collected prior to respite admission and post respite care by semi-structured interviews and using the Relative Stress Scale inventory (RSSI), a validated scale to measure relative distress in relation to caring. Twenty-five carers were included but pre- and post-data were completed by 12 carers. Qualitative data was analysed by using a process of constant comparison and quantitative data by descriptive and comparative statistical analysis.

No clear theoretical proposition was stated by the authors, but from the definition of respite care it is possible to deduce that ‘respite care is expected to provide relief from care-giving to the primary care provider’ (theoretical proposition 1, Fig. 4 ). This proposition was tested quantitatively by pre- and post-test using the RSSI showing that the majority of carers experienced either a negative or no change in scores following the respite stay (no test of significance was stated). Accordingly, the theoretical proposition was not supported by the quantitative empirical data. The qualitative empirical results, however, were supportive in showing that most of the carers considered respite care to be important as it enabled them to have a break and a rest from ongoing care-responsibilities. From this divergent empirical data it could be suggested changing or developing the original theoretical proposition. It seems that respite care gave the carers relief from their care-responsibilities but not from the distress carers experienced in relation to caring (measured by the used scale). We would therefore suggest that in order to lessen distress related to caring, other types of support is also needed which would change the theoretical proposition as suggested (theoretical proposition 2).

Fig. 4 illustrates the theoretical propositions, empirical findings from qualitative and quantitative data and the logical relationships between these. Theoretical proposition 1 was not supported by the quantitative findings (indicated in Fig. 4 by the broken arrow), but the qualitative findings supported this proposition. From these divergent empirical findings, the theoretical proposition could accordingly be changed and developed. Respite care seemed to provide relief from carers’ on-going care-responsibilities, but other types of support need to be added to provide relief from distress experienced (theoretical proposition 2).

3.2.4. Triangulation to produce theoretical propositions

Methodological triangulation has also been applied to illustrate how theoretical propositions can be produced by drawing on the findings from a Finnish study by Lukkarinen (2005) ( Fig. 5 ). The purpose of this longitudinal study was to describe, explain and understand the subjective health related quality of life (QoL) and life course of people with coronary artery disease (CAD). A longitudinal quantitative study was undertaken during the year post treatment and 19 individuals also attended thematic interviews one year after treatment. This study is one of the few studies that clearly defines theoretical underpinnings for both the selected methods and their purpose, namely “to obtain quantitatively abundant average information about the QoL of CAD patients and the changes in it as well as the patients’ individual, unique experiences of their respective life situations” ( Lukkarinen, 2005 :622).

Illustrating the use of triangulation ( Erzberger and Kelle, 2003 ) to develop theory from the study by Lukkarinen (2005) .

The results of the quantitative analysis showed that the male and female CAD patients in the youngest age group had the poorest QoL. While patients’ QoL improved in the dimensions of pain, energy and mobility it deteriorated on dimensions of social isolation, sleep and emotional reactions. From the viewpoint of methodological triangulation used in the study the aim of the quantitative approach was to observe changes in QoL at the group level and also explore correlations of background factors to QoL. The qualitative approach generated information concerning both QoL in the individuals’ life situation and life course and the individuals’ rehabilitation. Both the quantitative and the qualitative analysis showed the youngest CAD patients to have the poorest psychosocial QoL. The results obtained using qualitative methods explained the quantitative findings and offered new insight into the factors related to poor psychosocial QoL, which could be used to help develop theoretical propositions around these. Patients at risk of poorer QoL were those with an acute onset of illness at a young age that led to an unexpected termination of career, resulting in financial problems, and worries about family. This group also experienced lack of emotional support (especially the females with CAD) and were concerned for the illness that was not alleviated by treatment. The interviews and the method of phenomenological psychology therefore helped to gain insight into the participants’ situational experience of QoL and life course, not detectable by the use of a questionnaire.

Fig. 5 illustrates the theoretical propositions, empirical findings from qualitative and quantitative data and the relationships between these. The use of the mixed methods approach enabled a clearer understanding to emerge in relation to the lived experience of CAD patients and the factors that were related to poor QoL. This understanding allows new theoretical propositions about these issues to be developed and further explored, as depicted at the theoretical level.

4. Discussion

As the need for, and use of, mixed methods research continues to grow, the issue of quality within mixed methods studies is becoming increasingly important ( O’Cathain et al., 2008 , O’Cathain et al., 2007 ). Similarly, the need for guidance on the analysis and integration of qualitative and quantitative data is a prominant issue ( Bazeley, 2009 ). This paper firstly intended to review the types of analytic approaches (parallel, concurrent or sequential data analysis) that have been used in mixed methods studies within healthcare research. As identified in previous research ( O’Cathain et al., 2008 ), we found that the majority of studies included in our review employed parallel data analysis in which the different analyses are not compared or consolidated until the full analysis of both data sets have been completed. A trend to conduct separate analysis on quantitative and qualitative data is apparent in mixed methods healthcare studies, despite the fact that if the data were correlated, a more complete picture of a particular phenomenon may be produced ( Onwuegbuzie and Teddlie, 2003 ). If qualitative and quantitative data are not integrated during data collection or analysis, the findings may be integrated at the stage of interpretation and conclusion.

Although little pragmatic guidance exists within the wider literature, Erzberger and Kelle (2003) have published some practical advice, on the integration of mixed methods findings. For mixed methodologists, the ‘triangulation metaphor’ offers a framework to facilitate a description of the relationships between data sets and theoretical concepts and can also assist in the integration of qualitative and quantitative data ( Erzberger and Kelle, 2003 ). Yet despite the fact that the framework was published in 2003 within Tashakkori and Teddlie's (2003) seminal work, the Handbook for Mixed Methods in Social and Behavioural Research, our search revealed that it has received little application within the published body of work around mixed methods studies since its publication. This is surprising since mixed methodologists are acutely aware of the lack of guidance with regards to the pragmatics and practicalities of conducting mixed methods research ( Bryman, 2006 , Leech et al., 2010 ). Furthermore, there have been frequent calls to move the field of mixed methods away from the “should we or shouldn’t we” debate towards the practical application, analysis and integration of mixed methods and its’ findings and what we can learn from each other's work and advice. Consequently, we have a state of ambiguity and instability in the field of mixed methods in which mixed methodologists find themselves lacking appropriate sources or evidence to draw upon with which to facilitate the future design, conduct and interpretation of mixed methods studies. It is for these reasons that we, in this paper, also intended to identify and select studies that could be used as examples for the application of Erzberger and Kelle's (2003) triangulation metaphor.

When reviewing the studies it was clear that the majority of theoretical assumptions were implicit, rather than explicitly stated by authors. Wu and Volker (2009) previously acknowledged that while studies undoubtedly have a theoretical basis in their literature reviews and the nature of their research questions, they often fail to clearly articulate a particular theoretical framework. This is unfortunate as theory can help researchers to clarify their ideas and also help data collection, analysis and to improve the study's rigour ( Wu and Volker, 2009 ). When using triangulation as a methodological metaphor ( Erzberger and Kelle, 2003 ), researchers are encouraged to articulate their theoretical propositions and to validate their conclusions in relation to the chosen theories. Theory can also guide researchers when defining outcome measures . Should the findings not support the chosen theory, as shown in our examples on complementary and divergent results, researchers can modify or expand their theory accordingly and new theory may be developed ( Wu and Volker, 2009 ). It is therefore our belief that using triangulation as a methodological metaphor in mixed methods research can also benefit the design of mixed method studies.

Like other researchers ( O’Cathain et al., 2008 ), we have also found that most of the papers reviewed lacked clarity in whether the reported results primarily stemmed from qualitative or quantitative findings. Many of the papers were even less clear when discussing their results and the basis of their conclusions. The reporting of mixed methods studies is notoriously challenging, but clarity and transparency are, at the very least, crucial in such reports ( O’Cathain, 2009 ). Using triangulation as a methodological metaphor ( Erzberger and Kelle, 2003 ) may be one way of addressing this lack of clarity by explicitly showing the types of data that researchers have based their interpretations on. It may even help address some of the issues raised in the debate on the feasibility of integrating research methods and results stemming from different epistemological and ontological assumptions and paradigms ( Morgan, 2007 , Sale et al., 2002 ). In order to carry out methodological triangulation researchers also need to identify and observe the consistency and adequacy of the two methods, positivistic and phenomenological regarding the research questions, data collection, methods of analysis and conclusions.

While we used systematic principles in our search for mixed methods studies in healthcare research, we cannot claim to have included all such studies. In many cases, reports of mixed methods studies are subjected to ‘salami slicing’ by researchers and hence the conduct of, and findings from, individual approaches are addressed in separate papers. Since these papers are often not indexed as a ‘mixed method’ study, they are undoubtedly more difficult to identify. Furthermore, different terminologies are used to describe and index mixed methods studies within the electronic databases ( Halcomb and Andrew, 2009a ), making it challenging to be certain that all relevant studies were captured in this review. However, the studies included in this review should give a sufficient overview of the use of mixed analysis in healthcare research and most importantly, they enable us to make suggestions for the future design, conduct, interpretation and reporting of mixed methods studies. It is also important to emphasise that we have based our triangulation examples on the data published but have no further knowledge of the analysis and findings undertaken by the authors. The examples should thus be taken as examples and not alternative explanations or interpretations.

Mixed methods research within healthcare remains an emerging field and its use is subject to much debate. It is therefore particularly important that researchers clearly describe their use of the approach and the conclusions made to improve transparency and quality within mixed methods research. The use of triangulation as a methodological metaphor ( Erzberger and Kelle, 2003 ) can help researchers not only to present their theoretical propositions but also the origin of their results in an explicit way and to understand the links between theory, epistemology and methodology in relation to their topic area. Furthermore it has the potential to make valid inferences, challenge existing theoretical assumptions and to develop or create new ones.

Conflict of interest

None declared.

Ethical approval

Not required.

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Qualitative Research in Nursing and Health Professions Regulation

• Allison Squires, PhD, RN, FAAN Allison Squires Search for articles by this author
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• Westhorp G.
• Scopus (111)
• Macintyre Latta M.
• Schnellert L.
• Spector-Mersel G.
• Wolgemuth J.R.

Design Dictates the Analytic Approach

• Castro F.G.
• Kellison J.G.
• Scopus (292)
• Scopus (218)

Samples, Sampling, and Saturation

• Malterud K.
• Siersma V.D.
• Guassora A.D.
• MacPhail C.
• Ranganathan M.
• Nelson L.K.
• Norris A.C.
• Farris A.J.
• Babbage D.R.
• Scopus (97)
• Scopus (10142)

Framing Findings

• Scopus (242)
• • Introducing quotes with a single sentence, rather than establishing the context of the quote and how it links to the theme
• • Inserting overly long quotes to represent experiences or the phenomenon
• • Failing to transition between quotes and the next paragraph without an explanatory or transition sentence
• • Choosing quotes that do not represent the theme
• • Inserting too many quotes
• • Separating every quote, regardless of length (35 words or more should be in a separate paragraph), without integrating them into the paragraph for a seamless reading experience.

Choosing Quotes

Managing word count limitations, avoiding discussion pitfalls and the generalizability trap.

• Carminati L.

Conclusions

Ce posttest, instructions, provider accreditation.

• a. Local and national governmental oversight through health professions regulation is needed for professional practice.
• b. Health professions are regulated in order to avoid a risk of harm to the public.
• c. Congress mandates that all professions are regulated.
• d. Both a and b
• a. There are not enough studies to determine the effectiveness of qualitative research yet.
• b. Quantitative research is more critical because it provides both exploratory and explanatory data.
• c. Qualitative research can play a vital role in ensuring that the stakeholder’s voice is represented and their experiences inform the evaluation of regulations and their associated policies.
• d. None of the above
• a. Identification, modification, or abolition
• b. Creation, modification, or elimination
• c. Oversight, enforcement, or evaluation
• d. Creation, development, or destruction
• c. Data saturation
• d. Reliability
• a. Data saturation
• b. Trustworthiness
• a. Termination
• b. Content closure
• c. Conclusion
• d. Data saturation
• a. Rigorous
• b. Trustworthy
• c. Unbiased
• d. Credible
• a. Grounded theory
• b. Phenomenology
• c. Ethnography
• d. Generic qualitative descriptive
• a. The applicability of the results is immediately apparent and translatable into the real world.
• b. The end goal of the study is to generate a theory from the data.
• c. The study must describe the lived experience of a phenomenon.
• d. Generic approaches offer flexibility for studying regulation and regulatory issues.
• 12. Pragmatic qualitative studies _____
• 13. Case studies _____
• 14. Realist evaluations _____
• a. Might work well exploring a state level analysis of a regulatory change
• b. A way to compare contemporary and historical stakeholder perspectives around the legislative process or similar phenomena
• c. Might be useful for studying how new regulations have affected those subject to them during the early phases of implementation
• d. Contributes to the evidence to support or change a regulation
• a. Recruit a sample size that will achieve data saturation.
• b. Aim for a heterogeneous sample.
• c. Plan to achieve a minimum sample size of 8 as a realistic and achievable goal in most cases.
• d. Sample size has no impact on regulatory research.
• a. Long quote
• b. Strong opening sentence
• d. Phenomenon
• a. Representative of participants’ experiences
• b. Improve the trustworthiness of results
• c. Articulately or succinctly explain a phenomenon
• d. All of the above
• a. The discussion section may end up too “thin” because the authors have left no room in the word count for a robust discussion of the findings
• b. The discussion section uses the first paragraph to summarize the findings from the study and how they are unique from the literature
• c. The authors assume the findings are generalizable to the broader population.
• a. They should include all findings, even if the content does not tie back to the original research question.
• b. They can provide useful direction for others seeking to replicate the study in different contexts or with populations affected by the same regulations.
• c. Suggestions for realistic, existing, measurable variables that might be sensitive to the effects of a regulation cannot be useful for a qualitative study focused on regulation.
• d. Qualitative findings can always be applied to other regional, state, national, or international populations.

Evaluation Form (required)

• • Explain the importance of qualitative research for studies about regulatory issues in nursing. 1 2 3 4 5 ___________________________________
• • Discuss the core concepts of qualitative research. 1 2 3 4 5 ___________________________________
• • Describe common methodological challenges researchers can encounter when conducting qualitative research on professional regulatory issues. 1 2 3 4 5 ___________________________________
• • Identify solutions that can enhance the quality, rigor, and trustworthiness of the findings for regulatory studies. 1 2 3 4 5 ___________________________________
• • Were the authors knowledgeable about the subject? 1 2 3 4 5 ___________________________________
• • Were the methods of presentation (text, tables, figures, etc.) effective? 1 2 3 4 5 ___________________________________
• • Was the content relevant to the objectives? 1 2 3 4 5 ___________________________________
• • Was the article useful to you in your work? 1 2 3 4 5 ___________________________________
• • Was there enough time allotted for this activity? 1 2 3 4 5 ___________________________________
• Krefting L.
• Scopus (1933)

Article info

Identification.

DOI: https://doi.org/10.1016/S2155-8256(18)30150-9

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• Preview As is standard in scholarly publishing, NCSBN’s Journal of Nursing Regulation (JNR) requires its authors to disclose any potential conflicts of interest (COI). Although COI information has always been collected by our staff in order to support editors’ review of the paper, it was not our standard practice to publish COI statements in each article. In this issue, JNR is retrospectively publishing the COI statements, which were collected with the below papers at submission, in order to make potential COI’s transparent to readers, as well as editors.

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