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Strategies for Supporting Evidence-Based Practice through Mixed-Methods Research

Consider this scenario:
One of the assignments in your course is for small groups of students to retrieve three studies on the same topic, critically appraise the studies, and develop a presentation for their peers. When one group meets with you to discuss their articles on the topic of patients without health insurance, they have questions. The students have correctly identified one study as being quantitative, using data from electronic health records to compare the hypertension outcomes of persons with and without health insurance. The students are confident the second article reports the findings of a qualitative study of the lived experience of not having health insurance. The third article has them puzzled, however, and they ask, “What is mixed methods research?”

Mixed methods studies are being conducted by nurses and other health professionals in increasing numbers. A literature search on almost any health-related topic will identify mixed methods studies. Why are these methods being used? Philosophical and practical reasons are motivating the use of mixed methods research designs.

Philosophical reasons
You and your students may prefer quantitative or qualitative research based on your own views of science. Or, you may agree with researchers who believe a combination of quantitative and qualitative methods are needed to study complex problems. These researchers have developed data collection strategies and study designs that combine the methods in a meaningful way. Mixed methods researchers may adopt a pragmatic philosophy of research that supports a variety of strategies, exploits the strengths of both quantitative and qualitative research, and creatively produces a multidimensional description or solution. Nurses may gravitate to pragmatism because of our commitment to solving problems and providing holistic, comprehensive care. Findings from mixed methods studies can also make a unique contribution to evidence-based practice, a practical motivation.

Evidence-based practice
The motivation to conduct mixed methods studies is linked to the mandate to provide evidence-based care for patients in a variety of settings. The Institute of Medicine identified evidence-based practice as one of the core competencies for healthcare professionals in 2005. Building on their work, the Quality and Safety for Nursing Education (QSEN) project defined the knowledge, skills, and attitudes nurses need to achieve these competencies. Nurse educators accepted the challenge and integrated the QSEN competencies, including evidence-based practice, into curricula across all levels.

A widely-accepted definition of evidence-based practice is the integration of the best research evidence available, the needs and preferences of the individual patient and family, and the clinical expertise of the health professional. Rigorous mixed methods studies produce scientific evidence balanced and illuminated by the experiences of the individual, findings that provides unique insights to support evidence-based care. When the quantitative and qualitative findings of mixed methods studies are congruent with each other, their triangulation strengthens the evidence. When the quantitative and qualitative findings are incongruent with each other, the awareness of the need to solicit patient and family perspectives is heightened. Mixed methods studies remind us that the best research evidence is effectively applied in clinical settings when patient and family perspectives are incorporated.

Teaching Strategies
Because students are going to encounter mixed methods studies, you may be thinking that mixed methods content should be added to your course. How can you guide students to understand mixed methods studies and evaluate their quality? One strategy is to identify the decisions the researchers made about how to implement the study.

  • Were the quantitative and qualitative approaches implemented concurrently or sequentially?
  • Were the quantitative and qualitative data analyzed and interpreted separately and then combined? Or were the findings of one component used to design the other component?
  • Did the same sample provide the quantitative and qualitative data or were different samples used for each approach?
  • How were the results of each approach combined or compared?
  • If there were incongruencies between the qualitative and quantitative results, how were they interpreted and presented?
The next step is to evaluate the study guided by another set of questions.
  • Was the design appropriate for the research question?
  • Were the methods rigorously implemented?
  • What insights do the findings provide that either method alone might not have revealed?
  • How do these findings inform evidence-based care in my setting?

Closing thoughts
Your students have one last question. “Which research approach is best - quantitative, qualitative, or mixed methods research?” Your answer is “it depends,” because different research questions require different research methods. As research methods continue to evolve in response to complexity of health care, embrace the innovation and prepare yourself and your students to be knowledgeable consumers of research.

Learn more and request your complimentary review copy of Understanding Nursing Research, 7th edition here.

Jennifer Gray,

RN, PhD, FAAN
Co-Author of:
Understanding Nursing Research, 7th edition

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