The idea of using a mixed method approach to research in the healthcare field tends to look at the situation, both patient care and professional issues of quality of care and job satisfaction, in a more holistic manner. Studying a problem using both approaches allows factors and variables that come up during the qualitative phase to also be explored in more depth quantitatively. In addition, studying the problem from a qualitative focus allows the research to take on a more human face, and also deal with issues that are not necessarily black/white for every individual, a continuum.
¶ … healthcare has been moving from a total "organic" model to a more holistic viewpoint of the patient and their individual needs. Healthcare professionals have come to realize that within any organization, nothing is ever in isolation. Research has shown us many things that can be improved using the holistic and multi-cultural models, as well as the direction(s) we are suggesting with our new program. Clearly, the empirical research shows us that there are many modifiers that can create illness, modify illness patterns, contribute to healing, and act in a preventative manner (Adler, 1994). This is particularly true when dealing with chronic diseases like AIDS. Specialized AIDS units within a modern healthcare facility offer a team of experts who are familiar with the various permutations of the disease and who have greater responsibility and autonomy within the nursing staff. This should, in theory, increase both objective and subjective outcomes for the patient and provide greater job satisfaction for the health care professionals (Aiken and Sloan, 1997).
Research Question (Qualitative): Do nurses who work in a specialized AIDS ward feel more job satisfaction, empowerment and autonomy than nurses treating similar patients in a general ICU or ward? Open ended questions might also bring up more salient data from the healthcare professional.
Research Question (Quantitative): What are the measurable outcomes in terms of productivity (patient hours, sick days) for nurses treating patients in a specialized AIDS ward vs. nurses treating patients in a general ICU or ward.
Methods: There has been an intellectual conflict between quantitative and qualitative research within the medical sciences for decades. Quantitative research focuses on specific and narrow questions that can be measured mathematically, while qualitative research focuses on interpretations of various emotions, feelings and beliefs of the population. Qualitative methods provide researchers a way to explore and investigate a problem or situation that may move beyond measurement and have a continuum of scale -- e.g. feelings about empowerment, etc. (Laws and McLeod, 2005).
Strengths and Weaknesses of Method: The quantitative measure above would measure the nurse's time/patient and attendance. This assumes that these two measurements are adequate to measure productivity. Because AIDS patients are unique, it would be impossible to link patient care within a specialized ward with physical outcomes, but one could include a qualitative question about patient "feelings of care." Similarly, qualitative analysis would ask open-ended questions like "feelings of worth, autonomy, job satisfaction, etc." But would vary considerably between nurse and patient, and therefore become rather subjective.
If the study was purely quantitative we would measure a small piece of the overall picture of the value of a specialized ward. We might, for instance, find that nurses were less likely to be absent from work and have a higher patient/nurse ratio of care than in other wards. Would this totally measure the questions? No, since there are also other variables that would impact the study. Nurses in one area or another might be more or less healthy overall; the ratio to patient might be higher or lower, there might be more stress within the workplace, etc. If we simply looked at qualitative "feelings," though, we would have a similar, rather myopic viewpoint of the situation. Nurses might "feel" more empowered, but that might be a condition of their own personalities, etc. -- patient hours might be relevant to care based on the number of nurses assigned to the ward. Neither study would fully answer the questions surrounding efficacy of a specialized unit.
Ideal: For this study, there would be major advantages to combining the two into a mixed-method study. Chow (2010) study demonstrates that there are three major advantages to using a mixed methods approach to studies that involve interpretations, opinions, and judgments about healthcare: 1) The MM approach increases the manner in which the overall findings are more comprehensively linked between qualitative data (Phase 2) and quantitative measurement (Phase 1); A MM approach expands the dimensions and applications of the research by allowing client opinions and satisfaction/dissatisfaction measurements, and; 3) A MM approach increases the methodological robustness by providing a check and balance between qualitative and quantitative methods (Chow).
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