Journal of Advanced Nursing

Title.  The qualitative content analysis process

Aim.  This paper is a description of inductive and deductive content analysis.

Background.  Content analysis is a method that may be used with either qualitative or quantitative data and in an inductive or deductive way. Qualitative content analysis is commonly used in nursing studies but little has been published on the analysis process and many research books generally only provide a short description of this method.

Discussion.  When using content analysis, the aim was to build a model to describe the phenomenon in a conceptual form. Both inductive and deductive analysis processes are represented as three main phases: preparation, organizing and reporting. The preparation phase is similar in both approaches. The concepts are derived from the data in inductive content analysis. Deductive content analysis is used when the structure of analysis is operationalized on the basis of previous knowledge.

Conclusion.  Inductive content analysis is used in cases where there are no previous studies dealing with the phenomenon or when it is fragmented. A deductive approach is useful if the general aim was to test a previous theory in a different situation or to compare categories at different time periods.

Aim.  The aim of this paper is to distinguish the integrative review method from other review methods and to propose methodological strategies specific to the integrative review method to enhance the rigour of the process.

Background.  Recent evidence‐based practice initiatives have increased the need for and the production of all types of reviews of the literature (integrative reviews, systematic reviews, meta‐analyses, and qualitative reviews). The integrative review method is the only approach that allows for the combination of diverse methodologies (for example, experimental and non‐experimental research), and has the potential to play a greater role in evidence‐based practice for nursing. With respect to the integrative review method, strategies to enhance data collection and extraction have been developed; however, methods of analysis, synthesis, and conclusion drawing remain poorly formulated.

Discussion.  A modified framework for research reviews is presented to address issues specific to the integrative review method. Issues related to specifying the review purpose, searching the literature, evaluating data from primary sources, analysing data, and presenting the results are discussed. Data analysis methods of qualitative research are proposed as strategies that enhance the rigour of combining diverse methodologies as well as empirical and theoretical sources in an integrative review.

Conclusion.  An updated integrative review method has the potential to allow for diverse primary research methods to become a greater part of evidence‐based practice initiatives.

Aim. To outline the key concepts and principles of the Delphi technique.

Methods. Reference is made to a selection of studies that illustrate a variety of methodological interpretations. Drawing on Heshusius's concept of ‘goodness criteria’, particular emphasis is given to the question of scientific merit and means of evaluation.

Conclusion. Although the technique should be used with caution, it appears to be an established method of harnessing the opinions of an often diverse group of experts on practice‐related problems.

Aim.  This paper reviews the key research literature regarding men's health‐related help seeking behaviour.

Background.  There is a growing body of research in the United States to suggest that men are less likely than women to seek help from health professionals for problems as diverse as depression, substance abuse, physical disabilities and stressful life events. Previous research has revealed that the principle health related issue facing men in the UK is their reluctance to seek access to health services.

Method.  The investigation of men's health‐related help seeking behaviour has great potential for improving both men and women's lives and reducing national health costs through the development of responsive and effective interventions. A search of the literature was conducted using CINAHL, MEDLINE, EMBASE, PsychINFO and the Cochrane Library databases.

Results.  Studies comparing men and women are inadequate in explaining the processes involved in men's help seeking behaviour. However, the growing body of gender‐specific studies highlights a trend of delayed help seeking when they become ill. A prominent theme among white middle class men implicates ‘traditional masculine behaviour’ as an explanation for delays in seeking help among men who experience illness. The reasons and processes behind this issue, however, have received limited attention.

Conclusions.  Principally, the role of masculine beliefs and the similarities and differences between men of differing background requires further attention, particularly given the health inequalities that exist between men of differing socio‐economic status and ethnicity. Further research using heterogeneous samples is required in order to gain a greater understanding of the triggers and barriers associated with the decision making process of help seeking behaviour in men who experience illness.

Title.  Factors affecting the utilization of antenatal care in developing countries: systematic review of the literature.

Aim.  This paper is a report of a systematic review to identify and analyse the main factors affecting the utilization of antenatal care in developing countries.

Background.  Antenatal care is a key strategy for reducing maternal mortality, but millions of women in developing countries do not receive it.

Data sources.  A range of electronic databases was searched for studies conducted in developing countries and published between 1990 and 2006. English‐language publications were searched using relevant keywords, and reference lists were hand‐searched.

Review methods.  A systematic review was carried out and both quantitative and qualitative studies were included.

Results.  Twenty‐eight papers were included in the review. Studies most commonly identified the following factors affecting antenatal care uptake: maternal education, husband’s education, marital status, availability, cost, household income, women’s employment, media exposure and having a history of obstetric complications. Cultural beliefs and ideas about pregnancy also had an influence on antenatal care use. Parity had a statistically significant negative effect on adequate attendance. Whilst women of higher parity tend to use antenatal care less, there is interaction with women’s age and religion. Only one study examined the effect of the quality of antenatal services on utilization. None identified an association between the utilization of such services and satisfaction with them.

Conclusion.  More qualitative research is required to explore the effect of women’s satisfaction, autonomy and gender role in the decision‐making process. Adequate utilization of antenatal care cannot be achieved merely by establishing health centres; women’s overall (social, political and economic) status needs to be considered.

Studies on ‘hidden populations’, such as homeless people, prostitutes and drug addicts, raise a number of specific methodological questions usually absent from research involving known populations and less sensitive subjects. This paper examines the advantages and limitations of nonrandom methods of data collection such as snowball sampling. It reviews the currently available literature on sampling hard to reach populations and highlights the dearth of material currently available on this subject. The paper also assesses the potential for using these methods in nursing research. The sampling methodology used by Faugier (1996) in her study of prostitutes, HIV and drugs is used as a current example within this context.

Title.  Transition shock: the initial stage of role adaptation for newly graduated Registered Nurses.

Aim.  The aim of this paper is to provide a theoretical framework of the initial role transition for newly graduated nurses to assist managers, educators and seasoned practitioners to support and facilitate this professional adjustment appropriately.

Background.  The theory of Transition Shock presented here builds on Kramer’s work by outlining how the contemporary new graduate engaging in a professional practice role for the first time is confronted with a broad range and scope of physical, intellectual, emotional, developmental and sociocultural changes that are expressions of, and mitigating factors within the experience of transition.

Data sources.  This paper offers cumulative knowledge gained from a programme of research spanning the last 10 years and four qualitative studies on new graduate transition.

Discussion.  New nurses often identify their initial professional adjustment in terms of the feelings of anxiety, insecurity, inadequacy and instability it produces. The Transition Shock© theory offered focuses on the aspects of the new graduate’s roles, responsibilities, relationship and knowledge that both mediate the intensity and duration of the transition experience and qualify the early stage of professional role transition for the new nursing graduate.

Conclusion.  Transition shock reinforces the need for preparatory theory about role transition for senior nursing students and the critical importance of bridging undergraduate educational curricula with escalating workplace expectations. The goal of such knowledge is the successful integration of new nursing professionals into the stressful and highly dynamic context of professional practice.

Background.  Focus group interviews are a method for collecting qualitative data and have enjoyed a surge in popularity in health care research over the last 20 years. However, the literature on this method is ambiguous in relation to the size, constitution, purpose and execution of focus groups.

Aim.  The aim of this article is to explore some of the methodological issues arising from using focus group interviews in order to stimulate debate about their efficacy.

Discussion.  Methodological issues are discussed in the context of a study examining attitudes towards and beliefs about older adults in hospital settings among first‐level registered nurses, nursing lecturers and student nurses. Focus group interviews were used to identify everyday language and constructs used by nurses, with the intention of incorporating the findings into an instrument to measure attitudes and beliefs quantitatively.

Conclusions.  Experiences of conducting focus group interviews demonstrated that smaller groups were more manageable and that groups made up of strangers required more moderator intervention. However, as a data collecting strategy they are a rich source of information.

This paper is a review of the literature on reflection The purpose was to unravel and make sense of the complex literature, and to identify the skills required to engage in reflection An analysis of the literature revealed that differences between authors’ accounts of reflective processes are largely those of terminology, detail and the extent to which these processes are arranged in a hierarchy Key stages of reflection are identified and represented by a model Skills required to engage in reflection were found to be implicit in the literature and these are identified Methodological issues related to empirical literature are discussed It is suggested that reflection is an important learning tool in professional education and that the skills required for reflection need to be developed in professional courses

Getting evidence into practice: the role and function of facilitation

Aim of paper. This paper presents the findings of a concept analysis of facilitation in relation to successful implementation of evidence into practice.

Background. In 1998, we presented a conceptual framework that represented the interplay and interdependence of the many factors influencing the uptake of evidence into practice. One of the three elements of the framework was facilitation, alongside the nature of evidence and context. It was proposed that facilitators had a key role in helping individuals and teams understand what they needed to change and how they needed to change it. As part of the on‐going development and refinement of the framework, the elements within it have undergone a concept analysis in order to provide theoretical and conceptual clarity.

Methods. The concept analysis approach was used as a framework to review critically the research literature and seminal texts in order to establish the conceptual clarity and maturity of facilitation in relation to its role in the implementation of evidence‐based practice.

Findings. The concept of facilitation is partially developed and in need of delineation and comparison. Here, the purpose, role and skills and attributes of facilitators are explored in order to try and make distinctions between this role and other change agent roles such as educational outreach workers, academic detailers and opinion leaders.

Conclusions. We propose that facilitation can be represented as a set of continua, with the purpose of facilitation ranging from a discrete task‐focused activity to a more holistic process of enabling individuals, teams and organizations to change. A number of defining characteristics of facilitation are proposed. However, further research to clarify and evaluate different models of facilitation is required.