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l am new into doing research as a major subject and l am having some dificultities in choosing the proper methodology for my research question. l am interested in symptom management in oncology patients. My researsh question reads as ” What influences nurses decision making in managing opioid- induced constipation in oncology patients? “. l have chosen qualitative method using a phenomenology approach to gather in -depth understanding of this topic with thematic analysis of data. First l will introduce a decision making pathway tool for bowel management then followed by interviewing the users (nurses) in a natural setting (CLINICAL SETTING) so as to gain their attidutes and experience into this phenomenon
Hi Faith: Your research design makes sense. However, I am confused by “I will introduce a decision making pathway tool for bowel management”. Would you elaborate a bit on this issue?
Wondering why and when you will introduce this tool or approach – before or after the data gathering?
My issue in on poorly mismanaged of the symptom in an oncology clinical setting. Nurses are making their dicision management of constipation following a set clinical guideline of bowel management. My aim is to explore the experiences of these nurses in using this bowel management guideline. A different decision making pathway tool for bowel management will be used by nurses in the ward for a certain period of time then followed by the interviews ( data garthering) on their experiences of using this tool. Is the phenomenology approach appropriate for this study ? Thank you so much all for the response.
If I am not wrong, you will make the intervention by introducing the decision making pathway tool first and then capturing their experiences, right?
Pheno approach seems ok. You want to gain an in-depth knowledge of nurses experiences, right?
However, if you’re familiar with QuanTI method, quasi-experimental R is more useful here mixed with interviews.
Have you reviewed lite on previous clinical guidelines and other issues. Does the lite say that introducing pathway tool is appropriate in your R setting?
You got it all right! l am not familiar with Quan TI method, is this a mixed methodology where Quan & Qual are used together, e.g surveys and interviews? I will look into that, thanks. My problem was on choosing the appropriate method to capture nurses experiences.
There is no issue in introducing the pathway, but the problem was how, but from what you suggested is getting clear.
The Research Question is a little weak itself – it seems you will end up with your raw data as a set of influences, so they are basically statements. But is that your outcome, what you are really looking for? My advice would be to think about what some call actors, those who will actually use what you produce to make changes in treatments? So the question is would you just hand over a set of influences or would you perhaps process them into a checklist as your final outcome and the checklist is designed to be used by nurses, the actors. The point is unless you know what the final outcome form is one can hardly decide what to collect or what to do with it afterwards.
Hi Fred. My actors are nurses and these actors they are the ones who uses the management tools and are the front liners in implementing treatment interventions. As the users, the final outcomes are based on their decision making. My questions are:
What influences their bowel management decision making?
Are they just following the guidelines and not looking outside the box?
Are they making assumptions such as,” all patients taking opioids for pain will experience constipation ” do they consider other factors which might cause this symptom? do they question the guidelines, does the guideline apply to all cancer patient?
What conversations take place when assessing these patients? Is it a well defined symptom in this group of patients.?
l appreciate your input, it does shapes my topic. l started with a very broad topic which l have narrowed down to this. The outcome is to inform nurse so as to improve the management of opioid- induced constipation (OIC).
Hi Fred, I think you are treating Faith’s study more as a stats-based work. It’s phenomenology where statements, accounts, and other input count as real data and not raw.
When I use the term raw I just mean its the state before you process it to get your outcome. The study seems to start with a solution, a decision making tool so the study amounts to an evaluation of that tool. So there does not seem to be any looking for influences at all since on presumes all decisions are fixed. One might though say that the tool asks questions and the nurses presumably make some kind of assessment, so is that what is meant By influences here?
The answers and real data will probably come from the in- depth interviews ( phenomenology) which will then lead to appropriate interventions in managing this distressing symptom which is so far poorly addressed as evidenced by its poor management. The tool is not a major concern, the aim is to gain insight to this problem as experienced by nurses looking after these patients.
I think yiu are going in the right direction. The issue from a research pint of view is that you or the nurses are using a tool so it sounds as if they are not making decisions but the variance comes because they have to look at the patient and answer a question posed by the tool – well i think that is what is being done. Now if youare looking at their answers to questions the tool poses that also is fine though it sounds as if you want to find out their reasoning and that also sounds fine. Now knowing your actors should help you to decide what form your outcome should take. What I mean here is that you will collect your data as the study progresses and then you have to organise it in some way (which we can discuss later) and the final step is to generate your outcome and tgat outcome is what then gets used by your actors. Nor I don’t know enough to say what it might be but let’s be simple and say that using your data you create a position paper – that is a report which discusses and highlights any issues and charts a way forward for let’s say the consultants to consider and initiate further action (in that case the consultants are your actors).Alternatively, you might create a set of recommendations to improve the tool or a training plan for nurses so that they can more accurately identify patient problem etc
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