Quantitive and Qualitative Article Review
Kristi Schneider
Walden University
NURS-4000 Res/Scholarshp Evid-based Prac2016
3-20-2016
Quantitive and Qualitative Article Review Quantitive and qualitative studies in research are an important aspect of the nursing profession. Researching and reviewing quantitive and qualitative articles is a process of systematic examination of materials to enhance, validate and learn new knowledge (Schmidt and Brown, 2012, p. 67). As Schmidt and Brown (2012) state, quantitive research design is used to predict relationships and explain relationships and causality whereas qualitative research design gives meaning to events of phenomenon’s (p.72). The purpose of this paper is to identify and interpret research questions, study designs, sample sizes and representativeness, the strengths and weakness of the designs, as well as results of data analysis of both quantitive and qualitative research designs.
Overview of Quantitive Design Using the Research Study “A Bundle Strategy Including Patient Hand Hygiene to Decrease Clostridium difficile Infections.”
Research Question The basis of a research question is to pose an interrogatory question that describes the variables and population of the research study (Schmidt & Brown, 2012, p. 72). In the article “A Bundle Strategy Including Patient Hand Hygiene to Decrease Clostridium difficile Infections.”, (Pokrywka et al., 2014), Pokrywka et al. (2014) present the research question; will the effect of an expanded bundle strategy, to include patient hand hygiene, make an impact on the rate of Clostridium difficile (C. difficile) of hospitalized patients? This question can be stemmed from the main research problem that the prevalence of C. difficile in hospitalized patients causes increased hospital costs, mortality and length of stay (Pokrywka et al., 2014, p. 145). In attempting to answer the research question, Pokrywka et al. (2014) analyze and validate the hypothesis to prove that integrating patient participation of hand hygiene will decrease the incidence of contracting C-difficile through the fecal-oral route while in the hospital setting.

Study Design The design of the study “A Bundle Strategy Including Patient Hand Hygiene to Decrease Clostridium difficile Infections” (Pokrywka, et al., 2014) is quantitative in nature. According to Schmidt and Brown (2012), quantitive study designs are used to evaluate relationships among variables and can be either non-experimental or experimental (Schmidt & Brown, 2012, p. 175). In the case of this article, the design was experimental. The researchers manipulated the independent variable by creating tools such as brochures and signage; they also implemented protocols for before meal hand washing. They then determined the effect upon the dependent variable which was the rate of C. difficile after interventions were implemented. This study also used a between-group design, which defined by Schmidt and Brown (2012) is a design to compare two different groups of subjects to make a comparison (Schmidt & Brown, 2012, p. 148-49). The article reviewed, compared the results between the rates of C, difficile before (July 2009-June 2009) and then after the intervention was implemented (July 2009-June 2010).
Sample size and Representativeness One major factor when attempting to answer a research question is to come up with a sampling method. This sampling method is determined by the purpose of the research and the research design. Sample subjects are a group of individuals that are representative of all eligible people (Schmidt & Brown, 2012, p. 247). In the article “A Bundle Strategy Including Patient Hand Hygiene to Decrease Clostridium difficile Infections” (Pokrywka, et al., 2014), Pokrywka et al. (2014) chose a probability sampling method, where the individuals of the sample population had an equal chance of being selected for inclusion in the study. The sample size appears to demonstrate homogeneity as the design only used cases meeting specific criteria; that being the number of people infected with C. difficile before and after interventions were applied in the chosen time frames. The total sample size of this literature review was 336 individuals. The sample is representative because there does not appear to be instances of selection bias. Since the study was performed on a broad range of patients and 156,956 hospitals days in 2009 and 166,838 hospital days in 2010, it is unlikely that the sample is skewed. The sample size was also adequate as the research team literature review did a great job determining how many samples would be needed.
Results of Data Analysis Quantitive data uses statistics to describe the sample represented (Schmidt and Brown, 2012). In the article reviewed, “A Bundle Strategy Including Patient Hand Hygiene to Decrease Clostridium difficile Infections” (Pokrywka, et al., 2014), the rate of C. difficile infections were calculated using chi-square test. According to Schmidt and Brown (2012), the chi-square statistic finds differences between groups of demographic variables (Schmidt & Brown, 2012 p.328 ). In this article review, the data analysis procedure calculated the rate of C. difficile infections in the categories, health acquired and health acquired extended rates as the numerator, and inpatient days as the denominator and multiplied by 10,000 (per 10,000 patient days). After monthly rates from July 2008 to June 2009 were compiled, the results were 10.45, with 164 cases (129 HA cases and 35 HAE cases) in 156,956 patient days. This finding was then were compared to the rates after the implementation of hand hygiene practices during the period of July 2009 to June 2010, which were 6.95 per 10,000 patient days (116 cases/166,838 patient days x 1000). After the application of the chi-square test, the statistical significance was P=0.0009 (Pokrywka, et al., 2014, p. 147). The result of the statical significance validates that there was indeed a decrease in the number of C. difficile cases within a year regarding adding the patient hand hygiene to the best-practices bundle.
Summary of Strengths and Weaknesses The strengths of the study “A Bundle Strategy Including Patient Hand Hygiene to Decrease Clostridium difficile Infections” (Pokrywka, et al., 2014), was its quantitive nature and extensive literature review. By doing the literature review, Pokrywka et al. (2014) were able to define interventions and set guidelines for the intervention period based on what was found in the literature. The authors confirmed validity by using hypothesis testing. According to Schmidt and Brown (2012), hypothesis testing is where hypotheses are derived from theory and tested with a new instrument (Schmidt & Brown, 2012, p. 74-75). In the case of this quantitive analysis, the new instrument was the interventions derived from the literature review which was compared to the period of non-intervention.
One of the weaknesses of this study was that the H1N1 virus was also spreading throughout the patient population which was possibly a confounding variable, as the awareness of the flu virus may have increased hand hygiene during the study. The study demonstrates test-retest reliability because patients were compared using the same screening, before and after the interventions. In this case the intervention was bundle of interventions designed to reduce the incidence of C-diff infection Qualitative Design Analysis
Research Question Research questions aim to address gaps in knowledge that requires a solution that can be explained, predicted or described to improve nursing practice (Schmidt & Brown, 2013). Also, according to Schmidt and Brown (2012), many research questions are derived from current nursing theories and focus on testing new theories to see if they can predict an outcome. In the article, “I hate having nobody here. I’d like to know where they all are’: Can qualitative research detect differences in quality of life among nursing home residents with different levels of cognitive impairment?” (Cahill & Diaz-Ponce, 2011), the research question is based on the theory that quality of life may be affected by differing levels of cognitive impairment (CI). The research question Cahill and Diaz-ponce (2011) ask is; Are there differences or similarities that exist in the quality of life perceptions among nursing home residents with varying levels of cognitive impairment?
Study Design
The study design used in the article, “I hate having nobody here. I’d like to know where they all are’: Can qualitative research detect differences in quality of life among nursing home residents with different levels of cognitive impairment?” (Cahill & Diaz-Ponce, 2011), was qualitative in nature. Qualitative designs focus on words instead of numbers, with the main intent to give meaning to a phenomenon. The data collected in qualitative studies stem from describing events, examining the context, and telling stories (Schmidt & Brown, 2012, p. 188). Cahill and Diaz-Ponce (2011), use exploratory, “nonexperimental design used when little is known about a phenomenon; and descriptive designs, “provide a picture of a situation as it is naturally happening without manipulation of any of the variables” (Schmidt & Brown, 2012 Pg. 176). They used these methods when trying to give meaning to the phenomenon that quality of life perceptions may be effected by CI
Sample Size and Representativeness In the use of qualitative designs, it is important to have appropriate sample sizes and representativeness. Although qualitative studies usually have smaller sample sizes, they can be accurate in representing the target population (Schmidt & Brown, 2012). In the article “I hate having nobody here. I’d like to know where they all are’: Can qualitative research detect differences in quality of life among nursing home residents with different levels of cognitive impairment?” (Cahill & Diaz-Ponce, 2011), Cahill and Diaz-Ponce (2011) used random sampling. Cahill and Diaz-ponce (2011), randomly selected four nursing homes and then randomly selected 25 participants from each home. From there, nine participants were excluded because they were cognitively intact. Five participants were excluded because they had severe dementia and could not communicate. One home was excluded because had been dominated by religious perceptions on quality of life. After all the exclusions were made, the result was 61 participants. Representativeness as defined by Schmidt and Brown (2012), includes subjects that possess similar characteristics that can be generalized to the target population (Schmidt and Brown, 2012, p. 249). The sample was representative of the target population because not only was the sample random, but the participants were all from similar homes with similar staffing. Also, the sample participants were classified into groups of cognitive impairment which were pretty close in the number of participants. Of the 61 men and women selected, 13 were considered mildly impaired, 20 moderately impaired and 28 severely impaired (Cahill and Diaz-Ponce, 2011, p. 564).
Results of Data Analysis Procedures Qualitative data analysis takes information obtained from field notes and interviews and categorizes, compares, conceptualizes and examines the data. From there the data is coded and put into manageable units (Schmidt & Brown, 2012, p. 341). In the article “I hate having nobody here. I’d like to know where they all are’: Can qualitative research detect differences in quality of life among nursing home residents with different levels of cognitive impairment?” (Cahill & Diaz-Ponce, 2011), Cahill and Diaz-ponce (2011) used a thematic approach. This approach involved taking interview data and searching for common themes and sub-themes. Cahill and Diaz-Ponce (2011), asked each of the participants 15 the same open-ended questions. From there they manually analyzed the 15 interview questions, and 28 codes were agreed upon. Some examples of the codes were; hobbies, privacy, fun, dependence, environment and visitors (not all codes were listed). Each interview was then cut and sorted manually until results could be clustered into groups of themes and sub-themes. These themes included; social contact, pleasurable activities, attachment, and affect. The data analysis provide many conclusions. Of the theme social contact, Cahill and Diaz-Ponce (2011) concluded that those with mild to moderate CI highly appreciated family visits. They spoke positively towards staff and other residents although a few complained about their peers. In contrast, the participants with severe CI were mostly negative responses in regard to family, and staff and did not speak much of other residents. The moderate to severe group appeared to be less mindful of their peers (Cahill & Diaz-Ponce, 2011, p. 565). The theme of pleasurable activities revealed by Cahill and Diaz-Ponce (2011) concluded that most of the mild and moderate group enjoyed activities. These two groups valued the stimulation of the activities they were able to participate in, although sometimes saddened by the activities they could no longer do. The severely CI individuals mostly showed indifference and disinterest in even talking about activities (Cahill & Diaz-Ponce, 2011, P. 567). For the theme of attachment, Cahill and Diaz-Ponce, (2011) concluded results that focused on the sense of feeling, “at home”, 54% of the residents with mild CI indeed felt at home, whereas the moderate CI individuals 32% felt at home, and those with severe CI only about 18% felt at home. Several of the participants inadvertently spoke about their previous homes because it was still important to them (Cahill & Diaz-Ponce, 2011, p. 565-567). The theme of affect was rather diffuse, Cahill and Diaz-Ponce, 2011) stated that each of the three groups, the results predominantly entailed happiness, loneliness, and sadness. Concerning happiness and sadness, all three groups had associations to these feelings. When it came to loneliness, only two individuals from the mild and moderate groups felt lonely. On the other hand, the severe CI group predominantly felt lost, abandoned and the need for human contact. A small group of moderate and severe CI individuals felt extreme hopelessness (Cahill & Diaz-ponce, 2011, p. 567-569). The overall conclusion was that those with mild and moderate CI their perceptions on quality of life were quite similar. They also found that those with severe CI perceived quality of life as less than adequate, focusing on isolation and loneliness. Cahill and Diaz-ponce, 2011 address the need for more research in regard to the severe CI group so that a better understanding of their world could be obtained and interventions can be made to improve their quality of life.
Summary of Strengths and Weaknesses The article reviewed “I hate having nobody here. I’d like to know where they all are’: Can qualitative research detect differences in quality of life among nursing home residents with different levels of cognitive impairment?” (Cahill & Diaz-Ponce, 2011), had many strengths and weaknesses. One main strength that this study provided was the ability to distinguish and detect similarities and differences in quality of life among nursing home residents with differing levels of CI. It gave meaning to the phenomenon; that quality of life perceptions may be effected by CI. This is a strength because there is limited studies of quality of life in this type of population, and it is one step closer to addressing this gap in knowledge. One detrimental weakness that this study possessed was that it came from only the participants perspective on quality of life. Staff, relatives or any outside source was not used as a comparative variable, so there was not a baseline consensus on quality of life for the non-CI. Other weakness that could have played a part in outcome could be that the sample of nursing homes was relatively small, private and that it was based in only one city. Another factor that was not taken into consideration was the health of the individuals. No detailed health information was obtained in regard to participant background or predispositions that could have affected the outcome. The way the data analysis was conducted was time-consuming, as the researchers hand wrote the interview data. Hand writing the data instead of recording the conversations could also be a problem because there is no way to verify if the writers wrote the information down correctly.
Summary of Qualitative and QualityArticle Review This article review focused on quantitive and qualitative study research designs. The research questions for both designs were identified and interpreted. The sample size, representativeness and data were all analyzed in order to generate and validate new knowledge regarding the clinical issue, and populations involved. Strengths and weakness were identified so that future research on these topics could be enhanced. By breaking down these studies, we as nurses are able to close the knowledge gap to aid in improving clinical outcomes and the promotion of health across the lifespan.

References
Cahill, S & Diaz-Ponce, A.M. (2011). ‘I hate having nobody here. I’d like to know where they all are’: Can qualitative research detect differences in quality of life among nursing home residents with different levels of cognitive impairment? Aging & Mental Health, 15(5), 561-572. doi: 10.1080/13607863.2010.551342
Pokrywka, M., Feigel., J., Douglas, B., Grossberger, S., Hensler, A., & Weber, D. (2014). A bundle strategy including patient hand hygiene to decrease clostridium difficile infections. MedSurg Nursing, 23(3), 145-164. Retrieved from http://www.medsurgnursing.net/cgi-bin/WebObjects/MSNJournal.woa
Schmidt, N.A., & Brown, J.M. (Eds.). (2012). Evidence-based practice for nurses: Appraisal and application of research. (Laureate Education, Inc., custom ed.). Sudbury, MA: Jones and Bartlett.