Student Nurse

Research Designs

Introduction

The aim of this assignment is to critically compare and contrast 2 research articles entitled ‘Direct entry midwifery: traditional midwives’ perceptions’ (Lobo 2002) (appendix 1) and ‘Competencies of midwives with single or dual qualifications at the point of registration in Scotland’ (Fleming et al 2001) (appendix 2).  There are a number of reasons for choosing these articles firstly anecdotally the competence of direct entry and nurse midwives is hotly debated in and out of the clinical environment.  Secondly the competence of newly qualified practitioners is often being doubted, even by the midwives themselves in some cases (Boon 2005, Jones 2004).  Finally nurse and midwifery education is of personal interest to the author.

‘Direct entry midwifery: traditional midwives’ perceptions’ (Lobo 2002) looks at traditionally trained nurse midwives’ views of newer 3 year direct entry midwives and will be known throughout this assignment as article 1 and ‘Competencies of midwives with single or dual qualifications at the point of registration in Scotland’ (Fleming et al 2001) evaluates if the different training affects their skills and abilities as qualified midwives and will be known as article 2.

There is very little research carried out on the topic of the differences between direct entry and nurse entry midwives, so the research articles were chosen by what was available rather than the type of research approach used.  Surveys are the most widely used research strategy maintains Polgar and Thomas (2000) so being aware of the pros and cons of this type of methodology is advantageous. The other article uses what it calls exploratory descriptive research, which according to Carter (2000) is important for studies that there is little prior knowledge of.  Both strategies are based on qualitative approaches, which are growing in their use within health and social sciences (Greenhalgh and Taylor 1997), however article 2 also uses a quantitative approach.

Both articles used appropriate methodology for the research they had undertaken, however article 1 proved to have a much poorer dissemination technique than article 2, its data collection and analysis were poorly portrayed within the article, although it did reprieve itself slightly in the latter part of the paper where it went on to discuss the findings.  However overall this research article appeared of an inferior quality and not so deeply researched as article 2 which went through each step of the research process in detail before coming to its conclusion.

The research was needed at the time because this was a controversial topic area, with little previous research on the actual outcome of implementing the newer 3 year training although there was research available on the competencies of newly qualified practitioners on the whole such as the Peach Report (UKCC 1999).

 

Critical Appraisal

Although both articles being critically evaluated are looking at the outcomes of midwifery education on the capabilities of the qualified midwife, they both use different approaches to achieve this. 

Article 1 uses an explorative, descriptive design, which although Carter (2000) advocates its use in fairly unresearched topics she goes on to say this is often disputed by other authors who question the ability of a design to be both descriptive and exploratory at the same time.  Polgar and Thomas (2000), Polit and Hungler (1997) and Rees (1997) all make no mention of exploratory research as a design in its own right.   However as there is little research in relation the views of nurse midwives on their direct entry colleagues it seems a fair strategy to use for gaining insight into this subject. Equally other approaches such as phenomenology may have been just as useful for eliciting people’s feelings and opinions on this subject and could have been utilised instead (Polgar and Thomas 2000).  Exploratory research however is beneficial for finding patterns and exploring new concepts that have not been looked at before (Cutliffe and Ward 2003), therefore the study would be seen as appropriate and it may not have lended itself so easily to a phenomenological approach.  As the best research design depends on the research question or questions being asked, it would appear for article 1, where the views of traditional midwives are being sought that a qualitative approach is the ideal (Sackett and Wennberg 1997).

The descriptive element of this research is essentially describing what the researcher has seen or heard and makes no attempt to explain what has been found (Carter 2000).  It is therefore considered to be a suitable method of exploratory research in that the new findings are described with no effort to elucidate their meaning in relation to the research.

The authors of article 2 use an entirely different approach to their research opting for a survey design.  Surveys utilise a non-experimental approach, which gauges a wide range of opinions.  They are useful for studying variables, gaining the views of individuals and collecting demographic data.  Because surveys have been found to be user friendly in that they use a self reporting style, they have good feedback and are a popular choice of research method (Polit and Hungler).  They are also cheap and efficient and commonly used therefore making them appear like a less intimidating choice of approach (Rees 1997).   This proves that surveys are a valuable approach to gaining both qualitative and quantitative information and its use would appear pertinent for the purpose of this research.

Prior to actually carrying out a research study the researcher would implement a literature search and review to justify the need for the research to take place (Polgar and Thomas 2000).  For article 1 this appears more of a discursive look at the research describing it rather than reviewing its appropriateness or its use in developing key themes, whereas article 2 thoroughly appraises the previous research undertaken and how this could help the researcher in undertaking their current study.  The appraisal of literature is a crucial component of evidence-based practice (Thompson and Cullum 1999), nonetheless the 1st article appears to have a fairly poor grasp of this concept as both the introduction and literature review appeared to be combined (Cutliffe and Ward 2003), which is negative point.  The second article gives a clear introduction not confused with the literature review and clearly states the aims of the study.  The actual literature content of both reviews is appropriate as there is limited information available even at the current date.

The research presented by Lobo (2002) in article 1 appeared to be undertaken by her alone. Although she was doing this as part of her masters degree she gave the impression of being a novice, however has since gone on to contribute to government projects and other ventures.  On the other hand the second article had five authors from a variety of backgrounds this leads to less chance of researcher bias as credibility is maintained (Polit and Hungler 1997) but this is dependant upon each individual’s input into the research project, all of whom have experience of nursing and most of higher academic research.

There has been much debate over the use of qualitative research as some feel it is not scientific and therefore has no place in medicine, however Greenhalgh and Taylor (1997) insist that not all quantitative studies show scientific evidence either and suggest those who read papers are just as likely to accept any piece of research as long as it contains a statistic. They go on to promote the use of qualitative research in nursing and midwifery advocating that it helps focus on clinical problems and helps make sense of phenomena (Greenhalgh and Taylor 1997).  Sackett and Wennberg (1997) would even go as far as saying that qualitative research is essential and stipulate that the best choice of research approach is the one that provides the best answer, this is a sentiment that Mays and Pope (2000) concur with.

A quantitative approach is the traditional research methodology of medicine and comes from its logical positivism roots (Polgar and Thomas 2000) and is mainly concerned with technical theories, and causality.

The exploratory research (article 1) would be deemed qualitative and non experimental and the survey research (article 2) could be interpreted as both qualitative and quantitative as surveys are one of the few designs that can incorporate both approaches although there is disputed by some authors (Jack and Clark 1998). Methods of data collection are the means by which the research data is obtained and analysed (Polit and Hungler 1997). The exploratory study in article 1 utilised a semi-structured interview format and article 2, used a questionnaire method plus interviewing.

Both pieces of research implemented pilot studies as a trial run prior to the main study to assess their particular study’s capability as a research method.  Pilot studies are introduced before the main study to ensure there would not be any problems with the study or to iron out any problems that do appear prior to starting the actual research.  Rees (1997) supports the use of pilot studies not only as a means to detect problems but also to judge the feasibility of the study particularly in terms of time, resources and reliability.  Porter and Carter (2000) expand on this proposing that it also allows the researcher the chance to analyse the data. For Article 2 this allowed a period of retesting to take place prior to the actual research being commenced, and although article 1 made minor changes there is no indication within the paper to suggest that retesting took place.

As there is little subject matter on exploratory research it is difficult to appraise which type of data collection method is most suited to this approach, however the application of semi-structured interviews would appear to fit with the purpose of the research.  They are mainly used when investigating qualitative research responses (Polit and Hungler 1997). Semi-structured interviews are favourable in terms of obtaining information, as they allow the respondents the freedom to express themselves while allowing the researcher the means to prevent the interview losing sight of its aims (Polgar and Thomas 2000).  Article 2 also used interviews, from a convenience sample and used one key question, giving the impression of using unstructured interviews. 

Their use of questionnaires as their main data collection method with the addition of interviews aids triangulation however this unstructured interview can lead to the responses being very varied and a time-consuming data analysis process (Polgar and Thomas 2000). It appears that neither article indicates exactly how the qualitative data was recorded or analysed. Yet in article 2 is gives us an in-depth account of the qualitative data collection and analysis processes from the questionnaire.  It provides descriptive and inferential statistical findings and backs this up with tables and charts and adds to the validity of the qualitative data by proving quotes to back up its findings.

As Lobo (2002) was a lone researcher there is no opportunity for correlation of the results of the interviews, which could have taken place if 2 researchers took part independently recording the responses or while analysing the data, in technique known as investigator triangulation (Polit and Hungler 1997).  As the second article has 5 authors this would not be She makes no indication of how her data was collected although she had planned to use focus groups as a follow up but does not make it clear whether this would have been an additional means of data collection or for dissemination purposes. As the former it could have added more credibility to the research through method triangulation (Polit and Hungler 1997).  The participants were unable to comply with the request for the focus group, which could be perceived as poor information delivery at the outset of the research process with participants not being fully aware of the process. As only one method was used to collect the data this could possibly result in information, which may have been arrived at by coincidence.

The small sample of n=8 perhaps could have added to the unsatisfactory outcome with the focus group, where out of a larger sample more participants may have been able to comply and improve the credibility of the research.  However in qualitative research the number of participants can be quite small nevertheless the optimum number is that which will achieve satisfactory result (Polgar and Thomas 2000), which becomes apparent that this is not the case with this research.

The description in the text of the sample site and their inclusion criteria did not seem to meet up, in article 1, as the inclusion criteria seemed to reflect individual traits of the participants rather than a physical environment of the institutions.

Ethical approval was sought by the researchers of article 1 and consent was also gained, however article 2 has not made it clear whether they had gained consent or ethical approval.

The findings from article 1 do not really tell us much except that as team workers, new members should be supported no matter what their background and training are. The findings from article 2 are well disseminated but it highlights the issue that although both types of midwives are better skilled in certain areas they are both found have significantly higher skills than supervisors of midwives expected for their level of midwifery education.

 

Conclusion

This assignment has looked at both quantitative and qualitative research and in more depth has examined an exploratory and survey design.  It has gone on to explore the similarities and differences of the various methods of data collection, namely questionnaires and interviews.

The exploratory research would benefit from a follow up study, as this would seem like a good and relevant recommendation.  As it has described the feelings and views of a very small sample n=8 with no triangulation apparent, a larger scale study maybe able to pick up on the themes identified.  Additionally as the researcher only interviewed the traditional midwives themselves it could benefit from a more inclusive follow up.

Furthermore the literature reviewed related to some dated work and was based on a time when traditional midwives were still in a majority, more up to date research may provide a different response.  Both studies are now dated themselves and the findings maybe different since the implementation of the Making a Difference programme of midwifery education (UKCC 1999).  However article 2 appeared to be of a far superior quality with a much more in-depth use of the research framework

Regardless of the fact that evidence based medicine has been in existence for many years it is still in its infancy in the realm of midwifery practice (Sackets et al 1996, Rees 1997).  As such it will no doubt continue to grow within the profession and therefore it is vital that practitioners are able to distinguish between good and bad research.  And in addition know when to utilise it and consider how it will affect their future practice.

Additionally there is need to work together as a team to help improve midwifery care and ensure that any perceived differences do not filter into the practical setting at this emotional time for women. 

Both traditional midwives and direct entry midwives bring their own skills and should be appreciated for the skills they do have and not the skills they do not.


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last updated 12/03/06

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