Scientific research is based on finding solutions to problems through systematic collection, interpretation, and evaluation of data. Qualitative research is an approach to scientific research that is used to describe life experiences, cultures, and social processes from the perspectives of those involved (Busetto et al., 2020). This method generates non-numerical data and focuses on naturally occurring, ordinary events. In nursing, knowledge from qualitative research is used to guide understanding of patient needs and describing forces that affect health.
Characteristics of Qualitative Research
The primary characteristic of qualitative research is that it is conducted in a natural setting (Gray & Grove, 2020). Researchers utilizing this approach collect data at the locations where issues happen or are studied. Qualitative researchers usually collect data through observation, direct interviews, and documentation. There is limited utilization of research instruments and questionnaires made by others. Qualitative research uses multiple sources of data to inform decision-making. Another key feature of this research approach is that researchers focus on the meaning of participants rather than what is said by other authors or researchers (Busetto et al., 2020). The perspectives used to conduct research include ethnography, cultural concepts, and gender differences. Issues that may benefit from qualitative research in nursing include analysis of mother-child bonding after delivery, common feeding problems of newborns, or barriers that nurses face in implementing evidence-based practice.
Qualitative Research Methodologies
There are five different approaches to qualitative research including phenomenological research, grounded theory research, ethnographic research, exploratory-descriptive qualitative research, and historical research (Gray & Grove, 2020). Phenomenology is the first approach that describes experiences from the participant’s perspective. This approach is both a philosophy and a research method used to understand human experiences. Grounded theory is another approach where researchers produce a general and abstract theory of a particular process, action, or interaction from participants. The findings from research using the grounded theory are from the concrete world experience of the participants (Gray & Grove, 2020). This approach is used to examine experiences and processes with a breadth and depth that quantitative research cannot. Ethnography is a branch of anthropology that analyzes the culture of people in their natural environment over a long period. This method is used to understand the view of life from an indigenous perspective.
Strengths and Weaknesses
Qualitative research is an approach used to describe life experiences from the perspective of the participants. One of the strengths of this approach is that it provides more content used for practical application. It enables researchers to understand why people do things and the practical ways to solve complex issues in life (Gray & Grove, 2020). During the research, qualitative research uses relatively a smaller sample size compared to other approaches. This method gives scientists a chance to develop specific insights about human beings. Qualitative research eliminates the potential for bias within data because interpretation is made according to the views of the participants (Gray & Grove, 2020). This way, the information collected is accurate compared to qualitative approaches.
Qualitative research has limitations that make it a less choice for some situations. Firstly, the sample size used is small making the research findings questionable to many (Busetto et al., 2020). Secondly, this approach is time-consuming when collecting data points because a lot of information is always available. Another key weakness of this approach is that it does not offer a statistical representation of data (Gray & Grove, 2020). The best result that can be produced is a comparison of outcomes and how or why things happen the way they do. Lastly, qualitative researchers must know about the topic of discussion to obtain appropriate responses from researchers.
Research Design USe
Qualitative research is the study of the nature of phenomena including the context in which they appear and the perspectives from which they can be perceived (Busetto et al., 2020). In healthcare, qualitative research is usually underutilized because its research methods are on the lower hierarchy of evidence. This design is used when assessing complex multi-component interventions that address questions beyond what works toward what works for whom. The process of research always begins with formulating a research question, identifying the qualitative research design, data collection, analysis, and reporting of findings. The most commonly used research designs in healthcare are observations, semi-structured interviews, and focus groups.
Purpose of the Study
Hand hygiene is an effective way to prevent contamination and transmission of diseases during healthcare service delivery. The purpose of this study was to understand barriers to hand hygiene compliance among healthcare workers during the COVID-19 pandemic (Ahmadipour et al., 2022).
Design of the Study
The research utilized a descriptive exploratory research design. The reason for using this method was to understand the perceptions and emotions of healthcare providers toward hand hygiene practices. I think the research approach used was appropriate to the research question. The aim was to obtain the thoughts of healthcare workers as to why hand hygiene was a problem in the ICU. The exploratory approach could allow the researchers to formulate a problem for more clear investigation. The descriptive approach was used to explain the individual perceptions of healthcare workers about hand hygiene compliance barriers.
Ethical issues related to this study include obtaining approval from an ethics committee and informing the participants about the research. Consent is the second aspect that must be considered before conducting research and it involves explaining the purpose and any expected consequences. Another ethical issue is confidentiality and the right to withdraw from the research at any time. The researchers in this study ensured compliance with ethical research guidelines by seeking approval from the Ethics Committee of Kerman University of Medical Sciences (Ahmadipour et al., 2022). After the selection of the participants, an explanation of the research and expected outcomes was given. Written consent was obtained and the participants were assured about the confidentiality of the data.
A purposive sampling method was used to select participants. The recruitment strategy involved interviewing participants suitable for the study including workers who served in the ICU during the COVID-19 period. Twenty-five healthcare workers were recruited for the study. I believe this sampling technique was appropriate because all the participants chosen worked in the ICU. These individuals had experience with hand hygiene during the COVID-19 pandemic and were best suited to answer the research question. Purposive sampling is a non-probability sampling technique that allows for the selection of individuals with characteristics needed for the study.
Data Collection Methods
Data collection was done using a semi-structured individual interview. Open-ended questions were asked beginning with some prepared questions to familiarize the researcher. The interview sessions lasted from 45 minutes to 55 minutes during which the researcher encouraged the participants to share their experiences.
Validity and Reliability
Validity and reliability represent how well research methods measure something. Validity refers to the accuracy of a tool to measure what they are supposed to measure. Reliability refers to the consistency of a tool to reproduce the same results under the same condition. Semi-structured interviews are always considered the best because they represent both elements (Ahmadipour et al., 2022). This method provides high validity because researchers can gather first-hand information. However, their validity is always questionable because it is challenging to compare responses between participants. In this study, the researchers did not consider the validity and reliability of the semi-structured interview technique.
A content analysis method was used to analyze data. The researchers followed the five steps of Graneheim and Lundman during the analysis process. Data management was done by entering each interview text into the MAXQDA software version 10. All extracted categories of data were checked and approved by the authors. The trustworthiness of the data was determined using Guba and Lincoln’s criteria.
Being a qualitative study, no statistical methods were used to analyze findings.
Findings and Limitations
The healthcare workers that participated in the study included anesthesiologists (n = 5), nurses (n = 18), and physiotherapists (n = 2). The findings were categorized into barriers associated with individuals, management, and organizations. Individual barriers included things like improper attitudes and inadequate knowledge of healthcare workers (Ahmadipour et al., 2022). Managerial barriers identified included wrong behavioral patterns of managers and unsuitable planning and training. Barriers associated with the organization included a heavy workload, improperly designed wards, and the lack of equipment. The limitations of the study include a small sample size that limits the generalization of results. Secondly, the COVID-19 pandemic caused some potential participants to decline to participate in the study.
Trustworthiness and Applicability
The trustworthiness of qualitative research is dependent on the aspects of credibility, transferability, and confirmability of the research findings. The approach used in this research was of high quality and content analysis of data makes the findings credible. A peer review was conducted to ascertain the effectiveness of data collection methods, interview techniques, and other procedures for analysis. Although a small sample size was used to conduct this study, the findings can be used to inform healthcare changes that can improve hand hygiene practices in the ICU.
Quantitative research is defined as the process of collecting and analyzing numerical data (Gray & Grove, 2020). Researchers utilizing this method collect data and analyze it for obtaining results using different mathematical, statistical, and computational tools. The results of quantitative research provide a better understanding of the connection between two ideas, cause-and-effect relationships, or incidence.
Characteristics of Quantitative Research
Quantitative research is discriminated from qualitative research using different measures. Firstly, quantitative research contains measurable variables that measure the characteristics of populations (Gray & Grove, 2020). Examples include age, number of children, or economic status. The second characteristic is that quantitative research uses standardized research instruments. These instruments are used to ensure the accuracy, reliability, and validity of data. Quantitative research assumes a normal population distribution curve that allows for large population numbers during studies (Gray & Grove, 2020). Another crucial feature is that quantitative research presents data in tables, graphs, and figures. These measures are used to consolidate large numbers of data and show trends or relationships among variables.
Quantitative research is characterized by the use of measuring devices or statistical instruments. These instruments allow for the accurate collection and analysis of data for which the instruments are calibrated for. Lastly, quantitative research can be used to predict outcomes. Nursing issues that can be researched using the quantitative approach include things like determining the leading cause of heart disease, evaluation of the effectiveness of primary patient care, evaluation of the population affected by diabetes, or methods of preventing suicidal attempts among psychiatric patients.
Observational Vs Interventional Design
Observational is a qualitative research design where researchers observe the participants’ ongoing behavior in a natural setting. There are different types of observational studies including case-control observational studies, cohort observational studies, and cross-sectional observational studies (Gray & Grove, 2020). Interventional studies are designed to evaluate the direct impact of therapeutic or preventive measures on outcomes. The difference between the two approaches is that the researcher intervenes at some point throughout the study.
Experimental Vs Quasi-Experimental Design
Experimental research is one of the intervention design groups that involves testing the null hypothesis by applying intervention to experimental subjects (Gray & Grove, 2020). For an experimental study to happen, at least two separate groups must be present. The control group is distinct and does not receive the intervention during research. A quasi-experimental research design is used to test the hypothesis of a cause-and-effect relationship when an experimental design is not applicable (Gray & Grove, 2020). Unlike the experimental design, quasi-experimental lacks one or more key features of experimental designs like the absence of a control group, lack of researcher manipulation of the independent variable, or random assignment of subjects.
Inferential and Descriptive Statistics
Descriptive statistics are used to give information that describes data in some manner. It is used to describe both individual or entire population samples and they are usually not concerned with the differences between two data sets (Ali & Bhaska, 2016). Measures of descriptive statistics include distribution, central tendency, and variability. Inferential statistics focus on generalizing findings about a larger population based on representative samples. This measure is used to test a hypothesis and see whether the data is generalizable to the broader population. Inferential and descriptive statistics relate to levels of measurement in some way. These levels include nominal, ordinal, interval, and ratio. These levels limit which descriptive statistics can be used to get an overall summary of data and which inferential statistics can be performed (Ali & Bhaska, 2016). Depending on the level of measurement, the researcher can perform different descriptive statistics to get a summary of data and further use inferential statistics to see if the results support or refute the hypothesis.
Research Design Use
Quantitative research involves a systematic investigation of phenomena by gathering quantifiable data and performing statistical analysis. This method collects data from existing personnel using sampling methods and sending out questionnaires or surveys. The process begins by analyzing a theory and formulating a hypothesis that must be tested (Gray & Grove, 2020). The next steps involve choosing the correct research design, operationalizing concepts, selecting participants, and collecting data. Upon data collection, data processing and analysis using statistical methods are used. The final steps involve discussing the findings and drawing conclusions that accept or reject the tested hypothesis.
Purpose and Design
Hand hygiene is an important measure used in preventing healthcare-associated infections. The purpose of the selected study was to evaluate the effect of three different educational programs on improving hand hygiene compliance, knowledge, and perception among healthcare workers in a tertiary care hospital in Indonesia (Santosaningsih et al., 2017). The study design utilized was a randomized controlled trial where interventions were allocated to the pediatrics, surgery, and medicine departments.
Blinding and Randomization
Blinding represents a situation in research where participants are prevented from knowing certain information that may somehow influence the outcomes. Blinding is done in RCTs and its purpose is to prevent observer bias. Randomization is the process of assigning participants to treatment and control groups, assuming that each has an equal chance of being assigned to a group (Gray & grove, 2020). This measure is used to prevent selection bias and insure against accidental bias. The identified study used the drawing lots method to randomly assign the four healthcare departments to three different interventions or no intervention. Blinding was not done because multiple interventions were used.
Ethical issues involved in the research include informed consent, seeking approval from an ethics committee, confidentiality, and the right to withdraw from the research. The study was approved by the medical ethics committee (Santosaningsih et al., 2017). Informed consent was not obtained because the research involved little risk of harm to the participants. The anonymity of healthcare workers was guaranteed in the initial survey used to familiarize the participants with the research.
Sampling Method and Recruitment
The purposive sampling method was used to identify four healthcare departments that could benefit from hand hygiene interventions. The selected departments included surgery, internal medicine, Obst-gyn, and pediatrics. The recruitment strategy was easy because the project was regarded as a hospital infection control program. All members of the healthcare team including students were allowed to participate in the study.
This study did not include any calculations of the sample size. All members of the healthcare team from the four departments participated in the research.
The main method of data collection involved ascertaining hand hygiene compliance using a survey administered in the pre-intervention and post-intervention phases. The observation method was used to ascertain compliance to hand hygiene with every observation moment lasting 30 to 60 minutes (Santosaningsih et al., 2017). Apart from these tools, the knowledge and perception questionnaire based on the WHO tools was administered. This questionnaire consisted of three single items and three multiple items.
Validity and Reliability
As explained before, validity and reliability represent how well research methods measure something. Validity refers to the accuracy of a tool to measure what they are supposed to measure (Gray & Grove, 2020). Reliability refers to the consistency of a tool to reproduce the same results under the same condition. This research utilized two data collection tools including surveys and questionnaires. The validity and reliability of these tools were not addressed in the research. However, the quality of the survey used was not bad, the same as the study questionnaire. The use of Likert-scale items to allocate marks to responses during the pre-and post-intervention phases ensured the reliability of the survey.
Data analysis was done using various statistical tools. The Pearson Chi-Square statistic or Fisher’s exact test was used to analyzing data regarding compliance to hand hygiene for each of the WHO five moments of hand hygiene. The independent T-test and the Chi-Square test were used to analyze knowledge and perception improvement. The backward multiple regression analysis was used to factors associated with hand hygiene compliance.
The statistics used to analyze data included Chi-Square, T-test, and the Mantel-Haenszel statistic. The Chi-square test was used to measure nominal data concerning compliance to hand hygiene practices. The T-test independent statistic was also used to measure nominal data while the Mantel-Haenszel statistic was used when there were significant differences in observed data (Santosaningsih et al., 2017). Some of the terms used during data analysis included level of significance, confidence interval, and statistically significant. The level of significance is used to define whether the null hypothesis is assumed to be accepted or rejected. Confidence interval refers to the probability that a population parameter will lie between a set of given values (Gray & Grove, 2020). Statistical significance is a term used to quantify whether an outcome is due to chance or some factor of interest.
Findings and Limitations
Compliance with hand hygiene was the first measure monitored. The overall compliance with hand hygiene before the interventions was 19.5% and this increased to 27% after the implementation of the interventions (Santosaningsih et al., 2017). The knowledge and perceptions of healthcare workers to hand hygiene before the intervention was 5.8 with a median score of 6. Upon intervention, the knowledge level increased and produced a score of 6.2 (Santosaningsih et al., 2017). Overall, the improvement of hand hygiene compliance led to statistically significant results in knowledge scores.
One of the limitations of the study is that it was conducted while the hospital was preparing for national accreditation. Secondly, the participation of workers in the knowledge and perception survey was affected by the preparation for accreditation.
Trustworthiness and Applicability
Reliability is the measure used to establish the trustworthiness of quantitative research approaches. The use of surveys and questionnaires to obtain data from the respondents makes this research reliable and trustworthy. The use of statistical methods like the T-test and Chi-square to analyze data provides a solid ground for obtaining statistically relevant findings. A total of 2766 hand hygiene opportunities were observed during the study period and 284 healthcare workers participated in the knowledge and perception survey (Santosaningsih et al., 2017). This number represents a reasonable value that can be used to inform healthcare decisions. The applicability of this research however remains questionable because it was conducted in a single healthcare facility. The study provides room for more research from different healthcare facilities about hand hygiene practices and associated barriers.
Ahmadipour, M., Dehghan, M., Ahmadinejad, M., Jabarpour, M., Mangolian Shahrbabaki, P., & Ebrahimi Rigi, Z. (2022). Barriers to hand hygiene compliance in intensive care units during the COVID-19 pandemic: A qualitative study. Frontiers in Public Health, 2763.
Ali, Z., & Bhaskar, S. B. (2016). Basic statistical tools in research and data analysis. Indian Journal of Anaesthesia, 60(9), 662–669.
Busetto, L., Wick, W., & Gumbinger, C. (2020). How to use and assess qualitative research methods. Neurological Research and practice, 2(1), 1-10. https://doi.org/10.1186/s42466-020-00059-z
Gray, J. R., Grove, S. K. (2020). Burns and Grove’s the practice of nursing research:
Appraisal, synthesis, and generation of evidence (9th ed.). Elsevier.
Santosaningsih, D., Erikawati, D., Santoso, S., Noorhamdani, N., Ratridewi, I., Candradikusuma, D., … & Severin, J. A. (2017). Intervening with healthcare workers’ hand hygiene compliance, knowledge, and perception in a limited-resource hospital in Indonesia: a randomized controlled trial study. Antimicrobial Resistance & Infection Control, 6(1), 1-10.
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