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Qualitative Design

The philosophical underpinnings of qualitative studies include perspectives of phenomena and a consideration for multiple realities held by different individuals (Munhall, 2010). The outcomes of qualitative research rely heavily on the information provided by those with subject experience related to the study (the participants), providing data through first- person narratives (Munhall, 2010). The acquisition of contextualized, multi-faceted descriptions enrich the understanding of a phenomenon (Holloway & Wheeler, 2010). In contrast, a quantitative study focuses on collecting numerical data to validate hypotheses and draw generalizations (Maltby Williams, McGarry, & Day, 2013).

Phenomenology is based on the idea that understanding a phenomenon is attainable through the subjective perceptions of people who underwent the experience being studied (Flood, 2010). Phenomenological studies emphasize that the person is fundamental to the environment; therefore, researchers must focus on individual perceptions (Flood, 2010; James, Cottle, & Hodge, 2010). The purpose of phenomenological research is often to describe the participants experiences with the phenomena, the interpretations of these experiences, and the meaning of those experiences to the participants (Sissolak, Marais, & Mehtar, 2011). This study investigated the phenomenon of elderly patients perceptions of pain 48 hours after undergoing ORIF surgery.

The study used a qualitative descriptive phenomenological approach to explore the following two research questions: (a) What are the perceptions of pain and pain management of patients between 65 and 75 years of age 48 hours after ORIF surgery? (b) What are the perceptions of adaptation for patients between 65 and 75 years of age after ORIF surgery?Husserls (1970) descriptive approach was selected because it used knowledge development that could effectively achieve the objectives of this inquiry and supplement what was already known regarding the phenomenon under investigation. The philosophical underpinnings of qualitative studies include perspectives of phenomena and a consideration for the multiple realities held by different individuals (Munhall, 2010).

Data Collection and Instrumentation

The study integrated a pilot study into the methodology, which explored one research question: What are the perceptions of pain and adaptation of patients 65 and 75 years of age after open reduction and internal fixation surgery? The pilot study was conducted with four patients, who answered 11 interview questions. Results of the pilot study were used to validate the appropriateness of the research questions.

Before conducting any data collection procedures, a letter of cooperation was received from the hospital prior to seeking Institutional Review Board (IRB) approvals from the University of Phoenix and the hospital. This facilitated the appropriate access to hospital records to identify the patients who had ORIF surgery within the specified period of the study. I sought self and peer monitoring to adhere to HIPPA laws. No participant information was left unattended and all documents pertaining to the study were confidential. Once IRB from the University of Phoenix and the hospital were approved, data collection started with recruiting participants for the study. An introductory and recruitment letter was sent to the patients and the orthopedic surgeons asking for assistance in finding candidates who were suitable for the study. Information on patients who had ORIF was obtained from the patients' charts. The patients consented to disclosing their identities and surgeries to a researcher. The participants were approached after their procedures, and informed consent and interviews were scheduled at the patients convenience. No patient was asked to sign an informed consent or beinterviewed while under the influence of pain medication.

Data collection was conducted as a one-on-one recorded personal interview and was facilitated by a semi-structured interview guide composed of ten open-ended questions, which made up the Pain Perception Interview Questions (PPIQ). A closing semi-structured question ("Do you have anything else to add?") was added to facilitate further information gathering or clarification. Interviews were one hour long and took place in the participants room. Questions focused on the perceptions of pain and pain management 48 hours after ORIF surgery and adaptation after ORIF as narrated in participants own words.

Population and Sampling

Prior to data collection, each participant reviewed and signed a consent form and received information about the reasons for the study. Before the start of each interview, participants were made aware that they could discontinue the interview if they experienced pain and if their healthcare provider entered the room. One of the most important responsibilities of a researcher of human subjects is to ensure informed consent of any participants. Research cannot be undertaken without this consent. Informed consent gave the researcher permission to delve into private areas of a human subjects life and enter a persons emotional, physiological, intellectual, or other very intimate arena that must be protected. I transcribed all information obtained from the participants and I was the sole individual with access to the participant information. At the conclusion of the study, all information, including audio recordings and field notes, were locked in an encrypted secure electronic database.

A total of 12 participants was recruited from a community primary care hospital that conducted an average of 12 ORIF surgeries monthly. Ten participants met the studys inclusion criteria: (a) age between 65 and 75 years; (b) have undergone ORIF surgery in the past 48 hours, (c) speak and understand English fully; and (d) should not exhibit any form of mental illnesses. The concepts of diminishing returns and saturation in qualitative studies were considered when determining the sample size for the study.

Data Analysis

The use of NVivo 10.0 (QSR International) to process the data collected from the interviews enhanced categorizing statements and emerging themes. The modified Van Kaam (1969) method, based on Husserls (1970, 2012) philosophy, was used to analyze the data collected. Van Kaams method requires that intersubjective agreement be reached with other expert judges. Roys four modes of adaptation -- physical, self-concept, role function, and interdependence -- were used to determine adaptation responses (AR) and ineffective responses (IR) of participants based on responses to the PPIQ. Van Kaams (1969) approach in the phenomenological generation and analysis of data has been frequently utilized by nurse researchers because of its rigor in accomplishing accurate results from studies.

Using Moustakas' (1994) seven-step approach in conjunction with the NVivo 10 software, participants were interviewed, and textual datum collected and analyzed to discern themes that developed from the data. Additionally, a descriptive analysis was conducted regarding the differences between the participants responses. Analysis involved comparing the invariant constituents that was revealed within the main themes.

The coding process utilized the NVivo 10 software that has the capability to list the key words and phrases emerging from the transcripts of the participants. For instance, key words identified in interview question one was (a) personal, (b) different, and (c) self. This list of words and phrases guided me to identify specific codes that were then re-uploaded in NVivo 10 for code grouping. For instance, the key word personal was identified as differences of pain. The grouped codes served as the basis for determining the themes. These themes were refined from the coded text to reflect the themes critical to the central question.

The preliminary grouping was coded by the following: (a) experiences of pain, (b) perceptions of pain, (c) failure of pain management, (d) understanding pain management options, (e) involvement mechanism in pain management, (f) factors affecting caregiver interaction, (g) meanings of adaptation, and (h) recommendations of pain management. These groupings were then utilized to understand the lived experiences of elderly concerning pain management.

Question:

a) Please illustrate the methodology used in this qualitative study (2 marks)

b) Describe the application of the methodology stated above in qualitative research study (4 marks)