Critical Appraisal

Critically appraise one qualitative and one quantitative research article on a chosen topic. Discussing the advantages and disadvantages of each methodology, along with the impact of research on professional nursing practice

1 Introduction

Research involves systematic investigations of objects, individuals, populations, organizations, or relevant settings. According to Babbie (2013), the main aim of research activities in social settings is to establish new facts through which new conclusions and inferences could be reached. Based on these scholarly observations, it is worth indicating that research constitutes the establishment of facts to draw valid inferences and steering the continuity of new skill and knowledge acquisition by complementing the existing literature about a given subject under investigation (Borbasi and Jackson, 2012). With scientific methods employed, it is further inferable that research seeks to find the truth through investigation or experimentation. In the healthcare industry, the concept of research has continually received growing attention due to the need to unearth some of the major forces that play a predictive role in shaping the realization of different healthcare organizations' visions and missions. According to Burns and Grove (2009), research has gained increasing attention in the healthcare industry due to the need to understand various factors through which organizations could keep abreast with the ever-changing needs of health care service users, as well as the stakeholders’ preferences. As avowed by Burns and Grove (2011), some of these areas that have attracted growing research interest include the cost and quality of health care, personal behaviors affecting a community’s or population’s access to health care, aspects of health technologies, organizational processes and structures, financing systems, and the role of social factors in shaping a population’s perception of health care services. This paper provides a critical appraisal of a qualitative study and a quantitative study. The main aim is to gain insight into the aims and objectives of the selected studies, the research designs embraced, data collection and analysis processes, and the conclusions and recommendations made; besides the degrees of the studies’ levels of ethical conformity in relation to their approaches to data collection and participant selection.

Based on this critical appraisal aim, two major concepts that are worth defining include qualitative research and quantitative research. According to Elliott, Aitken, and Chaboyer (2012), qualitative research strives to dive deeper into a problem or provide insights into a problem while ensuring that hypotheses or ideas for possible quantitative research are provided. As concurred by Hoffmann, Bennett, and Del Mar (2013), qualitative research seeks to gain n understanding of some of the underlying motivations, opinions, or reasons behind the experiences of a given population. Hence, it can be inferred that qualitative research aims to offer an explicit rendering of broad patterns, order, and structure relative to emerging themes that characterize a given group of participants (Imms and Greaves, 2013). On the other hand, Jirojwong, Johnson, and Welch (2011) observed that quantitative study involves a systematic empirical observation targeting observable phenomena using computational, mathematical, or statistical techniques. Also, Jirojwong, Johnson, and Welch (2014) stated that quantitative researchers gather quantifiable data before engaging in the computational, mathematical, and statistical techniques. The eventuality is that the results obtained by quantitative researchers can be presented and analyzed numerically, upon which future trends relative to the subject under investigation can be predicted.

Other scholarly studies have documented the correlation between research and evidence-based practice (EBP), as well as the potential contribution of the former to the latter. For example, Liamputtong (2013) observed that research, whether qualitative or quantitative, seeks to validate existing knowledge or develop new knowledge. Hence, it can be inferred that research practices strive to translate evidence before applying the results to clinical decision-making processes. Thus, the research seeks to provide the best evidence. On the other hand, Moxham (2012) stated that the primary objective of EBP is to incorporate patient preferences and values, as well as clinical expertise into the research use. Therefore, the research seeks to offer new knowledge about a certain subject and contributes to EBP, whereby the latter establishes and translates the best evidence accruing from the research practice into clinical practices − for improving patient and family outcomes.

As mentioned earlier, this paper provides a critical appraisal of a qualitative study and a quantitative study. As Moxham (2012) avowed, critical appraisal refers to a process through which the results obtained from scientific evidence or research are assessed systematically and carefully. Indeed, the critical appraisal practice is important because it paves the way for judging the research's relevance, value, and trustworthiness in a certain context. Particularly, the paper employs a Critical Appraisal Skills Program (CASP) to appraisal a quantitative study involving a randomized control trial targeting adults with major depression relative to dietary improvement and a qualitative study involving the lived experiences of handling depression among community members.

2 Methods

For qualitative and quantitative studies, mixed outcomes have been documented regarding the merits and limitations associated with it. According to Polit and Hungler (2013), qualitative research is advantageous because it provides detail and depth by stretching beyond the analysis of counts and ranks to record the participants' behaviors, feelings, and attitudes. Also, qualitative research is advantageous because it creates openness by encouraging the participants to expound on the responses provided, leading to new subjects or topic areas, hence research continuity (National Institute for Health and Care Excellence, 2018). Furthermore, qualitative research simulates the individual experiences of people. It ends up yielding a detailed picture regarding why they act the way they do and exhibit certain feelings about selected actions (Nieswiadomy, 2012). It is also notable that qualitative research avoids prejudgment because it explains the motivations behind certain participant responses (Polit and Hungler, 2013).

Despite its promising nature, qualitative research has been associated with some limitations. For instance, Wright-St Clair, Reid, Shaw, and Ramsbotham (2014) documented that qualitative research involves fewer people because it demands more time and other resources, eventuality compromising the aspects of outcome validity and reliability. Also, this research technique has been documented to make it less easy to generalize because it involves small sample sizes, especially with exact numbers being reported in the place of percentages that are, otherwise, reported by quantitative researchers. It is also imperative to highlight that it is difficult to make systematic comparisons in qualitative research because the open nature of the study allows the participants to offer widely differing responses, with subjectivity highly likely. Lastly, qualitative research depends on the researcher's skill, especially during direct observation, focus group discussions, and conducting interviews (Babbie, 2013).

Regarding quantitative research, merits and demerits have also been documented. For example, Borbasi and Jackson (2012) observed that quantitative research involves more significant numbers of subjects, allowing broader studies that enhance outcome generalization. As observed by Burns and Grove (2009), quantitative research is also advantageous because it allows for greater objectivity of the results, having summarized data regarding the studied phenomena. It is also notable that quantitative research eliminates personal bias because the researcher keeps "distance" from the participants, eventually avoiding potential manipulation and interference with the results (Burns and Grove, 2011). However, the research approach is disadvantageous because it is associated with superficial and narrower datasets. Also, the technique only allows for numerical descriptions instead of detailed narratives through which the human perceptions, experiences, and accounts can be elaborated. Given that quantitative researchers focus on artificial and unnatural environments, the degree of control they exhibit (such as laboratory results) tends to yield less reliable results than qualitative researchers, emphasizing real-world results (Elliott, Aitken, and Chaboyer, 2012).

The quantitative research embraced community-based recruitment strategies, with the participants selected using simple random sampling. According to Hoffmann, Bennett, and Del Mar (2013), the merit of this approach is that it eliminates sampling bias and that the selected participants are better placed to represent the targeted sampling frame in the entirety. However, the demerit of simple random sampling is that it requires a lot of money, effort, and time (Imms and Greaves, 2013). The qualitative study employed stratified sampling; according to Jirojwong, Johnson, and Welch (2011), stratified sampling is conducted in such a way that the researcher establishes various types of participants making up the target population or sampling frame before working out on the required proportions through which a representative sample could be achieved. In the study, stratified sampling was evident whereby the researchers selected individuals experiencing at least one episode of depression and that the participants were expected to be those not in need of treatment at the research time. Thus, the inclusion/exclusion criteria reflected a stratified sampling approach. According to Jirojwong, Johnson, and Welch (2014), this sampling technique is advantageous because the selected sample tends to be highly representative of the target population, paving the way for the making of generalizations regarding the subject under investigation and in relation to the results obtained. However, Liamputtong (2013) cautioned that stratified sampling is disadvantageous because it is time-consuming (Moxham, 2012). Regarding the sample size, the quantitative study involved a larger number of participants (67 randomized individuals) than qualitative research with a smaller number of participants (18). Therefore, it can be inferred that outcome generalization and reliability was more likely to be achieved in the quantitative study than the qualitative investigation.

Regarding the data collection processes, the quantitative study employed a randomized control trial, which involves the random allocation of individuals into groups that receive standard treatments and those that receive treatments under investigation; with those receiving the standard treatment acting as the control (National Institute for Health and Care Excellence, 2018). Notably, mixed outcomes have been reported relative to the merits and demerits of randomized control trials (RCTs). For example, Wright-St Clair, Reid, Shaw, and Ramsbotham (2014) asserted that RCTs minimize selection and allocation bias and that double-blinding reduces assessment bias while blinding reduces performance bias. Also, Babbie (2013) indicated that RCTs reduce confounding factors because prognostic factors are distributed unequally, and that unknown and known factors are used to make groups comparable. However, RCTs are disadvantageous whereby validity calls for multiple sites, power calculation calls for large sample sizes (that prove resource-intensive), and long trial run time poses a danger of loss of relevance (Nieswiadomy, 2012). For the selected qualitative study focusing on the lived experiences and handling of depression among community members, the data collection approach involved the use of in-depth interviews. As documented by Polit and Hungler (2013), interviewing as a data collection method is advantageous because they add a human dimension to impersonal information, apply to sensitive topics where respondents could be uncomfortable to discuss in focus group scenarios, and offer in-depth investigations of issues; upon which comprehensive data might be obtained (Wright-St Clair, Reid, Shaw, and Ramsbotham, 2014). Interviews have also been associated with high response rates and the clarification of ambiguous answers, with new subject areas that emerge, leading further to research continuity (Babbie, 2013).

Regarding its disadvantages, this method of collecting data is time-consuming (due to the need to transcribe and code the interview data), makes it difficult to analyze data (because unstructured and semi-structured interviews yield non-standard responses), and is less reliable because the data obtained remains specific based on the uniqueness of the interviewees. There is also an interviewer effect when the identity of the researcher is known to the interviewee, as well as possible inhibitions in which the video recorder or the tape recorder leads to an artificial research setting or situation whereby the respondent could respond differently compared to a situation where they were studied in their natural environments via an approach such as participant observation (Borbasi and Jackson, 2012). Lastly, interviews are resource-intensive because they call for travel and transcription expenses, especially in research situations involving geographically widespread informants (Burns and Grove, 2009).

In the research practice, it is also worth indicating that ethical considerations play a crucial role in governing the data collection and participant selection or sampling processes. As asserted by Burns and Grove (2011), ethical considerations are important because they promote the research's main aim via the avoidance of error while assuring truth and yielding new knowledge. Ethical considerations also promote collaborative work due to fairness, mutual respect, accountability, and trust (Elliott, Aitken, and Chaboyer, 2012). It is also notable that ethical standards are worth following because they pave the way for the researcher to be accountable to the rest of the public; including issues surrounding animal care and use, human subjects’ protections, conflicts of interest, and research misconduct (Hoffmann, Bennett and Del Mar 2013). According to Imms and Greaves (2013), ethical considerations are also crucial because they attract public support for the research, including research project funding. Overall, ethical considerations promote social and moral values such as public health and safety, compliance with the law, animal welfare, human rights, and social responsibility. In the selected quantitative study, the Human Research Ethics Committees of St. Vincent’s and Barwon Health approved the research process. Also, all participants, having been presented with the study’s complete description, provided informed consent. For the qualitative study, the participants signed informed consent forms before participating in the scheduled interviews. Thus, both studies made ethical considerations before collecting data.

3 Results

In the quantitative study, the main aim was to find out the efficacy of embracing dietary improvement programs towards treating major depressive episodes. With 166 individuals assessed to discern eligibility and 67 of the members enrolled (34 being the control group and 33 the diet intervention group), the study was established in such a way that 21 individuals were exposed to a combination of pharmacotherapy and psychotherapy. In contrast, nine were exposed to psychotherapy exclusively. Also, 25 individuals underwent pharmacotherapy solely. Thus, 55 individuals underwent some form of therapy. Findings suggested that the dietary support group exhibited significantly greater improvements when 12 weeks and the baseline on MADRS were compared, yielding superior results compared to the social support control group. Thus, it was concluded that during the management of the otherwise highly prevalent mental health problem, dietary improvement improves to be an accessible and efficacious treatment strategy. It was inferred further that the benefits accruing from the dietary improvement tend to extend to common co-morbidities with which the mental disorder is associated. For the qualitative study, the central objective was to determine how individuals diagnosed with depression tend to manage and experience life with 18 in-depth interviews conducted between 2015 and 2016. The study target individuals who experienced moderate depression previously and at the time of the investigation. To yield a grounded theory, the data obtained from the interviews was analyzed using constant comparisons. In the findings, the study established that a common concern among the participants involved the need for belonging.

Based on the lived experiences, a depression management approach that the majority of the participants embraced involved "risking existence." This experience involved four major phases. These phases included courage to be, daring dependence, giving clues, and ungraspable processing. With “risking existence” emerging as a common theme through which the participants handled depression, the study established further that three essentials played a complementary role. These essentials included shame, to endure, and hope. Hence, it was concluded that individuals experiencing depression endure despair, suffering, and pain. For nurses and the nursing practice, the study inferred that the need to stretch beyond symptoms with which patients present and determine the meaning of those symptoms to each individual could not be overstated.

Relative to data analysis, the quantitative study employed the International Conference on Harmonization E9 statistical principles in which participants who completed and those who did not complete the 12-week trial were compared via independent chi-square analyses and t-tests. Indeed, this approach was adequate because it allowed for the analysis of two groups to discern trends in the average change within the 12-week trial that stretched from the baseline to the 12^th week. On the other hand, the qualitative study relied on the transcription of interviews verbatim. Similar to the quantitative study, the qualitative study's reliance on interview transcription was appropriate because the eventual open coding allowed for the concurrent data collection and analysis processes. Comparing new codes with the existing codes yielded preliminary categories that translated into final themes. In relation to nursing practice, this advocated for practitioners' need to ensure that they orient themselves when working with individuals experiencing depression to ensure that different strategies are applied to different strategies based on the degree of relevance. For the quantitative study, the authors advocated for nurse practitioners' need to incorporate determine some of the pathways that pose a mediating effect or moderating role in shaping diet practitioners' need for the successful handling of depressive illness. The authors also advocated for the need for nurse practitioners to facilitate the depressed patients' access to dietetics support, upon which beneficial effects with which dietary improvement (relative to handling depression) are associated would be felt.

From a comparative perspective, another attribute from which insight could be gained in relation to the selected qualitative and quantitative studies involves research rigor or validity. In quantitative research, Jirojwong, Johnson, and Welch (2011) observed that research rigor entails the precision or soundness of a research study in terms of reporting, analysis, data collection, and planning. On the other hand, Jirojwong, Johnson, and Welch (2014) asserted that research rigor as a feature of qualitative research refers to the results' trustworthiness. For the selected quantitative study, consistency was evident whereby the researchers stuck to their aim, specific objectives, research questions, and the intended quest to address the problem statement. The data collection process focused on the group of participants that the inclusion/exclusion criteria had specified, and the analysis that followed adhered to the description in the methodology. The findings were also reported systematically relative to the aim and specific objectives of the study. With the findings and recommendations made without veering off the main subject under investigation, it is worth inferring that the quantitative study achieved research rigor and that outcome validity was evident. In relation to the qualitative research, findings revolved around the lived experiences of individuals experiencing depression, as well as some of the coping mechanisms they had embraced. Thus, the findings were representative of the phenomena that the study strives to investigate. Therefore, it can also be inferred that the qualitative study achieved the research attribute of outcome validity.

4 Application/Discussion

Whereas both studies are insightful, the quantitative study that sought to establish the efficacy of dietary improvement for adults experiencing major depression, having employed a randomized control trial approach, can be perceived to be of higher quality. The comprehensiveness informs this inference of the data collected. The study also focused on a larger sample size that constituted participants from different socio-cultural, demographic, and geographical settings. Given that the diverse outcomes obtained from these participants proved representative of the entire target population or sampling frame, it is worth acknowledging that they can be generalized to the rest of the population on focus. Therefore, the quantitative study proves superior to the qualitative study that focused on relatively smaller sample size, suggesting further that it is of higher quality.

Regarding the current nursing practice guidelines or policy, both studies (qualitative and quantitative) are in line with the standards. According to Liamputtong (2013), the current practice guidelines surrounding the research process hold that the research process needs to flow from the introduction or provision of the background information to the explanation of the problem statement, the specification of the aim and objectives, a review of relevant literature, the description of a methodology through which data is collected (while ensuring that ethical considerations are followed), a discussion of the results based on research evidence, and a conclusion that culminates into a given study’s relevance or implication for the nursing practice. In this case, both studies satisfy the guidelines, primarily by ensuring that they do not veer off the intended research paths that require researchers to tie the literature review and the discussion of findings based on the primary aim of the nursing research study.

It is also worth noting that the qualitative and quantitative studies approach a similar subject from different viewpoints. From the methodological perspective, the quantitative study is conducted in an artificial setting where a control group and an intervention group are presented. With a randomized control trial embraced and stratified sampling utilized, the study presents numerical data regarding the parameters or variables under investigation. Whereas the artificial research setting poses a danger of making the participants behave unnaturally, with part of the group having been controlled (the intervention group), the study's findings prove insightful because a large sample size is used, and the findings are deemed, representative. On the other hand, the qualitative study is conducted by focusing on small sample size and interviewing the participants (who have been selected via simple random sampling) in a natural research setting. The qualitative study is also seen to gain information from the participants without intervention, interference, or manipulation. With mixed outcomes obtained earlier regarding the merits and demerits with which both types of researchers or methodologies are associated, this paper infers that neither qualitative nor quantitative research can be used singly. Instead, qualitative research needs to lay a foundation for conducting more in-depth quantitative research. Comprehensive, valid, and reliable data might be obtained, presented, and analyzed.

5 Conclusion

In summary, qualitative and quantitative research approaches prove insightful to nursing practice and research. Whereas the researchers can focus on the same or similar topics, their approach to the data collection, analysis, participant selection, ethical considerations, and the reporting of the findings prove unique. From the selected articles' analysis, it is evident that qualitative research reflects an investigative or exploratory approach. Particularly, the results obtained from qualitative research, as evidenced by the selected qualitative study's findings, are not conclusive; neither can they be employed towards making generalizations. Despite this potential flaw, it remains inferable that the research technique is essential towards the development of a deep understanding of a sound rationale and thematic complex through which further decision-making in a field such as nursing practice can be made.

Regarding quantitative research, the comparative analysis and critical appraisal presented above reveals that it offers a broad base from which recommendations regarding a final course can be made. It is also evident that when qualitative research is employed, smaller sample size is involved and is unlikely to yield representative cases. On the other hand, quantitative research is seen to focus on a large number of cases, and the diversity of the participants tends to be a better representation of the target population or sampling frame. Also, qualitative research strives to discover or establish patterns relative to the lived experiences of individuals. In contrast, based on this critical appraisal, quantitative research entails a continual interplay involving theory and analysis. With each approach exhibiting mixed outcomes in terms of merits and demerits, it is concluded that an ideal approach is one in which quantitative and qualitative research approaches are combined to yield a mixed-methods study that strives to give insight into the correlations between or among different variables in nursing practice.