Where in the World Is Evidence-Based Practice?
March 21, 2010, was not EBPs date of birth, but it may be the date the approach grew up and left home to take on the world.
When the Affordable Care Act was passed, it came with a requirement of empirical evidence. Research on EBP increased significantly. Application of EBP spread to allied health professions, education, healthcare technology, and more. Health organizations began to adopt and promote EBP.
In this Discussion, you will consider this adoption. You will examine healthcare organization websites and analyze to what extent these organizations use EBP.
To Prepare:
Review the Resources and reflect on the definition and goal of EBP.
Choose a professional healthcare organizations website (e.g., a reimbursing body, an accredited body, or a national initiative).
Explore the website to determine where and to what extent EBP is evident.
Posta description of the healthcare organization website you reviewed. Describe where, if at all, EBP appears (e.g., the mission, vision, philosophy, and/or goals of the healthcare organization, or in other locations on the website). Then, explain whether this healthcare organizations work is grounded in EBP and why or why not. Finally, explain whether the information you discovered on the healthcare organizations website has changed your perception of the healthcare organization. Be specific and provide examples.
Guest Editorial
Nurse Educators: Leading Health Care to
the Quadruple Aim Sweet Spot
E
ighteen years ago, an alarming
report on preventable deaths from
medical errors was released by
the Institute of Medicine (IOM, 2000).
That report featured the estimate that
approximately 100,000 people in the
United States die each year because of
preventable medical errors. A subse-
quent IOM report (2003) called for all
health professionals to be better pre-
pared to keep patients safe, focusing
on five core competencies for health
professions education: patient-centered
care, interprofessional collaboration,
evidence-based practice, quality im-
provement, and informatics.
Visionary leaders in nursing educa-
tion were ahead of the curve, responding
to the call for safer and more effective
care via the Quality and Safety Education
for Nurses (QSEN) project (Cronenwett
et al., 2007). In 2008, the Institute for
Healthcare Improvement announced a
major initiativethe Triple Aimwhich
focuses on simultaneous pursuit of three
aims: improving the experience of care,
improving the health of populations, and
reducing per capita costs of health care
(Berwick, Nolan, & Whittington, 2008,
p. 759). Subsequently, Bodenheimer
and Sinsky (2014) proposed a fourtha
quadrupleaim to improve the work life
of health care providers, both clinicians
and staff.
What progress has been made during
the past 19 years since the IOM report,
with 10 years of QSEN education, and
9 years after the Triple Aim was launched?
Improvements in some health outcomes
have been reported. For instance, the
United States has seen a 15% reduction in
infant mortality rates compared with 2005
(Kochanek, Murphy, Xu, & Tejada-Vera,
2014). Numbers of hospital-acquired con-
ditions, such as central line-associated
bloodstream infections (CLABSIs), pres-
sure ulcers, and falls with injuries have
significantly decreased from 2010 to
2013, according to a recent report from the
American Hospital Association (2015).
However, in terms of better care and lower
costs, we are not yet there. James (2013)
has estimated annual hospital patient
deaths due to preventable harm to be over
400,000 per year. Reports from consumers
of health care continue to include stories
of poor care experiences, including lack
of compassion and frustrations in navigat-
ing the complexities of the care system.
Further, the aim of lower costs per capita
has yet to become reality. Although an
estimated 20 million people were newly
insured through the Patient Protection
and Affordable Care Act (ACA, 2010),
political challenges to the ACA remain,
including rising costs, high out-of-pocket
expenses, and access to affordable insur-
ance.
In the world of leadership, there is a
term referred to as the sweet spot, where
economic health and the common good
coexist and are the keys to achieving vi-
able and sustainable solutions (Savitz &
Weber, 2008). Is it possible to reach the
sweet spot of the Quadruple Aim? Acad-
emy Health and the Robert Wood John-
son Foundation are partnering to pursue
this formidable aim, proposing that care
delivery systems collaborate across mul-
tiple sectors to provide an affordable ap-
proach to improving population health
(Hacker, 2017).
Are we as a profession just going to
sit back and wait for that to happen? I be-
lieve that nurse educators are well posi-
tioned to lead the way to this lofty sweet
spot goal. Nursing schools and nurse
educators already work across multiple
sectors to prepare nurses at all levels,
from prelicensure to doctoral education.
Nurse educators are already in all settings
across the care continuum as practitioners
themselves and as mentors to nursing stu-
dents applying theory in practice. Many,
if not most, prelicensure through DNP
nursing students have been well prepared
with the QSEN competencies. Those at
the graduate level are leading evidence-
based systems improvement initiatives
as a part of their practice immersion and
culminating projects.
I have seen the power of what nurses
can do to bring the multiple sectors to-
gether in the interest of patient safety,
quality, population health, and affordable
care. Faculty and students have taken
a Quadruple Aim approach. Working
in communities and across the globe,
they have engaged with community and
global leaders and local health advocates,
such as Promotores (lay Hispanic health
advocates), to partner for better health
outcomes. Faculty and students have con-
ducted community needs assessments to
identify health priorities. They have pro-
vided health education and health screen-
ing. They have applied the processes and
tools of the science of improvement to
community-based projects to facilitate
collaboration across sectors to improve
health outcomes. They have been part of
teams who have provided resources that
communities often cannot afford alone.
They have gathered and analyzed the
metrics to measure results. The response
from local leaders and health advocates
707Journal of Nursing Education Vol. 56, No. 12, 2017
GUEST EDITORIAL
is consistently positive, acknowledging
their contributions. And both students
and faculty have benefitted from these
practice experiences.
My greatest concern is that those
who lead national associations in both
education and practice have not found a
way to rise above their respective self-
interests with a genuine commitment to
work in partnership towards the Qua-
druple Aim sweet spot. Some have not
yet learned what visionary 20th century
organizational leadership pioneer Mary
Follett Parker taught about the distinc-
tion between power with versus power
over (Briskin, Erickson, Ott, & Callahan,
2009). Power over depends on relation-
ships of polarity, suspicion, and differ-
entials in power. Power with relies on
relationships of respect, stakeholder en-
gagement, and multisector approaches,
resulting in co-created power.
Faculty and students typically work
in collaboration with their patients and
families, as well as their clinical partners
across sectors, to improve health care
and health outcomes. That is what QSEN
has taught us. Through care coordina-
tion models, we typically collaborate in a
power with stance to reach both optimal
learning and optimal health outcomes,
contribute to cost-effectiveness, and con-
tribute to quality of life. Coordination
of care, including patients as partners in
care, is one evidence-based strategy for
reaching the Triple Aim. Care coordina-
tion is a philosophy and attitude as much
as it is a process. We need to teach our
politicians and public officials about the
care coordination model and how it ad-
dresses gaps in care in order to achieve
optimal health outcomes. I have seen this
facilitative education around care coordi-
nation take place when students and fac-
ulty are present at the policy table as im-
portant health care issues are addressed,
specifically relating to homelessness and
care for children and families who are at
high risk for foster care. Conversations
have moved beyond debate to generative
dialogue because nurses (faculty, stu-
dents, nurse leaders, and nurses as board
members) have been at the table.
Faculty, students, and their precep-
tors could teach many organizational and
political leaders by modeling how lever-
aging a power with approach is a viable
pathway to the Quadruple Aims sweet
spot. Power with is what makes clinical
nurses, nurse educators, and nurse lead-
ers so effective and so special. With a
rising emphasis on population health, we
have many more opportunities to com-
municate with political leaders and other
policy makers. We must believe in our-
selves as leaders of the Quadruple Aim
and act accordingly if we are ever going
to reach the sweet spot.
Power with and power ahead. What a
concept!
References
American Hospital Association. (2015). Zeroing
in on the Triple Aim. Retrieved from http://
www.aha.org/content/15/brief-3aim.pdf
Berwick, D.M., Nolan, T.W., & Whittington, J.
(2008). The Triple Aim: Care, health, and
cost. Health Affairs, 27, 759-769. doi:10.1377/
hlthaff.27.3.759
Bodenheimer, T., & Sinsky, C. (2014). From
Triple to Quadruple Aim: Care of the patient
requires care of the provider. Annals of Family
Medicine, 12, 573-576. doi:10.1370.afm.1713
Briskin, A., Erickson, S., Ott, J., Callanan, T.
(2009). The power of collective wisdom and
the trap of collective folly. San Francisco,
CA: Berrett-Koehler.
Cronenwett, L., Sherwood, G., Barnsteiner, J.
Disch, J. Johnson, J., Mitchell, P., . . . War-
ren, J. (2007). Quality and safety education
for nurses. Nursing Outlook, 55, 122-131.
doi:10.1016/j.outlook.2007.02.006
Hacker, K. (2017, March 27). Bridging the di-
vide: The sweet spot in health care and pub-
lic health. [Web log post]. Retrieved from
http://www.academyhealth.org/blog/2017-
03/bridging-divide-sweet-spot-health-care-
and-public-health
Institute of Medicine. (2000). To err is human:
Building a safer health system. Washington,
DC: The National Academies Press. https://
doi.org/10.17226/9728
Institute of Medicine. (2003). Health professions
education: A bridge to quality. Washington,
DC: The National Academies Press. https://
doi.org/10.17226/10681
James, J.T. (2013). A new, evidence-based esti-
mate of patient harms associated with hospi-
tal care. Journal of Patient Safety, 9, 122-128.
doi:10.1097/PTS.0b013e3182948a69
Kochanek, K.D., Murphy, S.L., Xu, J., &
Tejanda-Vera, B. (2014). Deaths: Final data
for 2014. National Vital Statistics Reports,
65(4). Retrieved from https://www.cdc.gov/
nchs/data/nvsr/nvsr65/nvsr65_04.pdf
Patient Protection and Affordable Care Act, 42
U.S.C. 18001 et seq. (2010).
Savitz, A.W. & Weber, K. (2008). The sustainabil-
ity sweet spot: Where profit meets the common
good. In J.V. Gallos (Ed.), Business leadership:
A Jossey-Bass reader (2nd ed., pp. 230-243). San
Francisco, CA: John Wiley & Sons.
Jan Boller, PhD, RN
Adjunct Associate Professor
College of Nursing
Creighton University
The author has disclosed no potential
conflicts of interest, financial or otherwise.
doi:10.3928/01484834-20171120-01
708 Copyright SLACK Incorporated
Reproduced with permission of copyright owner. Further reproduction
prohibited without permission. 202 Copyright 2009 The Author(s)
Evidence-Based Practice: Critical
Appraisal of Qualitative Evidence
Kathleen M. Williamson
One of the key steps of evidence-based practice is to critically appraise evidence to best answer a clinical question. Mental
health clinicians need to understand the importance of qualitative evidence to their practice, including levels of qualitative
evidence, qualitative inquiry methods, and criteria used to appraise qualitative evidence to determine how implementing
the best qualitative evidence into their practice will influence mental health outcomes. The goal of qualitative research is
to develop a complete understanding of reality as it is perceived by the individual and to uncover the truths that exist.
These important aspects of mental health require clinicians to engage this evidence. J Am Psychiatr Nurses Assoc, 2009;
15(3), 202-207. DOI: 10.1177/1078390309338733
Keywords: evidence-based practice; qualitative inquiry; qualitative designs; critical appraisal of qualitative
evidence; mental health
Evidence-based practice (EBP) is an approach that
enables psychiatric mental health care practitioners
as well as all clinicians to provide the highest quality
of care using the best evidence available (Melnyk &
Fineout-Overholt, 2005). One of the key steps of EBP
is to critically appraise evidence to best answer a
clinical question. For many mental health questions,
understanding levels of evidence, qualitative inquiry
methods, and questions used to appraise the evidence
are necessary to implement the best qualitative evi-
dence into practice. Drawing conclusions and making
judgments about the evidence are imperative to the
EBP process and clinical decision making (Melnyk &
Fineout-Overholt, 2005; Polit & Beck, 2008). The over-
all purpose of this article is to familiarize clinicians
with qualitative research as an important source of
evidence to guide practice decisions. In this article, an
overview of the goals, methods and types of qualita-
tive research, and the criteria used to appraise the
quality of this type of evidence will be presented.
QUALITATIVE BELIEFS
Qualitative research aims to generate insight,
describe, and understand the nature of reality in
human experiences (Ayers, 2007; Milne & Oberle,
2005; Polit & Beck, 2008; Saddler, 2006; Sandelowski,
2004; Speziale & Carpenter, 2003; Thorne, 2000).
Qualitative researchers are inquisitive and seek to
understand knowledge about how people think and
feel, about the circumstances in which they find
themselves, and use methods to uncover and decon-
struct the meaning of a phenomenon (Saddler, 2006;
Thorne, 2000). Qualitative data are collected in a
natural setting. These data are not numerical; rather,
they are full and rich descriptions from participants
who are experiencing the phenomenon under study.
The goal of qualitative research is to uncover the
truths that exist and develop a complete understand-
ing of reality and the individuals perception of what
is real. This method of inquiry is deeply rooted in
descriptive modes of research. The idea that multiple
realties exist and create meaning for the individuals
studied is a fundamental belief of qualitative research-
ers (Speziale & Carpenter, 2003, p. 17). Qualitative
research is the studying, collecting, and understand-
ing the meaning of individuals lives using a variety
of materials and methods (Denzin & Lincoln, 2005).
WHAT IS A QUALITATIVE
RESEARCHER?
Qualitative researchers commonly believe that indi-
viduals come to know and understand their reality in
Kathleen M. Williamson, PhD, RN, associate director, Center for
the Advancement of Evidence-Based Practice, Arizona State
University, College of Nursing & Healthcare Innovation, Phoenix,
Arizona; [emailprotected]
Journal of the American Psychiatric Nurses Association,Vol. 15, No. 3 203
Critical Appraisal of Qualitative Evidence
different ways. It is through the lived experience
and the interactions that take place in the natural
setting that the researcher is able to discover and
understand the phenomenon under study (Miles &
Huberman, 1994; Patton, 2002; Speziale & Carpenter,
2003). To ensure the least disruption to the environ-
ment/natural setting, qualitative researchers care-
fully consider the best research method to answer
the research question (Speziale & Carpenter, 2003).
These researchers are intensely involved in all
aspects of the research process and are considered
participants and observers in setting or field (Patton,
2002; Polit & Beck, 2008; Speziale & Carpenter,
2003). Flexibility is required to obtain data from the
richest possible sources of information. Using a
holistic approach, the researcher attempts to cap-
ture the perceptions of the participants from an
emic approach (i.e., from an insiders viewpoint;
Miles & Huberman, 1994; Speziale & Carpenter,
2003). Often, this is accomplished through the use of
a variety of data collection methods, such as inter-
views, observations, and written documents (Patton,
2002). As the data are collected, the researcher
simultaneously analyzes it, which includes identi-
fying emerging themes, patterns, and insights
within the data. According to Patton (2002), quali-
tative analysis engages exploration, discovery, and
inductive logic. The researcher uses a rich literary
account of the setting, actions, feelings, and mean-
ing of the phenomenon to report the findings
(Patton, 2002).
COMMONLY USED
QUALITATIVE DESIGNS
According to Patton (2002), Qualitative methods
are first and foremost research methods. They are
ways of finding out what people do, know, think, and
feel by observing, interviewing, and analyzing docu-
ments (p. 145). Qualitative research designs vary by
type and purpose: data collection strategies used and
the type of question or phenomenon under study. To
critically appraise qualitative evidence for its valid-
ity and use in practice, an understanding of the
types of qualitative methods as well as how they are
employed and reported is necessary.
Many of the methods are routed in the anthropol-
ogy, psychological, and sociology disciplines. Many
commonly used methods in the health sciences
research are ethnography, phenomenology, and
grounded theory (see Table 1).
Ethnography
Ethnography has its traditions in cultural
anthropology, which describe the values, beliefs,
and practice of cultural groups (Ploeg, 1999; Polit
& Beck, 2008). According to Speziale and Carpenter
(2003), the characteristics that are central to eth-
nography are that (a) the research is focused on
culture, (b) the researcher is totally immersed in
the culture, and (c) the researcher is aware of her/
his own perspective as well as those in the study.
Ethnographic researchers strive to study cultures
from an emic approach. The researcher as a par-
ticipant observer becomes involved in the culture
to collect data, learn from participants, and report
on the way participants see their world (Patton,
2002). Data are primarily collected through obser-
vations and interviews. Analysis of ethnographic
results involves identifying the meanings attrib-
uted to objects and events by members of the cul-
ture. These meanings are often validated by
members of the culture before finalizing the results
(called member checks). This is a labor-intensive
method that requires extensive fieldwork.
TABLE 1. Most Commonly Used Qualitative Research Methods
Method
Purpose
Research question(s)
Sample size (on average)
Data sources/collection
Ethnography
Describe culture of people
What is it like to live . . .
What is it . . .
30-50
Interviews, observations, field
notes, records, chart data,
life histories
Phenomenology
Describe phenomena, the
appearance of things, as lived
experience of humans in a natural
setting
What is it like to have this
experience? What does it feel like?
6-8
Interviews, videotapes, observations,
in-depth conversations
Grounded theory
To develop a theory rather than
describe a phenomenon
Questions emerge from the data
25-50
Taped interview, observation,
diaries, and memos from
researcher
Source. Adapted from Polit and Beck (2008) and Speziale and Carpenter(2003).
204 Journal of the American Psychiatric Nurses Association,Vol. 15, No. 3
Williamson
Phenomenology
Phenomenology has its roots in both philosophy
and psychology. Polit and Beck (2008) reported,
Phenomenological researchers believe that lived
experience gives meaning to each persons percep-
tion of a particular phenomenon (p. 227). According
to Polit and Beck, there are four aspects of the
human experience that are of interest to the phe-
nomenological researcher: (a) lived space (spatial-
ity), (b) lived body (corporeality), (c) lived human
relationships (relationality), and (d) lived time (tem-
porality). Phenomenological inquiry is focused on
exploring how participants in the experience make
sense of the experience, transform the experience
into consciousness, and the nature or meaning of
the experience (Patton, 2002). Interpretive phenom-
enology (hermeneutics) focuses on the meaning and
interpretation of the lived experience to better
understand social, cultural, political, and historical
context. Descriptive phenomenology shares vivid
reports and describes the phenomenon.
In a phenomenological study, the researcher is an
active participant/observer who is totally immersed
in the investigation. It involves gaining access to
participants who could provide rich descriptions
from in-depth interviews to gather all the informa-
tion needed to describe the phenomenon under study
(Speziale & Carpenter, 2003). Ongoing analyses of
direct quotes and statements by participants occur
until common themes emerge. The outcome is a vivid
description of the experience that captures the
meaning of the experience and communicates clearly
and logically the phenomenon under study (Speziale
& Carpenter, 2003).
Grounded Theory
Grounded theory has its roots in sociology and
explores the social processes that are present within
human interactions (Speziale & Carpenter, 2003).
The purpose is to develop or build a theory rather
than test a theory or describe a phenomenon (Patton,
2002). Grounded theory takes an inductive approach
in which the researcher seeks to generate emergent
categories and integrate them into a theory grounded
in the data (Polit & Beck, 2008). The research does
not start with a focused problem; it evolves and is
discovered as the study progresses. A feature of
grounded theory is that the data collection, data
analysis, and sampling of participants occur simulta-
neously (Polit & Beck, 2008; Powers, 2005). The
researchers using ground theory methodology are
able to critically analyze situations, not remove
themselves from the study but realize that they
are part of it, recognize bias, obtain valid and reliable
data, and think abstractly (Strauss & Corbin, 1990).
Data collection is through in-depth interview and
observations. A constant comparative process is used
for two reasons: (a) to compare every piece of data
with every other piece to more accurately refine the
relevant categories and (b) to assure the researcher
that saturation has occurred. Once saturation is
reached the researcher connects the categories, pat-
terns, or themes that describe the overall picture
that emerged that will lead to theory development.
ASPECTS OF QUALITATIVE RESEARCH
The most important aspects of qualitative inquiry
is that participants are actively involved in the
research process rather than receiving an interven-
tion or being observed for some risk or event to be
quantified. Another aspect is that the sample is pur-
posefully selected and is based on experience with a
culture, social process, or phenomena to collect infor-
mation that is rich and thick in descriptions. The final
essential aspect of qualitative research is that one or
more of the following strategies are used to collect
data: interviews, focus groups, narratives, chat rooms,
and observation and/or field notes. These methods
may be used in combination with each other. The
researcher may choose to use triangulation strategies
on data collection, investigator, method, or theory and
use multiple sources to draw conclusions about the
phenomenon (Patton, 2002; Polit & Beck, 2009).
SUMMARY
This is not an inclusive list of qualitative methods
that researchers could choose to use to answer a
research question, other methods include historical
research, feminist research, case study method, and
action research. All qualitative research methods are
used to describe and discover meaning, understand-
ing, or develop a theory and transport the reader to
the time and place of the observation and/or inter-
view (Patton, 2002).
THE HIERARCHY OF
QUALITATIVE EVIDENCE
Clinical questions that require qualitative evi-
dence to answer them focus on human response and
Journal of the American Psychiatric Nurses Association,Vol. 15, No. 3 205
Critical Appraisal of Qualitative Evidence
meaning. An important step in the process of apprais-
ing qualitative research as a guide for clinical prac-
tice is the identification of the level of evidence or the
best evidence. The level of evidence is a guide that
helps identify the most appropriate, rigorous, and
clinically relevant evidence to answer the clinical
question (Polit & Beck, 2008). Evidence hierarchy for
qualitative research ranges from opinion of authori-
ties and/or reports of expert committees to a single
qualitative research study to metasynthesis (Melnyk
& Fineout-Overholt, 2005; Polit & Beck, 2008). A
metasynthesis is comparable to meta-analysis (i.e.,
systematic reviews) of quantitative studies. A meta-
synthesis is a technique that integrates findings of
multiple qualitative studies on a specific topic, pro-
viding an interpretative synthesis of the research
findings in narrative form (Polit & Beck, 2008). This
is the strongest level of evidence in which to answer
a clinical question. The higher the level of evidence
the stronger the evidence is to change practice.
However, all evidence needs be critically appraised
based on (a) the best available evidence (i.e., level of
evidence), (b) the quality and reliability of the study,
and (c) the applicability of the findings to practice.
CRITICAL APPRAISAL OF
QUALITATIVE EVIDENCE
Once the clinical issue has been identified, the
PICOT question constructed, and the best evidence
located through an exhaustive search, the next step
is to critically appraise each study for its validity
(i.e., the quality), reliability, and applicability to use
in practice (Melnyk & Fineout-Overholt, 2005).
Although there is no consensus among qualitative
researchers on the quality criteria (Cutcliffe &
McKenna, 1999; Polit & Beck, 2008; Powers, 2005;
Russell & Gregory, 2003; Sandelowski, 2004), many
have published excellent tools that guide the process
for critically appraising qualitative evidence (Duffy,
2005; Melnyk & Fineout-Overholt, 2005; Polit &
Beck, 2008; Powers, 2005; Russell & Gregory, 2003;
Speziale & Carpenter, 2003). They all base their cri-
teria on three primary questions: (a) Are the study
findings valid? (b) What were the results of the
study? (c) Will the results help me in caring for my
patients? According to Melnyk and Fineout-Overholt
(2005), The answers to these questions ensure rele-
vance and transferability of the evidence from the
search to the specific population for whom the practi-
tioner provides care (p. 120). In using the questions
in Tables 2, 3, and 4, one can evaluate the evidence
and determine if the study findings are valid, the
method and instruments used to acquire the knowl-
edge credible, and if the findings are transferable.
The qualitative process contributes to the rigor or
trustworthiness of the data (i.e., the quality). The
goal of rigor in qualitative research is to accurately
represent study participants experiences (Speziale
& Carpenter, 2003, p. 38). The qualitative attributes
of validity include credibility, dependability, confirm-
ability, transferability, and authenticity (Guba &
Lincoln, 1994; Miles & Huberman, 1994; Speziale &
Carpenter, 2003).
Credibility is having confidence and truth about
the data and interpretations (Polit & Beck, 2008).
The credibility of the findings hinges on the skill,
competence, and rigor of the researcher to describe
the content shared by the participants and the abil-
ity of the participants to accurately describe the
phenomenon (Patton, 2002; Speziale & Carpenter,
2003). Cutcliffe and McKenna (1999) reported that
the most important indicator of the credibility of
findings is when a practitioner reads the study find-
ings and regards them meaningful and applicable
and incorporates them into his or her practice.
Confirmability refers to the way the researcher
documents and confirms the study findings (Speziale
TABLE 2. Subquestions to Further Answer, Are the Study Findings Valid?
Participants
Sample
Data collection
How were they
selected?
Was it adequate?
How were the
data collected?
Did they provide
rich and thick
descriptions?
Was the setting
appropriate to
acquire an
adequate sample?
Were the tools
adequate?
Were the
participants
rights protected?
Was the sampling
method
appropriate?
How were the data
coded? If so
how?
Did the researcher
eliminate bias?
Do the data accurately
represent the study
participants?
How accurate and
complete were the
data?
Was the group or
population adequately
described?
Was saturation achieved?
Does gathering the data
adequately portray the
phenomenon?
Source. Adapted from Powers (2005), Polit and Beck (2008), Russell and Gregory (2003), and Speziale and Carpenter (2003).
206 Journal of the American Psychiatric Nurses Association,Vol. 15, No. 3
Williamson
& Carpenter, 2003). Confirmability is the process of
confirming the accuracy, relevance, and meaning of
the data collected. Confirmability exists if (a) the
researcher identifies if saturation was reached and
(b) records of the methods and procedures are
detailed enough that they can be followed by an
audit trail (Miles & Huberman, 1994).
Dependability is a standard that demonstrates
whether (a) the process of the study was consistent, (b)
data remained consistent over time and conditions,
and (c) the results are reliable (Miles & Huberman,
1994; Polit & Beck, 2008; Speziale & Carpenter, 2003).
For example, if study methods and results are depend-
able, the researcher consistently approaches each
occurrence in the same way with each encounter and
results were coded with accuracy across the study.
Transferability refers to the probability that the
study findings have meaning and are usable by oth-
ers in similar situations (i.e., generalizable to others
in that situation; Miles & Huberman, 1994; Polit &
Beck, 2008; Speziale & Carpenter, 2003). To deter-
mine if the findings of a study are transferable and
can be used by others, the clinician must consider
the potential client to whom the findings may be
applied (Speziale & Carpenter, 2003).
Authenticity is when the researcher fairly and
faithfully shows a range of different realities and
develops an accurate and authentic portrait for
the phenomenon under study (Polit & Beck, 2008).
For example, if a clinician were to be in the same
environment as the researcher describes, they would
experience the phenomenon similarly. All mental
health providers need to become familiar with these
aspects of qualitative evidence and hone their criti-
cal appraisal skills to enable them to improve the
outcomes of their clients.
CONCLUSION
Qualitative research aims to impart meaning of
the human experience and understand how people
think and feel about their circumstances. Qualitative
researchers use a holistic approach in an attempt to
uncover truths and understand a persons reality.
The researcher is intensely involved in all aspects
of the research design, collection, and analysis pro-
cesses. Ethnography, phenomenology, and grounded
theory are some of the designs that a researcher may
use to study a culture, phenomenon, or theory. Data
collection strategies vary based on the research
question, method, and informants. Methods such as
interviews, observations, and journals allow for
information-rich participants to provide detailed lit-
erary accounts of the phenomenon. Data analysis
occurs simultaneously as data collection and is the
process by which the researcher identifies themes,
concepts, and patterns that provide insight into the
phenomenon under study.
One of the crucial ste
