The research study will be done in two different stages. Stage one will comprise of two steps as discussed.
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1.8.1 STEP ONE: QUANTITATIVE RESEARCH
Stage One of the research study will comprise of a quantitative approach, which will be explorative, descriptive and contextual in nature.
1.8.1.1 Research design
A research design is the plan or blueprint for conducting a study (LoBiondo-Wood and Haber, 2010:577). The research design for the quantitative approach will be comprehensively discussed in Chapter 3.
1.8.1.1.1 Quantitative research
Quantitative research is conducted to describe new situations, events or concepts in the world, to examine relationships among concepts and ideas and to determine the effectiveness of treatments. Quantitative research is a formal, objective, systematic process in which numerical data is used to obtain information about a topic or an event (Burns and Grove, 2003:18, 27). The research study will be quantitative as it will aim, by means of a structured questionnaire, to describe the four identified nursing care practices related to patient safety as performed by professional nurses for mechanically ventilated patients in critical care units in the Nelson Mandela Metropole.
1.8.1.1.2 Exploratory Study
An exploratory study may be used to gain insight into an area for which there is little information available. An exploration is used to obtain a better understanding of the phenomenon (Babbie, 2005:89). The research study will aim to explore the four identified nursing care practices related to the safety of mechanically ventilated patients in the critical care units in the Nelson Mandela Metropole.
1.8.1.1.3 Descriptive Study
A descriptive study aims to include data, facts, empirical generalisations, narrative and stories, which provide truthful descriptions of phenomena in the world (Mouton, 1996:102). The research study will be descriptive as it will, by means of a structured questionnaire, reveal data and facts pertaining to the four identified nursing care
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practices related to the safety of mechanically ventilated patients in critical care units in the Nelson Mandela Metropole.
1.8.1.1.4 Contextual Study
A contextual study aims to study the phenomena because of their intrinsic and immediate contextual significance (Mouton, 1996:133). According to Holloway and Wheeler (2002:34), the context includes the environment or conditions and the location in which the study takes place. The research study will be conducted in the critical care environment, which comprises of critically ill, intubated adult patients who are connected to mechanical ventilators. The location will be all critical care units, both in the public and private sectors, in the Nelson Mandela Metropole. Professional nurses are specific to the context as they are rendering care to mechanically ventilated patients in the critical care units.
1.8.1.2 Research method
The research method consists of the systematic, methodological and accurate execution of the research design (Babbie and Mouton 2002:74). The research method for the quantitative approach involve identifying the research population, which in this study will be the professional nurses working in the adult critical care units in the Nelson Mandela Metropole. A convenient sampling method will be used in selecting the appropriate sample for the study.
A pilot study is a trial run of an investigation, conducted on a small scale, to determine whether the research design and method are relative and effective. The pilot study will also ensure that the research instrument is adequately designed by pre-testing it. A pilot study will make it easy to correct areas of misunderstanding and improves the reliability of the study. Based on the pilot study results of the questionnaire, the researcher may delete or re-write questions, change open-ended questions to closed ones and vice versa and verify that all response options have been provided (Fox and Bayat, 2007:103). The pilot study will be conducted in one of the critical care units in the private health care sector.
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Data will be collected by means of a structured questionnaire comprising of different sections exploring and describing the four identified nursing care practices. Data analysis will be done by means of a statistical programme and with aid of a statistician. Descriptive and inferential statistics will be used to describe and summarise data. Data will be graphically presented by mean of bar graphs and tables. Based on the results of the data analysed, the two nursing care practices that are done the least according to best recommended practices will be included in the systematic reviews.
The research method will be described comprehensively in Chapter 3 of this study.
1.8.1.3 Reliability and validity of the quantitative approach
The quality of research studies is of utmost importance in conducting research. Unless measurement tools validly and reliably reflect the concepts being tested, conclusions drawn from the empirical phase of the study will be invalid (LoBiondo- Wood and Haber, 1998:328).
Reliability refers to the fact that if a test, model or measurement is consistent, it is reliable in supplying the same answer at different times. Reliability is concerned with consistency, accuracy, precision, stability, equivalence and homogeneity. A reliable instrument is one that produces the same results if the behaviour is measured again by the same scale (Fox and Bayat, 2007:145). Validity refers to whether a measurement instrument accurately measures what it is supposed to measure. When the instrument is valid, it truly reflects the concept it is supposed to measure (Babbie and Mouton, 2002:648). The application of these concepts will be described in Chapter 3.
1.8.2 STEP TWO: SYSTEMATIC REVIEW
A systematic review is a summary of research evidence pertinent to a specified question, in which systematic and explicit methods are used to identify, select, critically appraise and synthesise the available research evidence (Craig and Smyth, 2007:344). A systematic review is a form of research and is frequently referred to as “secondary research”. “Primary research” involves the design and conduct of a
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study, including the collection of primary data from participants, and its analysis and interpretation. The systematic review also collects and analyses data, but usually from published and unpublished reports of completed research (Pearson et al, 2007:54).
In this research study, a systematic review will be undertaken on two of the four identified nursing care practices related to the safety of a mechanically ventilated patient in a critical care unit. The nursing care practices for inclusion in the review will be determined by the findings of the data analysis as derived from the structured questionnaires. Nursing care practices that are done according to the least best recommended practices will be included in the systematic review. For the scope of this study, it was decided to perform a systematic review on two of the identified four nursing care practices as performed by professional nurses in the critical care units.
The research design and method to be used for a systematic review will be comprehensively discussed in Chapter 3 of this study.
1.8.3 ASSESSMENT OF QUALITY OF STUDIES INCLUDED FOR CRITICAL APPRAISAL IN THE SYSTEMATIC REVIEW
As part of the systematic review, all studies are assessed for methodological rigour. Critical appraisal of the studies is done to assess whether the methods and results of the research studies included in the review are sufficiently valid to be considered useful information. A great number of assessment tools and checklist have been developed to aid in the critical appraisal process (Evans, 2001:54). When assessing the quality of randomised control trials, four different types of bias: selection, performance, detection and attrition are assessed. These concepts, as well as the JBI critical appraisal tools accessed via the JBI SUMARI software package, which will be used to assess the quality of the studies to be included in the review, are discussed comprehensively in Chapter 3 of this study.
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1.9 STAGE TWO: DEVELOPMENT OF EVIDENCE-INFORMED CLINICAL