Introduction
This book is designed to develop your appreciation of some of the key features of research methodologies and approaches. By completing the exercises in this book, you will gain a better knowledge and understanding of the research processes involved. From the outset we should state that this book is for healthcare professionals and students who are new to research and, therefore, we have assumed that you have no prior knowledge of research. Consequently, we have avoided using unnecessary jargon that may confuse you and make it difficult for you to feel confident about undertaking your own research proposal. After all, that is the most interesting and important part of your involvement with ‘research’.
To begin with, this chapter offers some definitions and discussions about:
- research;
- clinical audit;
- comparison of clinical audit and research;
- clinical effectiveness; and
- evidence-based practice.
The discussions in this chapter are put into context and discussed within the current healthcare climate. The chapter concludes with activities relating to practice for you to undertake. These, and the activities in the other chapters, will help you to understand fully the content of the chapters by your undertaking something related to them.
What is research?
Let us start at the very beginning and discuss what we mean by ‘research’.
The word ‘research’ is frequently used in everyday conversations, but has different meanings according to the context in which it is used. This chapter specifically relates to research undertaken within a healthcare context. In healthcare we are always looking for answers to questions that are related to the health and well-being of our patients/clients. For example, we may wish to find answers to questions such as:
- What are patients’ perspectives concerning a new type of treatment?
- How does the effectiveness of one type of wound dressing compare with that of another?
- How do healthcare professionals feel about working in a multi-disciplinary team?
And so on.
So, from what you have just read, you can see that research begins with a question. Now, you may think that we know the answers to some of these questions – and you may be right – but unless we subject these answers to a scientific process, then our knowledge and understanding could be said to be intuitive at best, and at worst quite possibly be based on guesswork and hunches.
The role of research, therefore, is to provide a systematic framework for obtaining answers to questions by studying and gathering the evidence in a scientific manner. In other words, the process of arriving at an answer to a question in the context of healthcare research has to follow certain rules. These rules are set out in different philosophies which underpin the type of research that is being undertaken. By following these rules our research can be judged by others to be objective, valid and reliable – three important tests of how good a piece of research is. So, to simplify: research is a way of thinking about a problem in a systematic and scientific way. We call this way of thinking about a problem a research process.
We can now take a few moments to look at the stages of the research process (see Table 1.1). As you can see from Table 1.1, the process of undertaking research involves eight stages which we need to work through when preparing a research proposal and doing the research study itself. These eight stages are:
You may have come across some words that are new to you in this list, but do not worry, as you work through this book and the accompanying web program, you will become familiar with all these terms, and many others, and understand them and their significance to the process of undertaking and reading research studies. If you think of research as being a foreign language, then, just as you have to learn a new vocabulary and grammar, and their contexts, so it is with learning about research. Research has its own vocabulary and ‘grammar’ (methodology and philosophy) and you have to learn these within the context of a research study. Similarly, just as it is better and much easier to learn a foreign language when you are living with it – for example, living in the country where the language you are studying is spoken – so you will learn about research and understand it much better and far more easily if you are learning it in a ‘live’ situation – when doing some research. This is the reason for encouraging and helping you to write a research proposal (whether for an actual research study or as a virtual project) as you work through the accompanying web program.
Table 1.1 Stages of research.
| Stage 1 | What? | |
| Conceptual | This involves thinking, reading, theorising, rethinking and discussing your ideas with colleagues and experts in the field or in your area of interest. | |
| Stage 2 | ||
| Question/hypothesis formulation | At this point, you would be reading the related literature to (i) get an idea of what has been done and how it has been done; (ii) assess the results of the research and gaps in the literature; and (iii) formulate your question/hypothesis which will provide direction for the research. (A hypothesis is a tentative statement to explain observations or facts and which requires experimental investigation for verification.) | |
| Stage 3 | ||
| Formulate aims and objectives | Aims are statements of what the research sets out to achieve. In other words, what do you want to find out? Objectives are a set of specific statements pertaining to the aim of the research and must fulfil the requirements of the aim. Aims and objectives are therefore interrelated and the latter can be seen as being more detailed information about the aims. They are the intellectual activities that the researcher will perform throughout the research process. | |
| Stage 4 | How? Whom? Where? | |
| Design and planning | The researcher must make a number of decisions about how to go about doing the research. These methodological decisions have implications for the validity and credibility of the study findings. If the methods used to collect and analyse the data are flawed, then the conclusions will be flawed also and doubtful. At this stage of the research process, you will be involved in: • Selecting the research design: i.e. the overall plan, how to get answers to the question being studied and how to handle some of the difficulties encountered in the study. • Thinking about a theoretical framework: you may wish to use a theoretical framework to structure and analyse the research. • Identifying the population to be studied. • Selecting measures for the research variables: i.e. defining the research variables and clarifying exactly what each means. • Designing the sampling plan: decide on your sample and how you will collect data, bearing in mind time and cost, and level of skill required. Sampling procedures include probability sampling and non-probability sampling (these are discussed later in the book). • Deciding on location. • Finalising and reviewing the research plan: showing your research plan to colleagues to get constructive criticism. The research plan is sometimes referred to as the research proposal. • Ethical considerations: you will need to discuss this with your R&D lead (or their equivalent) to ascertain what other approval may be required. Approval must be obtained before data collection. • Pilot study, if appropriate. | |
| Stage 5 | How? | |
| Empirical stage – data collection | This involves the collection of the data and approaches used to answer the research question/hypothesis. More than one method may be used; the commonest are interviews and questionnaires. | |
| Stage 6 Analytic stage | How? | This is the process of systematically explaining the data so that their meaning, structure and relationships are clearly articulated. The analysis will depend on whether the approach used is quantitative or qualitative. The key point is that the information gathered will be transformed so that it provides useful information and lets you reach conclusions. Qualitative data involve integration and synthesis of narrative data, whereas quantitative data are analysed through statistical procedures to describe, summarise and compare data. Whatever approach you use, the analysis must be carried out in relation to the research problem. |
| Stage 7 Presentation of results/findings | How? | You should put a lot of thought into how you present your results or findings. For example, consider whether figures or graphs are the best way to bring out your data and whether these will help the reader follow what you have found. Tables are also useful for presenting information as they can provide a complete picture for the reader. |
| Stage 8 Dissemination | How? | Results of data are of little use if they are not communicated to others. Ideally, the final step of a first-class study is to plan for its utilisation in practice. |
The other thing to point out about the list on pages 2–4 and Table 1.1 is that all these stages are covered fully in this book by being assigned a whole chapter so that we can introduce you to the eight stages and help you to understand them as you work though the book and accompanying web program.
At this stage, it is important to stress that the research proposal is essential to the whole process of undertaking research because it encapsulates everything that we need to go through in order to undertake a research study. Consequently, the better the proposal, the better and easier is the process of undertaking a research study. It is this process of absorbing information, knowledge and understanding in its natural and ‘live’ context that is the rationale for this book and web program, both of which are focused on helping you to prepare a research proposal.
The next section discusses the ‘audit’ and explains the differences between research and audit.
What is clinical audit?
Many healthcare students undertaking a project as part of their degree programme, or other academic studies – and indeed many qualified healthcare professionals who wish to look at a problem in their own practice – are uncertain if their work will be classified as research or as an audit, as the two activities are closely related. For example, they both:
- involve questions relating to quality of care;
- can be done prospectively (looking forward) or retrospectively (looking back);
- use:
- are usually professionally led.
Nevertheless, audit and research are very different processes.
The National Institute for Health and Clinical Excellence (2002: 1) defines an audit as a:
‘quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change. Aspects of the structures, processes and outcomes of care are selected and systematically evaluated against explicit criteria. Where indicated, changes are implemented at an individual, team or service level and further monitoring is used to confirm improvement in healthcare delivery.’
An earlier UK government White Paper, Working for Patients (Secretary of State for Health (1989: 39), describes medical audit as:
‘a systematic, critical analysis of the quality of medical care, including the procedures used for diagnosis and treatment, the use of resources, and the resulting outcome for the patient.’
The Healthcare Commission (2004) expands this:
‘The overall aim of clinical audit is to improve patient outcomes by improving professional practice and the general quality of services delivered. This is achieved through a continuous process where healthcare professionals review patient care against agreed standards and make changes, where necessary, to meet those standards. The audit is then repeated to see if the changes have been made and the quality of patient care improved’ (http://www.healthcarecommission.org.uk/ihealthcareproviders/serviceprovidersinformation/nationalclinicalaudit.cfn).
Whereas,
‘Research is the attempt to derive generalisable knowledge by addressing clearly defined questions with systematic and rigorous methods’ (Department of Health 2005 : 3) .
In other words, research is the systematic process of collecting and analysing information to increase our understanding of the topic being investigated. The researcher is therefore charged with contributing to knowledge. (If you are uncertain or concerned at this stage, then go back to the earlier discussion in this chapter about research.)
The method or process that we use in clinical audit is called the clinical audit cycle, whereas in research it is the research process, as outlined in Table 1.1 above.
The clinical audit cycle is a process of continuous improvement within the context of healthcare and treatment. The purpose of the clinical audit cycle is to identify problems and ask questions about healthcare practice in order to help healthcare practitioners reflect, review and act so that they can start to resolve these problems and questions, and so make changes that will improve patient/client care. It is called a clinical audit because it is often represented as an audit cycle or spiral, in which, following the identification of a problem or asking a question, the following processes are put into practice:
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