Using case study within a sequential explanatory design to evaluate the impact of specialist and advanced practice roles on clinical outcomes: the SCAPE study

BMC Medical Research Methodology

Cecily Begley¹  Declan Devane²  Kathy Murphy²  Agnes Higgins¹  Catherine Comiskey¹  Imelda Coyne¹  Naomi Elliott¹  Dympna Casey²  Joan G Lalor¹ 

[1]School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland

[2]School of Nursing & Midwifery, National University of Ireland, Galway, Ireland

关键词: Workforce;    Complex evaluation;    Midwifery;    Nursing;    Advanced practice;    Specialist practice;    Case study;   

Others  :  1125936
DOI  :  10.1186/1471-2288-13-55

 received in 2012-10-17, accepted in 2013-03-27,  发布年份 2013

【 摘 要 】

Background

The role of the clinical nurse/midwife specialist and advanced nurse/midwife practitioner is complex not least because of the diversity in how the roles are operationalised across health settings and within multidisciplinary teams.

This aim of this paper is to use The SCAPE Study: Specialist Clinical and Advanced Practitioner Evaluation in Ireland to illustrate how case study was used to strengthen a Sequential Explanatory Design.

Methods

In Phase 1, clinicians identified indicators of specialist and advanced practice which were then used to guide the instrumental case study design which formed the second phase of the larger study. Phase 2 used matched case studies to evaluate the effectiveness of specialist and advanced practitioners on clinical outcomes for service users. Data were collected through observation, documentary analysis, and interviews. Observations were made of 23 Clinical Specialists or Advanced Practitioners, and 23 matched clinicians in similar matched non-postholding sites, while they delivered care. Forty-one service users, 41 clinicians, and 23 Directors of Nursing or Midwifery were interviewed, and 279 service users completed a survey based on the components of CS and AP practice identified in Phase 1. A coding framework, and the generation of cross tabulation matrices in NVivo, was used to make explicit how the outcome measures were confirmed and validated from multiple sources. This strengthened the potential to examine single cases that seemed ‘different’, and allowed for cases to be redefined. Phase 3 involved interviews with policy-makers to set the findings in context.

Results

Case study is a powerful research strategy to use within sequential explanatory mixed method designs, and adds completeness to the exploration of complex issues in clinical practice. The design is flexible, allowing the use of multiple data collection methods from both qualitative and quantitative paradigms.

Conclusions

Multiple approaches to data collection are needed to evaluate the impact of complex roles and interventions in health care outcomes and service delivery. Case study design is an appropriate methodology to use when study outcomes relate to clinical practice.

【 授权许可】

   
2013 Lalor et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Rosenberg JP, Yates PM: Schematic representation of case study research design. J Adv Nurs 2007, 60(4):447-452.
• [2]Stake R: Case studies. In Handbook of Qualitative Research. 2nd edition. Edited by Denzin NL, Linclon Y. Thousand Oaks, CA: Sage; 1995.
• [3]Luck L, Jackson D, Usher K: Case study: a bridge across the paradigms. Nurs Inq 2006, 13(2):103-109.
• [4]Johnstone PL: Mixed methods, mixed methodology health services research in practice. Qual Health Res 2004, 14(2):259-271.
• [5]Yin R: Enhancing the quality of case studies in health services research. Health Serv Res 1999, 34(5):1209-1224.
• [6]Merriam S: Qualitative research and case study applications in education. San Francisco: Jossey-Bass; 1998.
• [7]Stake R: Case studies. In Handbook of Qualitative Research. 2nd edition. Edited by Denzin N, Linclon Y. Thousand Oaks, CA: Sage; 2000.
• [8]Bergen A, While A: A case for case studies: exploring the use of case study design in community nursing research. J Adv Nurs 2000, 31(4):926-934.
• [9]Woods LP: Designing and conducting case study research in nursing. Nursing Times Res 1997, 2(1):48-56.
• [10]Sharp K: The case for case studies in nursing research: the problem of generalization. J Adv Nurs 1998, 27(4):785-789.
• [11]Yin RK: Case Study Research: Design and Methods, Volume 5.. 3rd edition. Thousand Oaks, CA: Sage Publications; 2003.
• [12]Plano Clark VL, Creswell JW: The Mixed Methods Reader. Thousand Oaks, CA: Sage; 2008.
• [13]Gerrish K, Guillaume L, Kirshbaum M, McDonnell A, Nolan M, Read S, Tod A: Empowering Front-Line Staff to Deliver Evidence-Based Care: The Contribution of Nurses in Advanced Practice Roles. Sheffield: Sheffield Hallam University; 2007.
• [14]Guest DE, Peccei R, Rosenthal P, Redfern S, Wilson-Barnett J, Dewe P, Coster S, Evans A, Sudbury A: An Evaluation of the Impact of Nurse, Midwife and Health Visitor Consultants. London: Kings College London; 2004.
• [15]Lathlean J: Researching the implementation of pioneering roles in nursing and midwifery: empirical insights about lecturer practitioners, consultant nurses and nurse registrars. J Res Nurs 2007, 12(1):29-39.
• [16]Health Service Executive: Corporate Plan. Dublin: HSE; 2001–2011. http://www.hse.ie/eng/services/…/corporate/Support%20Services%202012 webcite
• [17]Yin RK: Case Study Research: Design and Methods. Newbury Park, CA: Sage; 1994.
• [18]Patton M: Enhancing the Quality and Credibility of Qualitative Analysis. HSR: Health Services Research 34:5 Part II (December 1999). 1999, 1189-1208.
• [19]Yin R: Case Study Research: Design and Methods. 3rd edition. London: Sage; 2003.
• [20]Stake R: The Art of Case Study Research. Thousand Oaks, California: Sage; 1994.
• [21]Glen S, Waddington K: Role transition from staff nurse to clinical nurse specialist: a case study. J Clin Nurs 1998, 7(3):283-290.
• [22]Dooley LM: Case study research and theory building. Adv Dev Hum Resour 2002, 4(3):335-354.
• [23]Mariano CCSMIPM: Nursing Research: A Qualitative perspective. In Case Study: the Method. In Nursing Research: A Qualitative perspective . 3rd edition. Edited by Munhall P. Massachusetts: Jones and Bartlett; 2001.
• [24]Hewitt-Taylor J: Challenging the balance of power: patient empowerment. Nurs Stand 2002, 18(22):33-37.
• [25]Gerring J: Case Study Research. Principles and Practices. New York: Cambridge University Press; 2007.
• [26]Bryar R: An examination of case study research. Nurse Res 1999/2000, 7(2):61-78.
• [27]McGloin S: The trustworthiness of case study methodology. Nurse Res 2008, 16(1):45-55.
• [28]Sandelowski M: “Casing” the research case study. Res Nurs Health 2011, 34:153-159.
• [29]Casey D, Houghton C: Clarifying case study research: examples from practice. Nurse Res 2010, 17(3):41-49.
• [30]Tellis W: Results of a case study on information technology at a university. Qual Rep 1997., 3(4) http://www.nova.edu/ssss/QR/QR3-3/tellis3.html webcite. (Last accessed: August 15 2008)
• [31]Bryant-Lukosius D, Vohra J, DiCenso A: Resources to facilitate APN outcomes research. In Outcome Assessment in Advanced Nursing Practice. Edited by Kleinpell R. New York: Springer Publishing Company; 2009:267-286.
• [32]National Council for Nursing and Midwifery: Framework for the Establishment of Advanced Nurse/Advanced Midwife Practitioners. 4th edition. Dublin: ; 2008. http://www.lenus.ie/hse/bitstream/10147/45620/1/8490.pdf webcite
• [33]Kennedy F, McDonnell A, Gerrish K, Howarth A, Pollard C, Redman J: Evaluation of the impact of nurse consultant roles in the United Kingdom: a mixed method systematic literature review. J Adv Nurs 2011, 00:000-000.
• [34]Begley C, Begley C, Murphy K, Higgins A, Elliott N, Lalor J, Sheerin F, Coyne I, Comiskey C, Normand C: An Evaluation of Clinical Nurse and Midwife Specialist and Advanced Nurse and Midwife Practitioner Roles in Ireland (SCAPE). Dublin; 2010. http://www.nursing-midwifery.tcd.ie/assets/research/pdf/SCAPE_Final_Report_13th_May.pdf webcite
• [35]Ragin CC: Casing and the Process of Social Research. In What is a Case? Exploring the Foundations of Social Inquiry. Edited by Ragin CC, Becker HS. New York: Cambridge University Press; 1992:217-226.
• [36]Begley C, Murphy K, Higgins A, Elliott N, Lalor J, Sheerin F, Coyne I, Comiskey C, Normand C, Casey D: An Evaluation of Clinical Nurse and Midwife Specialist and Advanced Nurse and Midwife Practitioner Roles in Ireland (SCAPE). Dublin: National Council for Nursing and Midwifery in Ireland; 2010.
• [37]Wolcott HF: The art of fieldwork. Walnut Creek, California: Alta Mira Press; 1995.
• [38]Ritchie J, Spencer L: Qualitative data analysis for applied policy research. In Analyzing qualitative data. Edited by Bryman A, Burgess R. London: Routledge; 1994:173-174.
• [39]Schultz R, O’Brien A, Czaja S, Ory M, Norris R, Martir LM, Belle SH, Burgio L, Gitlin L, Coon D: Dementia caregiver intervention research: in search of clinical significance. Gerontologist 2002, 42(5):589-602.
• [40]Bryant-Lukosius D, DiCenso A: A framework for the introduction and evaluation of advanced practice nursing roles. Nurs Health Care Manag Policy 2004, 48(5):530-540.
• [41]Bryant-Lukosius D, Vohra J, DiCenso A: Resources to facilitate APN outcomes research. In Outcome Assessment in Advanced Practice Nursing. 2nd edition. Edited by Kleinpell R. New York: Springer Publishing Company; 2009:267-286.
• [42]Ragin C: Using qualitative comparative analysis to study causal complexity. Health Serv Res 1999, 34(5):1225-1238.