Invisible Nursing Research

I firmly believe that the nursing research process and the nursing practice process are parallel processes (Fawcett & Garity, 2009). It follows, then, that every encounter between a nurse and a person seeking nursing services (that is, a client or a patient) is single case research. Rolfe (2006) explained that single case research is conducted with “unique individuals [who] the nurse meets in each of her [or his] clinical encounters” (p. 40). Rolfe values this research design as a way to advance what he calls nursing science of the unique, which he views as a way to combine practice with experimental research.

However, the research that does occur as practice is largely invisible—nurses who practice and nurses who conduct research rarely think of practice as a research enterprise. The exception may be nurses who subscribe to the idea of praxis, which is “a philosophical construct that brings together knowing (thought) and doing (method) as dialectic whole” (Freire, as cited in Kagan, Smith, Cowling, & Chinn, 2009, p. 78). In nursing, praxis sometimes means simultaneous research and practice. An example of simultaneous research and practice is Newman’s (2008) Research as Praxis Protocol: The Process of Pattern Recognition, which is the practice and research methodology for her grand theory of health as expanding consciousness.

Nurses who care for patients in any setting typically start each encouter with a question such as “How are you feeling now?” Patients usually answer with a few or many words that reflect how they are feeling, such as “Fine,” “Scared about the [procedure scheduled for that day or the next],” or “Worried about my family because . . . .” Nurses also typically take vital signs and review reports of laboratory tests of specimens of body fluids (blood, urine, or others). The reports usually consist of numbers that indicate the extent of deviation from normal laboratory test values. These seemingly simple approachs to determining the patient’s current health condition may be considered relatively sophisticated ways to collect data. The words are qualitative data, and the numbers are quantitative data.

The research design that most closely resembles nursing practice is mixed methods. This increasingly prevalent research design is used by researchers of many disciplines. The ascendency of mixed methods research is evident in the increasingly wide distribution of the Journal of Mixed Methods Research, which was first published in 2007, and the recent founding and increasing visibility of the Mixed Methods International Research Association (MMIRA; http://mmira.wildapricot.org). MMIRA has begun to sponsor international conferences every other year—the association’s inaugural conference was held in 2014 in Boston, Massachusetts, with participants from several countries across the globe–and regional or national conferences during the opposite year—regional conferences currently are scheduled for 2015 in Mona, Jamaica; in Sendai, Japan; and in the United States in Philadelphia, Pennsylvania.

Mixed methods research is an integration of a qualitative research design (typically a descriptive design) and quantitative research design, which may be descriptive quantitative, correlational, or experimental. The qualitative portion or phase is referred to as QUAL or qual, which means that the data are words. The quantitative portion or phase of a study is referred to as QUAN or quan, which indicates that the data are numbers (upper case is used when the study is primarily QUAN or QUAL, whereas lower case (quan or qual) is used when the other portion of the study is regarded as supplementary). Specific mixed methods designs can be QUAL + quan, QUAN + qual, or QUAL + QUAN (Creswell, 2015). A core characteristic of mixed methods research is that it “mixes (or integrates or links) the two forms of data concurrently by combining them (or merging them), sequentially by having one build on the other, or embedding one within the other” (Creswell & Plano-Clark, 2011, p. 5). The special feature of mixed methods research is the integration, rather than simple combination, of qualitative and quantitative data (Creswell, 2015).

Ideally, nursing practice involves collection of both word and number information and data that are integrated to form an understanding of the whole person’s health condition. Reliance on only word data or only number data provides only a part of the whole of the person, and borrowing from Chinn and Kramer (2011), is a pattern gone wild. The specific approach, QUAN + qual, QUAL + quan, or QUAL + QUAN depends on the conceptual model or grand theory selected by the nurse to guide practice, as well as the health condition of the patient, the setting in which nursing practice occurs, and the comfort of the nurse with collection and analysis of clinical information as data in the form of words and numbers.

Inasmuch as mixed methods research designs are used by researchers from various disciplines, they could be ideal designs for multidisciplinary research (Fawcett, 2013) and collaborative practice (Fawcett, 2014). For example, regardless of disciplinary origin, some researchers and practitioners have greater understanding of how to collect, analyze, and interpret word data; whereas others have greater understanding of how to collect, analyze, and interpret number data; and still others have greater understanding of how to integrate word and number data.

I strongly encourage practicing nurses to publish their encounters with patients as mixed methods research to make visible what has been invisible throughout the history of nursing. I also strongly encourage editors of all types of nursing journals to provide space for these nurses’ work, perhaps as stories of practice formalized into mixed methods research. Partnerships between Doctor of Philosophy (PhD)-prepared nurses and Doctor of Nursing Practice (DNP)-prepared nurses and other practicing nurses should facilitate publication of such papers (Florczak, Poradzisz, & Kostovich, 2014).

In closing, I refer readers to Florczak’s (2014) stimulating discussion of issues surrounding mixed methods research, including paradigms and designs. And, I welcome readers’ responses to the ideas presented in this essay.