Using Theory to Guide Quantitative Research

Fix et al. (2018) noted that patient-centered care (PCC) is ubiquitous in healthcare systems, where the systems are moving forward with its implementation. However, extremely little information is available about healthcare employees or their work, who are at the forefront in implementing the care. For this reason, Fix et al. (2018) researched to examine how hospital workers conceptualized patient care critically. The research was conducted in the form of quantitative interviews about patient-centered care. 

Other researchers, Murcia & Lopez (2016), embarked on a quest to comprehend nurses' experience in the delivery of care to culturally diverse families. The researchers used quantitative meta-synthesis to come up with their results. 

Theoretical Framework 

Patient-centered care is becoming prominent from the 20th century, where PCC first became a center of focus in the healthcare system (Fix et al., 2018). The sole purpose of PCC is to improve outcomes and increase patient satisfaction. PCC has proven to be beneficial with evidence linking it to better healthcare ratings, improvement of a variety of health conditions, and increased adherence (Feo & Kitson, 2016). As of now, PCC has become a quintessential aspect of healthcare as it extends beyond healthcare provision into medical law, education, and quality improvement. However, there lacks a consensus about the constituents of patient-centered care. While most policymakers and researchers agree that PCC provided a shift from the mundane traditional disease-focused approach, there is limited research on hospital staff's perception of the subject (Meleis, 2018). Previous research tends to focus on the parameter of PCC and how it improved the healthcare system. While this is the case, concrete efforts are underway to shift focus. For instance, one of the initiatives is the transformation of the US Veteran Health Administration into a healthcare system that is patient-based. The transformation inspired Fix et al. (2018) to conduct a qualitative study about the healthcare professional's view of PCC. The researchers used four of the 150 VHA medical centers that were designated as Centers of Innovation. 

In multicultural societies, cultural diversity comes from different ethnic groups co-existing in the same region or country (Murcia & Lopez, 2016). Although diversity is often appreciated, the cultural multiplicity, in this case, presents the heath section with some problems. For instance, healthcare providers have to not only cope with inequalities and consider cultural singularity in the promotion of services but also deliver culturally competent care by overcoming individual focus (Truong, Gibbs, Paradies & Priest, 2017). For this reason, healthcare providers are gearing towards attendance to family preference. Due to the caregivers' need to portray commitment, they turn into a critical factor of perfecting their healthcare provisions to families of all ethnic and cultural origins (Murcia & Lopez, 2016). Based on these facts, the researchers used quantitative meta-synthesis with an interpretive focus to establish the nurses' experience in providing services in culturally diverse families. 

Summary of Findings 

Fix et al. (2018) conducted 77 interviews involving 107 employees across the chosen four research centers. Since the research was geared towards service improvement, no consent was needed, as confirmed by the Institutional Review Board. The researchers divided the findings into three groups using Mead and Bower's model. Based on their responses, most of them were well aligned with the description, and others extended the description to the organization while very few deviated from PCC constructs. Med and Bower's concepts are biopsychological perspective, therapeutic alliance, doctor-as-person, patient-as person, and sharing power and responsibility (Louw, Marcus & Hugo, 2017). From their definition of PCC, most of the nurses inferred the concepts. Based on these findings, critical components of PCC were understood by the nurses tasked with implementing them. 

Murcia & Lopez (2016) included 247 nurse participants in their 14studies. Out of the 14 reports that were included in the quantitative meta-synthesis, one was a doctoral thesis, while the other 13 were research articles. The results based on interpretive integration of findings included four categories and one meta-theme. The meta-theme is 'taking care of a culturally diverse family is the experience of crossing a tight rope' (Murcia & Lopez, 2016, p. 27). The nurses are accustomed to a world of uncertainty, which can be compared to crossing a tight rope. The experience is admirable but also challenging. Category one is 'The encountering with a culturally diverse family is a tightrope between responsibility, ethical commitment, and barriers' (Murcia & Lopez, 2016, p.18). Category two is 'The cultural manifestations of the family are like guts of the wind of instability' (Murcia & Lopez, 2016, p. 21). The cultural behaviors and practices were manifested in different ways. The problems came where certain cultures were rigid with no alternative answers, which hardened the nurses' work. Category three 'Crossing the tightrope with understanding, flexibility, and recursiveness' (Murcia & Lopez, 2016, p. 23). The nurses noted that flexibility was crucial, and this implied reception without judging families' behaviors and attitudes or comparing them to their own beliefs. Category four 'Involving the family is a favorable wind that helps you pass the tightrope' (Murcia & Lopez, 2016, p.25). Family members helped translate as well as wash the patient undergoing treatment. 

Quality of Evidence 

The research by Fix et al. (2018) is original since it is based on interviews of healthcare professionals mandated to implement PCC. Therefore, the approach to interview them was genius as it would get their honest opinions about the work that they were about to do. Furthermore, Fix et al. (2018) incorporated Med and Bower's concepts in differentiating the answers, which showed their commitment to following nursing principles in their interviews. However, there were shortcomings in the study. Being a quantitative analysis, some figures were expected in the findings. For example, if they had said 90% of the 107 employees knew the definition of PCC, the readers could have gotten a vivid picture. Similarly, the interview was too broad, having used two questions. Although most of the interviewees were familiar with PCC terms, more questions should have been added. 

The research by Murcia & Lopez (2016) was not original but a mere sampling of previously written journals. Consequently, it was challenging to come up with authentic results other than the ones already written in the journals. Nonetheless, the researchers delivered a high-quality quantitative meta-synthesis that was characterized by carefully crafted divisions of evidence. Murcia & Lopez (2016) explored all possible outcomes of the scenarios and also included some recommendations for intervention. However, the research also lacked numerical evidence. Although the research was supposed to be quantitative with the theory supporting the claims, the researchers concentrated on the theory aspect. 

Potential Use of Evidence 

The quantitative study by Fix et al. (2018) can be used as evidence to translate into practice. As noted above, the researchers used healthcare professionals from the United States’ most extensive integrated healthcare system, who were tasked with implementing PCC. Therefore, their views about the policies they were about to implement were relevant, and that substantiates the evidence. However, a few changes would have to be made to include quantitative results, which can be done by future research to modify the results. Once that happens, the works of Fix et al. (2018) will become a masterpiece and a point of reference for future PCC related research. The positive responses indicate that the professionals had an idea of what they were to do. 

The quantitative research lacks authenticity, and originality almost makes the evidence unusable for practice. As noted above, the researchers used journals instead of conducting interviews and collecting new evidence. In as much as the study was flawlessly done, the lack of originality affects it. The lack of numerical data in the evidence does not help either. However, the findings indicate the hardships that healthcare professionals go through in dealing with culturally diverse communities. Murcia & Lopez (2016) also, present the various scenarios by making comparisons. The authors compare the working experience of crossing a tight rope. In the end, the writers offer several solutions in their findings that may be helpful. For instance, they indirectly suggest using a family member to ease the burden of translation and washing the patient, through a review by one of the nurses. Although the research is not original, it compensates by offering practical solutions for healthcare providers working in such environments. 

Conclusion 

Fix et al. (2018) concluded that the ideals of patient-centered care were present in the healthcare system and had expanded to encapsulate a cultural shift in the delivery of care. Nonetheless, the conceptualization of patient-centered care differed among employees. For instance, the leadership viewed patient-centered from a broader perspective, which encompassed the current hospital initiatives. On the flip side, other junior employees conceptualized patient-centered care as inherent, particularly with specific positions. The view, as noted by the researchers, risks undermining implementation efforts. 

Murcia & Lopez (2016) concluded that nurses working to deliver care in culturally diverse families are challenged by the difficulties of barriers, ethical responsibilities of care, and cultural incompetence. The researchers experience the problem of participants omitting vital information, which presented a limitation. Nevertheless, they were able to find results that offer a baseline for intervention efforts as well as cultural competency training for nurses. 

References 

Feo, R., & Kitson, A. (2016). Promoting Patient-Centred Fundamental Care in Acute Healthcare Systems.  International Journal of Nursing Studies ,  57 , 1-11. 

Fix, G. M., Vandeusen Lukas, C., Bolton, R. E., Hill, J. N., Mueller, N., Lavela, S. L., & Bokhour, B. G. (2018). Patient‐Centred Care Is A Way of Doing Things: How Healthcare Employees Conceptualize Patient‐Centred Care.  Health Expectations ,  21 (1), 300-307. 

Louw, J. M., Marcus, T. S., & Hugo, J. F. (2017). Patient-Or Person-Centred Practice in Medicine? A Review Of Concepts.  African Journal of Primary Health Care & Family Medicine ,  9 (1), 1-7. 

Meleis, A. (2018). Theoretical nursing: Development and progress (6 th ed.). Philadelphia, PA. Walter Kluwer. 

Murcia, SEA, & Lopez, L. (2016). The Experience of Nurses in Care for Culturally Diverse Families: A Qualitative Meta-Synthesis.  Latin American Magazine of Enfermagem ,  24 . 

Truong, M., Gibbs, L., Paradies, Y., & Priest, N. (2017). " Just Treat Everybody with Respect": Health Service Providers' Perspectives on The Role of Cultural Competence in Community Health Service Provision.  ABNF Journal ,  28 (2). 

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