research methodology in nursing

• Member Benefits
• Communities
• Grants and Scholarships
• Student Nurse Resources
• Member Directory
• Course Login
• Professional Development
• Institutions Hub
• ONS Course Catalog
• ONS Book Catalog
• ONS Oncology Nurse Orientation Program™
• Account Settings
• Help Center
• Print Membership Card
• Print NCPD Certificate
• Verify Cardholder or Certificate Status

• Trouble finding what you need?
• Check our search tips.

• Oncology Nursing Forum
• Number 6 / November 2015

Case Study Research Methodology in Nursing Research

Diane G. Cope

Through data collection methods using a holistic approach that focuses on variables in a natural setting, qualitative research methods seek to understand participants’ perceptions and interpretations. Common qualitative research methods include ethnography, phenomenology, grounded theory, and historic research. Another type of methodology that has a similar qualitative approach is case study research, which seeks to understand a phenomenon or case from multiple perspectives within a given real-world context.

Become a Member

Purchase this article.

has been added to your cart

Related Articles

Systematic reviews, preferred reporting items for systematic reviews and meta-analyses, nursing intervention research.

• - Google Chrome

Intended for healthcare professionals

• Access provided by Google Indexer
• My email alerts
• BMA member login
• Username * Password * Forgot your log in details? Need to activate BMA Member Log In Log in via OpenAthens Log in via your institution

Search form

• Advanced search
• Search responses
• Search blogs
• Methodological...

Methodological standards for qualitative and mixed methods patient centered outcomes research

• Related content
• Peer review
• Bridget Gaglio , senior program officer 1 ,
• Michelle Henton , program manager 1 ,
• Amanda Barbeau , program associate 1 ,
• Emily Evans , research health science specialist 2 ,
• David Hickam , director of clinical effectiveness and decision sciences 1 ,
• Robin Newhouse , dean 3 ,
• Susan Zickmund , research health scientist and professor 4 5
• 1 Patient-Centered Outcomes Research Institute, 1828 L Street, Suite 900, Washington, DC, 20036, USA
• 2 Veterans Health Administration, United States Department of Veterans Affairs, Washington, DC, USA
• 3 Indiana University School of Nursing, Indianapolis, IN, USA
• 4 United States Department of Veterans Affairs, Salt Lake City, UT, USA
• 5 University of Utah School of Medicine, Salt Lake City, UT, USA
• Correspondence to: B Gaglio bgaglio{at}pcori.org
• Accepted 20 October 2020

The Patient-Centered Outcomes Research Institute’s (PCORI) methodology standards for qualitative methods and mixed methods research help ensure that research studies are designed and conducted to generate the evidence needed to answer patients’ and clinicians’ questions about which methods work best, for whom, and under what circumstances. This set of standards focuses on factors pertinent to patient centered outcomes research, but it is also useful for providing guidance for other types of clinical research. The standards can be used to develop and evaluate proposals, conduct the research, and interpret findings. The standards were developed following a systematic process: survey the range of key methodological issues and potential standards, narrow inclusion to standards deemed most important, draft preliminary standards, solicit feedback from a content expert panel and the broader public, and use this feedback to develop final standards for review and adoption by PCORI’s board of governors. This article provides an example on how to apply the standards in the preparation of a research proposal.

Rigorous methodologies are critical for ensuring the trustworthiness of research results. This paper will describe the process for synthesizing the current literature providing guidance on the use of qualitative and mixed methods in health research; and the process for development of methodology standards for qualitative and mixed methods used in patient centered outcomes research. Patient centered outcomes research is comparative clinical effectiveness research that aims to evaluate the clinical outcomes resulting from alternative clinical or care delivery approaches for fulfilling specific health and healthcare needs. By focusing on outcomes that are meaningful to patients, studies on patient centered outcomes research strengthen the evidence base and inform the health and healthcare decisions made by patients, clinicians, and other stakeholders.

The methods used in patient centered outcomes research are diverse and often include qualitative methodologies. Broadly, qualitative research is a method of inquiry used to generate and analyze open ended textual data to enhance the understanding of a phenomenon by identifying underlying reasons, opinions, and motivations for behavior. Many different methodologies can be used in qualitative research, each with its own set of frameworks and procedures. 1 This multitude of qualitative approaches allows investigators to select and synergize methods with the specific needs associated with the aims of the study.

Qualitative methods can also be used to supplement and understand quantitative results; the integration of these approaches for scientific inquiry and evaluation is known as mixed methods. 2 This type of approach is determined a priori, because the research question drives the choice of methods, and draws on the strengths of both quantitative and qualitative approaches to resolve complex and contemporary issues in health services. This strategy is achieved by integrating qualitative and quantitative approaches at the design, methods, interpretation, and reporting levels of research. 3 Table 1 lists definitions of qualitative methods, mixed methods, and patient centered outcomes research. The methodology standards described here are intended to improve the rigor and transparency of investigations that include qualitative and mixed methods. The standards apply to designing projects, conducting the studies, and reporting the results. Owing to its focus on patient centered outcomes research, this article is not intended to be a comprehensive summary of the difficulties encountered in the conduct of qualitative and mixed methods research.

Terms and definitions used in the development of the Patient-Centered Outcomes Research Institute’s (PCORI) qualitative and mixed methods research methodology standards

• View inline

Summary points

Many publications provide guidance on how to use qualitative and mixed methods in health research

The methodological standards reported here and adopted by Patient-Centered Outcomes Research Institute (PCORI) synthesize and refine various recommendations to improve the design, conduct, and reporting of patient centered, comparative, clinical effectiveness research

PCORI has developed and adopted standards that provide guidance on key areas where research applications and research reports have been deficient in the plans for and use of qualitative and mixed methods in conducting patient centered outcomes research

The standards provide guidance to health researchers to ensure that studies of this research are designed and conducted to generate valid evidence needed to analyze patients’ and clinicians’ questions about what works best, for whom, and under what circumstances

Established by the United States Congress in 2010 13 and reauthorized in 2019, 14 the Patient-Centered Outcomes Research Institute (PCORI) funds scientifically rigorous comparative effectiveness research, previously defined as patient centered outcomes research, to improve the quality and relevance of evidence that patients, care givers, clinicians, payers, and policy makers need to make informed healthcare decisions. Such decisions might include choices about which prevention strategies, diagnostic methods, and treatment options are most appropriate based on personal preferences and unique patient characteristics.

PCORI’s focus on patient centeredness and stakeholder engagement in research has generated increased interest in and use of methodologies of qualitative and mixed methods research within comparative effectiveness research studies. Qualitative data have a central role in understanding the human experience. As with any research, the potential for these studies to generate high integrity, evidence based information depends on the quality of the methods and approaches that were used. PCORI’s authorizing legislation places a unique emphasis on ensuring scientific rigor, including the creation of a methodology committee that develops and approves methodology standards to guide PCORI funded research. 13 The methodology committee consists of 15 individuals who were appointed by the Comptroller General of the US and the directors of the Agency for Healthcare Research and Quality and the National Institutes of Health. The members of the committee are medical and public health professionals with expertise in study design and methodology for comparative effectiveness research or patient centered outcomes research ( https://www.pcori.org/about-us/governance/methodology-committee ).

The methodology committee began developing its initial group of methodology standards in 2012 (with adoption by the PCORI’s board of governors that year). Since then, the committee has revised and expanded the standards based on identified methodological issues and input from stakeholders. Before the adoption of the qualitative and mixed methods research standards, the PCORI methodology standards consisted of 56 individual standards in 13 categories. 15 The first five categories of the standards are crosscutting and relevant to most studies on patient centered outcomes research, while the other eight categories are applicable depending on a study’s purpose and design. 15

Departures from good research practices are partially responsible for weaknesses in the quality and subsequent relevance of research. The PCORI methodology standards provide guidance that helps to ensure that studies on patient centered outcomes research are designed and conducted to generate the evidence needed to answer patients’ and clinicians’ questions about what works best, for whom, and under what circumstances. These standards do not represent a complete, comprehensive set of all requirements for high quality patient centered outcomes research; rather, they cover topics that are likely to contribute to improvements in quality and value. Specifically, the standards focus on selected methodological issues that have substantial deficiencies or inconsistencies regarding how available methods are applied in practice. These methodological issues might include a lack of rigor or inappropriate use of approaches for conducting patient centered outcomes research. As a research funder, PCORI uses the standards in the scientific review of applications, monitoring of funded research projects, and evaluation of final reports of research findings.

Use of qualitative methods has become more prevalent over time. Based on a PubMed search in June 2020 (search terms “qualitative methods” and “mixed methods”), the publication of qualitative and mixed methods studies has grown steadily from 1980 to 2019. From 1980 to 1989, 63 qualitative and 110 mixed methods papers were identified. Between 1990 to 1999, the number of qualitative and mixed methods papers was 420 and 58, respectively; by 2010 to 2019, these numbers increased to 5481 and 17 031, respectively. The prominent increase in publications in recent years could be associated with more sophisticated indexing methods in PubMed as well as the recognition that both qualitative and mixed methods research are important approaches to scientific inquiry within the health sciences. These approaches allow investigators to obtain a more detailed perspective and to incorporate patients’ motivations, beliefs, and values.

Although the use of qualitative and mixed methods research has increased, consensus regarding definitions and application of the methods remain elusive, reflecting wide disciplinary variation. 16 17 Many investigators and organizations have attempted to resolve these differences by proposing guidelines and checklists that help define essential components. 12 16 18 19 20 21 22 23 24 25 26 27 28 29 For example, Treloar et al 20 offer direction for qualitative researchers in designing and publishing research by providing a 10 point checklist for assessing the quality of qualitative research in clinical epidemiological studies. Tong et al 22 provide a 32 item checklist to help investigators report important aspects of the research process for interviews and focus groups such as the study team, study methods, context of the study, findings, analysis, and interpretations.

The goal of the PCORI Methodology Standards on Qualitative and Mixed Methods is to provide authoritative guidance on the use of these methodologies in comparative effectiveness research and patient centered outcomes research. The purpose of these types of research is to improve the clinical evidence base and, particularly, to help end users understand how the evidence provided by individual research studies can be applied to particular clinical circumstances. Use of qualitative and mixed methods can achieve this goal but can also introduce specific issues that need to be captured in PCORI’s methodological guidance. The previously published guidelines generally have a broader focus and different points of emphasis.

This article describes the process for synthesizing the current literature providing guidance on the use of qualitative and mixed methods in health research; and developing methodology standards for qualitative and mixed methods used in patient centered outcomes research. We then provide an example showing how to apply the standards in the design of a patient centered outcomes research application.

Methodology standards development process

Literature review and synthesis.

The purpose of the literature review was to identify published journal articles that defined criteria for rigorous qualitative and mixed methods research in health research. With the guidance of PCORI’s medical librarian, we designed and executed searches in PubMed, and did four different keyword searches for both qualitative and mixed methods (eight searches in total; supplemental table 1). We aimed to identify articles that provided methodological guidance rather than studies that simply used the methods.

We encountered two major challenges. First, qualitative and mixed methods research has a broad set of perspectives. 30 31 Second, some medical subject headings (MeSH terms) in our queries were not introduced until recently (eg, “qualitative methods” introduced in 2003, “comparative effectiveness” introduced in 2010), which required us to search for articles by identifying a specific qualitative method (eg, interviews, focus groups) to capture the literature before 2003 ( table 1 ). These challenges could have led to missed publications. To refine and narrow our search results, we applied the following inclusion criteria:

Articles on health services or clinical research, published in English, and published between 1 January 1990 and 14 April 2017

Articles that proposed or discussed a guideline, standard, framework, or set of principles for conducting rigorous qualitative and mixed methods research

Articles that described or discussed the design, methods for, or reporting of qualitative and mixed methods research.

The search queries identified 1933 articles (1070 on qualitative methods and 863 on mixed methods). The initial citation lists were reviewed, and 204 duplicates were removed. Three authors (BG, MH, and AB) manually reviewed the 1729 remaining article abstracts. Titles and abstracts were independently evaluated by each of the three reviewers using the inclusion criteria. Disagreements were adjudicated by an in-person meeting to determine which articles to include. This initial round of review yielded 212 references, for which the full articles were obtained. The full articles were reviewed using the same inclusion and exclusion criteria as the abstracts. Most of these articles were studies that had used a qualitative or mixed methods approach but were only reporting on the results of the completed research. Therefore, these articles were not able to inform the development of standards for conducting qualitative and mixed methods research and they were excluded, resulting in the final inclusion of 56 articles (supplemental table 2). Following the original search, the literature was scanned for new articles providing guidance on qualitative and mixed methods, resulting in four articles being added to the final set of literature. These articles come from psychology and health psychology specialties and seek to provide not only minimal standards in relation to qualitative and mixed methods research but also standards for best practice that apply across a wide range of fields. 32 33 34 35

Initial set of methodology standards

Using an abstraction form that outlined criteria for qualitative and mixed methods manuscripts and research proposals, we abstracted the articles to identify key themes, recommendations, and guidance under each criterion. Additional information was noted when considered relevant. A comprehensive document was created to include the abstractions and notes for all articles. This document outlined the themes in the literature related to methodological guidance. We began with the broadest set of themes organized into 11 major domains: the theoretical approach, research topics, participants, data collection, analysis and interpretation, data management, validity and reliability, presentation of results, context of research, impact of the researchers (that is, reflexivity), and mixed methods. As our goal was to distill the themes into broad standards that did not overlap with pre-existing PCORI methodology standards, we initially condensed the themes into six qualitative and three mixed methods standards. Following discussion among members of the working group, some standards were combined and two were dropped because of substantial overlap with each other or with previously developed PCORI methodology standards.

The key themes identified from the abstracted information were used as the foundation for the first draft of the new methodology standards. We then further discussed the themes as a team and removed redundancies, refined the labeling of themes, and removed themes deemed extraneous through a team based adjudication process. The draft standards were presented to PCORI’s methodology committee to solicit feedback. Revisions were made on the basis of this feedback.

Expert panel one day workshop

A one day expert panel workshop was held in Washington, DC, on 18 January 2018. Ten individuals regarded as international leaders in qualitative and mixed methods were invited to attend—including those who had created standards previously or had a substantial number of peer reviewed publications reporting qualitative and mixed methods in health research; had many years’ experience as primary researchers; and had served as editors of major textbooks and journals. The panel was selected on the basis of their influence and experience in these methodologies as well as their broad representation from various fields of study. The representation of expertise spanned the fields of healthcare, anthropology, and the social sciences (supplemental table 3).

Before the meeting, we emailed the panel members the draft set of qualitative and mixed methods standards, PCORI’s methodology standards document, and the background document describing how the draft standards had been developed. At the meeting, the experts provided extensive feedback, including their recommendations regarding what needs to be done well when using these methodological approaches. The panel emphasized that when conducting mixed methods research, this approach should be selected a priori, based on the research question, and that integration of the mixed approaches is critical at all levels of the research process (from inception to data analysis). The panel emphasized that when conducting qualitative research, flexibility and reflexive iteration should be maintained throughout the process—that is, the sampling, data collection, and data analysis. The main theme from the meeting was that the draft standards were not comprehensive enough to provide guidance for studies on patient centered outcomes research or comparative effectiveness research that involved qualitative and mixed methods. After the conclusion of the workshop, feedback and recommendations were synthesized, and the draft standards were reworked in the spring of 2018 ( fig 1 ). This work resulted in a new set of four qualitative methods standards and three mixed methods standards representing the unique features of each methodology that were not already included in the methodology standards previously adopted by PCORI.

Process of development and adoption of the Patient-Centered Outcomes Research Institute’s (PCORI) methodology standards on qualitative and mixed methods research

• Download figure
• Open in new tab
• Download powerpoint

Continued refinement and approval of methodology standards

In late spring 2018, the revised draft methodology standards were presented to PCORI’s methodology committee first by sharing a draft of the standards and then via oral presentation. Feedback from the methodology committee centered around eliminating redundancy in the standards proposed (both across the draft standards and in relation to the previously adopted categories of standards) and making the standards more actionable. The areas where the draft standards overlapped with the current standards were those for formulating research questions, for patient centeredness, and for data integrity and rigorous analyses. Each draft standard was reviewed and assessed by the methodology committee members and the staff workgroup to confirm its unique contribution to PCORI’s methodology standards. After this exercise, each remaining standard was reworded to be primarily action guiding (rather than explanatory). This version of proposed standards was approved by the methodology committee to be sent to PCORI’s board of governors for a vote to approve for public comment. The board of governors approved the standards to be posted for public comment.

The public comment period hosted on PCORI’s website ( https://www.pcori.org/engagement/engage-us/provide-input/past-opportunities-provide-input ) was held from 24 July 2018 to 21 September 2018. Thirty nine comments were received from nine different stakeholders—seven health researchers, one training institution, and one professional organization. Based on the public comments, minor wording changes were made to most of the draft standards. The final version of the standards underwent review by both the methodology committee and PCORI’s board of governors. The board voted to adopt the final version of the standards on 26 February 2019 ( table 2 ).

Patient-Centered Outcomes Research Institute’s (PCORI) methodology standards for qualitative methods and mixed methods

Application of methodology standards in research design

The standards can be used across the research continuum, from research design and application development, conduct of the research, and reporting of research findings. We provide an example for researchers on how these standards can be used in the preparation of a research application ( table 3 ).

Guidance for researchers on how to use Patient-Centered Outcomes Research Institute’s (PCORI) methodology standards for qualitative and mixed methods research in application preparation

QM-1: State the qualitative approach to research inquiry, design, and conduct

Many research proposals on patient centered outcomes research or comparative effectiveness research propose the use of qualitative methods but lack adequate description of and justification for the qualitative approach that will be used. Often the rationale for using qualitative methods is not tied back to the applicable literature and the identified evidence gap, missing the opportunity to link the importance of the approach in capturing the human experience or patient voice in the research aims. The approach to inquiry should be explicitly stated along with the rationale and a description of how it ties to the research question(s). The research proposal should clearly define how the qualitative approach will be operationalized and supports the choice of methods for participant recruitment, data collection, and analysis. Moreover, procedures for data collection should be stated, as well as the types of data to be collected, when data will be collected (that is, one point in time v longitudinal), data management, codebook development, intercoder reliability process, data analysis, and procedures for ensuring full confidentiality.

QM-2: Select and justify appropriate qualitative methods and sampling strategy

While the number of participants who will be recruited for focus groups or in-depth interviews is usually described, the actual sampling strategy is often not stated. The description of the sampling strategy should state how it aligns with the qualitative approach, how it relates to the research question(s), and the variation in sampling that might occur over the course of the study. Furthermore, most research proposals state that data will be collected until thematic saturation is reached, but how this will be determined is omitted. As such, this standard outlines the information essential for understanding who is participating in the study and aims to reduce the likelihood of making unsupported statements, emphasizing transparency in the criteria used to determine the stopping point for recruitment and data collection.

QM-3: Link the qualitative data analysis, interpretations, and conclusions to the study question

Qualitative analysis transforms data into information that can be used by the relevant stakeholder. It is a process of reviewing, synthesizing, and interpreting data to describe and explain the phenomena being studied. The interpretive process occurs at many points in the research process. It begins with making sense of what is heard and observed during data gathering, and then builds understanding of the meaning of the data through data analysis. This is followed by development of a description of the findings that makes sense of the data, in which the researcher’s interpretation of the findings is embedded. Many research proposals state that the data will be coded, but it is unclear by whom, their qualifications, or the process. Very little, if any, description is provided as to how conclusions will be drawn and how they will be related to the original data, and this standard highlights the need for detailed information on the analytical and interpretive processes for qualitative data and its relationship to the overall study.

QM-4: Establish trustworthiness and credibility of qualitative research

The qualitative research design should incorporate elements demonstrating validity and reliability, which are also known by terms such as trustworthiness and credibility. Studies with qualitative components can use several approaches to help ensure the validity and reliability of their findings, including audit trail, reflexivity, negative or deviant case analysis, triangulation, or member checking (see table 1 for definitions).

MM-1: Specify how mixed methods are integrated across design, data sources, and/or data collection phases

This standard requires investigators to declare and support their intent to conduct a mixed methods approach a priori in order to avoid a haphazard approach to the design and resulting data. Use of mixed methods can enhance the study design, by using the strengths of both quantitative and qualitative research as investigators are afforded the use of multiple data collection tools rather than being restricted to one approach. Mixed methods research designs have three key factors: integration of data, relative timing, and implications of linkages for methods in each component. Additionally, the standards for mixed methods, quantitative, and qualitative methodologies must be met in the design, implementation, and reporting stages. This is different from a multimethod research design in which two or more forms of data (qualitative, quantitative, or both) are used to resolve different aspects of the research question independently and are not integrated.

MM-2: Select and justify appropriate mixed methods sampling strategy

Mixed methods research aims to contribute insights and knowledge beyond that obtained from quantitative or qualitative methods only, which should be reflected in the sampling strategies as well as in the design of the study and the research plan. Qualitative and quantitative components can occur simultaneously or sequentially, and researchers must select and justify the most appropriate mixed method sampling strategy and demonstrate that the desired number and type of participants can be achieved with respect to the available time, cost, research team skillset, and resources. Those sampling strategies that are unique to mixed methods (eg, interdependent, independent, and combined) should focus on the depth and breadth of information across research components.

MM-3: Integrate data analysis, data interpretations, and conclusions

Qualitative and quantitative data often are analyzed in isolation, with little thought given to when these analyses should occur or how the analysis, interpretation, and conclusions integrate with one another. There are multiple approaches to integration in the analysis of qualitative and quantitative data (eg, merging, embedding, and connecting). As such, the approach to integration should determine the priority of the qualitative and quantitative components, as well as the temporality with which analysis will take place (eg, sequentially, or concurrently; iterative or otherwise). Either a priori or emergently, where appropriate, researchers should define these characteristics, identify the points of integration, and explain how integrated analyses will proceed with respect to the two components and the selected approach.

The choice between multiple options for prevention, diagnosis, and treatment of health conditions presents a considerable challenge to patients, clinicians, and policy makers as they seek to make informed decisions. Patient centered outcomes research focuses on the pragmatic comparison of two or more health interventions to determine what works best for which patients and populations in which settings. 5 The use of qualitative and mixed methods research can enable more robust capture and understanding of information from patients, caregivers, clinicians, and other stakeholders in research, thereby improving the strength, quality, and relevance of findings. 4

Despite extensive literature on qualitative and mixed methods research in general, the use of these methodologies in the context of patient centered outcomes research or comparative effectiveness research continues to grow and requires additional guidance. This guidance could facilitate the appropriate design, conduct, analysis, and reporting of these approaches. For example, the need for including multiple stakeholder perspectives, understanding how an intervention was implemented across multiple settings, or documenting the clinical context so decision makers can evaluate whether findings would be transferable to their respective settings pose unique challenges to the rigor and agility of qualitative and mixed methods approaches.

PCORI’s methodology standards for qualitative and mixed methods research represent an opportunity for further strengthening the design, conduct, and reporting of patient centered outcomes research or comparative effectiveness research by providing guidance that encompasses the broad range of methods that stem from various philosophical assumptions, disciplines, and procedures. These standards directly affect factors related to methodological integrity, accuracy, and clarity as identified by PCORI staff, methodology committee members, and merit reviewers in studies on patient centered outcomes research or comparative effectiveness research. The standards are presented at a level accessible to researchers new to qualitative and mixed methods research; however, they are not a substitute for appropriate expertise.

The challenges of ensuring rigorous methodology in the design and conduct of research are not unique to qualitative and mixed methods research, because the imperative to increase value and reduce waste in research design, conduct, and analysis is widely recognized. 36 Consistent with such efforts, PCORI recognizes the importance of continued methodological development and evaluation and is committed to listening to the research community and providing updated guidance based on methodological advances and research needs. 37

Acknowledgments

We thank the Patient-Centered Outcomes Research Institute’s (PCORI) methodology committee during this work (Naomi Aronson, Ethan Bach, Stephanie Chang, David Flum, Cynthia Girman, Steven Goodman (chairperson), Mark Helfand, Michael S Lauer, David O Meltzer, Brian S Mittman, Sally C Morton, Robin Newhouse (vice chairperson), Neil R Powe, and Adam Wilcox); and Frances K Barg, Benjamin F Crabtree, Deborah Cohen, Michael Fetters, Suzanne Heurtin-Roberts, Deborah K Padgett, Janice Morse, Lawrence A Palinkas, Vicki L Plano Clark, and Catherine Pope, for participating in the expert panel meeting and consultation.

Contributors: BG led the development of the methodology standards and wrote the first draft of the paper. MH, AB, SZ, EE, DH, and RN made a substantial contribution to all stages of developing the methodology standards. BG, SZ, MH, and AB drafted the methodology standards. DH, EE, and RN gave critical insights into PCORI’s methodology standards development processes and guidance. SZ served as qualitative methods consultant to the workgroup. BG provided project leadership and guidance. MH and AB facilitated the expert panel meeting. SZ is senior author. BG and SZ are the guarantors of this work and accept full responsibility for the finished article and controlled the decision to publish. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

Funding: No funding was used to support this work. All statements in this report, including its findings and conclusions, are solely those of the authors and do not necessarily represent the views of PCORI, its board of governors or methodology committee. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

Competing interests: All authors have completed the ICMJE uniform disclosure form at http://www.icmje.org/conflicts-of-interest/ and declare: no support from any organization for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

The lead author affirms that the manuscript is an honest, accurate, and transparent account of the work being reported; that no important aspects of the study have been omitted; and that any discrepancies from the work as planned have been explained.

Provenance and peer review: Not commissioned; externally peer reviewed.

Patient and public involvement: Patients and stakeholders were invited to comment on the draft standards during the public comment period held from 24 July 2018 to 21 September 2018. Comments were reviewed and revisions made accordingly. Development of the standards, including the methods, were presented at two PCORI board of governors’ meetings, which are open to the public, recorded, and posted on the PCORI website.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ .

• Collins CS ,
• Stockton CM
• Creswell JW ,
• Plano Clark VL
• Fetters MD ,
• Creswell JW
• ↵ Patient-Centered Outcomes Research Institute. Patient-centered outcomes research. 2010-19. https://www.pcori.org/research-results/about-our-research/research-we-support .
• Institute of Medicine
• Crabtree BF ,
• Klassen AC ,
• Plano Clark VL ,
• Clegg Smith KC ,
• Office of Behavioral and Social Sciences Research
• ↵ Patient Protection and Affordable Care Act, Pub. L. No. 111-148 Stat. 119 (March 23, 2010).
• ↵ Further Consolidated Appropriations Act, 2020, Pub. L. No. 116-94 (20 December 2019).
• ↵ Patient-Centered Outcomes Research Institute (PCORI). PCORI methodology standards. 2011-19. https://www.pcori.org/research-results/about-our-research/research-methodology/pcori-methodology-standards .
• Molina-Azorin JF
• Chapple A ,
• Treloar C ,
• Champness S ,
• Simpson PL ,
• Higginbotham N
• Cesario S ,
• Santa-Donato A
• Sainsbury P ,
• Flemming K ,
• McInnes E ,
• Davidoff F ,
• Batalden P ,
• Stevens D ,
• Mooney SE ,
• SQUIRE development group
• Gagnon MP ,
• Griffiths F ,
• Johnson-Lafleur J
• ↵ National Cancer Institute. Qualitative methods in implementation science. 2018. https://cancercontrol.cancer.gov/sites/default/files/2020-09/nci-dccps-implementationscience-whitepaper.pdf
• O’Brien BC ,
• Harris IB ,
• Beckman TJ ,
• ↵ National Institute for Health and Clinical Excellence. The guidelines manual. Appendix H: Methodology checklist: qualitative studies. https://www.nice.org.uk/process/pmg6/resources/the-guidelines-manual-appendices-bi-2549703709/chapter/appendix-h-methodology-checklist-qualitative-studies .
• Crabtree BF
• Johnson RB ,
• Onwuegbuzie AJ ,
• American Psychological Association
• Levitt HM ,
• Bamberg M ,
• Josselson R ,
• Suárez-Orozco C
• Motulsky SL ,
• Morrow SL ,
• Ponterotto JG
• Bishop FL ,
• Horwood J ,
• Chilcot J ,
• Ioannidis JPA ,
• Greenland S ,
• Hlatky MA ,
• ↵ Patient-Centered Outcomes Research Institute. The PCORI methodology report. 2019. https://www.pcori.org/sites/default/files/PCORI-Methodology-Report.pdf .

Nursing Research Methodology Guide

Nursing research is an art of scientific investigation that aims to solve healthcare problems or nursing issues. It uses disciplined methods to collect and analyze data to develop meaningful findings that help solve problems.

Research helps provide evidence pertinent to making sound decisions in a clinical setting. To properly conduct research, one must select appropriate research methods that facilitate systematic study planning, data collection, and information inquiry. When designing nursing research, you must understand what research methodologies are.

This article will explore research methodologies, why they are essential in nursing, the different types of research methods, and their characteristics.

Importance of Research Methodologies in Nursing Education

Research methodologies outline all the procedures, methods, and techniques used in a research study. They allow for data collection, analysis, and interpretation.

Research methodologies are instrumental in answering questions that are encountered in clinical practice. It details the researcher's valid and reliable approach to fulfilling their goals and objectives.

A sound research methodology can help in providing the following benefits.

• Give other researchers enough information to replicate their research.
• In case of any criticism, the researcher can return to their methodology to explain the approach used.
• Provides a specific plan for researchers to follow.
• It allows researchers to select the proper methods to fulfill their objectives.

Role of Research in Nursing Practice and Education

In nursing, research is the systematic investigation of developing relevant knowledge about issues that are important to nurses, such as practice, education, and administration. Since nurses are healthcare professionals, they do not only work in hospitals.

The scope of nursing practice is broad, and the (nurses) work in different sectors. Some work in teaching, and others in community health, business, government agencies, etc. Hence, the scope of nursing is getting wider, with many responsibilities. The responsibility of taking care of patients is vested in nurses. They deal with nursing problems and know the treatment options required by each patient, which treatment they should focus on, and which to terminate.

Adequately conducted research can provide evidence that helps healthcare professionals provide quality healthcare to patients and support nursing practices.

High-quality research allows professional growth by giving them the most accurate tools and opportunities to advance their nursing specialty.

Nurses had difficulty caring for patients before clinical hospitals or hospices were more specialized. However, now they rely heavily on research findings to reduce mortality risk and improve patient outcomes.

Nursing research of high quality means the study has answered an important question. It also means that the findings have an actual impact in terms of how care will be carried out to patients and teaching nursing students.

Nurses also have to inform their patients about the recent development in healthcare that can help them make informed decisions about their health or that of their loved ones.

Nursing students pursuing the RN and BSN programs can learn how to retrieve data, review, critique, and apply the results from the research.

Some other reasons why research is vital in nursing practice and education include the following:

• Nursing staff can gain more profound knowledge of various topics
• Conduct a careful and comprehensive search on diagnosis and other patient problems
• Come up with new and better ways to take care of the patient
• Improve nursing standards
• Minimize daily nursing challenges
• Update information on various fields where nurses are involved
• To solve day-to-day obstacles

Hence, research is an integral part of nursing practice. Nurses should rely on research to improve their knowledge, answer pertinent patient questions and provide high-quality care to those under their care.

How Research Methodologies Help Nurses Develop Evidence-based Practice

Evidence-based practices use the best available facts and evidence to improve patient care and outcomes. Essentially, it is a holistic process that integrates the following key elements: scientific research, the expertise of a healthcare professional, and the patient's perspective and preferences.

Studies show that patient outcomes improve significantly when nurses do their work in an evidence-based manner.

Nurses must understand research methodologies because they help advance nursing practice. Nurses use these methodologies to collect evidence-based information in decision-making, enhancing medical delivery and care for patients.

Research findings will offer nurses evidence-based data to develop new ways to assess, evaluate and deliver nursing care.

Types of Research Methodologies in Nursing

Research in nursing must be of high quality to yield valuable results. Nurses must have extensive knowledge and apply relevant evidence in their practice. This evidence can sometimes be in the form of research findings, filling the gaps in knowledge and expertise.

The methods primarily used in nursing to collect and analyze research may be qualitative or quantitative. Selecting the preferred methods solely relies on the one conducting the research. These methods inform nursing practice. Some research questions are best studied through qualitative methods, while others work well with quantitative methods.

However, researchers have recently adopted the best and most desirable methods. However, this is not to say that other methods do not work.

All three methods contribute immensely to nursing. Data collected in quantitative research provides a deeper understanding of everything in the social world. Qualitative data helps in understanding people's feelings, thoughts, and behaviors. The mixed method uses both data to gain a much deeper understanding of complex matters.

Mixed Methods Nursing Research

Mixed method research, also known as multimethodology, involves using elements of both qualitative and quantitative research to find answers to research questions. This aims to help you develop a complete picture since it integrates all the benefits of both methods.

In this method, researchers collect qualitative and quantitative data to conduct a study. This method has grown so much in nursing because of the increasing complexity of delivering proper healthcare. Researchers draw the strengths of the two methods and use them to draw perspective on intricate research topics. Using this method can deepen the understanding of all nursing phenomena.

Mixed methods involve purposefully combining methods in data collection, analysis, and interpretation of findings. The key word here is mixing. Remember that mixed research does not just mean collecting qualitative and quantitative data. You must consider how you will integrate them to come up with coherent conclusions.

Characteristics of Mixed-methods Research

As mentioned, mixed methods are all about collecting and analyzing both qualitative and quantitative data. This mixing of data is a unique aspect of mixed-method research. Mixing data allows a researcher to understand more about a problem than using either data alone.

The following are characteristics of mixed research.

• It involves the analysis of both qualitative and quantitative data
• There is the collection of qualitative and quantitative data in response to a hypothesis
• There is a need for convincing and meticulous procedures when using qualitative and quantitative methods of research
• It involves carefully integrating these two data collected by either emerging or embedding them.
• There is the use of a research approach that is based on a theoretical foundation.
• Using a specific mixed-method plan involving a concurrent integration

The following are examples of studies in healthcare that used mixed-method research.

• A Mixed Methods Research Study of Parental Perceptions of Physical Activity and Quality of Life of Children Under Home Lock Down in the COVID-19 Pandemic
• A mixed methods study on evaluating the performance of a multi-strategy national health program to reduce maternal and child health disparities in Haryana, India
• A mixed methods case study exploring the impact of membership in a multi-activity, multicenter community group on the social well-being of older adults

Qualitative Research in Nursing

Qualitative research is collecting, analyzing, and interpreting information about non-numerical data. This data is observed but cannot be measured. It includes opinions, thoughts, feelings, words, and behaviors. This research helps in understanding concepts and thoughts.

Qualitative research is mainly used to understand concepts that are not familiar. In nursing, qualitative research helps in generating evidence and determining patient preferences. It helps provide a deeper understanding of others and interpret their meanings and behaviors.

Generally, one will use qualitative research if one wants to know more about:

• Perceptions
• Representations
• Or anything subjective

Characteristics of Qualitative Research Method

Any good research must start from a reasonable starting position or a theoretical perspective. Quantitative research involves a positivist perspective whereby a researcher objectively and systematically obtains evidence to prove a hypothesis.

The following are characteristics of qualitative research.

• Researchers collect information from the source of the problem. They go where the participants are to collect the data. This information is collected by directly talking to the participants and seeing them in their natural habitat.
• The qualitative researcher is the key instrument. What this means is that they collect information through observation or direct interviews. They do not rely on questionnaires used by other researchers.
• It involves building patterns of information and themes from the ground up. On the other hand, build it up from separate data to a reasonable conclusion.
• Data is collected from multiple sources rather than relying on a single source.
• The researchers strive to understand the meaning of the data collected from the participants instead of summarizing what other researchers have found out.
• Researchers use perspectives such as cultural concepts, gender differences, race, etc., to collect data.
• Researchers make their own interpretations of what they have observed, seen, and heard. Because of this, there are usually different interpretations from researchers.
• Qualitative researchers aim to create a complete picture of the problem or question they are studying.

The following are examples of nursing research that has used qualitative methods are:

• The Work of Breastfeeding Among Women of Low Socioeconomic Status: A Qualitative Meta-synthesis
• Stressors Among Healthcare Workers: A Summative Content Analysis
• End-of-Life Care for Transgender Older Adults

Quantitative Research in Nursing

Quantitative research, also known as empirical research, collects numerical data that helps understand an existing hypothesis. In other words, this research is based on what can be measured accurately and precisely. This method is important because it helps collect and analyze more information. A complex problem can be reduced and restructured to several variables, resulting in factual, reliable, and generalizable data. One must therefore have background knowledge in mathematics and statistical skills.

Generally, researchers should use quantitative research if they aim to understand more about the following:

• Measurable differences
• Or anything else that is objective

Characteristics of Quantitative Research

Quantitative research uses statistics to make sense of something. It also involves making generalizations from data used to test theories about attitudes and behaviors. Quantitative data aims at clarifying any fuzziness that exists in qualitative data. The numerical insights provided will help you formulate a conclusion.

Here are the characteristics of quantitative research.

• All the methods used in collecting data are adequately structured. They also contain items requiring measurability, such as age, highest education, salary range, etc.
• It uses typically structured data collection methods such as polls, surveys, and questionnaires. These methods help draw the preferences of the participants.
• It relies on large sample sizes to collect data. Researchers conduct their study on a large number of participants to ensure reliability.
• Participants in the research are subjected to close-ended questions. Therefore, the results of these findings are less vague and limit the chances of participants providing wrong information.
• The information collected in quantitative research can be used multiple times.
• It uses close-ended questions, which are more specific than open-ended questions. Responses to open-ended questions are specific and scattered. One must have specific skills to select the needed answers.
• The outcomes from quantitative research are always in numerical form. For example, the answers can be presented in percentage form.
• Many researchers use previous research to analyze previous studies' outcomes to develop their own hypotheses.
• The outcomes of the quantitative study are used to provide a generalization for the whole population. This is because the study is conducted on a large sample size.

The following are examples of nursing studies that used quantitative research.

• Quantitative research on the impact of COVID-19 on frontline nursing staff at a military hospital in Saudi Arabia

Steps in Conducting Nursing Research

Research findings help provide a deeper understanding of how to care for patients.

The following are steps that help in conducting high-quality nursing research.

Step 1: Identify the problem / develop a Hypothesis

When conducting research, researchers try to find answers to a problem. Therefore, it is logical that the first step should be to identify the problem and then come up with the research question. For instance, if the goal is to find out whether there is a link between taking milk chocolate and type II diabetes in adults, one can pose the following hypothesis: Adults who take 20mg of chocolate milk every day have a higher chance of getting type 2 diabetes than those who consume only 10mg a day.

Identifying the keywords in your question is important. In this case, Type II diabetes, 20mg more, adults.

One must consider stating the problem clearly and unambiguously. Remember that research problems show unmet healthcare needs and opportunities l to do better.

When identifying a problem, researchers will use the SMART mnemonic .

S – Specific

M – Measurable

A – Achievable

R – Relevant

T – Time Bound

These problems can be sparked by the following:

• Personal experiences of a nurse.
• Socially significant nursing issues affecting a given population.
• An event that occurs in the workplace.
• Personal interactions in a particular study area trigger the need for further investigation.

The problems double up as the topic of your nursing research. You must analyze each problem individually and settle for one that you can manage. The research problem can be any issue that requires a solution and, in this context, it should relate to the nursing profession. You must provide a rationale for the problem and how your study addresses the issues.  

Step 2: Formulating Research Objectives, Hypothesis, and Questions

The second step in the nursing research process entails developing the scope of your research. This can be achieved by formulating research objectives and developing a research question or hypothesis. In the case of nursing research, coming up with a PICOT question or a clinical question is imperative.

A research objective is the clear, concise, and declarative statement a researcher expresses to guide the study. It helps identify and describe the variables and their relationships. It helps bridge the gap between research purpose and design. It also helps guide the data collection and analysis plans. An objective summarizes the intent and scope of the research. It also keeps the researcher focused and helps build a link with the problem statement. It should be SMART.

The research question you select for your research study should be clear and well-defined. You can derive a good research question from a literature search, theoretical frameworks on nursing, and your working experience. Ensure that your clinical research question is feasible, interesting, novel, ethical, and relevant to your field of study, area of specialization, or personal/career interests.

Nursing research might or might not include a hypothesis. A hypothesis is the formulation of the expected relationship between two or more variables in a population. For example, a reasonable hypothesis is:  

Healthcare providers with knowledge of standard screening methods for postpartum depression will help identify symptoms early.

There is a predicted relationship between knowledge of using standard PPD screening methods and early detection of symptoms.

Hypotheses apply to quantitative studies such as quasi-experimental or experimental nursing research studies. Once you test the hypothesis, you can accept or reject it, which you will include in the report write-up.

There are various types of hypotheses:

• Directional hypothesis – predicts the outcome in a specific direction. An example is when you say that persons with Type II Diabetes who have more excellent knowledge of self-management will have higher rates of adherence to treatment and management plans compared to those with no knowledge.
• Non-directional hypothesis – indicates a difference or correlation without being specific. For example, Type II Diabetes Mellitus patients who follow structured self-management programs have a higher chance of treatment adherence. Here, you do not indicate the directional relationship as the directional hypothesis does.
• Null hypothesis (Ho) – states no difference exist between groups or that there is no correlation between variables.
• Alternative hypothesis (H1) – states that there is a difference or correlation between variables.

Variables are qualities, properties, attributes, or characteristics that change or vary, such as age, sex, satisfaction, success, pain, stress, etc.

The independent (treatment or experimental variables) influence other variables. They enable or contribute to an inevitable outcome. It refers to the intervention of treatment the researcher performs to see some change in the dependent variables. It is the input.

The dependent variables are the outcome variables that reflect the independent variable's results, response, outcome, or effect. Majorly, dependent variables receive the action and can disappear, diminish, increase, and appear. When determining the effects of sugar consumption on obesity, obesity is the dependent variable, while sugar consumption is the independent variable.

We also have uncontrolled extraneous variables that influence the research study's findings. They affect the independent and dependent variables. They are referred to as threats of internal and external validity since they might lead to a bias in the selection, time, and instrument used.

Finally, we also have the demographic variables, which are the attributes of a population such as age, sex, religious beliefs, or educational levels that a researcher cannot manipulate.

Step 3: Reviewing the Literature

This is an essential step in the nursing research process. A literature review accounts for what has already been published about a particular research topic.

Conducting a literature review can help provide precise, relevant, and timely information on the topic of interest. It allows one to explore the background of their topic's scientific findings.

Your literature review should show that you are familiar with previous studies for a better interpretation of your results. It should also help you determine if there are new approaches or stimulate you to develop new ideas. The literature review can also help you to review the research topic and determine the knowledge gaps to justify your problem statement.

You should also identify the theoretical frameworks, tools, models, and instruments useful for a research problem.

When writing the literature review, you should consider primary sources. You should also use secondary sources such as scholarly journals, books, conference and seminar papers, theses and dissertations, and government or institutional (organizational) documents.

Some sources for literature review for nursing topics include conference papers, theses, journals, electronic databases, and books.

Related Reading: Literature Review vs. Systematic Reviews

Step 4: Develop a Research Plan

Once the research question has been identified, it is time to develop a study plan. When selecting the most appropriate research method, consider the following:

• Type of research ­that is suitable for the investigation, for example, descriptive, experimental, etc.
• The research design is experimental, survey, descriptive, case study, ethnography, phenomenology, grounded theory, and historical research.
• Details of the data to be collected and all relevant variables.
• Where the samples can best be collected and the techniques to be used.
• All the relevant methods for collecting data, e.g., Polls, observation, questionnaires, etc. One should consider all the aspects that could affect reliability and validity.

A research plan will minimize the time, effort, and money spent acquiring meaningful evidence. A proper plan will help in the following categories:

• Exploration and Surveys
• Data Analysis
• Observation

Step 5: Describe the Sample Population

Population, in this case, refers to the group one intends to study. The research topic will determine the study group selected. Therefore, one must select a topic they are familiar with, one that aligns with their specialization or professional interests, and one they can manage.

When investigating a select group of people in a community, one could target a specific age group, an ethnic group, and a particular geographical location.

Step 6: Collecting Data

Collecting data is vital in getting the information required to provide answers to the raised question. The data is organized into structures to make it easy to execute.

Data must be collected from different sources: primary and secondary.

Primary sources include:

• Focus groups - involve interviewing and observing people
• Questionnaire - asking a group of people a bunch of questions
• Observation - collecting data without asking people questions
• Interview - asking people questions about what they know

Secondary sources are:

• Literature survey
• Reports : Official and unofficial
• Library resources, including old reports, books, etc .

Step 7: Data Analysis

After gathering data, the researcher begins to analyze or interpret the information collected. Data analysis summarizes the collected data to develop patterns or relationships between them. This process involves cleaning, transforming, and modeling data for helpful information.

The steps for analyzing data are as follows.

• Going through the research plan.
• Organizing all the data collected.
• Writing a rough draft of the findings and conclusion. This is important as it will help in organizing one's thoughts.
• Polishing the rough draft to the final findings. A researcher will probably do this several times to ensure the final draft has no errors as they prepare for the final part.

Take note that the goal of the analysis is not to come up with information supporting a hypothesis but to review all data objectively to determine the most accurate. One must ensure this information is easy to understand.

Step 8: Create a Report

A report is a well-written text that shows details about the research conducted. This report is written after the researcher has collected and analyzed all the data about the topic. It is a reliable source for recounting research. One must only include significant findings and avoid irrelevant information when writing it.

Researchers report their findings in either of the following formats:

• Formal Paper (capstone project, QI report, thesis, dissertation, white paper, conference paper, etc.).
• Published Article
• PowerPoint Presentation
• Audio or Video
• Spreadsheet

Take note that this part is crucial. One must effectively explain their research findings clearly and succinctly.

Tips and Resources for Conducting Research

Having the right research skills can be the difference between succeeding or failing in nursing school and every part of a nursing career. Learning how to conduct research is essential since nursing keeps evolving rapidly.

Being successful in nursing means one needs to learn how to use literature, search engines and analyze the collected data. The following tips will help in conducting high-quality research.

1. Choose the Right Research Topic

This is the first step and perhaps the most crucial part of conducting research. One must select a topic that is within the parameters of the assignment. Nursing instructions give students guidelines on what to do and things to avoid. Therefore, students follow these guidelines so that the instructor can accept the final report.

Additionally, one must choose a topic that interests them and one that they are familiar with. Doing this will make the research process enjoyable.

2. Locate the Research Materials

Conducting adequate research means locating all the materials and utilizing all the provided resources. Some resources are available online, while others are available in print. Nursing schools also have access to journals not published on the Internet.

A student should take advantage of what the school offers regarding resources, as it will significantly help in research.

3. Refine the Search Results

When conducting research online, one must filter out any unnecessary resources. Researchers should consider only locating search results relevant to their area of study. They should use Google searches and other nursing literature searchers to narrow down their search results. To locate newspaper articles and magazines, Students should use electronic periodical databases. Additionally, they should only use the database best suited for the chosen topic.

4. Evaluate All the Sources

There is a lot of information on the Internet, and some are not accurate or relevant. Unlike books or print resources, no one has approved some of the information before being made public. Therefore, students must evaluate all their resources to ensure it is of the right quality. The CARS Checklist for Information Quality provides tips on assessing the sources' worth. Remember that the instructor expects highly credible and reliable research findings.

5. Be Prepared for Surprising Answers

High-quality research involves finding answers but not verifying what is already known. So one must keep an open mind when collecting data to learn more.

6. Make Notes

One should note all the relevant information pertinent to your study during research. When collecting information from a specific group of people, researchers must pay attention to what they are saying. In addition, they should use all the data collection methods provided to ensure relevant and reliable data.

7. Cite All Sources

When writing a report, one must cite all the sources used when conducting research. Using in-text citations acknowledges all the sources of information used in your paper. Then at the end of the paper, one must write down the list of all cited sources.

Citing sources is also an excellent way to prevent plagiarism in the work. Therefore, it is crucial to learn how to cite sources in either APA or Harvard format, which are the main formatting styles that nursing schools prefer.

Ethical Considerations When Conducting Research

Ethical considerations are principles guiding the research process and practice. This part is among the most critical parts of research. Researchers must always adhere to a specific code of conduct when collecting data from the population. The research will be doomed if one fails to follow these considerations.

Research ethics matter for integrity, dignity, and human rights. They ensure that aver research is conducted voluntarily and safely for all the participants.

Following all ethical considerations is an essential part of research because of the following reasons.

• It helps critically evaluate all the research work to ensure no apparent errors.
• It allows one to plan their work well to avoid any misleading results and ensure that all the questions on ethical procedures are resolved.
• Ensures that the public can trust their work, thus supporting and funding it.
• Promoting the aims of the research, for instance, expanding knowledge
• Supporting all the required collaborative work ethics such as fairness, mutual respect, etc. This is key because nursing research depends on collaboration between different groups.
• Remaining accountable for all actions taken when conducting research.

Significant Ethical Challenges in Nursing Research

When conducting your research, there are specific challenges one will come across. These can make it harder to complete the research. Three value systems involving research are connected to each other: society, science, and nursing. Therefore, significant ethical issues during research are linked to these three.

The challenges one will likely encounter when carrying out nursing research are:

1. Informed Consent

This means that an individual has knowingly and voluntarily decided to consent. It is a means by which a person's autonomy is protected. Individuals have to make informed decisions before participating in any research in which there are risks involved.

2. Beneficence- Do Not Harm

Also known as "be of benefit, do no harm," this ethical principle means a researcher must do effective and high-quality research to promote the welfare of others better. This can something be challenging, especially when using qualitative research. If proven not beneficial according to the expectations, it can raise significant ethical considerations for nurses.

3. Anonymity and Confidentiality

Anonymity and confidentiality are closely linked to beneficence. A person's anonymity is guaranteed when their identity is not linked to personal responses if you cannot guarantee anonymity to the subjects.

Confidentiality means that participants are free to withhold their information as they please. It becomes a dilemma when one has to break confidentiality to share important information.

4. Research Integrity

Working in a research environment means facing a highly competitive and performance-based environment. While this is good, it can lead to researchers engaging in unethical issues, reflecting a lack of integrity.

5. Conflict of Interest

Nurses and the institutions involved in research have varied interests, which can sometimes lead to conflicts. The conflicts can arise from different sources, such as interpersonal conflicts, holding multiple roles, financial issues, third-party pressures, etc.

Final Remarks on Nursing Research Methodology

Research in nursing is essential in finding and improving the different ways of treating and caring for patients. Nurses are the ones who know patients best. They understand what is working for them and what is not.  Research findings inform decision-making and advance nursing practice. Research methodology provides a detailed plan, keeping nurses on track and ensuring the process is smooth and effective.

In designing a research methodology, one must consider the research objectives. Knowing what information is expected at the end of the study will make it much easier to select the suitable methodology. Additionally, one must consider the nature of the research. If the goal is exploratory, qualitative research methods should be chosen. On the other hand, choosing the quantitative method is a good idea if the goal is to measure something. However, to understand a problem much better, one must combine both methods in mixed-method research.

If you are doing your undergraduate, MSN, DNP, or Ph.D. level nursing dissertation, capstone project, or thesis and need help, we have the best graduate-level nursing writers . Place an order today and get 100% confidential help, original papers, and direct access to your writer.

Struggling with

Related Articles

Tips for Passing NCLX RN exam on first attempt

Nursing Issue Paper: A Guide with Steps, Tips, Topics, and Ideas

Best Nursing Topics and Ideas for Presentations

NurseMyGrades is being relied upon by thousands of students worldwide to ace their nursing studies. We offer high quality sample papers that help students in their revision as well as helping them remain abreast of what is expected of them.

Person-centred Nursing Research: Methodology, Methods and Outcomes pp 71–82 Cite as

Methodologies for Person-Centred Nursing Research

• Famke van Lieshout 4 &
• Lorna Peelo-Kilroe 5 , 6  
• First Online: 27 April 2021

2232 Accesses

1 Citations

In this chapter, we articulate what for us are the key principles that provide the foundations for methodologies in nursing research that support and inform person-centred practice. We do this through a dialogical approach in which we will demonstrate how we worked with such principles in our research processes. We provide accounts of two methodologies namely participatory action research and critical creativity, which we have used in two separate studies. We share our experiences and the realities of undertaking person-centred nursing research through these methodologies and discuss how this links to the person-centred nursing framework. However, we do not advocate these methodologies as the only ones available to researchers. Person-centred nursing research is about the potential and underlying intent that working in a person-centred way as a (co-) researcher provides, rather than any one methodology. From our dialogue, we generated a visual model that illustrates the essential conditions for person-centred nursing research.

This is a preview of subscription content, log in via an institution .

Buying options

• Available as PDF
• Read on any device
• Instant download
• Own it forever
• Available as EPUB and PDF
• Compact, lightweight edition
• Dispatched in 3 to 5 business days
• Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Dewing J, Eide T, McCormack B. Philosophical perspectives on person-centredness for healthcare research. In: McCormack B, van Dulmen S, Eide H, Skovdahl K, Eide T, editors. Person-centred healthcare research. West Sussex: Wiley Blackwell; 2017.

Google Scholar  

Jacobs G, van Lieshout F, Borg M, Ness O. Being a person-centred researcher: principles and methods for doing research in a person-centred way. In: McCormack B, van Dulmen S, Eide H, Skovdahl K, Eide T, editors. Person-centred healthcare research. West Sussex: Wiley Blackwell; 2017.

van Lieshout F, Cardiff S. Reflections on being and becoming a person-centred facilitator. Int Pract Dev J. 2015;5(4):1–10. https://www.fons.org/library/journal/volume5-person-centredness-suppl/article4 . Accessed Aug 2020.

Gergen K. Relational being. Beyond self and community. Oxford and New York: Oxford University Press; 2009.

McCormack B, Titchen A. No beginning, no end: an ecology of human flourishing. Int Pract Dev J. 2014;4(2):1–21. https://www.fons.org/library/journal/volume4-issue2/article2 . Accessed 05/08/2020.

Titchen A, McCormack B. Dancing with stones: critical creativity as a methodology for human flourishing. Educ Action Res. 2010;18(4):531–54.

Article   Google Scholar  

Jacobs G. Conflicting demands and the power of defensive routines in participatory action research. Action Res. 2010;8(4):367–86.

Habermas J. The theory of communicative action. London: Beacon Press; 1981.

van Lieshout F. Taking action for action. A study of the interplay between contextual and facilitator characteristics in developing an effective workplace culture in a Dutch hospital setting, through action research. PhD Thesis, University of Ulster, Belfast; 2013. https://www.proefschriftenverpleegkunde.nl/publicatie-zoeken/entry/121/ . Accessed 05/08/2020.

Heron J. Co-operative inquiry. Research into the human condition. London: Sage; 1998.

Pincott J. Silencing your inner critic. Psychology Today. 2019. https://www.psychologytoday.com/ie/articles/201903/silencing-your-inner-critic . Accessed 05/08/2020.

van Lieshout F, Jacobs G, Cardiff S. Actieonderzoek: Principes voor verandering in zorg en welzijn. [Action research: principles for change in health and welfare]. Van Gorcum, Assen, Netherlands; 2017.

Reason P, editor. Human inquiry in action. London: Sage; 1988.

McCormack B, Titchen A. Critical creativity: melding, exploding, blending. Educ Action Res. 2006;14(2):239–66.

Titchen A, Cardiff S, Biong S. The knowing and being of person-centred research practice across worldviews: an epistemological and ontological framework. In: McCormack B, van Dulmen S, Eide H, Skovdahl K, Eide T, editors. Person-centred healthcare research. West Sussex: Wiley Blackwell; 2017.

Brown B. Dare to lead. London: Vermilion; 2018.

Hardiman M. Using two models of workplace facilitation to create conditions for development of a person-centred culture: a participatory action research study. J Clin Nurs. 2019;28:2769–81.

Cardiff S. Person-centred leadership: a critical participatory action research study exploring and developing a new style of (clinical) nurse leadership. PhD Thesis, University of Ulster, Belfast; 2014. https://www.proefschriftenverpleegkunde.nl/publicatie-zoeken/entry/104/ . Accessed 05/08/2020.

Buckley C. Giving voice to ‘hard to reach groups’ in healthcare research. A narrative approach. In: McCormack B, van Dulmen S, Eide H, Skovdahl K, Eide T, editors. Person-centred healthcare research. West Sussex: Wiley Blackwell; 2017.

Frost D. The facilitation of professional artistry in nursing practice: a critical, creative, collaborative inquiry. PhD Thesis, Queen Margaret University, Edinburgh; 2020.

Download references

Author information

Authors and affiliations.

Fontys University of Applied Sciences, School of People and Health Studies (NL), Eindhoven, Netherlands

Famke van Lieshout

Health Service Executive, Galway, Ireland

Lorna Peelo-Kilroe

Centre for Person-Centred Practice Research, Queen Margaret University, Musselburgh, Scotland

You can also search for this author in PubMed   Google Scholar

Corresponding author

Correspondence to Famke van Lieshout .

Editor information

Editors and affiliations.

Division of Nursing - School of Health Science, Queen Margaret University, Musselburgh, UK

Brendan McCormack

School of Nursing, University of Ulster, Newtownabbey, UK

Tanya McCance

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Cite this chapter.

van Lieshout, F., Peelo-Kilroe, L. (2021). Methodologies for Person-Centred Nursing Research. In: Dewing, J., McCormack, B., McCance, T. (eds) Person-centred Nursing Research: Methodology, Methods and Outcomes. Springer, Cham. https://doi.org/10.1007/978-3-030-27868-7_6

Download citation

DOI : https://doi.org/10.1007/978-3-030-27868-7_6

Published : 27 April 2021

Publisher Name : Springer, Cham

Print ISBN : 978-3-030-27867-0

Online ISBN : 978-3-030-27868-7

eBook Packages : Medicine Medicine (R0)

Share this chapter

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Publish with us

Policies and ethics

• Find a journal
• Track your research

Research Methods in Nursing

• Research Design & Methodology
• Study Pyramid

Qualitative Methods in Health Care Research

Vishnu renjith.

School of Nursing and Midwifery, Royal College of Surgeons Ireland - Bahrain (RCSI Bahrain), Al Sayh Muharraq Governorate, Bahrain

Renjulal Yesodharan

1 Department of Mental Health Nursing, Manipal College of Nursing Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India

Judith A. Noronha

2 Department of OBG Nursing, Manipal College of Nursing Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India

Elissa Ladd

3 School of Nursing, MGH Institute of Health Professions, Boston, USA

Anice George

4 Department of Child Health Nursing, Manipal College of Nursing Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India

Healthcare research is a systematic inquiry intended to generate robust evidence about important issues in the fields of medicine and healthcare. Qualitative research has ample possibilities within the arena of healthcare research. This article aims to inform healthcare professionals regarding qualitative research, its significance, and applicability in the field of healthcare. A wide variety of phenomena that cannot be explained using the quantitative approach can be explored and conveyed using a qualitative method. The major types of qualitative research designs are narrative research, phenomenological research, grounded theory research, ethnographic research, historical research, and case study research. The greatest strength of the qualitative research approach lies in the richness and depth of the healthcare exploration and description it makes. In health research, these methods are considered as the most humanistic and person-centered way of discovering and uncovering thoughts and actions of human beings.

Introduction

Healthcare research is a systematic inquiry intended to generate trustworthy evidence about issues in the field of medicine and healthcare. The three principal approaches to health research are the quantitative, the qualitative, and the mixed methods approach. The quantitative research method uses data, which are measures of values and counts and are often described using statistical methods which in turn aids the researcher to draw inferences. Qualitative research incorporates the recording, interpreting, and analyzing of non-numeric data with an attempt to uncover the deeper meanings of human experiences and behaviors. Mixed methods research, the third methodological approach, involves collection and analysis of both qualitative and quantitative information with an objective to solve different but related questions, or at times the same questions.[ 1 , 2 ]

In healthcare, qualitative research is widely used to understand patterns of health behaviors, describe lived experiences, develop behavioral theories, explore healthcare needs, and design interventions.[ 1 , 2 , 3 ] Because of its ample applications in healthcare, there has been a tremendous increase in the number of health research studies undertaken using qualitative methodology.[ 4 , 5 ] This article discusses qualitative research methods, their significance, and applicability in the arena of healthcare.

Qualitative Research

Diverse academic and non-academic disciplines utilize qualitative research as a method of inquiry to understand human behavior and experiences.[ 6 , 7 ] According to Munhall, “Qualitative research involves broadly stated questions about human experiences and realities, studied through sustained contact with the individual in their natural environments and producing rich, descriptive data that will help us to understand those individual's experiences.”[ 8 ]

Significance of Qualitative Research

The qualitative method of inquiry examines the 'how' and 'why' of decision making, rather than the 'when,' 'what,' and 'where.'[ 7 ] Unlike quantitative methods, the objective of qualitative inquiry is to explore, narrate, and explain the phenomena and make sense of the complex reality. Health interventions, explanatory health models, and medical-social theories could be developed as an outcome of qualitative research.[ 9 ] Understanding the richness and complexity of human behavior is the crux of qualitative research.

Differences between Quantitative and Qualitative Research

The quantitative and qualitative forms of inquiry vary based on their underlying objectives. They are in no way opposed to each other; instead, these two methods are like two sides of a coin. The critical differences between quantitative and qualitative research are summarized in Table 1 .[ 1 , 10 , 11 ]

Differences between quantitative and qualitative research

Qualitative Research Questions and Purpose Statements

Qualitative questions are exploratory and are open-ended. A well-formulated study question forms the basis for developing a protocol, guides the selection of design, and data collection methods. Qualitative research questions generally involve two parts, a central question and related subquestions. The central question is directed towards the primary phenomenon under study, whereas the subquestions explore the subareas of focus. It is advised not to have more than five to seven subquestions. A commonly used framework for designing a qualitative research question is the 'PCO framework' wherein, P stands for the population under study, C stands for the context of exploration, and O stands for the outcome/s of interest.[ 12 ] The PCO framework guides researchers in crafting a focused study question.

Example: In the question, “What are the experiences of mothers on parenting children with Thalassemia?”, the population is “mothers of children with Thalassemia,” the context is “parenting children with Thalassemia,” and the outcome of interest is “experiences.”

The purpose statement specifies the broad focus of the study, identifies the approach, and provides direction for the overall goal of the study. The major components of a purpose statement include the central phenomenon under investigation, the study design and the population of interest. Qualitative research does not require a-priori hypothesis.[ 13 , 14 , 15 ]

Example: Borimnejad et al . undertook a qualitative research on the lived experiences of women suffering from vitiligo. The purpose of this study was, “to explore lived experiences of women suffering from vitiligo using a hermeneutic phenomenological approach.” [ 16 ]

Review of the Literature

In quantitative research, the researchers do an extensive review of scientific literature prior to the commencement of the study. However, in qualitative research, only a minimal literature search is conducted at the beginning of the study. This is to ensure that the researcher is not influenced by the existing understanding of the phenomenon under the study. The minimal literature review will help the researchers to avoid the conceptual pollution of the phenomenon being studied. Nonetheless, an extensive review of the literature is conducted after data collection and analysis.[ 15 ]

Reflexivity

Reflexivity refers to critical self-appraisal about one's own biases, values, preferences, and preconceptions about the phenomenon under investigation. Maintaining a reflexive diary/journal is a widely recognized way to foster reflexivity. According to Creswell, “Reflexivity increases the credibility of the study by enhancing more neutral interpretations.”[ 7 ]

Types of Qualitative Research Designs

The qualitative research approach encompasses a wide array of research designs. The words such as types, traditions, designs, strategies of inquiry, varieties, and methods are used interchangeably. The major types of qualitative research designs are narrative research, phenomenological research, grounded theory research, ethnographic research, historical research, and case study research.[ 1 , 7 , 10 ]

Narrative research

Narrative research focuses on exploring the life of an individual and is ideally suited to tell the stories of individual experiences.[ 17 ] The purpose of narrative research is to utilize 'story telling' as a method in communicating an individual's experience to a larger audience.[ 18 ] The roots of narrative inquiry extend to humanities including anthropology, literature, psychology, education, history, and sociology. Narrative research encompasses the study of individual experiences and learning the significance of those experiences. The data collection procedures include mainly interviews, field notes, letters, photographs, diaries, and documents collected from one or more individuals. Data analysis involves the analysis of the stories or experiences through “re-storying of stories” and developing themes usually in chronological order of events. Rolls and Payne argued that narrative research is a valuable approach in health care research, to gain deeper insight into patient's experiences.[ 19 ]

Example: Karlsson et al . undertook a narrative inquiry to “explore how people with Alzheimer's disease present their life story.” Data were collected from nine participants. They were asked to describe about their life experiences from childhood to adulthood, then to current life and their views about the future life. [ 20 ]

Phenomenological research

Phenomenology is a philosophical tradition developed by German philosopher Edmond Husserl. His student Martin Heidegger did further developments in this methodology. It defines the 'essence' of individual's experiences regarding a certain phenomenon.[ 1 ] The methodology has its origin from philosophy, psychology, and education. The purpose of qualitative research is to understand the people's everyday life experiences and reduce it into the central meaning or the 'essence of the experience'.[ 21 , 22 ] The unit of analysis of phenomenology is the individuals who have had similar experiences of the phenomenon. Interviews with individuals are mainly considered for the data collection, though, documents and observations are also useful. Data analysis includes identification of significant meaning elements, textural description (what was experienced), structural description (how was it experienced), and description of 'essence' of experience.[ 1 , 7 , 21 ] The phenomenological approach is further divided into descriptive and interpretive phenomenology. Descriptive phenomenology focuses on the understanding of the essence of experiences and is best suited in situations that need to describe the lived phenomenon. Hermeneutic phenomenology or Interpretive phenomenology moves beyond the description to uncover the meanings that are not explicitly evident. The researcher tries to interpret the phenomenon, based on their judgment rather than just describing it.[ 7 , 21 , 22 , 23 , 24 ]

Example: A phenomenological study conducted by Cornelio et al . aimed at describing the lived experiences of mothers in parenting children with leukemia. Data from ten mothers were collected using in-depth semi-structured interviews and were analyzed using Husserl's method of phenomenology. Themes such as “pivotal moment in life”, “the experience of being with a seriously ill child”, “having to keep distance with the relatives”, “overcoming the financial and social commitments”, “responding to challenges”, “experience of faith as being key to survival”, “health concerns of the present and future”, and “optimism” were derived. The researchers reported the essence of the study as “chronic illness such as leukemia in children results in a negative impact on the child and on the mother.” [ 25 ]

Grounded Theory Research

Grounded theory has its base in sociology and propagated by two sociologists, Barney Glaser, and Anselm Strauss.[ 26 ] The primary purpose of grounded theory is to discover or generate theory in the context of the social process being studied. The major difference between grounded theory and other approaches lies in its emphasis on theory generation and development. The name grounded theory comes from its ability to induce a theory grounded in the reality of study participants.[ 7 , 27 ] Data collection in grounded theory research involves recording interviews from many individuals until data saturation. Constant comparative analysis, theoretical sampling, theoretical coding, and theoretical saturation are unique features of grounded theory research.[ 26 , 27 , 28 ] Data analysis includes analyzing data through 'open coding,' 'axial coding,' and 'selective coding.'[ 1 , 7 ] Open coding is the first level of abstraction, and it refers to the creation of a broad initial range of categories, axial coding is the procedure of understanding connections between the open codes, whereas selective coding relates to the process of connecting the axial codes to formulate a theory.[ 1 , 7 ] Results of the grounded theory analysis are supplemented with a visual representation of major constructs usually in the form of flow charts or framework diagrams. Quotations from the participants are used in a supportive capacity to substantiate the findings. Strauss and Corbin highlights that “the value of the grounded theory lies not only in its ability to generate a theory but also to ground that theory in the data.”[ 27 ]

Example: Williams et al . conducted a grounded theory research to explore the nature of relationship between the sense of self and the eating disorders. Data were collected form 11 women with a lifetime history of Anorexia Nervosa and were analyzed using the grounded theory methodology. Analysis led to the development of a theoretical framework on the nature of the relationship between the self and Anorexia Nervosa. [ 29 ]

Ethnographic research

Ethnography has its base in anthropology, where the anthropologists used it for understanding the culture-specific knowledge and behaviors. In health sciences research, ethnography focuses on narrating and interpreting the health behaviors of a culture-sharing group. 'Culture-sharing group' in an ethnography represents any 'group of people who share common meanings, customs or experiences.' In health research, it could be a group of physicians working in rural care, a group of medical students, or it could be a group of patients who receive home-based rehabilitation. To understand the cultural patterns, researchers primarily observe the individuals or group of individuals for a prolonged period of time.[ 1 , 7 , 30 ] The scope of ethnography can be broad or narrow depending on the aim. The study of more general cultural groups is termed as macro-ethnography, whereas micro-ethnography focuses on more narrowly defined cultures. Ethnography is usually conducted in a single setting. Ethnographers collect data using a variety of methods such as observation, interviews, audio-video records, and document reviews. A written report includes a detailed description of the culture sharing group with emic and etic perspectives. When the researcher reports the views of the participants it is called emic perspectives and when the researcher reports his or her views about the culture, the term is called etic.[ 7 ]

Example: The aim of the ethnographic study by LeBaron et al . was to explore the barriers to opioid availability and cancer pain management in India. The researchers collected data from fifty-nine participants using in-depth semi-structured interviews, participant observation, and document review. The researchers identified significant barriers by open coding and thematic analysis of the formal interview. [ 31 ]

Historical research

Historical research is the “systematic collection, critical evaluation, and interpretation of historical evidence”.[ 1 ] The purpose of historical research is to gain insights from the past and involves interpreting past events in the light of the present. The data for historical research are usually collected from primary and secondary sources. The primary source mainly includes diaries, first hand information, and writings. The secondary sources are textbooks, newspapers, second or third-hand accounts of historical events and medical/legal documents. The data gathered from these various sources are synthesized and reported as biographical narratives or developmental perspectives in chronological order. The ideas are interpreted in terms of the historical context and significance. The written report describes 'what happened', 'how it happened', 'why it happened', and its significance and implications to current clinical practice.[ 1 , 10 ]

Example: Lubold (2019) analyzed the breastfeeding trends in three countries (Sweden, Ireland, and the United States) using a historical qualitative method. Through analysis of historical data, the researcher found that strong family policies, adherence to international recommendations and adoption of baby-friendly hospital initiative could greatly enhance the breastfeeding rates. [ 32 ]

Case study research

Case study research focuses on the description and in-depth analysis of the case(s) or issues illustrated by the case(s). The design has its origin from psychology, law, and medicine. Case studies are best suited for the understanding of case(s), thus reducing the unit of analysis into studying an event, a program, an activity or an illness. Observations, one to one interviews, artifacts, and documents are used for collecting the data, and the analysis is done through the description of the case. From this, themes and cross-case themes are derived. A written case study report includes a detailed description of one or more cases.[ 7 , 10 ]

Example: Perceptions of poststroke sexuality in a woman of childbearing age was explored using a qualitative case study approach by Beal and Millenbrunch. Semi structured interview was conducted with a 36- year mother of two children with a history of Acute ischemic stroke. The data were analyzed using an inductive approach. The authors concluded that “stroke during childbearing years may affect a woman's perception of herself as a sexual being and her ability to carry out gender roles”. [ 33 ]

Sampling in Qualitative Research

Qualitative researchers widely use non-probability sampling techniques such as purposive sampling, convenience sampling, quota sampling, snowball sampling, homogeneous sampling, maximum variation sampling, extreme (deviant) case sampling, typical case sampling, and intensity sampling. The selection of a sampling technique depends on the nature and needs of the study.[ 34 , 35 , 36 , 37 , 38 , 39 , 40 ] The four widely used sampling techniques are convenience sampling, purposive sampling, snowball sampling, and intensity sampling.

Convenience sampling

It is otherwise called accidental sampling, where the researchers collect data from the subjects who are selected based on accessibility, geographical proximity, ease, speed, and or low cost.[ 34 ] Convenience sampling offers a significant benefit of convenience but often accompanies the issues of sample representation.

Purposive sampling

Purposive or purposeful sampling is a widely used sampling technique.[ 35 ] It involves identifying a population based on already established sampling criteria and then selecting subjects who fulfill that criteria to increase the credibility. However, choosing information-rich cases is the key to determine the power and logic of purposive sampling in a qualitative study.[ 1 ]

Snowball sampling

The method is also known as 'chain referral sampling' or 'network sampling.' The sampling starts by having a few initial participants, and the researcher relies on these early participants to identify additional study participants. It is best adopted when the researcher wishes to study the stigmatized group, or in cases, where findings of participants are likely to be difficult by ordinary means. Respondent ridden sampling is an improvised version of snowball sampling used to find out the participant from a hard-to-find or hard-to-study population.[ 37 , 38 ]

Intensity sampling

The process of identifying information-rich cases that manifest the phenomenon of interest is referred to as intensity sampling. It requires prior information, and considerable judgment about the phenomenon of interest and the researcher should do some preliminary investigations to determine the nature of the variation. Intensity sampling will be done once the researcher identifies the variation across the cases (extreme, average and intense) and picks the intense cases from them.[ 40 ]

Deciding the Sample Size

A-priori sample size calculation is not undertaken in the case of qualitative research. Researchers collect the data from as many participants as possible until they reach the point of data saturation. Data saturation or the point of redundancy is the stage where the researcher no longer sees or hears any new information. Data saturation gives the idea that the researcher has captured all possible information about the phenomenon of interest. Since no further information is being uncovered as redundancy is achieved, at this point the data collection can be stopped. The objective here is to get an overall picture of the chronicle of the phenomenon under the study rather than generalization.[ 1 , 7 , 41 ]

Data Collection in Qualitative Research

The various strategies used for data collection in qualitative research includes in-depth interviews (individual or group), focus group discussions (FGDs), participant observation, narrative life history, document analysis, audio materials, videos or video footage, text analysis, and simple observation. Among all these, the three popular methods are the FGDs, one to one in-depth interviews and the participant observation.

FGDs are useful in eliciting data from a group of individuals. They are normally built around a specific topic and are considered as the best approach to gather data on an entire range of responses to a topic.[ 42 Group size in an FGD ranges from 6 to 12. Depending upon the nature of participants, FGDs could be homogeneous or heterogeneous.[ 1 , 14 ] One to one in-depth interviews are best suited to obtain individuals' life histories, lived experiences, perceptions, and views, particularly while exporting topics of sensitive nature. In-depth interviews can be structured, unstructured, or semi-structured. However, semi-structured interviews are widely used in qualitative research. Participant observations are suitable for gathering data regarding naturally occurring behaviors.[ 1 ]

Data Analysis in Qualitative Research

Various strategies are employed by researchers to analyze data in qualitative research. Data analytic strategies differ according to the type of inquiry. A general content analysis approach is described herewith. Data analysis begins by transcription of the interview data. The researcher carefully reads data and gets a sense of the whole. Once the researcher is familiarized with the data, the researcher strives to identify small meaning units called the 'codes.' The codes are then grouped based on their shared concepts to form the primary categories. Based on the relationship between the primary categories, they are then clustered into secondary categories. The next step involves the identification of themes and interpretation to make meaning out of data. In the results section of the manuscript, the researcher describes the key findings/themes that emerged. The themes can be supported by participants' quotes. The analytical framework used should be explained in sufficient detail, and the analytic framework must be well referenced. The study findings are usually represented in a schematic form for better conceptualization.[ 1 , 7 ] Even though the overall analytical process remains the same across different qualitative designs, each design such as phenomenology, ethnography, and grounded theory has design specific analytical procedures, the details of which are out of the scope of this article.

Computer-Assisted Qualitative Data Analysis Software (CAQDAS)

Until recently, qualitative analysis was done either manually or with the help of a spreadsheet application. Currently, there are various software programs available which aid researchers to manage qualitative data. CAQDAS is basically data management tools and cannot analyze the qualitative data as it lacks the ability to think, reflect, and conceptualize. Nonetheless, CAQDAS helps researchers to manage, shape, and make sense of unstructured information. Open Code, MAXQDA, NVivo, Atlas.ti, and Hyper Research are some of the widely used qualitative data analysis software.[ 14 , 43 ]

Reporting Guidelines

Consolidated Criteria for Reporting Qualitative Research (COREQ) is the widely used reporting guideline for qualitative research. This 32-item checklist assists researchers in reporting all the major aspects related to the study. The three major domains of COREQ are the 'research team and reflexivity', 'study design', and 'analysis and findings'.[ 44 , 45 ]

Critical Appraisal of Qualitative Research

Various scales are available to critical appraisal of qualitative research. The widely used one is the Critical Appraisal Skills Program (CASP) Qualitative Checklist developed by CASP network, UK. This 10-item checklist evaluates the quality of the study under areas such as aims, methodology, research design, ethical considerations, data collection, data analysis, and findings.[ 46 ]

Ethical Issues in Qualitative Research

A qualitative study must be undertaken by grounding it in the principles of bioethics such as beneficence, non-maleficence, autonomy, and justice. Protecting the participants is of utmost importance, and the greatest care has to be taken while collecting data from a vulnerable research population. The researcher must respect individuals, families, and communities and must make sure that the participants are not identifiable by their quotations that the researchers include when publishing the data. Consent for audio/video recordings must be obtained. Approval to be in FGDs must be obtained from the participants. Researchers must ensure the confidentiality and anonymity of the transcripts/audio-video records/photographs/other data collected as a part of the study. The researchers must confirm their role as advocates and proceed in the best interest of all participants.[ 42 , 47 , 48 ]

Rigor in Qualitative Research

The demonstration of rigor or quality in the conduct of the study is essential for every research method. However, the criteria used to evaluate the rigor of quantitative studies are not be appropriate for qualitative methods. Lincoln and Guba (1985) first outlined the criteria for evaluating the qualitative research often referred to as “standards of trustworthiness of qualitative research”.[ 49 ] The four components of the criteria are credibility, transferability, dependability, and confirmability.

Credibility refers to confidence in the 'truth value' of the data and its interpretation. It is used to establish that the findings are true, credible and believable. Credibility is similar to the internal validity in quantitative research.[ 1 , 50 , 51 ] The second criterion to establish the trustworthiness of the qualitative research is transferability, Transferability refers to the degree to which the qualitative results are applicability to other settings, population or contexts. This is analogous to the external validity in quantitative research.[ 1 , 50 , 51 ] Lincoln and Guba recommend authors provide enough details so that the users will be able to evaluate the applicability of data in other contexts.[ 49 ] The criterion of dependability refers to the assumption of repeatability or replicability of the study findings and is similar to that of reliability in quantitative research. The dependability question is 'Whether the study findings be repeated of the study is replicated with the same (similar) cohort of participants, data coders, and context?'[ 1 , 50 , 51 ] Confirmability, the fourth criteria is analogous to the objectivity of the study and refers the degree to which the study findings could be confirmed or corroborated by others. To ensure confirmability the data should directly reflect the participants' experiences and not the bias, motivations, or imaginations of the inquirer.[ 1 , 50 , 51 ] Qualitative researchers should ensure that the study is conducted with enough rigor and should report the measures undertaken to enhance the trustworthiness of the study.

Conclusions

Qualitative research studies are being widely acknowledged and recognized in health care practice. This overview illustrates various qualitative methods and shows how these methods can be used to generate evidence that informs clinical practice. Qualitative research helps to understand the patterns of health behaviors, describe illness experiences, design health interventions, and develop healthcare theories. The ultimate strength of the qualitative research approach lies in the richness of the data and the descriptions and depth of exploration it makes. Hence, qualitative methods are considered as the most humanistic and person-centered way of discovering and uncovering thoughts and actions of human beings.

Financial support and sponsorship

Conflicts of interest.

There are no conflicts of interest.

• Open access
• Published: 16 April 2024

The mediating role of learning motivation in the relationship among perceived stress and emotional regulation among Saudi nursing students in clinical practice

• Bander Saad Albagawi   ORCID: orcid.org/0000-0002-6246-210X 1 ,
• Yasir S. Alsalamah 2 , 3 ,
• Abdulqadir J. Nashwan 4 ,
• Rakan Mansuor AL Rawili 5 , 6 ,
• Lisa A. Babkair 7 ,
• Sara A. Alkharji 8 ,
• Thamer Alslamah 9 &
• Mirna Fawaz 10  

BMC Nursing volume  23 , Article number:  245 ( 2024 ) Cite this article

Metrics details

Nursing students often face high levels of stress due to demanding responsibilities during clinical placement. Emotional regulation, the ability to manage and regulate one’s emotions effectively, is crucial for nursing students in dealing with stress and maintaining their overall well-being. Additionally, learning motivation plays a vital role in students’ engagement and academic success. The current investigation aimed at studying the link that exists among stress, learning motivation, and emotional regulation among Saudi undergraduate nursing students. The study also aimed at investigating the sequential mediating effects that motivation might perform in this association.

A quantitative cross-sectional methodology was used in the present research, which recruited 367 Saudi undergraduate nursing students.

The results of the ANOVA showed that the level of perceived stress was linearly and negatively correlated with emotional regulation and motivation. Upon conducting structural equation modeling, significant direct and indirect effect pathways were identified between perceived stress, emotional regulation, and motivation, while only indirect pathways were identified between perceived stress and emotional regulation.

Conclusions

This study provides evidence of the mediating role of learning motivation in the relationship between perceived stress and emotional regulation among Saudi nursing students. The results highlight the negative impact of stress on emotional regulation and learning motivation and emphasize the importance of addressing motivational factors in interventions aimed at enhancing emotional regulation among nursing students.

Peer Review reports

Student nurses must complete intensive nursing skill training in addition to receiving nursing schooling in order to fulfill the demands of clinical opportunities. A wide range of procedures are included in the practice of nursing, including collecting specimens, taking measurements, conducting sterile procedures, giving treatments and IV infusions, saving severely ill individuals, providing reassurance to patients, and providing emotional support [ 1 ]. All nursing staff members must possess these essential capacities. The level of care, medical condition, security of patients, and the caliber of therapy are all directly impacted by the appropriate method. As a result, nursing students’ training must include instruction in nursing competencies [ 2 ]. Practical educational programs are typically used to undertake nursing competency improvement. There exists a strong correlation between the characteristics and feelings that students display during hands-on training and their educational performance [ 3 ]. A German scholar, Pekrun, came up with the notion of academic emotions while researching how people learn [ 4 ].

Emotional regulation refers to a person’s capacity to respond to stress as a coping mechanism that controls a variety of processes, including emotional, behavioral, cognitive, physiological, and environmental processes. It has gained significant attention as a potential contributing component to issues with social adaptation. It has been discovered that emotional control in nursing students reduces anxiety and enhances their ability to function as nurses [ 5 ]. Emotions are significant since they serve as messages to the person, informing them that certain incidents or circumstances are sufficiently significant to warrant a reaction. In an educational setting, these might be instances, such as receiving feedback, where students perceive themselves as moving toward or away from their objectives. However, these cues may be ignored or misinterpreted; feelings may be helpful or detrimental to reaching objectives [ 6 ]. The process of regulating emotions relies on the wants and ambitions of a person. The goal of emotional regulation techniques is to change an emotion’s composition, strength, communication, or endurance [ 7 ].

Within the mechanistic framework of emotion regulation, two commonly studied strategies are cognitive reappraisal and suppression [ 7 ]. Cognitive reappraisal is considered an adaptive emotion regulation strategy as it allows individuals to modify their emotional responses by reframing the meaning of a situation in a way that reduces its emotional intensity. By employing cognitive reappraisal, individuals can shift their focus toward more positive aspects of a situation or reinterpret its significance, thereby regulating their emotional reactions effectively [ 8 ]. This strategy has been associated with various positive outcomes, including enhanced emotional well-being, reduced negative affect, and improved interpersonal functioning [ 9 ]. On the other hand, suppression, as an emotion regulation strategy, involves inhibiting the outward expression of emotions without necessarily changing their underlying emotional experience. While suppression may temporarily reduce the visible signs of emotional expression, it does not address the underlying emotional experience and can lead to negative consequences in the long run [ 9 ]. Research has shown that suppression can be associated with increased physiological arousal, decreased positive affect, and impaired interpersonal interactions [ 10 ]. Therefore, cognitive reappraisal is generally regarded as a more adaptive strategy compared to suppression.

Stress has a well-known impact on students’ conduct and psychological well-being. Dangerous environmental cues are the source of stress. Perceived emotions are generated after people analyze and assess the alarming signals using their mental abilities. These emotions are known as “perceived stress” [ 11 ]. Prior research has discovered a strong inverse relationship among a person’s pleasant feelings and perceived stress [ 12 ]. A different study found that learners reported stress was inversely connected with their joyous feelings [ 13 ]. It is possible to deduce that there are variables that operate as mediators between emotional conduct and perceived stress. Examining the effects of these variables may highlight individual variations.

Motivation to learn is the factor that not only commences education but also keeps it going and guides it. According to Urhahne and Wijnia [ 14 ], motivation to learn is an intrinsic drive and mental capacity that positively impacts the education of students. The kind and level of motivation to learn has a meaningful impact on the orientation, pace, and outcome of the learning process. Research indicates a strong relationship between learning motivation and stress, where pleasant learning emotions are positively impacted by motivation to learn [ 15 ].

The Resource Preservation Theoretical Model proposes a framework for understanding the processes underlying emotion regulation and its impact on individuals’ cognitive, emotional, and behavioral outcomes [ 16 , 17 ]. This model suggests that individuals engage in emotion regulation strategies to preserve their personal and environmental resources, thereby facilitating adaptation and well-being. In the context of the present study, the variables of perceived stress, emotional regulation, and learning motivation can be integrated within the framework of this model. Perceived stress represents the individual’s appraisal of the demands and challenges they experience in their clinical practice. Higher levels of perceived stress may indicate a greater need for effective emotion regulation strategies to preserve personal and environmental resources. Learning motivation, as a variable in this study, can be considered as a potential mediator within the Resource Preservation Theoretical Model. Learning motivation reflects the individual’s appraisal of the value and importance of their educational experience. It is plausible that higher levels of learning motivation may lead nursing students to actively engage in adaptive emotion regulation strategies, such as cognitive reappraisal, as a means to preserve personal and environmental resources in the pursuit of successful learning outcomes [ 17 ].

Previous research has established a significant association between perceived stress and emotional regulation. Studies have shown that higher levels of perceived stress are often linked to difficulties in regulating emotions effectively [ 18 , 19 ]. Individuals experiencing elevated levels of perceived stress may exhibit maladaptive emotional regulation strategies, such as suppression or avoidance, which can further exacerbate the negative impact of stress on their well-being [ 20 ]. As for the relationship between stress and motivation it has been demonstrated to be a paradox in the literature, where evidence is not conclusive [ 21 ]. In addition, the relationship between emotional regulation and motivation has only been the subject of theoretical work [ 22 ] and very few empirical studies [ 23 ], especially when considering stress. There is a dearth of studies specifically examining these relationships among Saudi nursing students in the context of clinical practice. Given the unique challenges faced by nursing students during their clinical training, such as high workload, exposure to critical situations, and emotional demands, investigating the mediating role of learning motivation can provide valuable insights into the mechanisms underlying the relationship between perceived stress and emotional regulation in this specific population. Addressing this gap can inform the development of targeted interventions and support programs to enhance nursing students’ learning motivation and promote their emotional well-being in the clinical setting. Therefore, the aim of this study was to investigate the mediating role of learning motivation in the relationship between perceived stress and emotional regulation among nursing students. We hypothesized that motivation would mediate the association between perceived stress and emotional regulation.

Research Design

This research is a subset of a bigger project that was carried out in Saudi Arabia involving students studying nursing. A quantitative cross-sectional research design was employed in the research in order to look for any relationships between the factors being studied. Cross-sectional designs help assess connections between variables at a certain point in time, despite its restriction on the establishment of causal linkages among variables.

This investigation involved nursing learners from King Saud University in Saudi Arabia who were enrolled in the Bachelor of Nursing Program (BSN). The students represented a variety of academic levels, excluding first-year students. Convenience sampling provided the greatest opportunity for the enrollment of students. Students who were proficient in English maintained continuous enrollment in the BSN program and had no record of suspension or dismissal were among those who satisfied the study’s qualifying standards. Most importantly, to be eligible to participate the student should have finished at least the first clinical placement in the first year. Students who had previously enrolled in a technical nursing diploma program changed their major and later enrolled in the BSN program, were moved into the program, or had a record of social or mental issues were not included to take part in the study. A power analysis was conducted to determine the right number of participants. Based on an estimated population that comprised 600 nursing students, a 95% confidence level, and a 5% margin of error, 235 students were needed in the sample. However, because structural equation modeling is used in this work to create a mediation model, a ratio of 15:1 was used to calculate the necessary sample size, which was based on an 80% power level and a moderate effect size of 0.3. Consequently, there was a need for an additional 105 students, meaning that 340 students would be the total sample size needed to sufficiently power the study and find an effect.

One of the major colleges in the nation and the very first to be formed in Saudi Arabia is King Saud University. The intended university provides a four-year nursing program with a required internship to prepare students for the workforce. A variety of learning possibilities are offered by the course of study to students, such as instruction in the classroom, high-fidelity simulations, problem-based learning through video, team-based learning, and more. Furthermore, students are required to undertake clinical practice at the affiliated hospital during their study period. In their clinical training students are assigned one patient per clinical day if they were practicing in a critical care area and 3–4 patients per clinical day if they were assigned to a regular floor. This is determined by the intended learning outcomes of the respective courses they are enrolled in, which specify certain nursing tasks to fulfill during clinical rotations.

Recruitment and data collection

The director of the nursing department at King Saud University was contacted and asked for a sample frame. They provided the investigators with a list of current nursing students. The list included the students’ university emails. 410 students received an email invitation to participate in this study. The email included the primary investigator’s contact details, a request for a consent form, and detailed study information. Those that replied with a consent form filled out were included. An 89% response rate was achieved by the 367 students out of the 410 who were asked to take part. Clear and concise communication about the study’s objectives and confidentiality of responses helped motivate students to take part. In addition, convenience sampling often relies on making participation as easy and convenient as possible for potential participants. This included factors such as flexible timing, convenient locations through which they could complete the questionnaire, and minimal burden on participants’ schedules. Moreover, the researchers made sure that the questionnaire was user-friendly, easily understandable, and not excessively time-consuming. The researchers also implemented a reminder system which was beneficial to prompt potential participants who have not yet responded. The students cited personal circumstances as the reason they chose not to participate in the study. A data-collecting period extending from September 2022 to April 2023 was utilized.

Instrumentation

Sociodemographic questionnaire.

A demographic data sheet was used to collect information about the student’s gender, age, and academic level.

Emotional regulation questionnaire (ERQ)

The current study assessed participants’ emotion regulation skills using the emotion regulation questionnaire (ERQ) [ 9 ]. The ERQ is a 10-item questionnaire that assesses how much people rely on cognitive reappraisal and suppression strategies to control their emotional states. Cognitive reappraisal refers to efforts to control emotional experience by changing one’s interpretation of internal and external cues. In contrast, suppression refers to efforts to prevent behavioral responses that result from emotional states. Both terms are used in process models of emotion regulation (Gross, 2015). Participants reported their level of agreement with each of the presented items using a 7-point Likert-type scale (1 = strongly disagree, 7 = strongly agree). Prior research has established the factorial and convergent validity of the instrument when applied to university students. Further, reliability analyses indicated that the reappraisal (Cronbach’s a = 0.84, McDonald’s & = 0.85) and suppression (Cronbach’s a = 0.78, McDonald’s & = 0.78) subscales of the ERQ demonstrated acceptable levels of internal consistency in the current investigation. In this study, the Cronbach alpha was 0.90. Numerous studies have provided evidence supporting the construct validity of the ERQ. For example, Gross and John conducted a series of studies demonstrating the convergent validity of the ERQ by examining its associations with other measures of emotion regulation, affect, and interpersonal outcomes [ 9 ]. Additionally, studies have investigated the factorial structure of the ERQ, supporting the presence of two distinct factors corresponding to cognitive reappraisal and suppression, where also Gyurak et al. (2011) examined the discriminant validity of the ERQ by comparing it to measures of implicit emotion regulation [ 24 ]..

Perceived stress scale (PSS)

We assessed undergraduate students’ perceptions of stress using the 10-item perceived stress scale (PSS) [ 25 ]. The PSS measures comprehensive perceived stress experienced across the past 30 days on a 5-point scale (0– never, 1 = almost never, 2 = once in a while, 3 = often, 4 = very often). Six of the 10 items were worded and scored in the non-reversed direction (i.e., “How often have you felt that you were unable to control the important things in your life”). Four of the 10 items were worded and scored in the reversed direction (i.e., “How often have you felt that things were going your way”). Total scores range from 0 to 40. The PSS was shown to demonstrate acceptable levels of internal consistency in the current examination (Cronbach’s a = 0.82, McDonald’s & = 0.81). Numerous studies have provided evidence supporting the construct validity of the PSS. For example, Cohen et al. (1983) conducted a validation study of the PSS and found that higher scores on the scale were associated with self-reported stress-related symptoms and measures of psychological distress [ 26 ]. The PSS has also demonstrated discriminant validity by showing differential relationships with other constructs. For instance, studies have found that the PSS correlates positively with measures of psychological distress, anxiety, and depression while showing weaker or non-significant correlations with constructs such as social support and self-esteem [ 27 ].

Motivated strategies for learning questionnaire (MSLQ)

The Motivated Learning Strategies Questionnaire (MLSQ) was utilized in this study to assess and evaluate the motivational factors influencing learning strategies among participants. The MLSQ, originally developed by Pintrich and De Groot [ 28 ] is a well-established instrument designed to measure students’ motivational beliefs and self-regulated learning strategies across various academic contexts. Participants respond to items on a Likert-type scale from 1 to 7, indicating the extent of their agreement or disagreement with statements related to each subscale. The higher the total score, the higher the motivation for learning. The Cronbach alpha for this study was 0.92. Studies have examined the factorial structure of the MSLQ in different educational contexts. While there are variations in the number of factors identified across studies, the MSLQ has consistently demonstrated a multidimensional structure, indicating that it measures multiple underlying constructs related to motivation and self-regulated learning [ 29 , 30 ]. The MSLQ has also demonstrated discriminant validity by showing differential relationships with other constructs. For instance, studies have found that the MSLQ subscales correlate differently with constructs such as self-efficacy, test anxiety, and academic achievement, supporting its ability to distinguish between different aspects of motivation and learning [ 29 , 30 ].

Data analysis

The data was analyzed using Statistical Package for Social Science (SPSS) version 26. Frequencies were used to describe the characteristics of the sample. Means, standard deviations, and confidence intervals were computed to explore the central tendency and spread of the data. Independent t-tests were used to explore the association between study variables and gender. ANOVA was used to determine if there is an association between academic level and study variables, as well as, perceived stress level and study variables. AMOS was used to carry out structure equation modeling (SEM) to test direct and indirect effects among study variables. The positioning of the variables and the hypothesized direct and indirect paths are justified by the fact that the model being tested is based on both empirical and theoretical considerations, which are used to explore possible relationships between the variables.

Ethical considerations

The researchers granted the approval from the Qassim University’s Research and Ethics Committee (Name and Number: ECO-R-191). All ethical considerations were applied according to the International Declaration of Helsinki’s principles and guidelines, where the students were informed about all details of the study before recruitment and were not forced to be inducted. The researchers are not engaged in any instructional activities with the participating students. No disadvantages were reported to students who did not participate, and written informed consent was obtained.

Participants’ characteristics

The study sample was made up of 264 (71.9%) male students and 103 (28.1%) female students. The majority of the students in the sample were in their second and third year of study, where the mean age of the participants was 21.11 ± 1.63 years (Table  1 ).

Descriptive statistics of study variables

The mean perceived stress score of the participating students was 23.60 ± 7.73, which is within the range for moderate perceived stress level. The mean motivation score was 136.60 ± 34.93, and that of emotional regulation was 43.23 ± 14.00 (Table  2 ). By examining the Q-Q plots, it seems that the data is approximately normally distributed with minor skewness to the left. The confidence intervals had minimal standard errors. Descriptive statistics showed that the vast majority (58%) of the students reported moderate stress levels, while 103 (28.1%) reported a high stress level. The mean scores of motivation and emotional regulation were examined by the level of perceived stress. The results showed that data was more normally distributed among students reporting moderate stress. Despite the histograms and normality curves in the other stress groups having minor skewness to the left, the Q-Q plots show indications of normality. This is expected considering the unequal groups, where the results of the descriptive statistics indicate unequal variances. The descriptive statistics also indicate how mean scores change according to ascending levels of perceived stress (Table  2 ).

Association between study variables and participant characteristics

An independent T-test was carried out to determine if there was an association between gender and the study variables. The results of Levene’s test showed equal variances for all variables. The test did not show any significant differences in means according to gender, where the recorded p -values were > 0.05, except for emotional regulation, where males recorded a higher mean than females ( p  = 0.04). An ANOVA was carried out to determine if there is an association between academic level and the study variables. The homogeneity of variance test showed no significant difference. The results of the ANOVA test showed no significant differences in the tested variables according to academic level (Table  3 ).

A bivariate Pearson correlation was carried out between the total scores of the study variables and age. The results showed that there was a positive linear statistically significant relationship of varying strength between all perceived stress ( p  = 0.00), motivation ( p  = 0.018), emotional regulation ( p  = 0.00), and age. The strongest correlation was noted between age and perceived stress (Table  4 ).

Association between study variables

An ANOVA test was conducted to determine if there is an association between perceived stress levels and motivation and emotional regulation. The homogeneity of variance test showed no significant difference. The results showed that the motivation ( p  = 0.00) and emotional regulation ( p  = 0.00) scores were statistically significantly different according to perceived stress levels. A post-hoc Bonferroni test was conducted and showed a significant difference in emotional regulation scores between all stress levels ( p  = 0.00), and a significant difference in motivation scores between low and high ( p  = 0.00), as well as moderate and high ( p  = 0.00) (Table  5 ).

A Pearson’s bi-variate correlational analysis was carried out to determine if there is a linear association between the study variables. The results showed that there was a moderate positive statistically significant linear association between motivation and emotional regulation ( r  = 0.57, p  = 0.00). A weak negative statistically significant linear association was detected between perceived stress and motivation ( r =-0.437, p  = 0.00) and a moderate negative statistically significant linear association was detected between perceived stress and emotional regulation ( r =-0.698, p  = 0.00) (Table  6 ).

SEM and mediation analysis

Based on the previous results multiple structural equation models were conducted to identify how the association between the study variables operates. The results showed that significant pathways exist between the study variables ( p  = 0.00), where a bi-directional path might exist between motivation and emotional regulation (Table  7 ).

The results further demonstrated that perceived stress had a significant direct, indirect, and total effect on motivation, yet no significant direct effect on emotional regulation. However, a significant direct effect was observed between motivation and emotional regulation ( p  = 0.00). Thus, this indicates that the association between perceived stress and emotional regulation is mediated by motivation and the association between motivation and emotional regulation could be further moderated by perceived stress and other unexplored factors (Table  8 ).

The present study aimed to investigate the mediating role of learning motivation in the relationship between perceived stress and emotional regulation among Saudi nursing students. Consistent with previous research [ 31 , 32 ], our results showed a negative correlation between perceived stress and emotional regulation. This finding suggests that higher levels of stress are associated with poorer emotional regulation abilities among nursing students. These findings are in line with the transactional model of stress and coping, which posits that stress can hinder individuals’ ability to effectively regulate their emotions [ 33 ]. The demands and challenges faced by nursing students, such as heavy workloads, clinical responsibilities, and academic pressure, may contribute to elevated stress levels, which in turn can compromise their emotional regulation skills. Scholars’ perspectives and focus increasingly evolved from unfavorable to pleasant feelings due to the impact of positive psychology. The relationship between stress and favorable emotions has been the subject of recent studies [ 34 ]. This finding can also be attributed to the culture of the students, where under stress young adults usually tend to suppress undesirable emotions rather than communicate them with others. In other cultures, it could have been a different case depending on the dynamics of interpersonal relationships. Thus, further investigation into this aspect could further our knowledge.

In addition, in the present investigation, emotional regulation and motivation to learn among nursing students were positively associated, where motivation was a significant predictor of the latter. This conclusion, which centered on the fundamental ideas of motivational theoretical terms, was in line with the findings of previous research conducted by Chen, Huang [ 35 ]. Better educational accomplishment and more favorable educational emotions are the results of students’ increased commitment and motivation to learn [ 36 ]. Additionally, those who are highly motivated to learn are more inclined to look for proactive coping strategies that work, which helps them feel less distressed [ 37 ].

Additionally, among Saudi nursing students, our study showed a negative link between experienced stress and motivation to learn. This result is consistent with other studies that have shown the negative effects of stress on students’ motivation [ 38 ]. This may be described by the cognitive appraisal process, where individuals perceive stresses as threats, resulting in a decline in their motivation levels [ 39 ]. High levels of stress might make nursing students less motivated to participate in class activities and work toward their academic objectives.

Most importantly, consistent with previous work [ 11 ], our study revealed the mediating effect of learning motivation between perceived stress and emotional regulation among Saudi nursing students. Specifically, higher levels of stress were associated with reduced learning motivation, which, in turn, led to poorer emotional regulation skills. This finding highlights the importance of addressing motivational factors in interventions aimed at enhancing emotional regulation among nursing students. According to earlier research, highly driven people typically retain pleasant emotions and an optimistic outlook in addition to seeing stress and life’s challenges from an optimistic viewpoint [ 40 ]. People with greater drive were more successful in embracing favorable and hopeful attitudes and high stress amid circumstances and at getting more social assistance therefore lessening their sensation of anxiety and diminished power. These abilities helped to foster and sustain positive emotions in the learning environment. Continuous development is necessary to build learning motivation, which is impacted by a variety of factors including awareness of oneself, family history, social context, and educational surroundings [ 41 ]. Thus, throughout nursing students’ clinical practice, universities, family members, and healthcare facilities should focus more on motivation to learn. Scholars and instructors should develop realistic strategies for addressing perceived stresses in certain learning environments, such as student nurses’ anxiety and diminished power in clinical settings, and refrain from stifling beneficial academic feelings. Moreover, since the most significant determinant of emotional regulation is academic drive, it is advised that instructors focus on fostering students’ enthusiasm in nursing clinical practice in order to enhance their ability to regulate emotions. This will help the learners’ educational achievement and their nursing skills.

Limitations and recommendations

One of the factors that limit our inquiry is our design. It is not possible to determine a causal link among the variables under study due to the cross-sectional design. Cross-sectional designs cannot determine whether the observed associations are causal or if they exist due to reverse causality, they do not capture the timing of events or changes in variables, and they do not account for the potential effects of maturation or time-related factors. Therefore, in order to get a deeper comprehension of the relationships between these factors, more studies on this subject should investigate and assess mediational frameworks using a longitudinal approach.

Another disadvantage is the multicollinear influence of using self-reporting for variable measurement. In order to reduce subjectivity and get more information about possible modifications in the parameter interactions, future research may use execution or performance methodologies instead of SEM, which was employed in this work to offset these effects.

An additional issue is the convenience sampling design. This may have resulted in a sampling bias and a non-representative sample that does not accurately reflect the larger population of nursing students or the diversity within that population, thus limiting the ability to make broader inferences or generalize the findings to other populations or settings. Further research could be done using data points from various educational institutions to generalize the findings.

Future research could involve conducting comparative studies to examine potential differences in the relationships between the variables across different contexts, educational systems, or cultural settings. This can provide valuable insights into the contextual factors that may influence the observed associations. Moreover, employing qualitative research methods, such as interviews or focus groups, can be valuable in gaining a deeper understanding of the experiences, perceptions, and contextual factors related to the variables under investigation.

The findings of this research show a substantial negative correlation between the participants’ motivation to learn and emotional management during clinical placement on one hand and participants’ reported stress on the other hand. Motivation to learn and reported stress were shown to be important precursors of emotional regulation. The investigation also demonstrated the critical role that motivation to learn had in regulating the relationship among felt stress and emotional regulation among student nurses, as in mitigating the negative effects of stress. Effectively enhancing learners’ motivation to learn might make them feel less stressed and more optimistic. Nurses who experience positive emotions during their education would possibly be better able to develop their abilities and become more competent nurses.

Nursing educators can use our results to develop strategies and interventions aimed at reducing stress levels among students. This may include implementing stress management programs, providing mentorship and support systems, and promoting self-care practices. In addition, our results call on nursing educators to enhance students’ intrinsic motivation for learning. Strategies such as incorporating engaging teaching methods, providing opportunities for autonomy and choice, and establishing clear learning goals can help foster students’ motivation to learn and regulate their emotions effectively. Nursing leadership and policymakers can also play a crucial role in allocating resources and implementing policies that prioritize the well-being of nurses and nursing students alike. This includes advocating for adequate high-quality nursing programs, staffing levels at nursing schools and hospitals, safe work environments, and comprehensive support systems for students during their clinical practice. By recognizing the unique challenges faced by nursing students and implementing supportive policies, legislators can contribute to the overall quality of nursing education and the well-being of future healthcare professionals.

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

Emotional Regulation Questionnaire

Perceived Stress Scale

Structural Equation Modeling

Motivated Learning Strategies Questionnaire

Hilleren IHS, Christiansen B, Bjørk IT. Learning practical nursing skills in simulation centers–a narrative review. Int J Nurs Stud Adv. 2022:100090.

Gregersen A, Hansen M, Brynhildsen S, Grøndahl V, Leonardsen A. Students’ perspectives on learning practical nursing skills: a Focus Group Study in Norway. Nursing research and practice. 2021;2021.

Rezakhani Moghaddam H, Aghamohammadi V, Jafari M, Absalan M, Nasiri K. Challenges faced by nursing students to work with nursing personnel: a qualitative study. Adv Med Educ Pract. 2020:313–9.

Pekrun R. Academic emotions. Handbook of motivation at school: Routledge; 2016. p. 120– 44.

Kim K, Lee J, Yoon J. Effects of Emotional Regulation, Resilience, and Distress Disclosure on post-traumatic growth in nursing students. Int J Environ Res Public Health. 2023;20(4):2782.

Article   PubMed   PubMed Central   Google Scholar  

Nozaki Y, Mikolajczak M. Extrinsic emotion regulation. Emotion. 2020;20(1):10.

Article   PubMed   Google Scholar  

Gross JJ. Emotion regulation. Handb Emotions. 2008;3(3):497–513.

Google Scholar  

McRae K, Ciesielski B, Gross JJ. Unpacking cognitive reappraisal: goals, tactics, and outcomes. Emotion. 2012;12(2):250.

Gross JJ, John OP. Individual differences in two emotion regulation processes: implications for affect, relationships, and well-being. J Personal Soc Psychol. 2003;85(2):348.

Article   Google Scholar  

Troy AS, Shallcross AJ, Mauss IB. A person-by-situation approach to emotion regulation: cognitive reappraisal can either help or hurt, depending on the context. Psychol Sci. 2013;24(12):2505–14.

Liu Y, Yu H, Shi Y, Ma C. The effect of perceived stress on depression in college students: the role of emotion regulation and positive psychological capital. Front Psychol. 2023;14:1110798.

Wang X, Luo R, Guo P, Shang M, Zheng J, Cai Y, et al. Positive affect moderates the influence of perceived stress on the mental health of healthcare workers during the COVID-19 pandemic. Int J Environ Res Public Health. 2022;19(20):13600.

Sterghos J. The indirect association of personality with perceived stress as mediated by humor in university students during COVID-19. 2023.

Urhahne D, Wijnia L. Theories of motivation in education: an integrative Framework. Educational Psychol Rev. 2023;35(2):45.

Liu C, Tang J, Jiang Z, Zhan X, Shen J, Wang M, et al. Influence of Academic Stress on College Students’ Learning Motivation. Mediating Role of Environment Satisfaction and Moderating Role of Learning Adaptability; 2023.

Tamir M, John OP, Srivastava S, Gross JJ. Implicit theories of emotion: affective and social outcomes across a major life transition. J Personal Soc Psychol. 2007;92(4):731.

Wang W, Xu H, Wang B, Zhu E. The mediating effects of learning motivation on the association between perceived stress and positive-deactivating academic emotions in nursing students undergoing skills training. J Korean Acad Nurs. 2019;49(4):495–504.

Schäfer A, Pels F, Kleinert J. Coping strategies as mediators within the relationship between emotion-regulation and perceived stress in teachers. 2020.

Thomas C, Zolkoski S, editors. Preventing stress among undergraduate learners: The importance of emotional intelligence, resilience, and emotion regulation. Frontiers in Education; 2020: Frontiers Media SA.

Katana M, Röcke C, Spain SM, Allemand M. Emotion regulation, subjective well-being, and perceived stress in the daily life of geriatric nurses. Front Psychol. 2019;10:1097.

Rudland JR, Golding C, Wilkinson TJ. The stress paradox: how stress can be good for learning. Med Educ. 2020;54(1):40–5.

Järvenoja H, Järvelä S, Törmänen T, Näykki P, Malmberg J, Kurki K, et al. Capturing motivation and emotion regulation during a learning process. Frontline Learn Res. 2018;6(3):85–104.

Järvenoja H, Järvelä S, Malmberg J. Supporting groups’ emotion and motivation regulation during collaborative learning. Learn Instruction. 2020;70:101090.

Gyurak A, Gross JJ, Etkin A. Explicit and implicit emotion regulation: a dual-process framework. Cogn Emot. 2011;25(3):400–12.

Cohen S, Kamarck T, Mermelstein R. Perceived stress scale. Measuring Stress: Guide Health Social Scientists. 1994;10(2):1–2.

Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983:385–96.

Lee E-H. Review of the psychometric evidence of the perceived stress scale. Asian Nurs Res. 2012;6(4):121–7.

Pintrich PR, De Groot EV. Motivational and self-regulated learning components of classroom academic performance. J Educ Psychol. 1990;82(1):33.

Pintrich PR, Smith DA, Garcia T, McKeachie WJ. Reliability and predictive validity of the motivated strategies for learning questionnaire (MSLQ). Educ Psychol Meas. 1993;53(3):801–13.

Richardson M, Abraham C, Bond R. Psychological correlates of university students’ academic performance: a systematic review and meta-analysis. Psychol Bull. 2012;138(2):353.

Gong Z, Wang H, Zhong M, Shao Y. College students’ learning stress, psychological resilience and learning burnout: status quo and coping strategies. BMC Psychiatry. 2023;23(1):389.

Xu F, Huang L. Impacts of stress response and negative emotion on mental health of college students during the COVID-19 outbreak. Front Psychiatry. 2022;12:784661.

Lazarus RS, Folkman S. Stress, appraisal, and coping. Springer publishing company; 1984.

Alexander R, Aragón OR, Bookwala J, Cherbuin N, Gatt JM, Kahrilas IJ, et al. The neuroscience of positive emotions and affect: implications for cultivating happiness and wellbeing. Neurosci Biobehavioral Reviews. 2021;121:220–49.

Chen X, Huang Z, Lin W. The effect of emotion regulation on happiness and resilience of university students: the chain mediating role of learning motivation and target positioning. Front Psychol. 2022;13:1029655.

Hayat AA, Shateri K, Amini M, Shokrpour N. Relationships between academic self-efficacy, learning-related emotions, and metacognitive learning strategies with academic performance in medical students: a structural equation model. BMC Med Educ. 2020;20(1):1–11.

Salimzadeh R, Hall NC, Saroyan A, editors. Examining academics’ strategies for coping with stress and emotions: A review of research. Frontiers in Education; 2021: Frontiers Media SA.

Yoo HJ, Marshall DT. Examining the relationship between motivation, stress, and satisfaction among graduate students. J Furth High Educ. 2022;46(3):409–26.

Salmela-Aro K. The role of motivation and academic wellbeing–the transition from secondary to further education in STEM in Finland. Eur Rev. 2020;28(S1):S121–34.

Rahe M, Jansen P, editors. Understanding the relationship between perceived stress, academic motivation, and physical activity in college students during the coronavirus pandemic. Frontiers in Education; 2022: Frontiers.

Toufan N, Omid A, Haghani F. The double-edged sword of emotions in medical education: a scoping review. J Educ Health Promotion. 2023;12.

Download references

Acknowledgements

The researchers would like to thank the Deanship of Scientific Research, University of Hail, for funding the publication of this project.

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and affiliations.

Medical Surgical Department, College of Nursing, University of Hail, Hail City, Saudi Arabia

Bander Saad Albagawi

Department of Nursing, Mental Health Hospital, Qassim Health Cluster, Qassim, Buraydah, Saudi Arabia

Yasir S. Alsalamah

Faculty of Health Science, Department of Nursing, University of Pretoria, Pretoria, South Africa

Nursing Department, Hamad Medical Corporation, Doha, P.O. Box 3050, Qatar

Abdulqadir J. Nashwan

General Directorate of Health Affairs in Aljouf, General Director of Academic and Training in Aljouf Health, Cluster Aljouf, Aljouf, Skaka, Saudi Arabia

Rakan Mansuor AL Rawili

Training Department, Indiana Kokomo University, Indiana, Kokomo, USA

Faculty of Nursing, King AbdulAziz University, 21589, Jeddah, Saudi Arabia

Lisa A. Babkair

Department of Mental Health, King Saud University Medical City, Nursing Affairs, Riyadh City, Saudi Arabia

Sara A. Alkharji

Department of Public Health, College of Public Health and Health Informatics, Qassim University, Al Bukairiyah, Saudi Arabia

Thamer Alslamah

College of Health Sciences, American University of the Middle East, Egaila, Kuwait

Mirna Fawaz

You can also search for this author in PubMed   Google Scholar

Contributions

The manuscript has been conceptualized and designed by M.F., Y.A., A.N., and B.A. Y.A. wrote the proposal and M.F. reviewed it and developed the manuscript. All authors worked on validation, data curation, analysis, writing, and finalizing the manuscript. S.A., L.B., R.A., and T.A. equally helped in data validation and analysis as well as reviewing the final draft and rewriting sections in the manuscript.

Corresponding author

Correspondence to Mirna Fawaz .

Ethics declarations

Ethical approval and consent to participate.

The researchers granted the approval from the Qassim University’s Research and Ethics Committee (Name and Number: ECO-R-191). All ethical considerations were applied according to the International Declaration of Helsinki’s principles and guidelines, where the students were informed about all details of the study before recruitment and were not forced to be inducted. No disadvantages were reported to students who did not participate, and written informed consent was obtained.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Albagawi, B.S., Alsalamah, Y.S., Nashwan, A.J. et al. The mediating role of learning motivation in the relationship among perceived stress and emotional regulation among Saudi nursing students in clinical practice. BMC Nurs 23 , 245 (2024). https://doi.org/10.1186/s12912-024-01893-1

Download citation

Received : 18 January 2024

Accepted : 24 March 2024

Published : 16 April 2024

DOI : https://doi.org/10.1186/s12912-024-01893-1

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Emotional regulation
• Nursing education
• Nursing students

BMC Nursing

ISSN: 1472-6955

• General enquiries: [email protected]

Designing implementation strategies for the inclusion of LGBTQIA+ and key populations content in undergraduate nursing curricula in KwaZulu-Natal, South Africa: Protocol for a Multi-Methods Research Project

Affiliations.

• 1 Durban University of Technology, Academic Development Unit, Faculty of Health Sciences, 7 Ritson Road, Berea, Durban, ZA.
• 2 University of KwaZulu-Natal, Centre for Rural Health, School of Nursing and Public Health, Durban, ZA.
• 3 University of KwaZulu-Natal, Discipline of Nursing, School of Nursing and Public Health, Durban, ZA.
• 4 University of KwaZulu-Natal, Discipline of Occupational Therapy, School of Health Sciences, Durban, ZA.
• 5 University of San Francisco California, Centre for AIDS Prevention Studies, San Francisco, California, US.
• 6 University of San Francisco California, Department of Community Health Systems, San Francisco, US.
• PMID: 38598816
• DOI: 10.2196/52250

Background: Literature suggests that Lesbian, Gay, Bisexual, Transgender, Intersex, Queer and Allied (LGBTQIA+) individuals encounter challenges with access and engagement with health services. Studies have reported that LGBTQIA+ individuals' experiences stigma, discrimination and health workers' micro aggression when accessing healthcare. There is compelling evidence to suggest that the LGBTQIA+ community are faced with disproportionate rates of HIV infection, mental health disorders, substance abuse and other non-communicable diseases. The South African National Strategic Plan (NSP) on HIV/AIDS, TB and STI's (2023-2028) recognises the need for providing affirming LGBTQIA+ health care as part of the country's HIV/AIDS response strategy that is rooted in comprehensive and holistic care underpinned by the principles of community oriented primary healthcare. However, current anecdotal evidence suggests paucity of LGBTQIA+ and key populations health content in the undergraduate health science curricula in South Africa. Moreover, literature reveals a general lack of health worker training regarding the health needs of LGBTQIA+ persons and other key populations such as sex workers, People Who Inject Drugs (PWID) and Men who have Sex with Men (MSM).

Objective: This protocol paper describes the design of a project that aims at facilitating the inclusion of health content related to the LGBTQIA+ community and other key populations in the undergraduate nursing curricula of KwaZulu-Natal, South Africa.

Methods: A multi-methods design encompassing collection of primary and secondary data using multiple qualitative designs and quantitative approaches will be used to generate evidence that will inform the co-design, testing and scale-up of strategies to facilitate the inclusion of LGBTQIA+ and key populations content in undergraduate nursing curricula in KwaZulu-Natal, South Africa. Data will be collected using a combination of convenience, purposive and snow ball sampling techniques from LGBTQIA+ persons, academic staff, undergraduate nursing students and other key populations such as MSM, PWID and sex workers. Primary data will be collected through individual in-depth interviews, focus groups discussions and surveys guided by semi-structure and structured data collection tools. Data collection and analysis will be an iterative process guided by the respective research design to be adopted. The continuous quality improvement process to be adopted during data gathering and analysis will ensure contextual relevance and sustainability of the resultant co-designed strategies that are to be scaled-up as part of the overarching objective of this study.

Results: The proposed study is designed in response to recent contextual empirical evidence highlighting the multiplicity of health challenges experienced by LGBTQIA+ individuals and key populations in relation to health service delivery and access to healthcare. The potential findings of the study may be appropriate for contributing to the education of nurses as one of the means to ameliorate these problems.

Conclusions: This research has potential implications for nursing education in South Africa and worldwide as it addresses up-to-date problems in the nursing discipline as it pertains to undergraduate students' preparedness for addressing the unique needs and challenges of the LGBTQIA+ community and other key populations. The findings may also provide baseline data to inform knowledge transfer to other health sciences disciplines that have not included LGBTQIA+ content in their undergraduate curricula in South Africa.

• Best Online Ph.D. In Management

Best Online Ph.D. In Management Of 2024

Published: Apr 16, 2024, 3:33pm

Key Takeaways

• A Ph.D. in management prepares students for advanced, research-based roles in business
• Concentrations for management Ph.D. programs vary widely, including areas like engineering management, project management and sport management
• The typical Ph.D. in management requires around 60 credits of coursework

A Ph.D. in management is one of the most advanced degrees you can attain in the business field. If you aspire to a high-level role in research, academia or consulting, you might consider pursuing a Ph.D. in management online.

Online Ph.D.s in management typically require a dissertation and delve into contemporary theories of leadership and management. However, many do not include in-person requirements. Rather than practical learning components, students complete theoretical coursework before turning their attention to their dissertations.

We’ve ranked the 10 best online Ph.D. programs in management. Read on to learn more.

Why You Can Trust Forbes Advisor Education

Forbes Advisor’s education editors are committed to producing unbiased rankings and informative articles covering online colleges, tech bootcamps and career paths. Our ranking methodologies use data from the National Center for Education Statistics , education providers, and reputable educational and professional organizations. An advisory board of educators and other subject matter experts reviews and verifies our content to bring you trustworthy, up-to-date information. Advertisers do not influence our rankings or editorial content.

• 6,290 accredited, nonprofit colleges and universities analyzed nationwide
• 52 reputable tech bootcamp providers evaluated for our rankings
• All content is fact-checked and updated on an annual basis
• Rankings undergo five rounds of fact-checking
• Only 7.12% of all colleges, universities and bootcamp providers we consider are awarded

Our Methodology

We ranked 13 accredited, nonprofit colleges offering online management Ph.D. programs in the U.S. using 14 data points in the categories of student experience, credibility, student outcomes and affordability. We pulled data for these categories from reliable resources such as the Integrated Postsecondary Education Data System ; private, third-party data sources; and individual school and program websites.

Data is accurate as of February 2024. Note that because online doctorates are relatively uncommon, fewer schools meet our ranking standards at the doctoral level.

We scored schools based on the following metrics:

Student Experience :

• Student-to-faculty ratio
• Socioeconomic diversity
• Availability of online coursework
• Total number of graduate assistants
• Proportion of graduate students enrolled in at least some distance education

Credibility :

• Fully accredited
• Programmatic accreditation status
• Nonprofit status

Student Outcomes :

• Overall graduation rate
• Median earnings 10 years after graduation

Affordability :

• In-state graduate student tuition and fees
• Alternative tuition plans offered
• Median federal student loan debt
• Student loan default rate

We chose the 10 best schools to display based on those receiving a curved final score of 88% or higher.

Find our full list of methodologies here .

• Best Online Accounting Degrees
• Best MBA In Finance Online
• Best Online Finance Degrees
• Best Online Master’s In Accounting Degrees
• Best Online Master’s In Finance

Degree Finder

Best online ph.d. in management, should you enroll in a ph.d. in management online, accreditation for online ph.d.s in management, how to find the right online ph.d. in management for you, frequently asked questions (faqs) about online ph.d.s in management, western new england university, capitol technology university, liberty university, university of the cumberlands, maharishi international university, bellevue university, troy university, indiana state university, national university, amridge university, featured online schools.

Learn about start dates, transferring credits, availability of financial credit and much more by clicking 'Visit Site'

Program Tuition Rate

$1,575/credit

Percentage of Grad Students Enrolled in Distance Education

Overall Graduation Rate

Located in Springfield, Massachusetts, Western New England University offers an online Ph.D. in engineering management comprising 10 classroom courses and a research-focused dissertation, which students must defend before faculty members. Notable courses in the 57-credit curriculum include operations research and project management.

WNE delivers most online coursework asynchronously through the Kodiak learning management system. Applicants need a minimum 3.5 cumulative GPA and must submit GRE scores. Students can enroll full time or part time.

• Our Flexibility Rating: Learn on your schedule
• School Type: Private
• Application Fee: $50
• Degree Credit Requirements: 57 credits
• Program Enrollment Options: Full-time, part-time
• Example Major-Specific Courses: Operations research, project management
• Concentrations Available: N/A
• In-Person Requirements: No

$950/credit

Located just outside of the nation’s capital city in South Laurel, Maryland, Capitol Technology University offers six online management Ph.D.s in engineering management, facilities management, occupational risk management, product management, project management and real estate management. All programs require 60 credits.

Learners don’t have to fulfill any on-campus courses or residencies, completing their Ph.D. entirely online.

• Our Flexibility Rating: Learn around your 9-to-5
• Application Fee: $100
• Degree Credit Requirements: 60 credits
• Program Enrollment Options: Full-time
• Example Major-Specific Courses: Product management future demands, engineering management research backgrounds
• Concentrations Available: Engineering management, facilities management, occupational risk management, product management, project management, real estate management

$565/credit

Located in Lynchburg, Virginia, Liberty University enrolls more than 135,000 students, most of whom take online courses. The university’s online Ph.D. program in organization and management – leadership provides a comprehensive study of leadership. The 60-credit curriculum includes courses like ethical leadership, leading effective teams, leading organizational change and leading theory. The program culminates with a dissertation.

Liberty delivers all program coursework asynchronously to maximize flexibility.

• Program Enrollment Options: Full time
• Example Major-Specific Courses: Ethical leadership, leading effective teams

$549/credit

Based out of Williamsburg, Kentucky, the University of the Cumberlands is a private, Christian-affiliated university that offers several online degrees, including a Ph.D. in business management.

The program’s 66-credit curriculum includes core courses in advanced managerial accounting, comparative economics, strategic marketing, and managerial ethics and social responsibility. All students also take courses in statistics and research methods, leading to a dissertation.

The curriculum offers seven focus areas, including entrepreneurship, finance and healthcare administration.

• Application Fee: $30
• Degree Credit Requirements: 66 credits
• Example Major-Specific Courses: Advanced managerial accounting, comparative economics
• Concentrations Available: Accounting, entrepreneurship, finance, healthcare administration, marketing, project management, strategic management

$6,000 to $10,800/year

Located in Fairfield, Iowa, Maharishi International University offers an online Ph.D. in management that stands out for several reasons. The degree incorporates a distinct focus on sustainability, and students do not take finals at the end of their courses. The program runs on a block system, in which students immerse themselves in a single course at a time. All students at MIU practice transcendental meditation twice per day.

Online students can choose between synchronous and asynchronous course delivery, although synchronous attendance is encouraged.

• Application Fee: $20
• Example Major-Specific Courses: Assessing human development, performance management in strategy research

$799/credit

Located in Bellevue, Nebraska, Bellevue University offers many online programs, including a Ph.D. in human capital management. While most coursework takes place online, students must complete two on-campus residencies: one at the start of the program and another at the beginning of the dissertation process. The 51-credit curriculum includes seminars in performance management, qualitative methods, and leading and aligning human capital.

The university delivers most online coursework asynchronously to promote flexibility.

• Degree Credit Requirements: 51 credits
• Example Major-Specific Courses: Seminar in performance management, seminar in qualitative methods
• In-Person Requirements: Yes, for two residencies

$550/credit

Based in Troy, Alabama, Troy University is a state school that offers several online programs, including a Ph.D. in sport management. The 60-credit curriculum delves into topics like sport management pedagogy and the legal aspects of sport. The program culminates with a dissertation that involves original research and scholarship. Students never need to visit campus.

Troy delivers all online coursework asynchronously through Canvas. Each online course typically lasts for nine weeks.

• School Type: Public
• Example Major-Specific Courses: Sport management pedagogy, seminar in legal aspects of sport

$450/credit

Located in Terre Haute, Indiana, Indiana State University offers several online programs, including a Ph.D. in technology management. The 66-credit curriculum includes five specialization options, among them construction management, manufacturing systems, and human resource development and industrial training. In addition to a specialization, all students must complete a research-focused dissertation requirement.

Notable courses in the curriculum include technology project management and advanced economic analysis. ISU offers its Ph.D. program in technology management along with a consortium of three other universities.

• Application Fee: $45
• Example Major-Specific Courses: Technology project management, advanced economic analysis
• Concentrations Available: Manufacturing systems, construction management, quality systems, digital communications, human resource development and industrial training

$442/quarter credit

Headquartered in San Diego, California, National University primarily focuses on online programs, offering distance degrees to students around the nation. The university’s Ph.D. in technology management requires 60 credits and includes courses in statistics with technology applications and principles of technology innovation management.

Students can choose from six concentrations, including computer science, information systems and data science. NU delivers most online coursework asynchronously. New students can begin the program each Monday.

• Application Fee: Free
• Example Major-Specific Courses: Statistics with technology applications, principles of technology innovation management
• Concentrations Available: Computer science, IT project management, information systems, engineering management, data science, cybersecurity

$700/credit

Based in Montgomery, Alabama, Amridge University maintains an affiliation with the Churches of Christ. Amridge has recently expanded its distance learning presence to include an online Ph.D. in organizational leadership and management.

The program’s 51-credit curriculum includes foundational courses in legal aspects of management, research methodology, and leading innovation and change. All students must also complete a qualifying examination, after which they tackle a research-focused dissertation in organizational leadership.

• Example Major-Specific Courses: Legal aspects of management, research methodology

Though distance learning is widely appealing, not all students thrive in online learning environments. To determine whether you should pursue your doctorate online, ask yourself the following:

• What are your other obligations? If you are a parent or if you plan to keep a full-time job while enrolled, asynchronous online learning might provide a good fit. Asynchronous course delivery eliminates scheduled class sessions, allowing you to complete assignments on your schedule so you can better manage your commitments.
• What’s your budget? Online learning is often more affordable than on-campus learning. Distance learners generally avoid campus-related costs like housing and transportation. Moreover, some public universities—which typically charge higher rates to out-of-state learners —allow online students to pay in-state or otherwise discounted tuition rates , regardless of their state residency status.
• What’s your learning style? While online learning offers flexibility and affordability, it is not for everyone. Distance learners need a great deal of discipline, organization and time management skills. If you need additional structure to do your best, you might prefer a synchronous, hybrid or on-campus program.

There are two important types of college accreditation : institutional and programmatic.

The U.S. Department of Education (ED) and Council for Higher Education Accreditation (CHEA) oversee the third-party agencies that handle the institutional accreditation process. Accrediting agencies evaluate schools for the quality of their academics, finances and faculty, among other areas. You must be enrolled at an institutionally accredited college to qualify for federal student aid.

To check a school’s accreditation status, you can look at its website or visit the database on CHEA’s website .

Programmatic accreditation provides a similar vetting service, but for specific degree programs and departments. The importance of programmatic accreditation varies by field, but it is fairly relevant in business.

For management programs, you should keep an eye out for accreditation from one of three organizations:

• The Accreditation Council for Business Schools and Programs
• The Association to Advance Collegiate Schools of Business
• The International Accreditation Council for Business Education

AACSB is not recognized by the ED or CHEA, but it is still widely respected in the business field and among the best-known business degree accreditors.

Consider Your Future Goals

An online Ph.D. in management can lead to high-level positions in academia or research. You may also be able to find work as an economist or a consultant.

In general, advanced business these positions involve analysis, research and scholarship. If you want to work as a C-level executive or entrepreneur, you might be better off getting an M.B.A. degree in your preferred business subfield. M.B.A. programs focus more on applied, practical business skills as opposed to theory.

If you know you want to work in research or academia, you should choose a Ph.D. in management that requires a dissertation. A dissertation will give you a chance to try out research and scholarship and perhaps even contribute to the field by publishing your findings in a journal. This work can help you land a job as a professor or researcher once you graduate.

Understand Your Expenses and Financing Options

Per-credit tuition rates for the 10 qualifying Ph.D. programs in our guide range from $450 to $1,575. Over the course of a typical 60-credit Ph.D. program, this translates to between $27,000 and $94,500 in total tuition. That’s no small investment.

To defray the cost of your graduate education, you should first fill out the Free Application for Federal Student Aid. The FAFSA is the gateway to federal student aid opportunities like loans, grants and scholarships. Universities and other aid providers may also use FAFSA data to determine their awards. Additionally, you can pursue financial aid through private lenders and third-party organizations.

What does a Ph.D. in management do?

A Ph.D. in management prepares graduates for careers in research, scholarship and academia. To that end, most management Ph.D. programs include a course in research methods and require students to complete a dissertation before they graduate.

How long is a Ph.D. in management?

Our top-ranked Ph.D. in management programs take between three and five years to finish, but completion times vary depending on program requirements and student enrollment status.

Which Ph.D. is best after an M.B.A.?

The best Ph.D. for an M.B.A. holder depends on their individual goals and circumstances. A Ph.D. in management generally builds on the managerial and business skills gained through an M.B.A. program.

Is a Ph.D. in management worth it?

The value of a Ph.D. in management depends on your career goals. This degree is a good fit for students who want to become business professors , researchers and consultants. If you want to become an executive or entrepreneur, an M.B.A. program is likely a better fit.

Mikeie Reiland is a writer who has written features for Oxford American, Bitter Southerner, Gravy, and SB Nation, among other publications. He received a James Beard nomination for a feature he wrote in 2023.