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Samuelle A Jean Charles

Jul 29 8:15pm

Reply from Samuelle A Jean Charles

                                                               

                Frazier's (2023) study is a well-suited application of mixed-methods design to a DNP-relevant practice problem: secondary traumatic stress (STS) among emergency room nurses. The project combined a quantitative survey strand measuring STS prevalence and a qualitative phenomenological strand exploring nurses' lived experiences of that stress. This design choice was appropriate because the underlying practice problem had both a measurable dimension (how many nurses are affected, and by what factors) and an experiential dimension (how STS affects nurses' work, relationships, and personal lives) that a single-method study could not have captured on its own. The project's findings, that coping style and education level predict STS more than structural job factors, and that STS bleeds into nurses' personal and relational lives, translate into actionable DNP practice implications, namely the need for early STS education, structured debriefing, and proactive stress-management support built into orientation and ongoing employment (Frazier, 2023). As a QI-oriented dissertation, the study's strength lies in generating both generalizable risk indicators and rich contextual understanding, which together provide a stronger evidence base for designing a targeted intervention than either strand alone (Flores et al.,2024).

       Frazier's (2023) practice-focused question centered on understanding both the prevalence of STS among emergency room nurses and the lived experience underlying that prevalence, which naturally called for a mixed-methods design rather than a single-method approach. The quantitative strand answered the "how much and what predicts it" portion of the question by establishing that a large proportion of ER nurses experience mild to severe STS and by identifying education level, avoidant coping, emotion-focused coping, and changes in perceived stress as significant correlates, while ruling out structural variables such as years of experience, trauma level, shift, and employment status. The qualitative strand then answered the "what does it feel like and how do nurses manage it" portion, using phenomenological interviews to surface five impact themes (patient care, workplace relationships, life outside the hospital, personal impact, and residual stress) and three coping themes (positive coping, dysfunctional coping, and debriefing). Because the practice question was explicitly two-part, magnitude/predictors and lived experience, the two strands were not redundant but complementary; the quantitative data identified who is at risk and which factors matter, while the qualitative data explained why those factors matter and how STS manifests in nurses' daily and personal lives (Frazier, 2023). This integration reflects what (Flores et al., 2024) describes as the core rationale for mixed-methods and triangulation designs in nursing research: using multiple data sources to answer different facets of a single clinical question so the combined findings are more complete than either method could produce alone.

           The effectiveness of each methodological component was evident in its contribution to actionable QI insights. The quantitative findings were effective in identifying patterns and risk factors, aligning with recent research indicating that maladaptive coping strongly predicts burnout and STS among nurses (Ratrout & Hamdan-Mansour, 2020). Meanwhile, the qualitative findings were particularly effective in contextualizing these patterns, illustrating how STS permeates nurses’ emotional lives and clinical performance. These narratives highlighted the need for structured debriefing, early STS education, and traumainformed organizational supports, recommendations consistent with contemporary workforce resilience literature (Beck et al., 2022). Overall, the mixedmethods approach enhanced the project’s practice relevance by producing both measurable evidence and rich experiential data that support targeted interventions to reduce STS in emergency nursing.

                                                                                               References

Beck C. T. (2011). Secondary traumatic stress in nurses: a systematic review.  Archives of psychiatric nursing,  25(1), 1–10. https://doi.org/10.1016/j.apnu.2010.05.005

 Flores. S.L. N., Dunbar, G. B., Aquino-Maneja, E. M.,  Squier, V. R., & Failla, K. R. (2024). Quantitative, Qualitative, Mixed Methods, and Triangulation Research Simplified.  The Journal of Continuing Education in Nursing,  55(7), 338–344. https://doi.org/10.3928/00220124-20240328-03

Frazier, M. C. (2023).  Examining the lived experience of secondary traumatic stress in emergency room nurses: A mixed methods study (Publication No. 30816304) [Doctoral dissertation, Saint Louis University]. ProQuest Dissertations and Theses Global.

Ratrout, H. F., & Hamdan-Mansour, A. M. (2020). Secondary traumatic stress among emergency nurses: Prevalence, predictors, and consequences.  International journal of nursing practice,  26(1), e12767. https://doi.org/10.1111/ijn.12767

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Omar El Shater

Jul 29 4:31pm| Last reply Jul 29 8:06pm

Reply from Omar El Shater

Mixed Methods Research in a DNP Quality Improvement Project

   Mixed methods research combines quantitative and qualitative approaches to provide a comprehensive understanding of complex healthcare problems. Quantitative methods determine whether an intervention is effective by measuring objective outcomes, while qualitative methods explore participants' experiences, perceptions, and contextual factors that influence implementation and sustainability. This combination is particularly valuable for Doctor of Nursing Practice (DNP) quality improvement (QI) projects because it allows nurse leaders to evaluate both clinical outcomes and the human factors that affect practice change. One DNP QI project that effectively utilized a mixed methods approach is Rampersad's (2023) study examining compassion fatigue and general health among oncology nurses.

   Rampersad (2023) examined the relationship between compassion fatigue and the general health of oncology nurses and explored nurses' personal experiences of workplace stress and coping strategies. The practice-focused question required both quantitative and qualitative evidence to understand the problem fully. Quantitative data were collected on compassion fatigue, burnout, secondary traumatic stress, and overall health using standardized instruments, allowing the researcher to determine the prevalence and severity of these issues. The qualitative interviews complemented these findings by providing detailed descriptions of nurses' emotional experiences, workplace challenges, organizational support, and coping mechanisms. Together, the quantitative findings identified the magnitude of compassion fatigue, while the qualitative findings explained why nurses experienced these outcomes and identified factors that could guide organizational interventions. This integration strengthened the evidence by connecting measurable outcomes to participants' lived experiences, providing a more comprehensive understanding of the practice problem (Rampersad, 2023; Tenny et al., 2022).

   Both components of the mixed methods design contributed unique strengths to the project. The quantitative component produced objective, measurable evidence that could be statistically analyzed and compared across participants, providing reliable data regarding compassion fatigue and general health. However, numerical findings alone could not explain the underlying causes of nurses' experiences or identify practical strategies for improvement. The qualitative component filled this gap by revealing themes related to emotional exhaustion, organizational culture, workload, peer support, and resilience. These insights generated practical recommendations for leadership interventions, staff support programs, and workplace wellness initiatives that would not have emerged through quantitative analysis alone. Mixed methods research, therefore, enhanced the project's relevance to evidence-based practice by combining statistical rigor with contextual understanding, enabling nurse leaders to design interventions that address both measurable outcomes and the experiences of healthcare professionals. Similar principles can be applied to patient safety initiatives, such as fall prevention, where quantitative studies evaluate intervention effectiveness, while qualitative studies identify barriers and facilitators to successful implementation (Khoja & Moosa, 2023; Tzeng & Yin, 2017).

References

Khoja, A., & Moosa, L. (2023).  Impact of tailored interventions for patient safety (TIPS) to reduce fall ratesLinks to an external site.Links to an external site. .  MEDSURG Nursing, 32(2), 89–93.

Rampersad, M. (2023).  Oncology nurses, compassion fatigue and general health: A mixed-methods studyLinks to an external site. Links to an external site.Links to an external site. . Walden University. https://scholarworks.waldenu.edu/dissertations/11819/ 

Tenny, S., Brannan, J. M., & Brannan, G. D. (2022). Qualitative study.  StatPearls. Retrieved July 29, 2026, from  https://www.ncbi.nlm.nih.gov/books/NBK470395/Links to an external site.

Tzeng, H.-M., & Yin, C.-Y. (2017).  A multihospital survey on effective interventions to prevent hospital falls in adultsLinks to an external site.Links to an external site. .  Nursing Economics, 35(6), 304–313.