To integrate the quantitative and qualitative data collected as part of the PEACH (Procalcitonin: Evaluation of Antibiotic use in COVID-19 Hospitalised patients) study, which evaluated whether procalcitonin (PCT) testing should be used to guide antibiotic prescribing and safely reduce antibiotic use among patients admitted to acute UK National Health Service (NHS) hospitals.
Triangulation to integrate quantitative and qualitative data.
Four data sources in 148 NHS hospitals in England and Wales including data from 6089 patients.
A triangulation protocol was used to integrate three quantitative data sources (survey, organisation-level data and patient-level data: data sources 1, 2 and 3) and one qualitative data source (clinician interviews: data source 4) collected as part of the PEACH study. Analysis of data sources initially took place independently, and then, key findings for each data source were added to a matrix. A series of interactive discussion meetings took place with quantitative, qualitative and clinical researchers, together with patient and public involvement (PPI) representatives, to group the key findings and produce seven statements relating to the study objectives. Each statement and the key findings related to that statement were considered alongside an assessment of whether there was agreement, partial agreement, dissonance or silence across all four data sources (convergence coding). The matrix was then interpreted to produce a narrative for each statement.
To explore whether PCT testing safely reduced antibiotic use during the first wave of the COVID-19 pandemic.
Seven statements were produced relating to the PEACH study objective. There was agreement across all four data sources for our first key statement, ‘During the first wave of the pandemic (01/02/2020-30/06/2020), PCT testing reduced antibiotic prescribing’. The second statement was related to this key statement, ‘During the first wave of the pandemic (01/02/2020-30/06/2020), PCT testing safely reduced antibiotic prescribing’. Partial agreement was found between data sources 3 (quantitative patient-level data) and 4 (qualitative clinician interviews). There were no data regarding safety from data sources 1 or 2 (quantitative survey and organisational-level data) to contribute to this statement. For statements three and four, ‘PCT was not used as a central factor influencing antibiotic prescribing’, and ‘PCT testing reduced antibiotic prescribing in the emergency department (ED)/acute medical unit (AMU),’ there was agreement between data source 2 (organisational-level data) and data source 4 (interviews with clinicians). The remaining two data sources (survey and patient-level data) contributed no data on this statement. For statement five, ‘PCT testing reduced antibiotic prescribing in the intensive care unit (ICU)’, there was disagreement between data sources 2 and 3 (organisational-level data and patient-level data) and data source 4 (clinician interviews). Data source 1 (survey) did not provide data on this statement. We therefore assigned dissonance to this statement. For statement six, ‘There were many barriers to implementing PCT testing during the first wave of COVID-19’, there was partial agreement between data source 1 (survey) and data source 4 (clinician interviews) and no data provided by the two remaining data sources (organisational-level data and patient-level data). For statement seven, ‘Local PCT guidelines/protocols were perceived to be valuable’, only data source 4 (clinician interviews) provided data. The clinicians expressed that guidelines were valuable, but as there was no data from the other three data sources, we assigned silence to this statement.
There was agreement between all four data sources on our key finding ‘during the first wave of the pandemic (01/02/2020-30/06/2020), PCT testing reduced antibiotic prescribing’. Data, methodological and investigator triangulation, and a transparent triangulation protocol give validity to this finding.
The aim of this study was to provide insights into how, through exploring goal-setting interventions, a nursing team in geriatric rehabilitation might refine their patient-centred strategies.
The study design was participatory action research (PAR).
Team members and nursing students, under the guidance of a facilitator, performed two PAR cycles. In the first cycle, the action phase consisted of preparing a multidisciplinary team meeting (MTM) with a patient. In the second cycle, based on the evaluation of the first, the participants worked with goals on a whiteboard in the patient's room. The data were collected in The Netherlands between February 2020 and June 2022. The data collection methods included the facilitator's logbook, observations, (group) interviews, charting activities and short surveys. Data analysis was conducted in weekly team sessions. The Guidelines for Best Practices in the Reporting of Participatory Action Research were followed.
In the first PAR cycle, the team learned that preparing an MTM with a patient did not enhance the patient's engagement in achieving their rehabilitation goals, but it was beneficial for the nurses' intermediate role between the patient and the multidisciplinary team. Clarity about responsibilities in the multidisciplinary team was a prerequisite for nurses to take on this role adequately. In the second PAR cycle, it became clear that working with a whiteboard in the patient's room had a positive effect on the patient's engagement in the rehabilitation process, and the nurses gained knowledge about a broader variety of professional rehabilitation domains.
Through PAR, the nursing team learned two lessons: cooperating with patients through MTM preparation and working with whiteboards enhanced their patient-centredness, but patients needed tangible goals to become engaged in their rehabilitation planning.
Prepare the multidisciplinary team meeting with the patient, as discussing rehabilitation goals can indirectly boost motivation by making older patients feel seen and heard, even if they seem unable to fully participate in the conversation. Clarify responsibilities in the multidisciplinary geriatric rehabilitation team. This is a prerequisite for nurses to take on an advocacy role for patients in multidisciplinary team meetings. To enhance patient-centred care, consider working with tangible goals on a whiteboard in the patient's room.
No public and patient involvement.