INTRODUCTION:

Psychiatric nursing or mental health nursing is the specialty of nursing that cares not only people with mental illness or mental distress, but also aims at improving the well being of general population with preventive and promotive health services. Nurses in this area has to elicit challenging behavior with an emphasis on the development of a therapeutic relationship or alliance.^[2] Psychiatric nurses deals with thoughts, subjective feeling and perceived problems and emotions which are not visible, tangible and cannot be measured in its all dimensions by a simple numerical tests. It is generally agreed that quantitative research methodology is not sufficient for researches based on psychiatric Nursing.

Multi methodology or mixed methods research:

Mixed methods research is a research design with philosophical assumptions as well as methods of inquiry. As a methodology, it involves philosophical assumptions that guide the direction of the collection and analysis of data and the mixture of qualitative and quantitative approaches in many phases in the research process. As a method, it focuses on collecting, analyzing, and mixing both quantitative and qualitative data in a single study or series of studies. Its central premise is that the use of quantitative and qualitative approaches in combination provides a better understanding of research problems than either approach alone.

Prevalence of Multi-method studies:

Due to the expertise needed and time required mixed studies are very rarely conducted and published. Review shows that all the journals are dominated by quantitative articles (65.3%- 43%) whereas qualitative studies (34.9%).

Mixed methods articles are the last group of importance in the journals² 2% prevalence rate found in counseling journals (Leech and Onwuegbuzie,2006), and the 5% found in various research journals that publish stress and coping research (Onwuegbuzie, Jiao, and Collins, 2007), Powell, Mihalas, Onwuegbuzie, Suldo, and Daley (2008) found a prevalence rate of 13.7% in the four leading school psychology journals; Niglas (2004) found a prevalence rate of 12.5%in 15 education journals in 3 years; and Collins, Onwuegbuzie, and Sutton (2007) found that mixed methods research represented 11.5% of articles published in special education journals over a 6-year period^3.

Methods used in Multi methodology:

Multi methodology or mixed methods research is an approach to professional research that combines the collection and analysis of quantitative and qualitative data. Mixed method studies attempt to bring together methods from different paradigms. This kind of integration, of qualitative with quantitative methods is also referred to as multi-strategy research. Therefore it is benefited with the advantages of both quantitative and qualitative designs.

Quantitative method includes numerical values and measurement which help researchers to describe and determine some patterns, such as human's social patterns, using deductive logic. Quantitative research designs are either descriptive (subjects usually measured once) or experimental (subjects measured before and after a treatment). A descriptive study establishes only associations between variables. An experiment establishes causality. These quantitative research designs usually are highly objective, and provide a springboard for generalizations arrived at through deduction of statistics and numeric responses. This design also help in the computation of the magnitude of the elements in a qualitative design. The results are expressed in numbers, usually with physical units.

Qualitative method deals with interpretation and exploration which guide researchers to understand and explain events and occurrences, such as humans' phenomenon from the social patterns. Qualitative research focuses on words instead of numbers on understanding and giving meaning to a phenomenon or an event. According to Benoliel (1984) Qualitative Research is defined as modes of systematic inquiry concerned with understanding human beings and nature of their transactions with themselves and with their surroundings. Leininger defined it as a systematic, subjective approach used to describe life experiences and give them meaning.³ This design help in Hypothesis generation, Illustrating meaning of description or relationships, Understanding relationships and causal processes, Theory development, Constructivist research and to determine the patient needs, preferences and motives and to describe the acceptability of an intervention.

The combination of the two methods is a foundation for developing mixed methods research which has been called as an "evolution of research methodology" (Creswell and Garrett, 2008). This combination will allow the integration of data collection and analysis techniques of both quantitative and qualitative methods in either parallel or sequential stages (Creswell, 2003; Tashakkori andTeddlie, 2003).

Multiple approaches can capitalize on the strengths of each approach and offset their different weaknesses. It could also provide more comprehensive answers to research questions going beyond the limitations of a single approach especially to which are complex and cannot easily be answered using a single method. In a mixed method study, conduct a series of semi-structured interviews with a small number of students and also carry out a large-scale survey. Mixed designs allow the integration of data collection and analysis techniques of both quantitative and qualitative methods in either parallel or sequential stages (Creswell, 2003; Tashakkori andTeddlie, 2003).

The use of multiple strategies to enhance construct validity (a form of methodological triangulation) is now routinely advocated by most methodologists. It is now considered a common feature of all good research.

Types of research approaches:

In a single approach design (SAD) only one analytic interest is pursued. In a mixed approach design (MAD) two or more analytic interests are pursued. A mixed approach design may include entirely “quantitative” approaches such as combining a survey and an experiment; or entirely “qualitative” approaches such as combining an ethnographic and a phenomenological inquiry¹.

Multi-method designs are generally intended to supplement one information source with another, or ‘triangulate’ on an issue by using different data sources to approach a research problem from different points of view. There are two types:

a. Multi-method quantitative studies stay within a quantitative paradigm but use more than one method of data collection. For example use of a survey mailed and the data collected from the same students from other sources like student record data. This kind of research design helps to crosscheck.

b. Multi-method qualitative methods might combine student interviews, observations made of email discussions and staff interviews. Again the key design idea is to cross-check between sources and to supplement one kind of data with another.

Mixed methods designs are conceptually more complex. They may provide a basis for triangulation but, more often, they become the source of different ways of conceptualizing the problem. They might set out to look at the same things from different points of view, but it often turns out that the view point implies such different ways of seeing that the lines of sight do not converge.

i. Mixed method studies might include a survey followed up by detailed individual interviews overall inquiry purpose – whether the aim is to confirm hypotheses or whether it is more exploratory

ii. ‘Mixed model studies’ It focuses on the possible relationship between two or more variables.

A mixed method study that involves the use of a questionnaire and case studies is likely to be very different if the case studies precede the survey, compared to a study in which they follow it.

Merits:

Mixed methods research helps answer questions that cannot be answered by qualitative or quantitative approaches alone not only more natural, it is also more persuasive than either words or numbers by themselves in presenting a complete picture of the devastation. If we use several different methods to investigate the phenomenon of interest, and the results provide mutual confirmation, we can be more confident that our results are valid (Niglas, 2004)². Teddlie and Tashakkori (2003, 2009) identified that mixed methods research can answer research questions that the other methodologies cannot, mixed methods research provides better inferences, and mixed methods provide the opportunity for presenting a greater diversity of divergent views. Greene et al. (1989) identified four additional purposes along with triangulation: complementarities (seeking elaboration, illustration, enhancement, and clarification of the results from one method with the findings from the other method), development (when the researcher uses the results from one method to help develop or inform the use of the other.

Collins, Onwuegbuzie, and Sutton (2006) suggested that Mixed methods research can add insights and understanding that might be missed when only a single method is used, and it may produce more complete knowledge necessary to inform theory and practice (Johnson and Onwuegbuzie, 2004). Mixed methods studies can access knowledge or insights unavailable to a qualitative study and a quantitative study undertaken independently (O’Cathain et al., 2007).

Criticisms:

Creswell and Plano Clark (2007) pointed out that conducting mixed methods research is not easy. Mixed methods studies are a challenge because they are perceived as requiring more work and financial resources, and they take more time. Increased time demands arise from the time it takes to implement both aspects of the study (Niglas, 2004). In addition, mixed methods research also requires that researchers develop a broader set of skills that span both the quantitative and the qualitative (Creswell, Tashakkori, Jensen, and Shapley, 2003; Tashakkori and Teddlie, 2003b). Another barrier is related to the challenges of publishing mixed methods studies (Bryman,2007; Plano Clark, 2005). The challenges generally arise from existing constraints such as page limits in journals².

Using mixed methods requires researchers to have a range of skills, either as individuals or across a team of researchers. Qualitative research is seen as deficient because of the personal interpretations made by the researcher, the ensuing bias created by this, and the difficulty in generalizing findings to a large group because of the limited number of participants studied.

Implications in Nursing:

Psychiatric Nursing which is based on therapeutic Nurse patient relationship aims at the modification of behavior. The result of this modification need to be measured in all its dimensions. In nursing education also future nurses need to acquire some qualities more than being master in knowledge and skill. So in all areas of research in the fields of Psychiatric Nursing multi method research plays an important role.

REFERENCES:

1. Creswell, Understanding mixed research. www.google.com. Cited on 24.12.10

2. Wilkin P (2003). Barker, P (ed) (2003). Psychiatric and Mental Health Nursing: The craft of caring. London: Arnold. pp. 26–33. ISBN 978-0-340-81026-2.

3. Brannen, J. (2005). Mixing methods: The entry of qualitative and quantitative approaches into the research process. International Journal of Social Research Methodology, 8, 173-184.

4. Bryman, A. (2006). Integrating quantitative and qualitative research: How is it done? QualitativeResearch,6, 97-113.

6. GK Priscilla, HA Elizabeth, Nursing Decision Making in the Pre arrest Period . Clinical Research an international Journal. Vol 19, No1 Feb 2010

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10. Kim YG, Song YH, Park MS .Effect of Cognition oriented Breast Self Examination Intervention aming Korean women and their spouses. PHN Public Health Nursing, A journal of Population baed Nursing, Wiley Black Well, May/ June 2009, Vol 26, No 3, ISSN 0737 – 1209

Received on 19.08.2011 Modified on 12.11.2011

Asian J. Nur. Edu. and Research 1(4): Oct-Dec. 2011; Page 120-122