Johns Hopkins Nursing Evidence-Based Practice Thrid Edition: Model and Guidelines

6 Evidence Appraisal: Research 123

Multiphasic, or multiphase, design is often used for program development and
evaluation (Creswell, 2014). This type of design involves both qualitative and
quantitative methods that are conducted in more than two phases. Data are col-
lected and analyzed in phases, and each subsequent phase is informed by the re-
sults from the prior phase.

Example: Exploratory Sequential Design

Al-Yateem (2013) aimed to develop guidelines to transition young adults from

child to adult cystic fibrosis care. This study used an exploratory sequential design

with two phases: the first, qualitative phase with focus groups of healthcare

providers and the second, quantitative phase with a questionnaire. Findings from

the focus groups yielded five themes and four categories. These findings were

then used to develop the questionnaire that was completed by 171 healthcare

providers and young adults with cystic fibrosis. Results from the survey were

used to validate the guidelines, and 36 relevant and feasible guidelines from six

categories for transitioning care were developed. Al-Yateem concluded that young

adults’ transition to adult cystic fibrosis care is addressed through assessment,

planning, and continuous evaluation of care, provision of information, promotion of

independence, and healthcare provider training.

Example: Multiphasic Design

Sangster-Gormey, Griffith, Schreiber, and Borycki (2015) conducted a multiphase

mixed-methods study to evaluate nurse practitioner (NP) integration in Canada.

The study, conducted over three years, began with Phase 1, a quantitative survey

of NPs. The researchers then added focus groups with NPs and chief nursing

officers during the first year (Phase 2). Phase 2 also included surveys of patients

and NPs’ coworkers, as well as interviews and focus groups with NPs who had

completed the survey in Phase 1. During Phase 3, the survey was administered

to NPs and the results were compared to Phase 1. Researchers also used case

studies of NPs to collect qualitative data during Phase 4. The study concluded

with individual patient interviews to explore the patient perspective of NP care.

This complex study allowed Sangster-Gormey et al. to comprehensively evaluate

the integration of NPs and included perspectives of NPs, other healthcare

professionals, and patients.