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INTRODUCTION

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By words we learn thoughts, and by thoughts we learn life.

—Jean Baptiste Girard

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*Mr. Ketterman's Case

Mr. Ketterman's decision about his advanced directive means that he would not accept any end-of-life care. I would like to understand more about why he and his wife have made this decision, as it is very different from the one I would make. (See Appendix for Mr. Ketterman's health history.)

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As we have discussed, evidence based practice requires that we both know and respect our patients' values as we make collaborative decisions with them about their health care. But, how do we learn about our patients and their values so as to facilitate the practitioner-patient partnership so essential to our practice? We can only do this through effective communication. The theories of communication and social interaction presented by Gordon in Chapter 6 provide us with a framework for this source of evidence for our health care decisions. In Chapter 7, Coulehan and Block presented a skilled method of interviewing patients so that we might uncover their strongly held values. This chapter will explore the components of evidence based practice (EBP) that focus on learning about patient values and preferences. It will also introduce qualitative research methods as a tool to achieve this goal.

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Both our clinical wisdom from years of reflective practice and the research evidence can help us learn how to improve our knowledge of usual and unusual patient perspectives on health and illness. Adhering to the value for respecting our patients is necessary, but it is not sufficient to our goal of building a solid, trusting therapeutic relationship. We must be willing to learn from the evidence about individual and group perspectives on recovery of function after disease or injury. Chapter 15 will introduce guidelines for determining the value of research evidence gained primarily from the traditional positivistic research paradigm; here we introduce an alternative research paradigm, the qualitative paradigm, which is uniquely suited to answering research questions that help us more deeply understand the patient's perspective. We will introduce the qualitative research paradigm first and then look at existing evidence developed with this approach as it relates to making patients true partners in the recovery or promotion of their health.

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THE QUALITATIVE RESEARCH PARADIGM

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Qualitative research paradigms offer a perspective that is different from the more familiar quantitative research designs. Quantitative research is linked to the philosophy of logical positivism, in which events are assumed to be limited to logical and controlled relationships between specific measurable variables. Therefore, the rationale for studying these relationships can be defined in advance, based on hypotheses that guide the methods of data collection. Accordingly, variables can be operationalized and assigned numerical values, independent of any historical, cultural, or social contexts within which the event is observed.1 These assumptions apply well to most physical and many biological ...

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