1. Judge, Deborah DNP, RN
  2. Opsahl, Angela DNP, RN, CPHQ
  3. Hensel, Desiree PhD, RN, PCNS-BC, CNE

Article Content

There is a growing professional emphasis on providing patient-centered care, but teaching patient-centered research methods to undergraduate students is far from routine.


Q methodology, or Q for short, is a philosophical framework and set of techniques for conducting research focused on individuals' preferences.1-3 Exposing nursing students to Q methodology provides an opportunity to explore subjective attitudes and points of view on virtually any topic that could be socially contested or debated.4 Unlike traditional quantitative research methods, participant profiles are correlated to each other to discover groups with common viewpoints.2,3 The most significant advantage of Q methodology is related to the method of combining qualitative and quantitative data so that a theme emerges from the data rather than resulting from the researcher's perspective.3,5 Q methodology has been more recently used in the medical education realm to understand student perspectives in research studies.6 Innovative methods to increase student engagement when introducing nursing research materials are necessary to support future use of evidence-based practice (EBP).7 The purpose of this teaching brief is to illustrate incorporation of mixed-methods research through Q methodology to promote student engagement and enhance learning within a prelicensure EBP course.


Implementation and Outcomes

In nursing, researchers seek to explore patient perspectives and attitudes. Awareness of how improving patient outcomes can be related to the nurses' positive attitude toward research and EBP is an area lacking in nursing education.8 Classroom activities that engage the learner and stimulate deeper thinking can promote enhanced understanding of EBP.8 Nurse educators should consider student learners' needs and identify which teaching strategies will produce optimal outcomes in the classroom. Meeting the learners' needs requires dedication from the faculty to remain current in best practice. Generation Z students are now entering universities where most undergraduate students are part of the millennial generation.9 It is important to understand similarities and differences to cultivate pedagogy supportive of learning needs in all generations. Understanding the differences, engaging students with adaptive learning activities, and implementing technology are ways to prevent generational conflicts and engage learners in the classroom.


To increase students' awareness of nontraditional, patient-centered research methods, 35 students in a traditional BSN program participated in a 2.5-hour interactive session using Q methodology. After a brief overview of the history of Q methodology, students engaged in creating a mock Q study on their opinions about substance abuse education in primary and secondary schools. To illustrate differences between the traditional quantitative and Q methodology approaches, students first completed a Likert scale rating of 16 opinion statements about substance abuse education.


The opinion statements were then presented to the students as a Q sort. Each statement was printed individually on a numbered card. Students sorted the statements first in 3 piles: statements they agreed with, statements they disagreed with, and statements they felt neutral about. Students expressed their preferences as they rank-ordered from high (+4) to low (-4) their level of agreement with each statement on a force distribution sorting sheet. Neutral items filled open spaces. Students began the process of individual data entry into a free online Q methodology program. Although the instructor had hoped to lead the class through the beginning steps of online data analysis, technical difficulties prevented continuing this aspect of the mock study. Instead, the instructor briefly provided an overview of the data analysis process through a PowerPoint presentation.



The students in the class were predominantly female (n = 32; male, n = 3). Their age ranges were 18 to 20 years (n = 4), 21 to 25 years (n = 30), and 31 to 35 years (n = 1). The primary class outcome was that all students experienced the characteristic Q methodology data collection process by completing a Q sort and entering data on a sorting sheet.


At the conclusion of the class, students provided anonymous written responses about their overall opinions of Q methodology, the class format, how they might use Q in their future career, and any other comments that they would like to share. Analysis of the anonymous comments returned by all 35 students revealed a wide range of overall opinions about Q methodology. Some students expressed favorable views that using Q methodology simplified the research process and was a good way to find opinions and conduct patient-centered research. Building the spirit of inquiry is a universal outcome of nursing education.10 Evidence that this class had helped build that spirit was found in comments relating to how students perceived that they might use Q methodology in their future career including to understand the patient's perspective, to understand nurses' opinions about workplace problems, and for quality improvement efforts. Other students believed that the method was confusing, was too complex for beginners, and would not be something that they ever used in the future. The hands-on class format and engagement in the mock study were viewed positively by many students. Having too much to learn in 1 session, believing that having previous knowledge about Q methodology would have improved the learning experience, and technical issues were areas most often cited as areas for class improvement.


Lessons Learned

The most noted criticism from students was lack of preassignment to prepare them for the in-class activity. Having students read an overview article on Q methodology before any future sessions would be essential. The second issue was related to Internet connectivity. For future plans, we will be sure to have an information technology person available to assist with technology during the activity. Written comments served as the primary mechanism for evaluating the class. The team determined that one of the most important outcomes from the class should have been the ability to understand a Q methodology journal article, but this outcome was not measured. Having students locate a Q study in a database and summarize the findings would have provided an objective way to evaluate student learning.



Nurse educators need to instill the spirit of inquiry among students and create greater linkages between education and practice.10,11 It can be challenging to implement teaching strategies that promote student engagement and enhance learning when teaching research and EBP to prelicensure nursing students. Although numerous studies have established improvements to use of EBP and research with training in other disciplines, we lack outcomes to nursing education.12


Performing a mock Q methodology study provides an innovative approach to teaching patient-centered research methods in pursuit of delivering EBP. There are potential benefits to introducing Q methodology to nursing students. Introducing the steps of a Q methodology in research courses within an undergraduate nursing program is the first step to generating nurses who may appreciate and understand the importance of a variety of research methods to support EBP in nursing.




1. Hensel D. Q methodology: an alternative design for undergraduate nursing honors research. J Nurs Educ. 2016;55(11):659-662. [Context Link]


2. McKeown B, Thomas DB. Q Methodology: Quantitative Applications in the Social Sciences Series. Vol. 66. 2nd ed. Thousand Oaks, CA: Sage; 2013. [Context Link]


3. Simons J. An introduction to Q methodology. Nurse Res. 2013;20(3):28-32. [Context Link]


4. Akhtar-Danesh N. A comparison between major factor extraction and factor rotation techniques in Q-methodology. OJAppS. 2017;7(4):147-156. [Context Link]


5. Killam L, Timmermans KE, Raymond JM. The barriers to and benefits of conducting Q-sorts in the classroom. Nurse Res. 2013;21(2):24-29. [Context Link]


6. Berkhout JJ, Teunissen PW, Helmich E, et al. Patterns in clinical students' self-regulated learning behavior: a Q-methodology study. Adv Health Sci Educ. 2017;22(1):105-121. [Context Link]


7. Phillips RM. Creative classroom strategies for teaching nursing research. Nurse Educ. 2014;39(4):199-201. [Context Link]


8. Henoch I, Ung EJ, Ozanne A, et al. Nursing students experiences of involvement in clinical research: an exploratory study. Nurse Educ Pract. 2014;14(2):188-194. [Context Link]


9. Shatto B, Erwin K. Teaching millennials and generation Z: bridging the generational divide. Creat Nurs. 2017;23(1):24-28. [Context Link]


10. National League for Nursing. Outcomes and Competencies for Graduates of Practical/Vocational, Diploma, Baccalaureate, Master's Practice Doctorate, and Research Doctorate Programs in Nursing. New York, NY: National League for Nursing; 2012. [Context Link]


11. National League for Nursing. The NLN vision for transforming research in nursing education. Nurs Educ Perspect. 2013;34(1):65-66. [Context Link]


12. PCORI. Patient-centered outcomes research institute: about us. 2017. Available at Accessed May 6, 2017. [Context Link]