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Nurse researchers are increasingly combining qualitative and quantitative methods in order to understand more fully the world of research subjects. Qualitative data are often used to explore the subjective meanings behind survey responses and to develop quantitative measures and scales. Insights from qualitative data help researchers to design instruments which are more sensitive to respondents' meanings and interpretations. The aim of this paper is to highlight the epistemological and methodological complexities involved in this enterprise through drawing on our own experience of developing an instrument to examine person-centredness in health care from a qualitative study of dissatisfaction. The intricacies of this project relate to: epistemological continuity and inconsistency; research roles; reflexivity; confirmation; and completeness. Through discussing the literature around integrating methods, we suggest that researchers could be assisted in their attempts to develop conceptually sound quantitative measures by extending the concept of reflexivity (used in qualitative research) to the quantitative components of mixed method studies. This would aid conceptual clarity by making explicit the social, cultural, and political construction of knowledge, and would also encourage researchers to reflect upon the ethical and political consequences of their research.

Studies of patient satisfaction are regarded by many as the most important way to obtain patients′ views. To date, relatively few studies have focussed specifically on dissatisfaction. Concerns have been expressed about the validity of the concept of satisfaction. Dissatisfaction, however, has received little attention since it has been assumed to be the opposite of satisfaction and thus already defined. Therefore, a series of assumptions have also been made about dissatisfaction, which may or may not compromise its validity or usefulness. The aim of this review is to clarify the concept of dissatisfaction by examining what studies of patient satisfaction can and cannot tell us about dissatisfaction; identifying assumptions; and finally by suggesting how research might best be oriented to accommodate the complexity of patient experiences.

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