第6节 讨论
质性研究论文的讨论部分主要包含两部分内容。首先，对本研究的结果和意义进行概括性总结。研究者应对本研究的结果呈现了什么样的社会、文化或实践问题/情境/现象进行陈述，展现出whole picture of the issue/situation/phenomenon以及这些问题/情境/现象可能的原因、过程和影响因素；阐释本研究结果与既往类似研究或理论的联系；说明本研究对于相关研究领域的贡献。其次，要与前言部分呼应，再次强调本研究的意义。当然，在讨论的最后，还需要给出结论。
如示例4-24所示，作者用“The results of our study highlighted the importance of...”，“The results described...”等引出本研究的意义与结果。
示例4-24 讨论部分引出主要研究结果及意义
The results of our study highlighted the importance of taking the whole person into consideration by focusing on patients'overall life situations and integrating the social，mental and physical aspects of their lives to understand their experience of CRF.The results described how oncology nurses were able to achieve a personal relationship of understanding to support the men with CRF.
讨论中，需要将本研究结果与既往研究进行对比和分析。这些对比与分析可以是与本研究结果一致的、不同的或有分歧的。如示例4-25所示，研究者引用既往结果对本研究结果进行支持并分析可能出现此结果的原因。
示例4-25 与既往研究的对比和分析
The oncology nurses in this study noted that men with CRF generally avoid talking about their experiences with the condition.Research（24）has shown that cancer patients often experience CRF as a new sensation and therefore have difficulty finding the words to describe it.Studies（25，26）have demonstrated that fatigue is often an unexpressed symptom and that there is a belief among patients that fatigue has to be managed alone because other people do not want to hear about or understand their condition.
这一部分，还需要对研究的特色（strengths）及局限性和不足之处（limitations）进行讨论。如示例4-26所示，作者分析了研究的特色，包括：①样本量充足：足够大的样本量以确保研究能进行深入分析；②多种数据收集方法以获得丰富的数据：应用半结构式问卷来补充收集资料，丰富质性访谈中相关重要信息。此外，作者还列举了研究的局限性，如样本纳入时未严格遵循纳入标准、结果的外延性不强。需要注意的是，尽管作者列出了研究的局限性，针对每个不足之处，作者均给予了一定的解释（“the rich experience”，“can be transferred to similar situations”）。通过此种方式，说明这些局限性瑕不掩瑜，研究依然具有科学性。
示例4-26 研究的特色及局限性(https://www.daowen.com)
Study strengths and limitations
This study sought to describe oncology nurses'experiences of meeting with men with cancer and talking about CRF.Nine oncology nurses were recruited using a purposeful sampling method and subsequently participated in the present study.This number was considered sufficient to maintain depth in the analysis and offered an excellent opportunity to study the various experiences of oncology nurses.The sample size in qualitative research should be large enough to achieve variations in experiences yet small enough to permit a deep analysis of the data（32）.A further strength of this study was the rich data collected using questions that followed a semistructured interview guide.The shortest interview lasted 30 minutes but was substantial as it contributed and complemented the other interviews with important data.
The study also had limitations.For example，one of the participants had worked as an oncology nurse for a shorter period than stipulated in the inclusion criteria，which required participants to have had at least three years'experience as an oncology nurse in municipal health care.This participant was motivated for their participation based on the rich experience of meeting with men with CRF.Finally，the results of this study cannot be generalised，but they can be transferred to similar situations（13）.
此部分，亦可讨论研究对护理实践、研究、教育、管理等领域的建议与启示（implications），如示例4-27所示。当然，根据期刊不同，这些内容也可放在结论部分。
示例4-27 本研究对未来实践的启示
This observation indicates the importance of making experiences of cancer-related fatigue visible.Oncology nurses therefore have a responsibility to ask about cancer-related fatigue and to make the men in their care aware of the symptom.Increased patient knowledge of this condition can support oncology nurses as they attempt to facilitate individual fatigue management among men.
与量性研究论文类似，质性研究论文的最后，也需要给出相应的总结。该总结是对研究核心内容的高度凝练（包括内容和结果）。如示例4-28所示，该总结中，作者再次回到研究目的，简述了研究内容，并对结果中得出的主题进行汇总。此外，作者还在这里提到了本研究对未来实践和研究的启示。
示例4-28 总结举例
Based on the perspectives of people living with dementia，their informal caregivers and healthcare professionals，we can conclude that to empower a person living with dementia，it is important that they have a sense of personal identity，can make their own choices，that their capabilities are addressed，and that they can experience a sense of worth.The four themes of empowerment seem to be important both at home and in nursing homes，and in different stages of dementia.However，support must be adjusted to the personal situation and individual capabilities，and，therefore，practical detailing of support differs.Our empowerment framework provides a basis for developing interventions to empower people living with dementia and to support（in）formal caregivers in this empowerment process.