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INTRODUCTION
Qualitative approaches to research are
based on a "world view" which is holistic and has the following beliefs:
- There is not a single reality.
- Reality based upon perceptions that are
different for each person and change over time.
- What we know has meaning only within a
given situation or context.
The reasoning process used in qualitative
research involves perceptually putting pieces together to make wholes. From this process
meaning is produced. However, because perception varies with the individual, many
different meanings are possible.
Burns & Grove (1993) The Practice of Nursing Research: Conduct, Critique &
Utilization 2nd Edition
Gestalts
The reasoning process outlined above can
be understood by exploring the formation of gestalts.
Gestalt is a German word, which
translates in to English as either figure or build when applied to a person, or shape or
form when applied to objects (as in gestalt gewinnen which means "to take
shape").
The concept of gestalt is closely related
to the holistic approach and proposes that knowledge about a particular phenomenon be
organized into a cluster of linked ideas, a gestalt.
A theory is a form of gestalt. If we are
trying to understand something new and are offered a theory that explains it our reaction
may be "Now that makes sense’’ or "Oh, I see."
Whatever the new thing was that we were
trying to understand has "gelled" for us.
One disadvantage of this process is that,
once we understand a phenomenon through the interpretation of a particular theory it is
difficult for us to see the phenomenon outside of the meaning given to it by the theory.
Thus in addition to giving meaning, a
theory can actually limit the meaning of a phenomenon.
The purpose of qualitative research is to
form new gestalts and sometimes to generate new theories.
To accomplish this, the researcher has to
"get outside of" any existing theories or gestalts that explain the phenomenon
of interest. The mind must be open to, new gestalts emerging through the abstract thinking
process of the researcher during the personal experiences of the qualitative research
process.
One qualitative researcher Ihde (1977) in
his book Experimental Phenomenology: An Introduction discussed this idea of gestalt
formation in relation to human visual perception.
He found that one of the important
strategies in switching from one view of a drawing to another was to change your focus.
As an example look at the drawing
depicted here.
Most people initially see a cube. This is
their sedimented
view.
Now try focusing on a different point of
the drawing or looking at it as two-dimensional rather than as three-dimensional.
If you concentrate and gaze for a long enough period, you can experience the change in
gestalt.
If you look long enough you may see a reverse of the original cube you saw. You can
imagine that it is a box made out of coloured glass with an opening at the top. Or the
opening can be to one side or the other. Alternatively, you could see it as a peculiarly
cut gemstone or a strange insect trapped in a hexagonal shaped box. Or you may just
perceive it as a bunch of lines with some coloured shading.
Now try looking at a second
drawing. Are you able to see more possibilities this time?
Ihde points out that a new reconstruction
tends to be considered odd at first and unnatural, but attains stability and naturalness
after a while.
The same can be true when we change our
ideas about nursing practice.
Changing Gestalts in Nursing Practice
Nursing has a strong traditional base.
With this tradition comes an historical view of such phenomena as patients, illness,
health, and nursing care and its effects. We are introduced to these so called sedimented
views very early in our nursing experiences.
By the term
sedimented, we mean a long held belief that has become unshakeable although it may be
mistaken.
Now, we are beginning to question many of
these long held ideas, and the insights gained are changing nursing practice.
For example for many years nurses
perceived the patient as being passive, dependent, and unable to take responsibility for
his or her care.
This view was heavily influenced by the
work done by Talcott Parsons in the 1950's through which he developed his theory of the
sick role.
Parson's view was that the person who was
sick had a responsibility to passively comply with doctors and nurses in order to become
well again.
Now, patients are more often perceived as
participating in their care and being responsible for their health.
Ascendance to the open context requires
more than just switching from one sedimented view to another. The nurse functioning within
an open context would be able to view the patient from a variety of perspectives.
Passive and dependent in some ways,
participating with health care givers in other ways, and directing his or her care in some
cases.
Qualitative research provides a process
through which we can examine a phenomenon outside of sedimented views. The earliest and
perhaps most dramatic demonstration of the influence qualitative research can have on
nursing practice was the year study conducted by Glaser and Strauss (1965, 1968, 1971).
They are credited with developing the qualitative approach referred to as grounded theory for
health related topics.
This study was reported in three books
entitled Awareness of Dying, Time for Dying, and Status Passage, which
described the social environment of dying patients in hospitals. At that time, the gestalt
commonly held was that people could not cope with knowing that they were dying. Therefore,
they must be protected from that knowledge. The environment of care was designed to
protect the patient from that knowledge. Glaser and Strauss examined the meanings that
social environment had to the patient.
The study changed our gestalt. Instead of
protecting, we saw the traditional care of the dying as creating loneliness and isolation.
We began to see the patient in a new light, and our care began to change. Kubler-Ross
(1969) perhaps influenced by the work of Glaser and Strauss then began her studies of the
dying using an approach similar to that of phenomenology. From this new orientation of
caring for the dying, hospice care began to develop, and now, nearly 30 years later, the
environment of care for the dying is different.
Can you think of any other shifts in
gestalt in nursing practice?
Scientific discipline or rigour is valued
because it is associated with the worth of research outcomes and studies are critiqued as
a means of judging rigour. Qualitative research methods have been criticized for lack of
rigour. However, these criticisms have occurred because of attempts to judge the rigour of
qualitative studies using rules developed to judge quantitative studies. Rigour needs to
be defined differently for qualitative research since the desired outcome is different
(Burns 1989; Dzurec 1989; Morse 1989; Sandelowski, 1986).
In quantitative
research rigour is reflected in narrowness, conciseness and objectivity and leads to
rigid adherence to research designs and precise statistical analyses. Rigour in
qualitative research is associated with openness, scrupulous adherence to a philosophical
perspective, thoroughness in collecting data, and consideration of all the data in the
development of a theory.
In order to be rigorous in conducting
qualitative research the researcher must ascend to an open context and be willing to
continue to let go of sedimented views.
This process is known to qualitative
researchers as deconstructing.
The researcher will be examining many
dimensions of the area being studied and forming new ideas (reconstructing) while
continuing to recognise that the present. Reconstructing is only one of many possible ways
of organizing data. Lack of rigour in qualitative research can be due to problems such as
inconsistency in adhering to the philosophy of the approach being used, failure to
"get away from" older ideas poorly developed methods. Other problems include
inadequate time spent collecting data, poor observations, failure to give careful
consideration to all the data obtained, and inadequacy of theoretical development.
We will look at the three main approaches
to qualitative research used in nursing research
- Phenomenology
- Grounded theory
- Ethnography
There are some other approaches classed
as qualitative research but they are less frequently encountered in nursing research.
These include Historical Research, Philosophical Research, and Critical Social Theory.
(see Burns & Grove [1993] ) or try linking to this excellent (although a little heavy
in parts!) site devoted to qualitative research.
You will need to either bookmark this
page or use the back button to return to it from the linked pages.
In some ways, the three main approaches
are very different and in others very similar.
However, in each method, the purpose is
to examine meaning. The unit of analysis is words rather than numerical values.
Although the data are gathered using an
open context this does not mean that the interpretation is value free. Each approach is
based on a philosophical orientation that influences the interpretation of the data. Thus,
it is critical to understand the philosophy on which the method is based. Consequently,
each approach is discussed in relation to the philosophical orientation as well as the
research methodology.
Phenomenology
Phenomenology is a 20th-century
philosophical movement dedicated to describing the structures of experience as they
present themselves to consciousness, without recourse to theory, deduction, or assumptions
from other disciplines such as the natural sciences.
Phenomenology is both a philosophy and a
research method. The purpose of phenomenological research is to describe experiences as
they are lived in phenomenological terms (i.e. to capture the "lived experience"
of study participants). The philosophers from which phenomenology emerged include Husserl,
Kierkegaard, Heidegger, Jean Paul Sartre etc.
The positions taken by these pioneers in
phenomenology are very different from those found in nursing today and may be difficult to
understand.
Philosophical Orientation
Phenomenologists view the person as
integral with the environment. The focus of phenomenological research is people's
experience in regard to a phenomenon and how they interpret their experiences.
All phenomenologists agree that there is
not a single reality; each individual has his or her own reality.
This is considered true even of the
researcher’s experience in collecting data and analysing it. " Truth is an
interpretation of some phenomenon; the more shared that interpretation is the more factual
it seems to be, yet it remains temporal and cultural" (Munhall 1989).
There are four aspects of the human
experience, which are of interest to the phenomenological researcher:
- Lived space (spatiality)
- Lived body (corporeality)
- Lived human relationships (relationality)
- Lived time (temporality)
All of these aspects are taken into
consideration we must be aware that people see different realities in different
situations, in the company of different people and at different times. I am sure that
everyone can recognise a "monday morning" feeling and would be aware that the
feelings expressed about one's life in an interview given at this time may be very
different to those given at another time.
Methodology
The broad question that phenomenologists
want answered is "What is the meaning of one’s lived experience?"
The only reliable source of information
to answer this question is the person.
Understanding, human behaviour or
experience requires that the person interpret the action or experience for the researcher,
and then the researcher must interpret the explanation provided by the person.
Developing Research Questions
The first step in conducting a
phenomenological study is to identify the phenomenon to explore. Next, the researcher will
develop research question. Two factors need to be considered in developing the research
question:
- What are the necessary constituents of
this feeling or experience?
- What does the existence of this feeling or
experience indicate concerning the nature of the human being?
Sampling
After developing the research question
the researcher identifies the sources of the phenomenon being studied and from these
sources seeks individuals who are willing to describe their experience(s) with the
phenomenon in question.
These individuals must understand and be
willing to express their inner feelings and describe any physiological experiences that
occur with the feelings.
Data Collection and Analysis
Data are collected through a variety of
means: observation, interactive interviews, videotape and written descriptions by
subjects.
Typically, the data is collected by
in-depth conversations in which the researcher and the subject (informant) are fully
interactive. Analysis begins when the first data are collected. This analysis will guide
decisions related to further data collection. The meanings attached to the data are
expressed within the phenomenological philosophy. The outcome of analysis is a theoretical
statement responding to the research question. The statement is validated by examples of
the data, often direct quotes from the subjects.
More information on phenomenology is
available at the following sites:
This is the phenomenology page.
The Center for Advanced Research in
Phenomenology
Grounded theory
Grounded theory is an inductive technique
developed for health-related topics by Glaser and Strauss (1967). It emerged from the
discipline of sociology. The term grounded means that the theory developed from the
research is "grounded" or has its roots in the data from which it was derived.
Philosophical Orientation
Grounded theory is based on symbolic
interaction theory. This theory holds many views in common with phenomenology.
George Herbert Mead (1934), a social
psychologist was a leader in the development of this theory. The theory of symbolic
interactionism is not a topic for full discussion here but is explored more fully in the
Sociology Theme of the course.
Briefly, though symbolic interactionism
explores how people define reality and how their beliefs are related to their actions.
Reality is created by people through attaching meaning to situations. Meaning is expressed
by symbols such as words, religious objects, and clothing. These symbolic meanings are the
basis for actions and interactions. Unfortunately, symbolic meanings are different for
each individual. Symbolic meanings may be shared by groups such as football supporters
etc.
These shared meanings are then
transferred to new members by socialisation.
Within nursing grounded theory has been
used most often in studying areas where there has been little previous research and in
gaining new insight into previously researched areas. Hence, it becomes an inductive
method of gaining knowledge.
Methodology
The steps of grounded theory research
occur simultaneously. The researcher will be observing, collecting data, organizing data,
and forming theory from the data at the same time. An important methodological technique
in grounded theory research is the constant comparative process in which every piece of
data is compared with every other piece.
Data Collection and Analysis
Techniques
Data may be collected by interview,
observation, records, or a combination of these. Typically grounded theory research
projects in nursing tend to have a sample of 25 - 50 people and are conducted by in depth
interview.
Data collection usually results in large
amounts of hand-written notes, typed interview transcripts, or video/audio taped
conversations that contain multiple pieces of data to be sorted and analysed. This process
is initiated by coding and categorising the data.
Outcomes
The outcome is a theory explaining the
phenomenon under study. The research report presents the theory supported by examples from
the data. The literature review and numerical results are not used in the report. The
report tends to be narrative discussions of the study process and findings.
The majority of qualitative nursing
studies that claim a theoretical background are based in grounded theory research.
Clements, Copeland, and Loftus (1990)
carried out a grounded theory study which looked at how parents coped with difficult times
when caring for a chronically ill child. They conducted audiotaped interviews of 30
families who used their clinic. The following is a brief statement of theory that came
from their research.
"The family of a chronically ill
child develops specific ways of coping in an attempt to meet the needs of all its members.
If support is available, equilibrium is achieved. If needs increase dramatically or
support changes there is a lack of equilibrium"
Ethnography
Ethnography focuses on the culture of a
group of people.
Ethnographic researchers can study
broadly defined cultures (e.g., The British, The English, Londoners etc.) in what is
sometimes referred to as a macro-ethnography.
Alternatively it may focus on more
narrowly defined ones (e.g., the culture of hostels for the homeless, nursing practices in
Intensive Care Units) referred to as micro-ethnography.
An underlying assumption of the
ethnographer is that every human group eventually evolves a culture that guides the
members view of the world and the way they structure their experiences.
The aim of the ethnographer is to learn
from (rather than to study) members of a cultural group -- to understand their world view
as they define it. Ethnographic researchers sometimes refer to emic and etic perspectives.
An emic perspective refers to the way the
members of the culture envision their world--it is the insiders view.
The etic perspective, by contrast, is the
outsiders interpretation of the experiences of that culture.
Ethnographers strive to acquire an emic
perspective of a culture under study. Moreover, they strive to reveal what has been
referred to as tacit knowledge. Information about the culture that is so deeply embedded
in cultural experiences that members do not talk about it or may not even be consciously
aware of it.
Ethnographers almost invariably undertake
extensive fieldwork to learn about the cultural group in which they are interested.
Ethnographic research is typically a labour-intensive endeavour that requires long periods
of time in the field months and even years of fieldwork may be required. In most cases,
the researcher strives to actively participate in cultural events and activities. The
study of a culture requires a certain level of intimacy with members of the cultural
group, and such intimacy can only be developed over time and by working directly with
those members as an active participant. The concept of researcher as instrument is
frequently used by anthropologists to describe the significant role the ethnographer plays
in analysing and interpreting a culture.
Methodology
As previously mentioned there are two
basic research approaches in anthropology, emic and etic. The emic approach to research
involves studying behaviour from within the culture. The etic approach involves studying
behaviour from outside the culture and examining similarities and differences across
cultures. The steps of ethnographic research include the following:
(1) Identification of the culture to be
studied,
(2) Identifying the significant variables
within the culture,
(3) Literature review,
(4) Gaining entrance,
(5) Cultural immersion,
(6) Acquiring informants,
(7) Gathering data,
(8) Analysis of data,
(9) Description of the culture
(10) Theory development
Data Collection and Analysis
Data collection involves primarily
observation and interview. The researcher may become a participant / observer in the
culture during the course of the study. Analysis involves identifying the meanings
attributed to objects and events by members of the culture. These meanings are often
validated by members of the culture before finalising the results.
Nursing Knowledge and Ethnography
Madeleine Leininger and her colleagues
have developed an ethnographical strategy for nursing research.
This research strategy is ethno-nursing
research, which emerged from Leininger’s theory of trans-cultural nursing.
Ethno-nursing "focuses mainly on
observing and documenting interactions with people of how their daily life conditions and
patterns are influencing human care, health, and nursing practices" (Leininger, 1985,
p. 238).
Munet-Vilero (1988) identifies three
problems related to the use of ethnographic methodology by nurses.
First, nurse researchers may not be
sufficiently familiar with the cultural mores of the people being studied or their
language.
Second, studies sometimes use measures
that are assumed, inaccurately, to be equivalent across cultures.
Third, interpretation of findings may be
inadequate due to the limited knowledge of the culture being studied.
Action Research
Action Research is neither quantitative
nor qualitative research. It has been argued that it is more of a tool for change than
true research. However it has often been used by nurses and it is appropriate that we look
at the method here.
Action Research "is a way of doing
research and working on solving a problem at the same time" (Cormack 1991 p155)
The method was developed to allow
researcher and participants work together to analyse social systems with a view to
changing them. In other words, to achieve specific goals.
It is seen as a community based method
and has frequently been employed in a wide range of settings: from hospitals and health
clinics to clubs, factories and schools.
The method has been used by teachers,
nurses, social workers, doctors, community workers, police officers etc. in order to
analyse problems in service delivery and ultimately to improve the service provided.
Examples include analysis of people's
health problems in a particular area by health professionals with the aim of producing
appropriate treatment and health promotion programmes.
The approach may include doing some base
line measures using questionnaires, observation or other research methods as an assessment
of the problem Objectives are then set and decisions made about how to bring about a
change. Whilst change plans are put into action progress is monitored, changing the plans
as necessary / appropriate. Once the change has been implemented a final assessment is
made and conclusions drawn, possibly accompanied by the writing of a report on the project
for those involved or for dissemination to others.
Therefore, action research " is a
process containing both investigation and the use of its findings" (Smith 1986 cited
by Cormack 1991 p 155)
The role of the researcher is to assist
practitioners to take control of and change their own work.
Hart and Bond (1995) in Action
Research for Health and Social Care: A Guide to Practice selected seven criteria which
they felt distinguished action research from other types of research.
Action Research:
- Has an educational function.
- Deals with individuals as members of
social groups.
- Is problem focused, context specific and
future orientated.
- Involves a change intervention.
- Aims at improvement and involvement.
- Involves a cyclic process in which
research, action, and evaluation are interlinked.
- Is found in a research relationship where
those involved are participants in the change process.
The phrase Look, Think, Act has been used
by Stringer (1996) in the book Action Research: A Handbook for Practitioners.
As stated above Action Research is
neither quantitative nor qualitative research but it may use techniques that are involved
in either or both of these approaches.
However, no matter what technique, or combination of techniques, is used the actual
process runs as follows.
- Identification of the problem
- Discussion and negotiation between
researcher and practitioners
- Literature Review
- Re-definition of the problem
- Selection of the research and evaluation
methods
- Implementation of change, data collection
and feedback. This often involves revisiting earlier steps in a cyclical process of
research and change
- There may be an overall review of the
study, recommendations and dissemination to a wider audience
This last stage does not always occur and
the results of the research may remain at a local level.
The cyclical nature of the process can be
represented diagrammatically as below.
Summary
To summarise, qualitative research:
- Uses words rather than numbers.
- Flows from concreteness to abstractness.
- Compared to quantitative research is
relatively new. Thus, new techniques and strategies are emerging.
- Data collection occurs concurrently with
data analysis.
- Involves the researcher influencing the
individuals being studied to varying degrees. In turn, the researcher is influenced by
those being studied.
This last point has raised many concerns
over the efficacy of the employment of qualitative methods in approaching nursing
research.
In many qualitative pieces of research
the researcher will observe social behaviour and will often participate in social
interaction with the subjects being studied.
The mere presence of the researcher may
alter the behaviour of those being studied.
This requires a lot of skill on behalf of
the researcher; empathy and intuition are both needed.
The researcher needs to be closely
involved in the subject's experience in order to be able to interpret it.
The researcher must be open to the
subject's perceptions rather than attach his or her own meanings to the experience.
This ultimately leads to concerns about
the role of the researcher as a participant, observer and as a nurse. Some authorities
suggest that the researcher should only 'wear their research hat' and avoid relating to
the subjects as a nurse.
Some say that the nurse role should
always come first due to professional responsibility and duty of care (as a legal
responsibility). Yet others maintain that the researcher should act as a whole person, not
just researcher or nurse.
All of which means that the researcher
should carefully consider the possibilities before setting off down this road of research.
Many confrontational situations can
arise. For example, participants might say "Don't write this down!" or
"Just between you and me!" They may even wish to withdraw information having
already given it possibly saying "Oh! I shouldn't have said that."
The researcher should always remember
that establishing relationships with participants could cause harm to either or both
parties. It can be just as easy for participants to feel disappointment, betrayal or
desertion as it is for them to feel confidence, commitment and friendship.
As already mentioned the researcher may
harm themselves because of their involvement. Cowles (1988) described how she felt
emotional stress and had trouble in sleeping at night because of her study into the
effects of murder upon other members of the victims family.
Last updated on Saturday April 10, 1999 22:55 +0100
e-mail any comments or queries to johnross@cwcom.net
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