There are a number of ways of explaining ethnography. Brewer 1994 and Brewer 2000, for example, has made a distinction between ethnography as methodology and ethnography as method. The former refers to a philosophical imperative to ‘understand’ how people experience their world and the latter to what ethnographers actually do, namely: to observe and listen through participant observation which, as others have observed, may involve observation alone or a more participative approach whereby researchers talk, work or even live in the company of those they encounter in the field of study (Burgess 1984 and Hammersley 1995). In trying to define ethnography, this section of the chapter refers to both the idea of ethnography as methodology and to the methods that ethnographers actually use. The account given is influenced by my own experiences of studying anthropology, engaging with feminist ideas and above all my work as a nurse.

Roughly translated the word ‘ethnography’ means ‘writing culture’. Ethnography refers to a long-established research tradition within the discipline of social anthropology, whereby early anthropologists sought to understand cultures other than their own through participant observation over a period of months and sometimes years. Typically research was conducted amongst relatively small groups of people or fairly self-contained societies, often previously unknown to the so-called developed world. The anthropologists wrote about what they observed and heard in these groups and societies, at the same time reflecting on this. The latterpractice of reflecting was important as it allowed anthropologists not only to describe what they heard and saw in the field but also to analyse expectations, ideas, values and beliefs, in short the ‘culture’ characterising the groups of people they studied. Their analyses also allowed them to compare and contrast between and across a range of cultures. Furthermore, it allowed them to explore the differences and similarities between their own and other cultures. Classic accounts of the practice of ethnography include Malinowski’s Argonauts of the Western Pacific (1922) in which, to summarise crudely, he describes a system of ceremonial exchange amongst the Trobriand Islanders. His work laid the foundation for further work on the importance of exchange, and the principle of reciprocity, as a means of maintaining social relationships and social control. Above all, despite the paternalism, colonialism and sexism inherent in much of the work undertaken in the early twentieth century (a criticism that could be levelled at far more recent ethnographic work), his wish was, as Kuper (1983) notes, to discover the Islanders’ ‘passions’ and ‘deepest ways of thinking’.

Since the early years of the discipline, anthropologists have extended their studies of culture and social organisation to include exploration within their own societies. This process was partly driven by critiques made by groups of people whom earlier anthropologists had studied. While they may have appreciated anthropologists’ quests to explore other ways of life (a point noted by Mead in her autobiographical book Blackberry Winter(1972)), the legitimacy of statements made about the ideas and values of a group of people hitherto completely unknown to the anthropologist was questioned. Indeed the very process of going out to study another culture came to be viewed by some anthropologists themselves as a way of expropriating knowledge for gain which did not necessarily benefit the society studied, and which was then reconstructed to produce a ‘Western’ version of the society. Some thirty years ago Said in his magnificent book Orientalism(1978) referred to how this approach had constructed a particular discourse; Western anthropologists were producing Western versions or constructions of those they encountered. The critique led anthropologists to strive to ‘see themselves’ in their work (Wheeler 1973) and to consider how they, themselves, actually constructed ‘otherness and ‘other cultures’, both ‘at home’ and ‘abroad’, drawing on their own ideas and values.

The movement to question the conduct and purpose of ethnography was given impetus by so-called radical anthropologists writing in the USA and the UK in the 1980s and 1990s, for example Clifford and Marcus (1986) in the USA, Atkinson (1990) in the UK. These and other authors drew attention to the devices used by anthropologists and others to persuade readers about the authenticity and truth of their observations as well as noting how what was written about other cultures could also be read as a statement about the anthropologist and the research community producing the knowledge. This written reflexivity was strengthened by the writings of feminists both in anthropology and sociology who drew attention to the diversity of possible ethnographies, even within one’s own culture and society. For example, Stanley and Wise (1983) have drawn attention to how in some writings ostensibly conveying ‘women’s experiences’ the category of ‘women’ is presented as homogeneous. Consequently some women may not recognise their experiences in the often very particular accounts written by social scientists with a specific purpose in mind and who are writing within a particular theoretical framework. Critiques such as these drew attention to how the ways in which ideas are interpreted and shaped and how they inform everyday life depends on a number of factors, not least the gender, race/ethnicity, age and socio-economic status of the anthropologist.

Ethnographic research has been conducted within the various fields of nursing by nurses including those with anthropological or sociological training, and by other researchers. A classic early example from the USA is Oleson and Whittaker’s The Silent Dialogue(1968) and, from the UK, Dingwall’s Social Organisation of Health Visitor Training(1977). In the 1980s, accounts of nursing based on ethnographic research within the UK included David Hughes (1988) study of aspects of interaction between nurses and doctors and James’ (1984) account of nurses working in palliative care. Work inspired by ethnography includes Melia’s (1981) research on student nurses’ understandings of their work, and work reflecting on how an ethnographic account is constructed includes the monograph Reflections on the making of an ethnographic text (Williams 1990), which draws on an ethnography of nursing in a London teaching hospital. In the 1990s there was a proliferation of ethnographic research including Smith’s (1992) account of how nurses care and the emotional labour involved. Porter’s work and his exposition of critical realist ethnography based on his ethnography of nursing’s relationship with medicine (1993, 1994, 1995) is another example.

The scope and depth of ethnographic research is such that much of the work mentioned was produced first as PhD theses. Typically, periods of observation in ethnographic research may extend from six months or so to 18 months or more. The trend for conducting ethnographic research for the PhD degree has gained momentum, producing work spanning a variety of settings from acute care to primary care. Examples of the former include ethnographies carried out in intensive care settings, exploring the contemporary nursing role in relation to medicine (Coombs 2000) and ritual and symbolism in this setting (Philpin 2004). Also included in this category is Wiseman’s study of the use of empathy in oncology wards (Wiseman 2003). Examples of ethnographies conducted in primary care settings include Hughes’ (2005) ethnography of nurses’ experiences of strategic decision-making in local Health Boards in Wales, and Clark’s (2001) ethnography of nursing care in Ethiopia. Ethnographic work has also been conducted in midwifery and related areas, for example Hunter’s study of the emotional labour experienced by midwives (2002), Mills’ research on aspects of contraception practices and meaning in Australia (2003) and Speier’s highly reflexive, ethnographic account of the childbirth educator as ethnographer (2002).

These are only a few examples of the use of ethnography in answering questions about role and practice mainly but not exclusively within nursing and on its boundaries with other professions. A feature of much of this work is the attention paid to the role of the researcher who may enter the field as both researcher and practitioner. The challenges and opportunities this presents are for the most part described in detail in the theses themselves. While I do not intend to discuss these in this chapter, it is worth mentioning that taken as a whole they contribute to a critique of assumptions made about the nature of researcher–researched relationships, researcher identity and the construction of knowledge. They are sources worth reading for those contemplating ethnographic research insofar as they document in detail how the position of the researchers in relation to the fields of study affects the products of research. In short they deal with the issue of reflexivity.

Seeing and hearing within the context of an ethnography are not simple matters. They are possible, as Whittaker (1986, p. xvi) suggests, ‘through decisions and strategies, which in their turn demand a highly developed sense of what are data and what are irrelevancies’. An ethnographer goes into the field of study with a working frame of reference, however underdeveloped it may be. To take Wicks as an example, her frame of reference rested in part on an interest in competing discourses: the dominant discourses of scientific medicine, on the one hand, and holistic, bedside healing, on the other. Her interest in these inevitably helped to filter out aspects of what was going on in the wards she visited as well as making other aspects highly significant. In short, the account she gives is very particular.

As in other methods discussed in this collection, reflexivity in assessing an ethnographer’s theoretical position is by now taken as axiomatic to rigorously conducted ethnographic research. This is so even though some might suppose that the outputs of observation or what is seen promise greater objectivity than the products of interviews or what is heard from people accounting for their actions. For example, actions captured on videotape may appear to be more objective than ‘subjective’ accounts given by those involved in those actions. Degrees of objectivity within ethnographic fieldwork are debatable; however, an ethnographer’s frame of reference (like a photographer’s frame) inevitably affects perspective and even when the evidence seems incontrovertible the representation of that evidence and its interpretation may differ between ethnographers. Cross referencing between researchers (inter-rater reliability) may help ameliorate uncertainties about truth. However, researcher reflexivity indicates recognition of the possibility that the product or ethnographic account produced is affected by the position of the researcher in relation to the field of study, and shows how this is so. This is not simply in relation to preferences and personality but rather in relation to the theories and ideas held by the researcher which form the backdrop against which she or he understands the data and findings are discussed.