Qualitative research is a scholarly approach to describe life experiences from the perspective of the persons involved. It is a way to give significance to the subjective human experience as well as gain insights to guide nursing practice (ZuZelo, 2012). These insights are gained not through measuring concepts or establishing causality but through improving our comprehension of a phenomenon of interest. Within a naturalistic holistic framework, qualitative research allows us to explore the depth, richness, and complexity inherent in the lives of human beings. The insights from this process can foster an understanding of patient needs and problems, guide emerging theories, and build nursing knowledge (Munhall, 2012). Although qualitative research is somewhat flexible, qualitative researchers use rigorous and systematic processes that require conceptualization, imaginative reasoning, and elegant expression. All scientists approach problems from a philosophical stance or perspective. The philosophical perspective of the researcher guides the questions asked and the methods selected for conducting a specific study. Both quantitative and qualitative researchers have philosophical perspectives. Quantitative studies are based primarily on the philosophy of logical positivism that values logic, empirical data, and tightly controlled methods (see Chapter 3) (Kerlinger & Lee, 2000; Shadish, Cook, & Campbell, 2002). Qualitative studies are based on a wide range of philosophies, such as phenomenology, symbolic interactionism, constructivism, and hermeneutics, each of which espouses slightly different approaches to gaining new knowledge (Liamputtong & Ezzy, 2005). Qualitative researchers ascribe to a view of science that values the uniqueness of the individual and the holistic approach to understanding human experiences. The philosophical perspective of the researcher is consistent with research questions that seek the participant’s perspective of a phenomenon or experience. Figure 4-1 demonstrates this idea, as the arrow on the left of the figure (“Philosophy”) shapes and fits with the next arrow (“View of Science”). Because of their philosophical perspectives, quantitative researchers hold views of science that value tightly controlled studies and generalizable numerical findings. In contrast, the philosophical perspectives of qualitative researchers influence their views of science. As a result, qualitative researchers value rigorous, but flexible designs to identify study findings. Through the study findings, we are able to increase our understanding of an experience using a discovery process that allows a complex picture to emerge (Forman, Creswell, Damschroder, Kowalski, & Krein, 2008). The primary thinking process used in quantitative studies is deduction; in contrast, qualitative researchers tend to be inductive thinkers (Forman et al., 2008). Deductive thinking begins with a theory or abstract principle that guides the selection of methods to gather data to support or refute the theory or principle. Forman et al. (2008) call this a “top-down” approach. Inductive thinking involves perceptually putting insights and pieces of information together and identifying abstract themes or working from the bottom up. From this inductive process, meanings emerge. Because the perception of each qualitative researcher is unique, the meanings identified within the data may vary from researcher to researcher. However, others should be able to retrace the analysis and thinking processes that resulted in the researcher’s conclusions. In order to do this, readers must be aware of the underlying philosophical perspective of the study being reviewed. Each type of qualitative research is consistent with a particular philosophical perspective (see Figure 4-1). The philosophy shapes the view of science that in turn shapes the approaches and methods selected for the study, just as the arrows in Figure 4-1 fit together like the pieces of a puzzle. The philosophical perspective includes an epistemology, a view of knowing and knowledge (Munhall, 2012). As a result, the philosophy directs the research questions and the collection and interpretation of the data. Creswell (2009) emphasizes this point by stating that the assumptions of the specific philosophical approach cannot be separated from the methods. For example, researchers who hold to a phenomenological philosophy of science will ask research questions about the “lived experiences” of persons. They will analyze the data in such a way as to develop a rich, deep description of an experience from the perspective of the participants. Although the researcher does not always clearly state the philosophical stance on which the study is based, a knowledgeable reader can recognize the philosophy through the description of the problem, formulation of the research questions, and selection of the methods to address the research questions. A well-designed qualitative study is congruent at each stage with the underlying philosophical perspective as identified by the researcher. Qualitative researchers use open-ended methods to gather descriptions of health-related experiences from participants (Fawcett & Garity, 2009). These open-ended methods include interviews, focus groups, observation, and document review (Speziale & Carpenter, 2007). When oral methods are used, the researcher will usually capture the interaction by an audio or video recording so that a transcript of the communication can be prepared for analysis. These methods are discussed in detail in Chapter 12. Scientific rigor is valued because it is associated with the worth of the research outcomes. The rigor of qualitative studies is appraised differently from the rigor of quantitative studies because of the differences in the underlying philosophical perspectives. Quantitative studies are considered rigorous when the procedures for the study are prescribed prior to data collection, the sample is large enough to represent the population, and researchers tightly control the collection and analysis of the data. A quantitative researcher expects that another researcher could replicate or repeat the study with a similar sample and receive similar results. This is desirable because quantitative researchers define rigor to include objectivity and generalizability. Rigorous qualitative researchers, however, are characterized by openness and demonstrate methodological congruence, scrupulous adherence to a philosophical perspective, thoroughness in collecting data, consideration of all the data in the analysis process, and self-understanding. The researcher’s self-understanding is important because qualitative research is an interactive process shaped by the researcher’s personal history, biography, gender, social class, race, and ethnicity as well as by those of the study participants (Creswell, 2009; Marshall & Rossman, 2011). Self-understanding allows the researcher to have insight into his or her potential biases related to the phenomenon of interest and prevent these biases from interfering with the voices of the participants being heard. These characteristics of qualitative researchers are essential to produce a valid study. Critical appraisal of the rigor of qualitative studies is discussed in more detail in Chapter 18. To reinforce the key points of Figure 4-1 that philosophy shapes one’s view of science, the methods, and criteria of rigor, a study of families with asthmatic children are presented as an example. Meah, Callery, Milnes, and Rogers (2009) explored how parents and preadolescent children shared the responsibility for asthma management. The researchers had noted a gap in knowledge about the transfer of responsibility from parents to children. The purpose of the study was to “examine meaning of responsibility in children’s lives and how parents and children negotiate these responsibilities over time” (Meah et al., 2009, p. 1953). An exploratory-descriptive qualitative study was conducted because quantitative studies had produced diverse results that did not provide adequate understanding of the transfer of responsibility. The study included a framework of responsibility, and the researchers designed the study to be consistent with feminist philosophy and sociological perspectives: Consistent with sociological perspectives, the familial unit was the focus, instead of only the child or only the parents. The researchers’ methods included conducting “open-ended, conversational-style interviews” with 18 children and their parents (Meah et al., 2009, p. 1954). The researchers also interviewed the parents separately. The recordings of the interviews were transcribed and “descriptive codes were developed from the transcripts” (p. 1954). The researchers briefly described how they displayed excerpts from the transcripts on charts that “enabled comparison of the children’s and adults’ perceptions while simultaneously facilitating comparison within children’s accounts and those of their parents” (p. 1954). The study results revealed the complexity of allowing children to manage their asthma, as they grow older: This example confirms that philosophy shapes one’s view of science, which in turn shapes the methods used in a study and the criteria by which the rigor of the study will be evaluated (see Figure 4-1). Because qualitative studies emerge from several philosophies, an understanding of different approaches to qualitative research is needed as a foundation for appraising the rigor of research and making appropriate application of the findings. Five approaches to qualitative research commonly conducted and published in the nursing literature are: phenomenological research, grounded theory research, ethnographic research, exploratory-descriptive qualitative research, and historical research (see Table 4-1). Although the five approaches have the commonalities already discussed, these approaches are different, in great part because researchers in different disciplines developed them. For example, the social and psychological scientists developed the approaches known as phenomenological research and grounded theory research (Giorgi, 2010; Reed, 2010). Anthropologists developed ethnography with its focus on culture (Morse & Richards, 2002). Exploratory-descriptive qualitative research has emerged from the disciplines of nursing and medicine and has a pragmatic focus on using the knowledge gained to benefit patients and families and improve health outcomes. Historians developed methods to analyze source documents, artifacts, and interviews of witnesses to summarize the knowledge gained by studying the past (Lewenson & Herrmann, 2008). Nurse researchers adapted these methods to understand changes within nursing and health care. The common purpose among the methods, however, is to examine the meaning of human experiences from the perspective of the “knower,” the person (or persons) to whom the experiences belong (Bassett, 2004). TABLE 4-1 Philosophical Orientations Supporting Qualitative Approaches to Nursing Research Although the data are gathered with openness to the individual experiences of study participants, this fact does not mean that the interpretation is value-free. Each approach is based on a philosophical orientation that influences the study design from the wording of the research question through the interpretation of the data (see Figure 4-1). Thus, you as a consumer of qualitative research must be aware of the guiding principles of the philosophical perspective of a study and use these principles to critically appraise a qualitative study. The discussion of each approach will cover its philosophical perspective or orientation, methodology, and contribution to nursing knowledge. Phenomenology is both a philosophy and a research method. The purpose of phenomenological research is to describe experiences (or phenomena) as they are lived-in phenomenological terms, to capture the “lived experience” of study participants (Fawcett & Garity, 2009; Munhall, 2012). The philosophical positions taken by phenomenological researchers are very different from those common in the culture and research traditions of the nursing field, which value large samples and generalizable findings. Philosopher Edmund Husserl (1859-1938) is considered the father of modern phenomenology (Phillips-Pula, Strunk, & Pickler, 2011). Husserl wrote Logical Investigations (1901/1970), in which he developed his ideas about phenomena in an effort to resolve the conflict in thought between human sciences (primarily psychology) and the basic sciences (such as physics). Phenomena make up the world of experience. These experiences cannot be explained by examining causal relations but need to be studied as the very things they are. A phenomenon occurs only when there is a person who experiences it. Thus, the experience must be described, not studied using statistics or the researcher’s preconceived ideas. To describe the experience, the researcher must be open to the participant’s worldview, set aside personal perspectives, and allow meanings to emerge. Husserlian phenomenologists believe that although self and world are mutually shaping, it is possible to separate oneself from one’s beliefs or set aside one’s beliefs to see the world firsthand in a naive way (Dowling, 2007). Setting aside one’s beliefs during qualitative research is called “bracketing.” Researchers who follow the philosophy proposed by Heidegger do not agree, taking the position that bracketing is not possible. Martin Heidegger (1889-1976) was a student of Husserl but expanded the goal of phenomenology from description of lived experience to the interpretation of lived experiences (Earle, 2010). Heidegger’s seminal work was Being and Time (1927/1962). Heideggerian phenomenologists believe that the person is a self within a body, or is embodied (Munhall, 2012). Munhall describes embodiment as “the unity of body and mind” that eliminates the “the idea of a subjective and objective world” (p. 127). She goes on to say, “the world is knowable only through the subjectivity of being in the world” (p. 127). For example, the interaction between the sensory input that your body sends to your brain and your brain’s thinking processes determines your perceptions of the world in which you exist. A depressed person may not notice the color of sunset or the joy in a child’s laughter. Another person may not be able to see the sunset because of blindness but may find special meaning in the nuances of the child’s laughter. In each situation, the person’s being in the world is shaped by the unity of body and mind. Heideggerian phenomenologists posit that the person is situated in specific context and time that shapes his or her experiences, paradoxically freeing and constraining the person’s ability to establish meanings through language, culture, history, purposes, and values (Munhall, 2012). For example, a 50-year-old man diagnosed with aggressive cancer in the United States would experience the diagnosis differently from a 20-year-old woman in rural Ethiopia receiving the same diagnosis. The body, the world, and the concerns, unique to each person, are the context within which that person can be understood. Heideggerians believe that the person experiences being within the framework of time, also called being-in-time. The contexts of the man and the woman with cancer would have different meanings, depending on whether they lived during the 1960s or the 2010s. The availability of treatment, financial resources, and gender roles are only a few of the factors that would shape the cancer experience for these individuals. Each of them has only situated freedom, not total freedom. The man has the freedom to choose physicians from among those who will accept his insurance. The woman may have the freedom only to choose whether she will use a traditional healer or not seek treatment at all. Until a disruption such as an expected diagnosis of cancer occurs, the person may not have considered the limits on meaning imposed by the context and the time. Other philosophers have built on Husserl and Heidegger’s perspectives and refined phenomenological methods. Merleau-Ponty (1908-1961) was among the French philosophers who further developed the Heideggerian concepts of being-in-time and embodiment (Munhall, 2012). He wrote The Phenomenology of Perception (1945/2002). Colaizzi (1973), Giorgi (1985), and van Manen (1990) proposed research guidelines for phenomenological research focused on procedural interpretations of the phenomenological method (Speziale & Carpenter, 2007). The novice nurse researcher interested in phenomenology should expand his or her knowledge in this area through immersion in the original writings of these philosophers (Munhall, 2012). All phenomenologists agree that there is not a single reality; each individual has his or her own reality. Reality is considered subjective, and as a result, unique to the individual. The researcher’s experiences in collecting data and analyzing the data during a study are also unique. The researcher must invest considerable time exploring the various philosophical stances within phenomenology to select one compatible with his or her perspective and the research question being asked. More detail on the conduct of phenomenological research is provided in Chapter 12. Phenomenology is the philosophical base for three nursing theories and studies that have explored these theories. These theories include the theory of humanistic nursing (Paterson & Zderad, 1976), the theory of human becoming (Parse, 1981, 1992), and the theory of caring (Watson, 1999). Paterson and Zderad emphasized in their theory of humanistic nursing that phenomenology shapes the nurse and the patient as they share experiences in the context of health care. The theory is applicable to research because the researcher meets the participant with openness and respect for uniqueness. On the basis of the values of Paterson and Zderad’s (1976) theory, Lesniak (2010) conducted a study with adolescent females who deliberately injure themselves by cutting. She interviewed six young women who described their experiences, including what they would like emergency nurses to know about self-cutting. From their interviews, the researchers identified “an element of loneliness,” “an overall meaning of angst and desperation,” and “a recovery process after the cutting is over” (Lesniak, 2010, p. 146). Emergency nurses adhering to Paterson and Zderad’s caring values who are alert to signs of self-cutting will assess the adolescent and identify strategies to “protect the adolescent from future self-injury” (p. 146). Lesniak noted that the sample was limited to white, middle-class adolescents and could not be generalized to adolescents of other races/ethnicities or income levels. In 1981, Parse described her theory of man-living-health as evolving from the foundation of existential phenomenology. As she conducted studies congruent with the theory, she refined her ideas into the human becoming theory (Parse, 1992). According to her theory, human beings co-create reality with the environment and structure meaning through images, words, and actions. Parse proposes research methods consistent with phenomenology, the philosophical foundation for her theory (Parse, 2001, 2011). Using Parse’s research methods, Chen (2010) conducted a study of the lived experience of moving forward among persons who had experienced a spinal cord injury. Chen collected data from 15 persons through “dialogical engagement, in which the true presence of the researcher was with the participant” (p. 1134). From the stories of the participants and the recordings of the research interactions, Chen extracted three core concepts that she reframed within Parse’s theory: “confronting difficulties,” “going on and finding self-value and confidence,” and “co-creating successes amid opportunities and restrictions” (pp. 1137-1138). The use of Parse’s theory during the interpretation of the data was consistent with her research approach but somewhat of a departure from remaining open to the meanings that emerge from qualitative data. Watson’s (1999) theory of caring is also congruent with phenomenology. She describes values of nurses that produce caring actions and an intersubjective experience shared by the nurse and patient. She proposes 10 carative factors that provide a structure for caring as the core of nursing. Transpersonal caring relationships and the carative factors “potentiate therapeutic healing processes and relationships: they affect the one caring and the one-being-cared-for” (Watson, 1997). Byers and France (2008) conducted a phenomenological study using Watson’s theory with nurses who care for patients with dementia hospitalized on medical-surgical units. From their interviews with nine nurses, they extracted a “synthesis of unity,” a sentence that captured the experience, which they stated as “They stay with you: they come home with you every day” (p. 47). High nurse-patient ratios and the needs of dementia patients challenged the nurses and resulted in stress. Because of their commitment to caring, the nurses were frustrated by giving what they perceived to be care that did not meet their personal standards. Byers and France conclude by noting that “the essence of caring is revealed as it is manifested in the RN caring for the patients with dementia yet it is also the RN who needs to be cared for” (p. 48). An appraisal can be made of this study similar to that of the Chen (2010) study. The use of a theory within a phenomenological approach has the potential to interfere with the emergence of the participants’ perspectives. Shorter and Stayt (2010) conducted a phenomenological study of the experiences of grief and coping mechanisms of nurses in an adult intensive care unit. The philosophical perspective, the methodology, and the contributions to nursing knowledge of this study are presented as an example of a phenomenological study. Shorter and Stayt designed their study to be consistent with the Heideggerian phenomenological perspective (Johnson, 2000) and to “explore critical care nurses’ experiences of grief and their coping mechanisms when a patient dies” (p.160). The researchers’ methodology included interviewing eight nurses and analyzing the narratives of the interviews according to Colaizzi’s guidelines, a specific approach to phenomenological data analysis (Dowling, 2007). The researchers found clusters of data around two phases in the experience—“the death experience” and “the death thereafter.” In describing the death experience, one nurse commented “I hate it when the patient dies suddenly—everything seems just so disorganized. … It makes me feel awful when that happens.… I like to feel that I have done everything that I can” (p. 162). Another nurse talking about the death thereafter said, “You do have to keep a distance in a way, because death happens so often on our unit. You’d be an emotional wreck if you let it bother you or affect you all the time” (Shorter & Stayt, 2010, p. 164). The death experience was described with the phrases “expectedness, control and good care,” “striking a chord,” and “meaningful engagement” (Shorter & Stayt, 2010, pp. 162-163). The phrases “formal support,” “informal support,” “normalization of death,” and “emotional dissociation” (pp. 163-164) described the death thereafter. Shorter and Stayt concluded that the grief and coping strategies of nurses are complex and may vary by type of care setting. Shorter and Stayt (2010) clearly identified the philosophical perspective and methods of their study, although they did not cite primary sources for either Heidegger or Colaizzi. Consistent with the Heideggerian perspective, they collected and analyzed data simultaneously. They used Colaizzi’s framework to cluster common meanings and identify themes from the transcripts of the interviews they had conducted. Shorter and Stayt explicitly noted adherence to the Heidegerrian tenets when they discussed the rigor of the study to include “co-construction of knowledge between researcher and participant” (p. 161). The researchers proposed that additional studies are needed to explore whether the coping strategies of nurses affect the quality of care they provide.
Introduction to Qualitative Research
http://evolve.elsevier.com/Grove/practice/
Perspective of the Qualitative Researcher
Philosophy Describes a View of Science
Philosophy Guides Methods
Philosophy Guides Criteria of Rigor
Approaches to Qualitative Research
Philosophical and Theoretical Orientations
Qualitative Approach
Phenomenology
Phenomenological research
Symbolic interaction theory
Grounded theory research
Naturalism and ethical principles
Ethnographic research
Interpretive and naturalistic perspectives; pragmatism
Exploratory-descriptive qualitative research
Historicism, pragmatism
Historical research
Phenomenological Research
Philosophical Orientation
Phenomenology’s Contribution to Nursing Science
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Introduction to Qualitative Research
