Participant observation has its origins in anthropology and sociology. However, early travellers in ancient times wrote down their observation of cultures they visited, often as participants in those cultures, making it probably the earliest of all forms of data collection. From the early days of fieldwork, anthropologists and sociologists became part of the culture they studied, and examined the actions and interactions of people in their social context, ‘in the field’. Studies in anthropology and sociology in particular used observation.

Immersion in a setting can take a long time, often years of living in a culture. DeWalt and DeWalt (2002) stress that researchers need to be involved in the context for a prolonged period of time; they should learn the language used in the setting. For health professionals this is an easy task as they are already familiar with language, routines and people in the setting, although they must be aware that these vary for context and situation. However, extraordinary occurrences and critical events must also be observed as they are specific to the setting. DeWalt and DeWalt advise attention to detail which includes ‘mapping the scene’, observing patterns, arrangements and activities.

Participant observation sometimes proceeds over one or several years, although some observation does not take as long. Health professionals, of course, are already members of and familiar with the culture they examine. For these reasons they may not need a long introduction to the setting; they might, however, miss significant events or behaviours in the locale because of familiarity. This also means that they should suspend prior assumptions, so as not to miss important aspects or misinterpret the situation.

Prolonged observation generates more in-depth knowledge of a group or subculture, and researchers can avoid disturbances and potential biases caused by an occasional visit from an unknown stranger. Observation is less disruptive and more unobtrusive than interviewing. However, participant observation does not just involve observing the situation, but also listening to the people under study.

Focus and setting

The dimensions of social settings, according to Spradley (1980) focus on the features which catalogue some ideas about the foci of observation, although these depend on the particular research question.

Nurse researchers and other health professionals centre particularly on the interaction of patients and professionals as well as the actions and activities of both groups. Not only are there descriptions of physical actions and interactions but also of the dialogue that goes on in the setting. The dimensions of the situation and context need detailed description and, eventually, interpretation by the researcher which often can only be developed through asking people about their behaviours and about the meanings of objects, routines and events. Hammersley and Atkinson (2007) argue that interviewing is part of participant observation.

Any appropriate setting can become the focus of the study. Participant observation varies on a continuum from open to closed settings. Open settings are public and highly visible such as street scenes, corridors and reception areas. In closed settings, access is more difficult and has to be carefully negotiated; personal offices or meetings in wards can be considered closed settings. It is useful to examine how people in the setting go about their routine and everyday business, how they act and interact with each other and how they relate to the space and the environment in which they are located. Rituals, routines and ways of communication can also be discovered. Gobo (2008) discusses two topics in observation: how to observe and what (whom) to observe. One of the answers to the first question is the matter of estrangement or alienation. Distancing from the setting (being a naïve observer) will generate surprise for the researchers and add a new lens through which settings and people can be observed. The question of what to observe can be answered more easily: Marginal groups are appropriate for observation; for instance, those who are ill are isolated from ordinary social interaction, and the researchers find it easier to suspend their assumptions. Some researchers study the adaptation of foreign nurses to a new culture, others observe learners on the hospital ward.

Researchers might observe critical incidents, dramatic events and examine language use, depending on location or topic, but they can also observe in detail exits and entrances of group members, body language, facial expressions and even choice of words (Abrams, 2000). In Gobo’s (2008) words, ‘social structure, talks and contexts’ (p. 162) must be taken into account.

Observation provides a holistic perspective on the setting. Health researchers can observe as insiders and ask questions, which an outside spectator could not do. If they become deeply engaged and stay for a considerable time, participants will become used to them, and the observer effect will be minimal. The problems and unexpressed needs of the participants also can be observed. Although participants describe their experiences in interviews and reflect on events and actions, researchers will not have to rely only on participants’ memories; they will be able to distinguish between ‘words and deeds’, ‘what they say and what they do’, which is not always the same. Observation, however useful and appropriate, is time-consuming; hence it is not generally used in undergraduate research, while postgraduates and health professionals in the clinical arena often include it.

Types of observation

Participant observers enter the setting without wishing to limit the observation to particular processes or people, and they adopt an unstructured approach. Occasionally certain foci crystallise early in the study, but usually observation progresses from the unstructured to the more focused until eventually specific actions and events become the main interest of the researcher.

Gold (1958) identified four types of (overlapping) observer involvement in the field which most qualitative researchers still describe:

The complete participant

The complete participant is part of the setting, a member of a group within it and takes an insider role that often involves covert observation.

Pope and Mays (2006) argue that covert observation might be justified in research with patients to whom access is difficult, or when investigating sensitive topics. In spite of the value of some of these studies, complete participation generates a number of ethical problems. First of all, one would have to question seriously whether covert observation in care settings, without knowledge or permission of the people observed, is ethical. After all, this is not a public, open situation such as a street corner or rally, where individuals cannot be identified. In the public domain, observation is permissible and may produce valuable data. For health professionals who advocate caring and ethical behaviour, covert observation in closed settings would be inadvisable. We would not advocate this type of observation, and undergraduates or novice researchers should never attempt it (see also Chapter 4).

The participant as observer

Here, researchers have negotiated their way into the setting, and as participant observers they are part of the work group under study. This seems a good way of doing research, as they are already involved in the work situation. They might want to examine aspects of their own hospital or ward, for instance. The first stage is to ask permission from the relevant gatekeepers and participants and explain the observer role to them. The advantage of this type of observation is the ease with which researcher–participant relationships can be forged or extended. Researchers can move around in the location as they wish, and thus observe in more detail and depth. For new researchers, observation is more difficult than interviewing because of the ethical issues involved and the time needed for ‘prolonged engagement’. For ethical reasons, the observers disclose their research role.

The observer as participant

An observer who participates only by being in the location rather than working there, is only marginally involved in the situation. In this case, researchers might observe a particular unit but not directly work as part of the work force; for instance, they might observe a location where they have not been previously. They must, however, announce their interest and their public role and go through the process of gaining entry and asking permission from patients, gatekeepers and colleagues. The advantages of this type of observation are the possibility of asking questions and being accepted as a colleague and researcher but not called upon as a member of the work force. On the other hand, observers are prevented from playing a ‘real’ role in the setting. Restraint from involvement is not easy, particularly in a busy situation where professionals must be protected from intrusion when working.

The complete observer

Complete observers do not take part in the setting and use a ‘fly on the wall’ approach. Being a complete observer when the observer is not a participant is only possible when the researchers have some distance from the setting and observe through a window, in a corner or through a two-way mirror where they are not noticed and have no impact on the situation or when they use static video cameras fixed on the ceiling.

There is no clear distinction however between some of these types of observation; they overlap.

Ethics issues in observation

Permission from participants should be requested in healthcare settings. Access and permission to observe is more difficult to achieve than in other forms of data collection. All within the setting are included for this permission and also those who have power to withhold and gain access, such as managers. When researchers have achieved the initial contact, it is important to establish rapport with the group or cultural members. Researchers must make it quite clear that they are not ‘spies’ for management in any of these situations.

Progression and process

Spradley (1980) claims that observers progress in three stages; they use descriptive, focused and finally selective observation. Descriptive observation proceeds on the basis of general questions that the observer has in mind. Everything that goes on in the setting provides data and is recorded, including colours, smells and appearances of people. Description involves all five senses. As time goes by, certain important areas or aspects of the setting become more obvious, and the researcher focuses on these because they contribute to the achievement of the research aim. Eventually observation becomes highly selective, centring on very specific issues only. Researchers adopt the strategy of progressive focusing. LeCompte et al. (1997) give guidelines for observation, which we will summarise here.

The ‘who’ questions

Who and how many people are present in the setting or take part in the activities? What are their characteristics and roles?

Nurse and midwife researchers observe the situation and specifically focus on the many role performances and interactions.

The ‘what’ questions

What is happening in the setting, what are the actions and rules of behaviour?

What are the variations in the behaviour observed?

Health professionals focus on the activities and behaviour of those involved.

The ‘where’ questions

Where do interactions take place? Where are people located in the physical space?

For health professionals this means looking at the ward, the clinic, the GP’s surgery or meeting. Even discussions at the bedside or handovers are of importance.

The ‘when’ questions

When do conversations and interactions take place? What is the timing of activities?

Events, discussions and interactions take place at different times. Health professionals must ask whether there is any significance in the timing of these.

The ‘why’ questions

Why do people in the setting act the way they do? Why are there variations in behaviour?

The ‘why’ questions are self-explanatory. Researchers examine the reasons for the activities, behaviour or critical incidents. This does of course, often include interviewing participants.

Process

Mini-tour observation leads to detailed descriptions of smaller and more intimate units, while grand-tour observations are more appropriate for larger settings. After the initial stages, certain dimensions and features of observation become interesting to the researcher who then proceeds to observe these dimensions specifically. ‘Progressive focusing’, which was discussed earlier, is not just a feature of interviewing but also of observation.

The study becomes more focused as time progresses, because the observer notices important behaviours or interactions. Focused observations are the outcome of specific questions. From broader observations, researchers might proceed to observing a small unit. They could look for similarities and differences among groups and individuals. For this type of observation narrow focus and specificity are useful and necessary.

Marshall and Rossman (2006) argue that observation means systematic exploration of events and actions as well as noting the use and position of artefacts (objects) in the setting under study. Researchers observe social processes as they happen and develop. Participant observations can focus on events, processes and actions, but they cannot explore past events and thoughts of participants; this has to be done in interviews. Hammersley and Atkinson (2007) see interviewing as part of participant observation. The early classical work demonstrates this clearly, particularly the research by Becker et al. (1961). The participants, namely medical students, were observed in their interaction with patients, colleagues and teachers, and the researchers then asked questions about what they saw and heard. Hammersley and Atkinson (2007), in fact, propose that one might see all social research as participant observation to the extent that the researcher actively participates in the situation.

Researchers may be reluctant to carry out formal participant observation because of time and access problems; for instance, it is easier to interview colleagues or clients than to observe them. Observation might change the situation, as people act differently in the presence of observers, although they often forget being observed in long-term research. The latter, however, takes more time than is available in student projects and therefore it is more often used by postgraduates and experienced researchers who have a longer time span for their research.

When observations are successful, they can uncover interesting patterns and developments, which have their basis in the real world of the participants’ daily lives, and the task of exploration and discovery is, after all, the aim of qualitative research.

As we have explained before, researchers sometimes triangulate within method. Triangulation enhances the trustworthiness and authenticity of the study (see Chapter 18).