Qualitative Research in Nursing

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Qualitative Research in Nursing Date of last revision : January 28, 2011 “Not everything that counts can be counted, and not everything that can be counted counts” -Albert Einstein INTRODUCTION


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Qualitative research methods have become increasingly important as ways of developing nursing knowledge for evidence-based nursing practice. Qualitative research answers a wide variety of questions related to nursing's concern with human responses to actual or potential health problems. (Ploeg J, 1999) Qualitative research is a type of scientific research which has its roots in philosophy and human sciences. Qualitative research plays an important part in providing evidence for practice in nursing, and is gaining greater acceptance within medicine. (Bailey C, 2002) Definition: "A quantitative approach is one in which the investigator primarily uses post-positivist claims for developing knowledge (i.e. cause and effect thinking, reduction to specific variables and hypotheses and questions, use of measurement and observation, and the test of theories)." (Creswell, 2003) Qualitative research is used to gain insight into people's attitudes, behaviours, value systems, concerns, motivations, aspirations, culture or lifestyles. Qualitative researchers aim to gather an in-depth understanding of human behavior and the reasons that govern such behavior. Qualitative research is often associated with naturalistic inquiry. Naturalistic methods of inquiry attempt to deal with the issue of human complexity by exploring directly. Naturalistic inquiry always takes place in the natural settings (field). Naturalistic studies result in rich, in-depth information that has the potential to elucidatethe multiple dimensions of complicated phenomenon. The qualitative method investigates the why and how of decision making, not just what,where, when. The qualitative researcher is interested in illumination and understanding rather than causal determination or





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prediction. DIFFERENCE BETWEEN QUALITATIVE AND QUANTITATIVE RESEARCH
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The key difference between quantitative and qualitative methods is their flexibility. In qualitative methods, the relationship between the researcher and the participant is often less formal than in quantitative research Quantitative Research • Seek to confirm hypotheses
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General framework

Qualitative Research • Seek to explore phenomena
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Postivist paradigm To predict & control Highly structured methods: questionnaires, surveys, and structured observation Rigid design Controlled & experimental Prediction Outcomes Generalisability

Objectives




Tools





Naturalistic paradigm To understand (what, how, & why) Use semistructured methods: in-depth interviews, focus groups, and participant observation Emergent design

Design

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Focus



Rich “thick” description Similarities & contrasts Process & context Non-statistical



Nature of data analysis Sampling



Statistical





Relatively large samples using often random sampling



Small samples using purposive, convenient or

snaw ball sampling technique. METHODS OF COLLECTING DATA Obtrusive
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Semi structured interviews In-depth interviews Focus Group Discussions Ethnography Participatory Action Research Narrative and Life History Participant observation

Unobtrusive methods
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Simple observation Document analysis (written records) Audio-visual Text analysis / Discourse analysis Material culture Auto-ethnography (object, subject and researcher)

Observation


Most intuitive method

Three most common methods are






Participant observation o appropriate for collecting data on naturally occurring behaviors in their usual contexts. In-depth interviews o optimal for collecting data on individuals’ personal histories, perspectives, and experiences, particularly when sensitive topics are being explored. Focus groups o effective in eliciting data on the cultural norms of a group and in generating broad overviews of issues of concern to the cultural groups or subgroups represented.

SAMPLING IN QUALITATIVE RESEARCH Sampling methods used in qualitative research are: 1. purposive sampling 2. quota sampling, and 3. snowball sampling






Purposive sampling o most common sampling strategy. o according to preselected criteria relevant to a particular research question o Sample sizes depend on the resources and time available, as well as the study’s objectives. Quota sampling o In quota sampling, rsearcher decides while designing the study how many people with which characteristics to include as participants. o Characteristics such as age, place of residence, gender, class, profession, marital status, use of a particular contraceptive method, HIV status, etc. are taken as inclusion criteria. o The criteria chosen by the researcher allow him to focus on people he thinks would be most likely to experience, know about, or have insights into the research topic. Snowball sampling o Also known as chain referral sampling. o In this method, participants or informants with whom contact has already been made use their social networks to refer the researcher to other people who could potentially participate in or contribute to the study. o E.g. To study a population of opium dependents, the researcher establishes a few contacts initially and these contacts help the reseracher to get in contact with other members in the group.

PURPOSE OF QUALITATIVE RESEARCH The purpose of qualitative research is to describe, explore, and explain phenomena being studied. Qualitative research questions often take the form of what is this? or what is happening here? and are more concerned with the process rather than the outcome.

( Ploeg J, 1999)
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For better understanding of a phenomenon and gain new perspectives Collect and explore in-depth information that can’t be conveyed quantitatively. Provide rich descriptions of complex phenomena. Explore sensitive topics Explore the issues of difficult to access groups / subcultures Explore culturally defined experiences Track unique / unexpected events Illuminate experience and interpretation by actors Gives voice to those rarely heard

CHARECTERISTICS
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Takes place in the natural setting Uses multiple methods that are interpretive Is emergent rather than tightly prefigured Fundamentally interpretive (role of researcher as interpreter) Researcher views social phenomena holistically Researcher systematically reflects on who he or she is in the inquiry and is sensitive to hiw or her personal biography and how it shapes the study Researcher uses complex reasoning that is multifaceted, iterative, and simultaneous Researcher adopts and uses one or more strategies of inquiry.

ETHICAL PRINCIPLES
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Respect for persons Beneficence Justice Respect for communities

PROCESSES IN QUALITATIVE RESEARCH


Conceptualizing and planning o Generally begin with a broad area to be studied. o Identify a site for data collection. o Make preliminary contactswith key actors in the selected site to ensure cooperation and access to



informants o In qualitative research, the research design is often referred to as emergent design- a design that emerges during the course of data collection. o Adiotaping or videotaping interviews with informants Conducting the qualitative study o Data collection o Data analysis o Interpretation o These processes take place in an interactive fashion. o The investigator starts data collection by talking with or observing a few people who have first-hand experience of the phenomenon under study. o The analysis of qualitative data is an intensive and time-consuming task. o As the ananlysis and interpretaion progress, the researcher identify themes and categories, which are used to build a descriptive theory of the phenomenon. o The guiding principle in deciding the sample size is data saturation. o Qualitative research reports are increasingly being published in nursing journals. o Qualitative finding are used as the basis for the formaulation of hypothesis that are tested by quantitative research.

ANALSYING DATA IN QUALITATIVE RESEARCH Methods
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Interpretive techniques Coding Recursive abstraction Content analysis

Steps 1. 2. 3. 4. Organize and prepare the data for analysis Read all data, get a sense of the whole Begin detailed analysis with coding process Generate a description of the setting/people as well as categories or themes for analysis 5. Identfy themes (writing, visual, etc.)

6. Interpret and make meaning out of data TYPES OF QUALITATIVE RESEARCH Ethnography
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Ethnography is a description and interpretation of a cultural or social group or system. The research examines the group’s observable and learned patterns of behaviour, customs, and ways of life. A picture of the “way of life” of some identifiable group of people Ethnography is closely related to Anthropology Its process include “doing fieldwork” and “going native” The focus of ethnography is with culture, and how people interact with each other. Its is a both a research process and a product Methods include o Direct observation o Participant observation o Unstructured Interview Reseach Process o The ethnographer is the primary research instrument o The researcher spends one year or more in the field setting long enough to see a full cycle of activity o For example, a full school year o Emic and etic perspectives  Outsider’s broad and analytical perspective on group studied  Insider view, familiarity, empathy, identification with group

Phenomenology




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Phenomenology describes the subjective reality of an event, as perceived by the study population; it is the study of a phenomenon. Phenomenological research techniques offer nurses a valuable way to understand the lifeworld of nursing (Walters AJ) Analysis /description of everyday life Method

o

Interview

Symbolic Interactionism
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Making sense of experience via symbols Symbols find meaning through and in interaction Closely related to Grounded theory Method o Semiotic analysis

Grounded Theory
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Grounded theory is an inductive type of research, based in the observations or data from which it was developed It uses a variety of data sources, including quantitative data, review of records, interviews, observation and surveys. Concepts are basic units of analysis Concepts grouped and related to form abstract categories Relationships between categories identified to develop “formal theory” Theory building- concepts, categories, themes are identified and developed during the study. Methods o Interview o Constant comparison

CRITICISMS




The issue in qualitative research is validity /credibility / dependability. o Measures of establishing validity-member check, interviewer corroboration, peer debriefing, prolonged engagement, negative case analysis, auditability, confirmability, bracketing, and balance Rigor in qualitative research o Triangulation is one way of promoting rigour in qualitative research. The term refers to the use of more than one method of data collection and can involve triangulation of data, investigators and theories.

CONCLUSION

Qualitative research must be systematic, rigorous and planned to make it credible and dependable. It involves critical self-scrutiny (active reflexivity) to produce explanations. Such investigations produce social explanations which are somewhat generalizable. Qualitative research is still not be seen as a unified body and face many criticisms. REFERENCES 1. Ploeg J. Identifying the best research design to fit the question. Part 2: qualitative designs. Evid Based Nurs 1999;2:36-37 2. Bailey C, Froggatt K, Field D, Krishnasamy M. The nursing contribution to qualitative research in palliative care 1990-1999: a critical evaluation. J Adv Nurs. 2002 Oct;40(1):48-60. 3. Strauss, Corbin. Basics of Qualitative Research: Grounded Theory Procedures and Techniques. Sage, Newbury Park, 1990. 4. Creswell, J.W.Research design. Qualitative, quantitative and mixed methods approaches. Thousand Oaks, CA: Sage, 2003. 5. Denzin & Lincoln (eds.). Handbook of Qualitative Research, 2ND ed., Sage Publications, Inc. London, 2000. 6. Polit H, Beck C T. Nursing research. 8th ed. New Delhi: Williams and Wilkins; 2008. 7. Walters AJ. Phenomenology as a way of understanding in nursing, Contemporary Nurse Journal;1994, 3:3- 134 141. Journals on Qualitative Research
1. 2. 3. 4. 5. 6.

Advances in Nursing Science Holistic Nursing Practice Journal of Advanced Nursing Journal of Family Nursing Nursing Research Nursing Science Quarterly

Selected Published Artciles on Qualitative Research in Nursing 1). Anthony S, Jack S. Qualitative case study methodology in nursing research: an integrative review. J Adv Nurs. 2009 Jun;65(6):1171-81

This paper is a report of an integrative review conducted to critically analyse the contemporary use of qualitative case study methodology in nursing research in the context of increasing complexity in health care and increasing use of case study in nursing research. A sample of 42 case study research papers were analyzed using Whittemore and Knafl's integrative review method. It was summarised that confusion exists about the name, nature and use of case study and this methodology, including terminology and concepts, is often invisible in qualitative study titles and abstracts, despite its high quality exists in nursing research. The reviews conclude that judicious selection and diligent application of literature review methods promote the development of nursing science. Case study is becoming entrenched in the nursing research lexicon as a well-accepted methodology for studying phenomena in health and social care, and its growing use warrants continued appraisal to promote nursing knowledge development. Attention to all case study elements, process and publication is important in promoting authenticity, methodological quality and visibility. 2). Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004 Feb;24(2):105-12.

This paper provides an overview of important concepts (manifest and latent content, unit of analysis, meaning unit, condensation, abstraction, content area, code, category and theme) related to qualitative content analysis; illustrates the use of concepts related to the research procedure; and proposes measures to achieve trustworthiness (credibility, dependability and transferability) throughout the steps of the research procedure. Interpretation in qualitative content analysis is discussed in light of Watzlawick et al.'s theory of communication. 3). DeSantis L, Ugarriza DN. The concept of theme as used in qualitative nursing research.West J Nurs Res. 2000 Apr;22(3):351-72.

This literature review of qualitative research methodology and nursing research studies reveals considerable diversity in the

identification of themes, the interpretation of the concept, and its function in data analysis. Part of the problem is the transfer of research methods from other disciplines to the study of nursing phenomena. The transfer often results in a blending of distinct research methods that compromises methodological rigor in data analysis and theory generation. A definition of theme is developed from the literature review and interdisciplinary definitions and descriptions. Five aspects of a theme and criteria foundational to the definition and concept of theme are identified. Implications of the concept of theme are presented for the conduct and application of research findings to the practice and development of nursing science. 4). Chen HY, Boore JR. Using a synthesised technique for grounded theory in nursing research. J Clin Nurs. 2009 Aug;18(16):2251-60. Nursing increasingly uses grounded theory for a broadened perspective on nursing practice and research. Authors suggested, nursing researchers intent on using a grounded theory methodology should pay attention to the theoretical discussions including theoretical sampling, theoretical sensitivity, constant comparative methods and asking questions, keeping memoranda diagramming, identification of a core category and a resultant explanatory theory. Authors introduces a newly synthesised approach which may provide a true reflection of Glaser's idea of 'emergence of theory from the data' and Strauss and Corbin's style of sampling and memoranda writing is employed. 5). Pale J. Husserl, phenomenology and nursing. Journal of Advanced Nursing 2008; 26:1. This study focuses on Husserl, and examines the relationship between his phenomenology and the accounts of it that are to be found in the nursing literature. Three central ideas were given particular attention: the phenomenological reduction, phenomena, and essence. It was argued that nurse researchers largely misunderstand these concepts and that, as a result, their version of Husserl's philosophy bears little resemblance to the original. Similarly, the project of identifying the 'essential structure' of a phenomenon, typically adopted by the nurse researchers who cite Husserl as an authority, comes close to being unintelligible. The author states that while the methods used in 'phenomenological' nursing research may still have some legitimacy, they cannot achieve what they are alleged to achieve, and they should be

detached from the framework of Husserlian ideas and terminology which is supposed to justify them.



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Nursing Research Quiz-I :: Biostatistics Nursing Research Quiz - II Nursing Research Quiz-III :: Qualitative Research Nursing Research Quiz-IV Nursing Research Quiz-V :: Biostatistics Nursing Research Quiz-VI :: Research Instruments Nursing Research Quiz-VII Nursing Research Quiz-VIII : Epidemiology Evidence Based Nursing Qualitative Research in Nursing Introduction to Biostatistics Critiquing Nursing Research Experimental Research in Nursing Introduction to Nursing Research Basic statistical

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Concepts for Nurses Action research in Nursing A self-report scale to assess the perceptions of patients undergoing radio-diagnostic towards the procedures (CT/MRI) A rating scale to evaluate



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