Routledge International Handbook of Qualitative Nursing Research

Cheryl Tatano Beck

• Publisher: Routledge
• Year: 2013
• Print ISBN:
  9780415673563
• eBook ISBN:
  9781136703409
• Topic: Medicine
• Subtopic: Health Care Delivery

Qualitative research, once on the fringes, now plays a central part in advancing nursing and midwifery knowledge, contributing to the development of the evidence base for healthcare practice. Divided into four parts, this authoritative handbook contains over forty chapters on the state of the art and science of qualitative research in nursing.

The first part begins by addressing the significance of qualitative inquiry to the development of nursing knowledge, and then goes on to explore in depth programs of qualitative nursing research. The second section focuses on a wide range of core qualitative methods, from descriptive phenomenology, through to formal grounded theory and to ethnography, and narrative research. The third section highlights key issues and controversies in contemporary qualitative nursing research, including discussion of ethical and political issues, evidence-based practice and Internet research. The final section takes a unique look at qualitative nursing research as it is practiced throughout the world with chapters on countries and regions from the UK and Europe, North America, Australasia, Latin America, to Japan, China, and Korea.

With an international selection of established scholars contributing, this is an essential overview and will help to propel qualitative research in nursing well into the twenty-first century. It is an invaluable reference for all nursing researchers.

1

Introduction to qualitative nursing research

Cheryl Tatano Beck

Qualitative nursing research: a subdiscipline

Morse (2010) asked: “How different is qualitative health research from qualitative research? Do we have a subdiscipline?” (p. 1459). Her answer was yes. Morse (2012) defined qualitative health research “as a research approach to exploring health and illness as they are perceived by the people themselves, rather than from the researcher’s perspective” (p. 21). Morse argued that the context, the participants in the research, and the nature of the research questions investigated in qualitative health research are distinct. She made the case (p. 1463) that researchers who conduct qualitative health research required special skills and qualifications as “insiders”:

• Health professionals are “street smart,” knowing the rules, regulations, and norms for working in a hospital or other health care contexts.
• Health professionals, with some working knowledge of the patient population, can recognize appropriate research questions.
• Because of their knowledge of the signs of fatigue and experience with illness, health professionals can monitor their patient participants throughout data collection.
• From their completed projects, health professionals can more readily make realistic recommendations for practice.

When conducting qualitative health research, a variety of health care professionals can be considered “insiders,” such as nurses, physicians, respiratory therapists, social workers, dieticians, and physical therapists, to name but a few. Each of these qualitative health researchers can make a unique contribution to their respective disciplines and to health care, providing understanding and meaning to our research agendas.

Kuzel (2010) agreed with Morse that “insiders” are generally better than “outsiders” to conduct believable qualitative research. Eisner (1998, p. 39) stressed that “qualitative research becomes believable because of its coherence, insight, and instrumental utility.” He called on qualitative researchers to have an enlightened eye, that is, “the ability to see what counts is what distinguishes novices from experts” (p. 34). Kuzel believed that experts in their respective fields are better suited to deliver these qualities that Eisner highlighted.

To begin this first ever International Handbook of Qualitative Nursing Research, I will ask the question: Is qualitative nursing research a subdiscipline of qualitative health research? Following Morse’s line of argument that qualitative health research is a subdiscipline of qualitative research, I believe qualitative nursing research is a subdiscipline of qualitative health research, and is particularly important for the advancement of nursing science. Many of Morse’s arguments for why qualitative health research is a subdiscipline are pertinent to making the case for narrowing again the focus of qualitative research, this time to qualitative research in the discipline of nursing (Figure 1.1).

Figure 1.1 Narrowing the focus of qualitative research

Qualitative health researchers need to be connoisseurs of the phenomena they are studying. These researchers are not connoisseurs in all health care-related disciplines. Phenomena studied in nutritional sciences, for example, are different than phenomena in medicine or social work or occupational therapy, including human behaviors associated with the physical phenomena. Nutrition, for instance, focuses on eating behaviors; medicine with symptom responses, compliance, and responses to therapy; occupational therapy to coping, and so forth. Each health care discipline can be considered a culture unto itself, with its own norms and perspectives. Medicine and these other disciplines do not have a subdiscipline of qualitative research yet but nursing does.

Members of each health care discipline can be considered as “insiders” while members of the other disciplines can be viewed as “outsiders.” Nursing is a culture different from the other “cultures” in health care. Nurse researchers are the “insiders” who have the required special skills and qualifications: (1) to conduct qualitative research on phenomena in the discipline of nursing; and (2) to develop a specific body of knowledge known as qualitative nursing research.

In this introductory chapter, the emergence of qualitative inquiry in nursing is described. The remainder of the chapter describes the four parts of this handbook: Part I: What does qualitative nursing research do?, Part II: Qualitative research methods, Part III: Contemporary issues in qualitative nursing research methods, and Part IV: International qualitative nursing research: State of the science.

Emergence of qualitative nursing research

In the 1960s, the federal nurse scientist program started and provided nurses opportunities to obtain doctoral degrees in the social sciences. Methods courses in anthropology and sociology were available for nurses to enroll in. Nurses studied with qualitative scholars such as Barney Glaser, Anselm Strauss, and Leonard Schatzman, to name but a few. At universities such as the University of California at San Francisco and Columbia University, nurses were educated in qualitative research methods. Jeanne Quint Benoliel, one of nursing’s first qualitative scientists, was educated in this first wave. Until that time many nurses who had undertaken doctoral studies obtained their degrees in education and psychology where quantitative research was the prevailing method.

In the 1970s and early 1980s, tensions occurred in the discipline of nursing between the predominant quantitative researchers and the qualitative researchers who were in the minority. Qualitative research was viewed as “soft science.” Hutchinson (2001) recounted how in the mid-1980s she and a few other qualitative nurse researchers who were members of the Council of Nursing and Anthropology met every year at the American Anthropology Association where they would present their qualitative papers. They would share with each other the high rejection rate of their qualitative manuscripts from journals that had rejected them for the wrong reasons. Reviewers not educated in qualitative methods would reject their manuscripts for reasons, such as small sample size and lack of random sampling. Hutchinson went on to tell how she and those few qualitative colleagues started on a mission to contact editors of journals to request that they add qualitative reviewers. Their efforts met with success in such journals as Western Journal of Nursing Research, Advances in Nursing Science, and Image: Journal of Nursing Scholarship. In the mid-1980s qualitative research textbooks in nursing were beginning to be published. Examples of these textbooks include Field and Morse’s (1985) Nursing Research: The Application of Qualitative Approaches, Parse, Coyne, and Smith’s (1985) Nursing Research: Qualitative Methods, Leininger’s (1985) Qualitative Research Methods in Nursing, and Munhall and Oiler’s (1986) Nursing Research: A Qualitative Perspective.

In 1986, Munhall astutely asked why had our nursing scholarship “evolved into a search for structural truth rather than dynamic meaning?” (p. 1). Why must nursing scholarship be polarized into two distinct positions of quantitative and qualitative research? Munhall argued (p. 5) that:

• our different angles enlarge our promise;
• are to be summative not negating;
• but engaging us in our community of endeavors.

Janice Morse in 1988 held a think tank for nurse leaders in qualitative research. Issues relevant to qualitative research were discussed. Morse published four edited volumes on qualitative research issues that were an outgrowth of these series of think tanks. The first volume was entitled Qualitative Nursing Research: A Contemporary Dialogue (Morse, 1991), followed by Critical Issues in Qualitative Research Methods (Morse, 1994). The third and fourth volumes were entitled Completing a Qualitative Project (Morse, 1997) and The Nature of Qualitative Evidence (Morse, Swanson, & Kuzel, 2001), respectively.

As the decade of the 1980s was coming to a close, the numbers of qualitative research manuscripts being published increased. Though progress was being made in the acceptance of qualitative research in our discipline, this was accompanied by a potential problem. There were not enough qualitative reviewers with expertise in different qualitative methods to review the influx of manuscripts. As a result, some sloppy qualitative research was being published. Research which included “method slurring” (Baker, Wuest, & Stern, 1992) of qualitative methods in a study was being published in top tier nursing journals. Reviewers, lacking substantive understanding of qualitative methods, used rule-bound checklists as criteria for reviews, whether the criteria were appropriate for the methods they were reviewing or not.

In 1991, Janice Morse launched the first issue of the journal Qualitative Health Research. At that time the journal had four issues per year with six articles in each issue. It took six years for Qualitative Health Research to be referenced in Medline. Its niche market and readership have grown tremendously so much so that 22 years later there are now 12 issues a year with about 12 articles in each issue.

Next in this introductory chapter the four parts of this first ever international handbook of qualitative nursing research are introduced.

Part I: What does qualitative nursing research do?

Part I consists of eight chapters. This first section of the handbook will feature the “so what” of qualitative nursing research. In Chapter 2, Janice Morse addresses the significance of qualitative inquiry to the development of nursing knowledge. The other seven chapters in Part I feature exemplars of qualitative nursing research programs.

In Chapter 3, Judith Wuest, Marilyn Ford-Gilboe, Marilyn Merritt-Gray, and Colleen Varcoe discuss the processes, challenges, and advantages of translating their grounded theory, “Strengthening Capacity to Limit Intrusion,” into a primary health care intervention for women who have left their abusive partners. Translation of grounded theories by researchers is crucial to facilitating their utilization in the clinical area.

In Chapter 4 the power of a program of qualitative research is clearly illustrated by Joanne Hall with her studies on traumatic experiences of marginalized groups. She examines the complex interrelated experiences, such as interpersonal violence, substance misuse, and racism in traumatized women.

Karin Olson in Chapter 5 describes her program of research on fatigue using qualitative research in conjunction with quantitative approaches. She and her team used their qualitative findings to reconceptualize fatigue, explore the social construction of fatigue, and develop the Edmonton Fatigue Framework.

In Chapter 6, Siv Söderberg presents her program of research on experiences of living with chronic pain syndrome that emerged from personal narrative interviews. By means of her research Söderberg illustrates that in order to preserve people’s dignity within the health care system, clinicians need to be aware of the vulnerability of persons with chronic pain and their dependence on the power of health care providers to meet their individual needs.

Mary Beth Happ’s qualitative research program in the care of ventilator-dependent ICU patients is highlighted in Chapter 7. Using a variety of qualitative and mixed methods Happ’s research helped to explicate the social and cultural context and processes of interaction during critical care treatment of ventilator-dependent patients. Her research trajectory moved from descriptive theory building to intervention development and testing and then on to qualitative program evaluation.

In Chapter 8, Lauren Clark, Susan Johnson, Mary O’Connor, and Jane Lassetter describe their series of qualitative studies aimed at filling in the gaps of clinicians’ understanding of Latino families’ cultural values and patterns of infant feeding that result in normal weight or childhood obesity. Their focused ethnography helped to identify the mismatch between Latino parents and clinicians’ cultural construction of childhood obesity, and in turn to develop effective childhood obesity prevention with Latino families.

In Chapter 9, Cheryl Tatano Beck’s program of research on postpartum depression illustrates a line of scientific inquiry that was knowledge-driven and not limited to either qualitative or quantitative research methods. Her series of qualitative studies using phenomenology and grounded theory provided the conceptual basis for the development of her instrument, the Postpartum Depression Screening Scale (PDSS). All the items on the PDSS were developed from her qualitative findings.

Part II: Qualitative research methods

Seventeen chapters comprise Part II of the handbook which concentrates on various qualitative research methods. Some of these chapters on different qualitative research methods start with a brief history of that method’s use in nursing research. Philosophical or theoretical underpinnings of the qualitative research method are discussed when appropriate. An advanced level discussion of the method and any various approaches to that method are addressed as well as any current debates or controversies regarding the method. A review of published studies over the past 20 years in which nurse researchers used that particular qualitative research method is included which leads to presentation of the state of the science of qualitative nursing research in regards to the method. Highlights of particular nursing research studies using that method and their analyses are included. Chapters end with a summary of the contributions of qualitative nursing research using this method, and future directions of this qualitative research method in nursing.

The first two chapters in Part II focus on phenomenology. In Chapter 10, Cheryl Tatano Beck describes the state of the science of descriptive phenomenology in nursing research. Published descriptive phenomenological studies conducted by nurse researchers across the globe over the past 20 years are reviewed. Trends in the methods used by nurse researchers and also the phenomena studied are identified.

Next, in Chapter 11, Patricia Munhall addresses interpretive phenomenology not only as a research method but also as a way of being-in-the-world. She helps the reader ...

Table of contents

• Cover Page
• Half Title page
• Title Page
• Copyright Page
• Dedication
• Contents
• List of figures
• List of tables
• About the editor
• Notes on contributors
• Acknowledgements
• 1 Introduction to qualitative nursing research
• Part I What does qualitative nursing research do?
• Part II Qualitative research methods
• Part III Contemporary issues in qualitative nursing research methods
• Part IV International qualitative nursing research: state of the science
• Index