Qualitative Research in Nursing and Healthcare

Immy Holloway, Kathleen Galvin

• Publisher: Wiley-Blackwell
• Year: 2016
• ISBN:
  9781118874486
• Edition: 4
• Topic: Medicine
• Subtopic: Nursing

Qualitative Research in Nursing and Healthcare is an invaluable resource for those who carry out qualitative research in the healthcare arena. It is intended to assist:

• Professionals and academics in the healthcare field who undertake or teach research in clinical or educational settings;
• Postgraduates who are undertaking qualitative research and want to revise qualitative research approaches and procedures before going on to more specialist texts; and
• Undergraduates in their last year who wish to learn about qualitative perspectives or carry out a project using these approaches.

Fully updated from the earlier editions by Holloway and Wheeler, it reflects recent developments in nursing research. This new edition provides clear explanations of abstract ideas in qualitative research as well as practical procedures. Structured into four sections, the book looks at the initial stages, methods of data collection, qualitative approaches and analysis of collected data. It also contains a chapter on writing up and publishing qualitative research.

With applied and practical examples throughout, Qualitative Research in Nursing and Healthcare is essential reading for those who are looking for a comprehensive introduction to qualitative research.

Part One
Introduction to Qualitative Research: Starting Out

Chapter 1
The Main Features and Uses of Qualitative Research

What is Qualitative Research?

Qualitative research is a form of social inquiry that focuses on the way people make sense of their experiences and the world in which they live. A number of different approaches exist within the wider framework of this type of research, and many of these share the same aim – to understand, describe and interpret social phenomena as perceived by individuals, groups and cultures. Researchers use qualitative approaches to explore the behaviour, feelings and experiences of people and what lies at the core of their lives. For example, ethnographers focus on culture and customs; grounded theorists investigate social processes and interaction, while phenomenologists consider and illuminate a phenomenon and describe the ‘life world’ or Lebenswelt. Qualitative approaches are useful in the exploration of change or conflict. The basis of qualitative research lies in the interpretive approach to social reality and in the description of the lived experience of human beings.

The Characteristics of Qualitative Research

Different types of qualitative research share common characteristics and use similar procedures though differences in data collection and analysis do exist.

The following elements are part of most qualitative approaches:

• The data have primacy (priority); the theoretical framework is not predetermined but derives directly from the data.
• Qualitative research is context-bound, and researchers must be context sensitive.
• Researchers immerse themselves in the natural setting of the people whose situations, behaviour and thoughts they wish to explore.
• Qualitative researchers focus on the ‘emic’ perspective, the ‘inside view’ of the people involved in the research and their perceptions, meanings and interpretations.
• Qualitative researchers use ‘thick description’: they describe, analyse and interpret but also go beyond the reports, descriptions and constructions of the participants.
• The relationship between the researcher and the researched is close and based on a position of immersion in the field and equality as human beings.
• Reflexivity in the research makes explicit the stance of the researcher, who is the main research tool.

The Primacy of Data

Researchers usually approach people with the aim of finding out about their concerns; they go to the participants to collect the rich and in-depth data that can then become the basis for theorising. The interaction between the researcher and the participants leads to an understanding of experience and the generation of concepts. The data themselves have primacy, generate new theoretical ideas, and they help modify already existing theories or uncover the essence of phenomena. It means that the research design cannot be predefined before the start of the research. In other types of research, assumptions and ideas lead to hypotheses which are tested (though this is not true for all quantitative research); sampling frames are imposed; in qualitative research, however, the data have priority. The theoretical framework of the research project is not predetermined but based on the incoming data. Although the researchers do have knowledge of some of the theories involved, the incoming data might confirm or contradict existing assumptions and theory.

This approach to social science is, initially at least, inductive. Researchers move from the specific to the general, from the data to theory or analytic description. They do not impose ideas or follow up assumptions but give accounts of reality as seen by the participants. Researchers must be open-minded, though they cannot help having some ‘hunches’ about what they may find, especially if they are familiar with the setting and some of the literature on the topic.

While some qualitative inquiry is concerned with the generation of theory such as grounded theory, many researchers do not achieve this; others, such as phenomenologists, focus on a particular phenomenon to delineate and illuminate it. All approaches usually provide descriptions or interpretation of participants' experiences and the phenomenon to be studied but go to a more abstract and theoretical level in their written work, especially when they carry out postgraduate research. Qualitative inquiry is not static but developmental and dynamic in character; the focus is on process as well as outcomes.

Contextualisation

Researchers must be sensitive to the context of the research and immerse themselves in the setting and situation. Both personal and social contexts are important. Patients might have particular religious or cultural beliefs, for instance, or personal perspectives on blood or pain, and that would affect their behaviour. The context of participants' lives or work affects their behaviour, and therefore researchers have to realise that the participants are grounded in their history and temporality. Researchers take into account the total context of people's lives – including their own – and the broader political and social framework of the culture in which it takes place. The conditions in which they gather the data, the locality, time and history are all involved. Events and actions are studied as they occur in everyday ‘real-life settings’. Koro-Ljungberg (2008) states that participants not only have personal values and beliefs but are also connected with their environment, and this influences their interactions with the researcher. It is important to respect the context and culture in which the study takes place. If researchers understand the context, they can locate the actions and perceptions of individuals and grasp the meanings that they communicate. The interest in context and contextualisation goes beyond that which influences the research; it also affects its outcomes and applications in the clinical situation. Scott et al. (2008) add that organisational context, group membership and other factors are also important in the applications and use of the research in healthcare settings. An example of contextualisation would be the description of the effects of a specific hospital on the actions and language of health professionals.

Immersion in the Setting

Qualitative researchers use the strategies of observing, questioning and listening, immersing themselves in the ‘real’ world of the participants. Observing, listening and asking questions will lead to rich data. Involvement in the setting also assists in focusing on the interactions between people and the way they construct or change rules and situations. Qualitative inquiry can trace progress and development over time, as perceived by the participants.

For the understanding of participants' experiences, it is necessary to become familiar with their world. When professionals do research, they are often part of the setting they investigate and know it intimately. This might mean that they could miss important issues or considerations. To be able to better examine the world of the participant, researchers must not take this world for granted but should question their own assumptions and act like strangers to the setting or as ‘naïve’ observers. They ‘make the familiar strange’ (Delamont and Atkinson, 1995). Immersion might mean attending meetings with or about informants, becoming familiar with other similar situations, reading documents or observing interaction in the setting. This can even start before the formal data collection phase.

Most qualitative inquiry investigates patterns of interaction, seeks knowledge about a group or a culture or explores the life world of individuals. In clinical, social care or educational settings, this may be interaction between professionals and clients or relatives, or interaction with colleagues. It also means listening to people and attempting to see the world from their point of view. The research can be a macro or micro study – for instance, it may take place in a hospital ward, a classroom, a residential home, a reception area or indeed the community. Immersion in the culture of a hospital or hospital ward, for instance, does not just mean getting to know the physical environment but also the particular ideologies, values and ways of thinking of its members. Researchers need sensitivity to describe or interpret what they observe and hear. Human beings are influenced by their experiences; therefore, qualitative methods encompass processes and changes over time in the culture or subculture under study.

The ‘Emic’ Perspective

Qualitative approaches are linked to the subjective nature of social reality; they provide insights from the perspective of participants, enabling researchers to see events as their informants do; they explore ‘the insiders’ vie...