Qualitative Research in Nursing

INTRODUCTION

• 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 prediction.

DIFFERENCE BETWEEN QUALITATIVE AND QUANTITATIVE RESEARCH

• 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	Qualitative Research
General framework	Seek to confirm hypotheses Postivist paradigm	Seek to explore phenomena Naturalistic paradigm
Objectives	To predict & control	To understand (what, how, & why)
Tools	Highly structured methods: questionnaires, surveys, and structured observation	Use semi-structured methods: in-depth interviews, focus groups, and participant observation
Design	Rigid design Controlled & experimental	Emergent design
Focus	Prediction Outcomes Generalisability	Rich “thick” description Similarities & contrasts Process & context
Nature of data analysis	Statistical	Non-statistical
Sampling	Relatively large samples using often random sampling	Small samples using purposive, convenient or snaw ball sampling technique.

METHODS OF COLLECTING DATA

Obtrusive

• Semi structured interviews
  
• In-depth interviews
  
• Focus Group Discussions
  
• Ethnography
  
• Participatory Action Research
  
• Narrative and Life History
  
• Participant observation

Unobtrusive methods

• 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
  • appropriate for collecting data on naturally occurring behaviors in their usual contexts.
• In-depth interviews
  • optimal for collecting data on individuals’ personal histories, perspectives, and experiences, particularly when sensitive topics are being explored.
• Focus groups
  • 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
  • most common sampling strategy.
  • according to preselected criteria relevant to a particular research question
  • Sample sizes depend on the resources and time available, as well as the study’s objectives.
• Quota sampling
  • In quota sampling, rsearcher decides while designing the study how many people with which characteristics to include as participants.
  • 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.
  • 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
  • Also known as chain referral sampling.
  • 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.
  • 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)

• 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

• 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

• Respect for persons
• Beneficence
• Justice
• Respect for communities

PROCESSES IN QUALITATIVE RESEARCH

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

ANALSYING DATA IN QUALITATIVE RESEARCH
Methods

• Interpretive techniques
• Coding
• Recursive abstraction
• Content analysis

Steps

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

TYPES OF QUALITATIVE RESEARCH

Ethnography

• 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
  • Direct observation
  • Participant observation
  • Unstructured Interview
• Research Process
  • The ethnographer is the primary research instrument
  • The researcher spends one year or more in the field setting long enough to see a full cycle of activity
  • For example, a full school year
  • Emic and etic perspectives
    
    • Outsider’s broad and analytical perspective on group
      studied
      
    • Insider view, familiarity, empathy, identification with
      group

Phenomenology

• 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
  
  • Interview

Symbolic Interactionism

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

Grounded Theory

• 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
  • Interview
  • Constant comparison

CRITICISMS

• The issue in qualitative research is validity /credibility / dependability.
  • Measures of establishing validity-member check, interviewer corroboration, peer debriefing, prolonged engagement, negative case analysis, auditability, confirmability, bracketing, and balance
• Rigor in qualitative research
  • 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. Advances in Nursing Science
2. Holistic Nursing Practice
3. Journal of Advanced Nursing
4. Journal of Family Nursing
5. Nursing Research
6. Nursing Science Quarterly

Selected Published Artciles on Qualitative Research in Nursing

Full-text articles

1. Barriers to and Facilitators of Clinical Practice Guideline Use in Nursing Homes

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

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.

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.

4). Chen HY, Boore JR. Using a synthesised technique for grounded theory in nursing research. J Clin Nurs. 2009 Aug;18(16):2251-60. 

5). Pale J. Husserl, phenomenology and nursing. Journal of Advanced Nursing  2008; 26:1.

Posted in: Nursing Research