Qualitative research has gained wide acceptance in nursing research. This book examines ethnography as a research design of particular relevance to nursing and provides specific information to guide graduate students or experienced nurses who are novices in the designs in conducting studies from the point of view of patients and their families. It reviews the philosophical basis for choosing ethnography as a research tool and describes in depth its key features and development level. The book provides directives on how to solve practical problems related to ethnography research, nursing examples, and discussion of the current state of the art. This includes a comprehensive plan for conducting studies and a discussion of appropriate measures, ethical considerations, and potential problems. It describes the meaning of health and well-being from the emic viewpoint of rural Nicaraguan men and talks about a study which explored health care providers’ perspectives regarding guideline compliance for rapid malaria testing in peripheral health facilities in Ghana. The book reviews the culture of the indigenous Zapotec Indians of Oaxaca, Mexico, and the application of Leininger’s transcultural nursing theory and describes a study, which examined childbirth in Fiji, compared the culturally specific methods used during childbirth to control pain and to reduce the risk of injury to the mother and the infant. It also deals with the needle exchange program to reduce the incidence rate of hepatitis and presents an ethnographic study done with a small group of poor and working-class Black American women who are sustained by their storefront church. The book also discusses other issues such as recovery of women from alcohol abuse, and personal privacy and interactional patterns in a nursing home.
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Meta-synthesis includes various techniques for integrating the findings of studies addressing a similar topic, into a more “general” theory. Quantitative meta-synthesis and meta-analysis use statistical techniques, usually for combining trials and comparing effect sizes to determine efficacy. These statistical methods are well developed, commonly used, and various software packages have been developed to facilitate these analyses. They are also a component of the Cochrane systematic reviews. Qualitative meta-synthesis is still in the developmental phase. The first text for combining qualitative studies was Nobit and Hare’s for meta-ethnography. In nursing, Paterson, Thorne, Canam, and Jillings published a text outlining criteria for method study, followed by Sandelowski and Barroso’s text in 2007, and Hanes and Lockwood. Meta-synthesis may be used for a variety of purposes, either descriptive or interpretative. Interpretatively, researchers have used meta-synthesis to move findings toward formal grounded theory, as in Kearney’s study on domestic violence.
Structural techniques of interviewing allow the researchers access to lay concepts, especially to those that are relatively uncommon and arise in the course of fieldwork or interviews. Anthropologists use methods of structured interviewing to elicit what they call cognitive domains of cultural groups, using linguistic techniques and logical relations between and within classes. The conceptual domain may be elicited from participants’ words, lay concepts, and sentences used in everyday language, that are all in the same level of contrast, using free lists and pile sorts. The insights obtained from the ways that participants sort cards, and the labels for each pile, are organized by the researchers into contrasting sets. All of the symptoms delineating tiredness and exhaustion from fatigue are symptoms recognized and reported by participants themselves, thereby illustrating the importance of developing lay concepts for linking lay and scientific knowledge in this case, medical and nursing management of fatigue.
This introduction provides an overview of the key concepts covered in the subsequent chapters of this book. The book discusses the theoretical foundations of nursing—how we find, develop, and use concepts and theory; how concepts and theory form the basis of research and how they are used and applied clinically. Most importantly, it teaches “how to think” and “how we think” as health care researchers and as professionals. A nurse is rarely doing one task at a time. While a nurse is greeting the patient, he or she is also assessing, identifying needs, and prioritizing care. For good care to occur there must be a relationship between the nurse and the patient. Both must trust each another—patients trust the nurse to watch over them while they sleep, or are in declining illness, or as they die. Correspondingly, patients do their part: following instructions, reporting new symptoms, and swallowing their pills.
In the literature there are two major conceptualizations of the illness experience. First, illness has been conceptualized as the individual’s experience of symptoms, which has been extensively described as the medical model. A second view focuses on the person and considers illness behavior as the ability of the ill person to cope with or to respond to the disease process. In the Illness-Constellation Model, the illness experience is defined as a four-stage process namely stage of uncertainty, stage of disruption, stage of striving to regain self and stage of regaining wellness. Clearly, it is time to move on and develop a broader understanding of the illness experience using human behavior as a basis for developing theory. The process of minimizing suffering consists of strategies directed at reducing the physical and psychological discomfort of illness, the social distress extending from changed roles and responsibilities, and the uncertainty of the unknown future.
This chapter discusses how to create a mid-range theory from multiple interrelated studies that resulted in lower level theories. Qualitative meta-analysis has a different purpose, and therefore a different outcome, than qualitative meta-synthesis techniques. Rather than meta-synthesis that produces a concept about the same topic, meta-analysis produces a higher level concept. In the literature there is some crossover with the terms “meta-synthesis” and “meta-ethnography”. Researchers are working with the concepts and theories developed from other studies. In the Illness-Constellation Model the chapter focuses on the perspective of the ill person as well as the perspectives of significant others. Media accounts of the health care system often give the impression that there is a major concern with an overutilization of health care facilities and with the cost of non-urgent consultations. Furthermore, health care professionals are frequently annoyed by non-urgent consultations and become condescending toward patients with “minor” complaints.
Conceptual comparison is a method used to delineate allied concepts. Concept comparison enables us to explore, compare, and delineate competing concepts: that is, to examine two or more concepts competing for the same phenomenon. Concept comparison may be used for different patterns of comparison. This chapter discusses the major types of concept comparison with examples. It illustrates the process of clustering concepts by delineating concepts that all account for nursing insight: intuition, emotional empathy, and inference. The chapter explains some methods which use qualitative inquiry research interviews to elicit the components of the concepts or for concept comparison. Judith Hupcey presents the example of cultural cohesion in social support and discusses disciplinary differences in trust. Trust has greater importance in nursing and psychology. Pragmatic utility is best used with lay concepts. Most importantly, the results of various methods of concept development should move the concept toward maturity.
The challenge of qualitative inquiry is essentially one of validity. In particular, there is a need to explore the problem in instances in which inquiry begins with a concept itself, rather than commencing with a basic description. Induction is a sacred tenet of qualitative inquiry. K. R. Popper identified the most well-known threat to inductive soundness, which has become the Achilles’s heel of qualitative inquiry. As an archaeologist tries to piece bones together, the inductive puzzle of inquiry is maintained, and, as inquiry proceeds, falls into place, the skeletal framework is padded, and provides the emerging model with indices of purpose and function. Data collection proceeds inductively, with the investigator seeking new insights, verification, and saturation. A theoretical framework organizes a coding scheme, and it is this structure that deductively prescribes the form of data collection instruments, measurements, and even types of analysis.
This chapter defines briefly the concepts, frameworks, theories, philosophical underpinnings and paradigms. A paradigm is often considered a global perspective that is generally accepted and relatively abstract and generalizable. A philosophical system provides a particular view or outlook. Moral philosophy deals with principles of human behavior and ethics. A concept is a mental image, a “conceptualization” of a thing, a collection of behaviors, or an idea. Behavioral concepts are concepts that refer to collections of behaviors that have been given a name. Scientific concepts are developed in the course of science as scientific definitions, or terms that are needed in order to conduct research. The midrange theory may provide insights from nursing: how to negotiate care, provide hope, and so forth; at a higher level, it may be useful for understanding communities and poverty, or aspects of culture and health, and so forth.
This chapter examines the way in which qualitative inquiry contributes to the development of established lay concepts, and qualitative strategies—analytic techniques—that may be used in defining the attributes or delineating the boundaries of developing data-derived concepts. It describes the process of developing concepts from transcribed interviews, following the process of categorizing, forming subcategories, defining and naming concepts, and forming and naming attributes. For a mature concept, the antecedents and outcomes must be clearly identified, fully described, and demonstrated. Qualitative methods provide researchers with different methods for describing and interpreting reality. In nursing, qualitative researchers are mainly using methods that develop concepts and theories from unstructured interviews, in particular, using ethnography and grounded theory. Qualitative research methods are rarely implemented without a concept focus. The majority of researchers are interested in “something” that is, a concept at some level of development.