Читать книгу Fundamentals of Qualitative Phenomenological Nursing Research - Brigitte S. Cypress - Страница 18

The research question dictates the method to be used for a qualitative study. Qualitative and quantitative questions are distinct, and serve different purposes. Some of the different types of qualitative research that will be discussed in this chapter are: phenomenology, grounded theory, ethnography, case study, and narrative research. Researchers from different disciplines use different approaches depending on what the purpose of their study is.

Narrative research begins with the experiences as expressed in the lived and told stories of individuals. Narrative is a spoken word or written text giving an account of an event/action chronologically connected. Examples of this approach are biographical studies, autobiographies, and life stories. Kvangarsnes et al. (2013) explored patient perceptions of chronic obstructive pulmonary disease (COPD ) exacerbation and patient experiences of relations with health personnel during care and treatment using narrative research design. They conducted ten in‐depth qualitative interviews with patients who had been admitted to two intensive care units (ICUs ) in Western Norway during the autumn of 2009 and the spring of 2010, and used narrative analysis and theories on trust and power to analyze the results. The patients perceived that they were completely dependent on others during the acute phase. Some stated that they had experienced an altered perception of reality and had not understood how serious their situation was. Although the patients trusted the health personnel in helping them breathe, they also told stories about care deficiencies and situations in which they felt neglected. This study shows that patients with an acute exacerbation of COPD often feel wholly dependent on health personnel during the exacerbation and, as a result, experience extreme vulnerability.

Where a narrative approach explores the life of a single person, a phenomenological study describes the meaning for several individuals of their lived experiences of a phenomenon. Phenomenology is the most inductive of all qualitative methods. It involves the study of the lived experiences of persons, the view that these experiences are conscious ones, and the development of descriptions of the essences of these experiences, not explanations or analysis. There are several different types of phenomenological approach, namely: descriptive‐transcendental (Husserl, Giorgi), interpretive/hermeneutic (Heidegger, Gadamer, Jean‐Luc Nancy, Van Manen), descriptive‐hermeneutic (Merleau‐Ponty, van Manen), empirical‐transcendental (Moustakas), and existential‐embodied (Sarte, Heidegger, Merleau‐Ponty). A phenomenological study conducted by Cypress (2014) explored the lived experiences of nurses, patients, and family members during critical illness in an emergency department (ED ). Data were collected over a six‐month period by means of in‐depth interviews, and thematic analysis was done using van Manen's (1990) descriptive‐ hermeneutic phenomenological approach. The findings indicate that the patients' and their family members' perceptions of the nurses in the ED related to their critical thinking skills, communication, sensitivity, and caring abilities. Nurses identified that response to a patient's physiological deficit is paramount in the ED, and that involving the patient and their family in the human care processes will help attain this goal.

While phenomenology aims to illuminate themes and describe the meaning of the lived experiences of a number of individuals, grounded theory attempts to move beyond description and to generate or discover a theory, an abstract analytical schema of a process or interaction shaped by the views of a large number of participants. This qualitative method was developed by Glaser and Strauss in 1967. Other grounded theorists followed, including Clarke (2005), who relies on post‐modern perspectives, and Charmaz (2006), who relies on constructivist approach. Gallagher et al. (2015) collected and analyzed qualitative data using grounded theory to understand nurses' EOL decision‐making practices in five ICUs in different cultural contexts. Interviews were conducted with 51 experienced ICU nurses on university or hospital premises in five countries. The comparative analysis within and across data generated by the different research teams enabled the researchers to develop a deeper understanding of EOL decision‐making practices in the ICU. The core category that emerged was “negotiated reorienting.” Gallagher et al. (2015) stated: “Whilst nurses do not make the ‘ultimate’ EOL decisions, they engage in two core practices: consensus seeking (involving coaxing, information cuing and voice enabling); and emotional holding (creating time‐space, and comfort giving)” (p. 794).

Although a grounded theory approach examines a number of individuals to develop a hypothesis, participants are not studied as one unit. Ethnography, meanwhile, uses a larger number of individuals and focuses on an entire cultural group as a single unit of analysis, describing and interpreting their shared and learned patterns of values, behaviors, beliefs, and language. There are many forms of ethnography, namely: confessional, life history, auto‐ethnography, feminist, ethnographic novels, visual ethnography found in photography, and video and electronic media. Price (2013) explored what aspects affect registered healthcare professionals' ability to care for patients within the technological environment of a critical care unit. They utilized ethnography to focus on the cultural elements within a given situation. Data collection involved participant observation, document review, and semi‐structured interviews with the nineteen study participants. An overarching theme of the “crafting process” was developed, with subthemes of “vigilance,” “focus of attention,” “being present,” and “expectations,” with an ultimate goal of achieving the best interests for the individual patient.

A culture‐sharing group in ethnography can be considered a case, but its aim is to ascertain how the culture works rather than to understand one or more specific cases within a bounded system. Creswell (2012) defines case study research as an approach in which the researcher explores a bounded system (a case) or multiple bounded systems (cases) over time through detailed in‐depth data collection involving multiple sources of information and reports a case description and case‐based themes (p. 73). In terms of intent, there are three types of case study: single instrumental, collective or multiple, and intrinsic. Hyde‐Wyatt (2014) studied spinally injured patients on sedation in the ICU. A reflection‐on‐action exercise was carried out when a spinally injured patient became physically active during a sedation hold. This was attributed to hyperactive delirium. Reflection on this incident led to a literature search for guidance on the likelihood of delirium causing secondary spinal injury in patients with unstable fractures. Through a case study approach, the research was reviewed in relation to a particular patient. This case study illustrated that there was a knowledge deficit when it came to managing the combination of the patient's spinal injury and delirium. Sedation cessation episodes are an essential part of patient care in the ICU. For spinally injured patients, these may need to be modified to sedation reductions to prevent sudden wakening and uncontrolled movement should they be experiencing hyperactive delirium.