Qualitative Methods in Nursing

Qualitative methods in the research focus on studies related to social behaviors in societies whose outcomes are generalized as the real scenario about studied variables. Qualitative research deals with non-tangible aspects including perceptions, experience, and behavior among humans. These variables have no standard numerical measurements and therefore they are assigned codes for analysis and interpretation (Atkinson et al., 2007). Two schools of thought are evident in social research; Positive and Interpretive views. Positivists believe in methodologies linked to natural science as characterized in psychology and sociology by testing theories and hypotheses.

This school emphasizes maintaining objectivity in avoiding biases in data acquisition so that findings could be generalized to similar scenarios through prediction. Researchers do have overall input concerning theoretical framework, sampling frame, and the nature of the research. Interpretive views on the other hand attribute clarity in distinguishing between man and material through thorough research methods. Human experiences are vital to explanation, prediction, and control; consequently, qualitative studies could be distinguished from quantitative methods through empathetic understanding (Bryman, 2001).

Characteristics of Qualitative Research

Several characteristics of qualitative research are illustrated as follows; first, data validity is held in high regard as it is the bedrock of theory formulation on a phenomenon under study. This involves expanding from specific to general objectives as they occur in a study (Denzin, 1989). Secondly, a researcher should possess the real environment of participants’ social and economic status as they contribute towards the behavior of respondents. During data collection, respondents should be accorded adequate time to express themselves wholly as it is believed they form an important part of the research (Atkinson.1995).

Thirdly, it is desired that researchers create a rapport by being neutral towards responses from participants and willing to gather more information as possible. This rapport has to be objective to the study (Patton, 1990). At the same time, the research tackles problems from a triangulation point of view. Investigator triangulation refers to a group of researchers performing a particular study for specific purposes (Strauss et al., 1964).

Triangulation is one of the preferred methods amongst experienced researchers in the nursing field. However, several methodologies could be employed in studies using strategies inclusive of nesting, sequential and parallel. The nested strategy involves choosing a theoretical framework that is enhanced by techniques from other methodologies. The sequential strategy involves the use of a qualitative technique in the process of developing a hypothetical framework while the parallel approach makes utilizes both qualitative and quantitative methods.

Data collection in qualitative research is based on different research philosophies including phenomenology, grounded theory, and ethnography. The method used should be acute and relevant, personally centered in approach which could help in generating a real picture of respondents’ life in consideration of ethics in achieving empathy through close relationships formed (Morse, 1994). The following factors determine the methodology used in research; the nature and type of the research problem, researcher’s point of view, skills and training of researcher, and resources available for the research project. For the benefits of health care, a critical and rigorous stance is necessary for the research methodology chosen (Delamont, 2000). Janesick (2000) emphasizes that researchers should not only be obsessed with the research method but rather with the substance of the research.

Grounded Theory as a Qualitative Method

This is a qualitative method in research where output is centered in formulating theories describing human social life through the provision of solutions to problems or explanations towards phenomena through selective empirical data analysis and interpretation. The basis of grounded theory is the interactions between humans, giving rise to human behaviors evolution. Interactions occur in a wide field including socio-economic spheres of participants where the theory seeks to capture the real events and explanation on occurrences of events, hence making future predictions on the same (Evans, 2001). Grounded theory was developed to demonstrate that data from qualitative research could be used in addressing phenomena, unlike positivists who thought that research work should have been quantitative, unlike qualitative research which occurs in natural settings (Glaser, 2005).

The major difference in grounded theory as a qualitative method compared to quantitative method is that the theory does not start with a defined theory rather the theory evolves in the course of study. Grounded theory is further divided into two sub-theories comprising; substantive theory which is entrenched in a specific area under research limited in scope. Formal grounded theory deals with construction of a comprehensive theory from several substantive studies focusing on a particular phenomenon. Formal theories are concepts that apply to a significant population under a phenomenon in study. These two theories are critical in studies including nursing (Glaser, 1967).

Characteristics of a Grounded Theory

Grounded theory has several characteristics as a scientific process that is briefly described herein. First, research objectives and hypotheses are not used as is the norm in quantitative methods, only research questions are used in grounded theories. These research questions are flexible and could be amended several times in the course of study. The questions are broad and open ended to allow development of a theory which is capable of changing under study, this does not concur with quantitative methods where research questions are defined rigidly and are not subject to change in course of study. Methodology used in grounded theory evolves in the course of study based on what is being conceptualized unlike quantitative method that has a rigid methodology (Creswell, 2003).

Secondly, sampling size within this theory is not definite like in quantitative method but it is based on theoretical sampling. Theoretical sampling helps in building a theory through data collection, coding and analysis so that the researcher has discretion to decide where to collect data and the type of data to be collected. The researcher does sampling based on purposive and on judgmental basis so that participants with relevant experience and knowledge are studied concerning a phenomenon (Glaser, 1978).

Thirdly, empirical data collection is done through primary data collection involving observation and interviews and secondary data collection including published documents with an option of combining the two methods. Empirical data generation requires the researcher to collect, code and analyze data concurrently which allows for data to be selectively enriched (Green, 2005) in line with theory formulation (Strauss and Corbin, 1990).

Initially, sets of data are drawn from homogeneous sources that are analyzed giving rise to first categories that defines selection of new data. Researcher has to process sufficient data which has been coded adequately allowing manipulation in line with evolving concepts in variables under study. Complex variables could be seen in scenarios such as learning medicine and problem based learning. Coding is done on three steps. First step is the use code responses from participants in a way which reflects their views or perception on specified phenomenon. The second step involves classifying responses from the first step into distinct categories. The third step involves integrating distinct categories in the second step in order to fully describe the research process (Strauss and Corbin, 1990).

Lastly, core vari­ables are processed through reduction, selective literature review and selective sampling of data. In reduction several categories are compared to obtain their relationships which could be placed under broad categories. Grounded theory has no literature review being done before data collection as it is in quantitative methods. The main reason is for the researcher to remain neutral in construction of emerging theory in the course of study without a restrictive benchmark like in quantitative research. When theory evolves in a course of study, data is selected selectively. This allows for objective formulation of patterns of a phenomenon, thus respondents who according to researcher views are selected purposively.

When this occurs categories tend to cluster, then core variables are noted. Core variable is summary of patterns of responses from participants which cut across all other patterns. Features of core variables in grounded theories includes: it occurs with highest mode in a set of data, it is common in the set of data, it has greater impact in formulation of an emerging theory and it accommodates variations in data analysis for the emergent theory. After a core variable is formulated the research moves to concept modification and integration in order to move from a descriptive to a theoretical level (Strauss and Corbin, 1990).

Areas where grounded theory could be applied

Ethnography and case study forms of research has been in use extensively and in preference in the field of nursing being linked to the nature of relevant research questions. Several concerns have been addressed to make ground theory applicable as a qualitative method in the field of behavioural science thus being accepted as a scientific model. Grounded theory seeks to explain human feelings, views and perceptions which changes with time and under different environmental settings and make predictions of human behaviour on the same. Problems in the society involving complex human intentions, motivation, feelings and perceptions which occur in a dynamic way there is a need to use ground theory as a qualitative research to address these problems (Strauss and Corbin, 1990).

Critique on the Article: Qualitative Studies on the Patient’s Experience of Weaning from Mechanical Ventilation

Qualitative research used in this article involved the use of inquiry processes which help in the understanding social and human aspects within the society. It helps in building an understanding on the manner in which people see and build their lives as important processes, how they relate to one another and finally interpret the relationships within the context of social environment (Black, 1994; Creswell, 1998). This research seeks to establish an understanding between the research objectives and findings from the interview.

Grounded theory was used in this case for the purposes of interpreting all the data collected. Collecting, interpreting and understanding of data is done best in grounded theory, where the collection of data, its analysis and theory are closely related bringing some relevance to the research undertaken (Strauss and Corbin, 1990; Hammersley,1992).

The different results can also be attributed to difference that exist in data description, analysis and interpretation used. The main objective for the use of grounded theory in this case was to produce candid description of the phenomenon in question and assist in the final interpretation on the meaning of the phenomenon. Qualitative research method also aims at developing concepts from the analyzed healthcare data and ultimately link them to appropriate theories. The interview guide used in this process is normally semi-structured and focus on the areas that bear much controversies within healthcare (Black, 1994).

Patients have always been ignored despite having the desire expressing their opinion on the nature of medical services they receive. Patients should not only be considered as passive clients but also their active participation is very necessary. This calls for the use of common concepts during the research process which are understandable to the patients and other participants (Strauss and Corbin, 1990).

Data collection

The method used to generate data in this research was both flexible and very sensitive to the area where data was collected. The major method adopted in this research was the use of in-depth interviews (Minichiello et al, 2003). Focus groups were used before conducting the in-depth interviews to help in stirring one another’s thinking. Within the groups they would share opinions or responses about the topic in question and this enabled them to think clearly along the same line of thinking. In-depth interviews were conducted immediately to find out on individual opinions which could not be shared publicly. However, the method applied, grounded theory, did not grant enough time for gathering patients together for the completion of the group interviews and individual interviews.

Rationale for using in-depth interviews

In-depth interviews were used to help gain an understanding on how patients responded emotionally and psychologically and how they interpret their interactions based on the entire social environment. In-depth interviews are considered flexible and easy to understand since they are generally open-ended, neutral, sensitive and very clear to the respondent. The structure provided by the method allowed for open conversations that provided detailed information about the interviewees general experiences (Whyte, 1982).

In-depth interviews were used to help in deep understanding of the social and physical settings of the environment where it is undertaken, the traditions, values, effects and roles practised by the respondents. Using in-depth interviews enabled collection of sufficient and crucial data information that could not be otherwise shared in group settings. This also reinforced trust between the interviewer and the interviewee and made the respondents to be willing to contribute more and more.

In this case study, groups of patients who had undergone weaning process from mechanical ventilation were interviewed. These patients had previously undergone various weaning attempts which were never successful. Verification of some values required the use of clinical instruments which were normally used to measure emotional and psychological problems (Pawson, 1996). Previous researches revealed that most of the respondents interviewed were always ready to provide detailed information required on condition that the interviewer provided them with guideline on important issues. In this research in-depth interview used was structured in such a manner as to reveal the nature of treatment, interaction, level of patient satisfaction and the level of collaboration between the nurses.

Critique

In the interview process undertaken in this article, the relevance of the respondents to the research question was considered. The methodologies applied in selecting patients was also reviewed for any discrepancies and accuracy of the processes used in collecting the data. Validity and appropriateness of the methodology was examined to establish whether it could support the findings on the whole research process. The data was checked for appropriate findings and analysis (Giacomini and Cook, 2000).

Only data which was relevant to the study process was collected organized and analysed to suite the given objectives. The validity of the findings in this interview required the use of multiple data sources and collection methods. It was also necessary for the results to be collected in various stations and comparison made to ascertain the relevance of the study to theory in books (Emden and Sandelwoski, 1999)

Respondents were however used appropriately based on qualitative research to answer the question of the study. The method used to explain how the respondents were chosen was not provided (Stake, 1994). The interview guides were provided but not the transcribed tapes. The whole information was however analysed to prove the accuracy of the research. Instruments were used in some circumstances to quantify the level of some emotional effects; this did not in any way serve the qualitative purposes of this research. Comparison was made after the interview between the patients with negative and positive responses.

Other methods which do not fall under qualitative analysis were used to establish the factors that led to psychological or emotional effects; one of the methods suggested was psychiatric treatment. Weaning failure need to be identified earlier before it produces some side effects on the patient and also the patient’s experiences needs to be established medically since there are chances of some patients giving in-appropriate information. This was however, not provided for within the methods applied in this research (National Health and Medical Research Council, 2007).

Article on compliance and Non compliance in nursing

Critique on the application of grounded theory

The article illustrates on the issue of non-compliance within the medical field. This could be defined as a person’s informed decision not to adhere to a therapeutic recommendation (Murphy & Canales, 2001, p.173). Qualitative research was used to determine reasons as to why non-compliance has been disputed in recent times from several health sectors. The article attributes this to the fact that the use of the term ‘non-compliance’ has been found inconsistent with medical ethics (Belchner, Berg and Inui, 1988, pp. 120-160).

Grounded theory gives the nurses the opportunity of applying their responsibility on such like patients through utilization of the available resources within the social set-up at minimum cost possible. Nurses could also use their responsibilities in promoting patient autonomy as well as respecting their choices. Patients tend to shy away when labelled non-compliant since this action seems to ignore their independence (Baer, 1986, pp. 77-85).

Critical evaluation of non-compliance by nurses in this article involved conducting in-depth interview with patience in the process of trying to identify the impact of the use of the term on their behaviours towards medical care (Murphy & Canales, 2001, pp. 173-181). The idea of power being bestowed on nurses makes the patients continue operating under oppression from the medical practitioners; this is since the principle of non-compliance imposes professional power. This assumption implies that healthcare professionals should be definers of health and help in diagnosing illness as well as advising on the benefits of treatment (Davis, 2007, 134-144).

This study utilized grounded theory analytical approach to obtain results revealing in-depth experiences which patients undergo based on the manner in which they are categorised. This is of importance to the healthcare department since it provides a very good ground for improvement.

The consequence of branding a patient as either compliant or non-compliant was very apparent and made some of the most devastating effects on patients’ response to medical treatment.

Field observations, interviews and the analysis used in this research assisted in the collection of up-to-date qualitative data (Mays and Pope, 2000). Grounded theory applied in this case enabled desired results and conclusions to be made on the social behaviour and general responses of patients towards medical treatment. The level of information provided by the data was able to support the allegations made on patient’s discomfort.

The conceptual framework within this article provides explicit explanation through the example cases provided and this makes it easy for interpretation and understanding of the results. However, there is a little challenge on the manner in which detailed methodological section is merged with the final results. The research had been conducted on those who are literate, but those who could not speak English as a language were ignored. The profile provided by the findings proved that more research should be done on the issue of non-compliance though in a different region.

The article provides so much on health promotion which helps in increasing people’s awareness and control over their general health. It is therefore necessary for an individual to reach the state of complete health by paying attention to various activities and needs which could lead to sustenance of good health. Individual’s health, touching on the physical, mental and social aspects, should have the ability of conforming and coping with change within the environmental set-up. This therefore qualifies health promotion not only as a responsibility of care givers, but also individual’s who really care about their well-being (Murphy & Canales, 2001, pp. 173-181).

Use of grounded theory within this article permitted the use of various communication tools by caregivers which facilitates health provision. These tools, like transcribed data, enables application of necessary guidance and support which could help in enhancing the patients’ confidence in managing their condition and understanding further, their own medication status. These processes revealed that self-management support plans should be provided to the patient for the purposes of facilitating the processes of helping in management of their conditions. This ensures consistency towards medical care. The article reveals the need t of considering psychological and social context of patient’s lifestyle and the impacts these have on self-management support which could affect the nature of the healthcare delivery method used (Battista & Fletcher, 1988, pp. 40-102).

The use of grounded theory in this case, reveals the fact that nurses should develop good communication skills which should be utilized in assuring patients on the safety of medical care process applied, despite their branding. According to the results obtained patient-centred care further requires that care givers should be advocating for patient’s good and try their level best to offer safety and effective treatment to patients. The patient should adhere to the suggested life-style changes prescribed in order to help in promotion of better outcome. Patients in such cases appear to be rational information users, this requires nurses to help him in understanding and using prescribed information from specified medical practitioners (Murphy & Canales, 2001, pp. 173-181).

The method applied helps in identifying several ways of assisting patients, one of the ways being the fact that nurses should become aware of the need of informing patients about recovery from sickness and the manner through which they could manage symptoms that may be as aresult of too much committment to work. Through this the nurses could also educate patients on the kind of lifestyles which affects health and benefits of adhering to medical prescriptions.

Nurses should utilize fully their role as educators on non-compliance patients so as to make them undestand better. The article further reveals on the importance of health information obtained from patients which should be individualized as per the agreement between patients and the practitioner and the readiness of indivduals to learn (Battista & Fletcher, 1988, pp. 40-102).

According to the results obtained nurses should be concerned with the duties of providing people with treatment, prevention measures and overall management of their health. This could be ensured through the assistance of professional services from qualified physicians. These services require adequate financing and should be performed based on already set policies and standards which govern medical system.

However, the industry faces some challenges which include costs and the complex processes which are followed to ensure quality result (Anderson, 1991, pp. 584-590). Findings from the research proves that adverse effects caused by non-compliance leads to high rate of re-hospitalizations which ultimately turn to be very expensive especially on the side of the patient (Baer, 1986, pp. 77-85). There is need to confer clear definition of these terms in order to avoid the kind of confusion it may cause towards affected patients. Medical providers need to change their view on compliance and non-compliance while dealing with patients in order to distinguish nursing as powerful and important constituent within health care

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