Controversial hypotheses on the relationship between researcher and informant in qualitative research

The culture of cancer and the therapeutic impact of qualitative research interviews

This paper is an account of the potential therapeutic impact of research interviews encountered while conducting a qualitative research study. Similarities between the therapeutic (or psychoanalytic) interview and the qualitative research interview are discussed and explored, with examples drawn from a current study. It is suggested that, as a listener, the nurse researcher may offer the participant a mechanism for reflection, greater self-awareness, finding a voice, obtaining information, and venting repressed emotions. Within the context of cancer the participant might have multiple care and information needs to which he/she may expect a therapeutic interaction from a nurse researcher. The potential therapeutic component of the nurse researcher role in the context of cancer care is described and considered. The paper suggests that there may be positive and negative aspects of a therapeutic component to the researcher role and that the researcher should think carefully concerning the stance that he/she will take in the field.

Split personalities: Role conflict between the nurse and the nurse researcher

This paper is a personal account of the nurse-nurse researcher role conflict encountered while conducting a qualitative research study. Difficulties in the transition from a clinical post to a nurse researcher role are described and the experiences of other authors dealing with such a role change are used to illustrate potential resolutions. An understanding of the concept of reflexivity is offered and a description of how this can be applied to consider the impact of ‘the self’ on the research. The paper suggests a solution to the well-known role conflict encountered by nurse researchers: including the nurse in the process of research, and being confident about taking a personal investigative approach. It is argued that drawing on the interactive skills of the nurse can benefit and not detract from the research process.

Clinical supervision in a mental health in-patient area

This longitudinal study aimed to identify those factors which hindered or enabled a system of clinical supervision to become established and maintained in a mental health in-patient area. It also aimed to examine the characteristics influencing the effectiveness of such a system. Results show that a committed, enthusiastic clinical manager is the key: when the physical environment and psychological atmosphere are conducive, irrefutable benefits are evident. The evidence suggests that the increased knowledge that results from the practice of clinical supervision would result in positive consequences at all levels of the organisation. Those factors which hindered supervision mainly related to practicalities, time management issues, and levels of support. Recommendations are related to the need for a comprehensive continuing training programme for all levels of nursing staff and the importance of strategic planning.

Gender and the pre-clinical experiences of female medical students: a taxonomy

CONTEXT

The number of women entering medical school has increased substantially in recent years. However, practising female doctors still report gender-associated professional challenges. We focused on female medical students to characterise how gender shapes the range of their professional experiences during the pre-clinical years of medical school.

METHODS

We conducted a qualitative study from 2006 to 2007 using in-depth interviews with 12 Year 3 female medical students at a private New England medical school who had completed their pre-clinical years of training. All transcripts were analysed using a grounded theory approach; the code structure was developed through a process of inductive reasoning. Coding team members coded all transcripts line by line, using a constant comparative method of analysis.

RESULTS

The resulting taxonomy identifies three domains that capture the recurrent gender-associated experiences of our participants: (i) observations of the effect of gender on pre-clinical educational experiences through instructor, student and institutional behaviour; (ii) responses to observations of gender-based occurrences in terms of emotional reactions and strategic responses, and (iii) gender-associated expectations for the clinical years and beyond brought about by a heightened awareness of gender. Participants reported subtle as well as overt gender-based experiences and emotional consequences of both.

CONCLUSIONS

Female medical students continue to report numerous gender-based experiences during their pre-clinical training. Such experiences have both emotional and educational consequences and institutions should develop multifaceted approaches to address the full spectrum of gender-based experiences that affect medical students.

"You know what I mean:" the ethical and methodological dilemmas and challenges for black researchers interviewing black families

In this article I provide a reflexive account of my research experiences with families of African descent. I examine the ways in which, as a researcher of African descent, I became part of the research process. Using data from an ethnographic study that explored the healthy lifestyle experiences and attitudes of families and adolescents of African descent in the northwest of England, I present a detailed discussion of the identity alteration, researcher-researched relationships, and insider-outsider tensions and dilemmas that arose while I collected data. I argue that researchers working with participants with whom they share similar ethnicity and historical experiences are likely to find that their professional self and personal life experiences overlap, and there can be difficulties in keeping them separate.

The effect of gender on the clinical clerkship experiences of female medical students: results from a qualitative study

PURPOSE

To characterize how female medical students perceive the role of gender within their medical education during the transition to the clinical curriculum.

METHOD

In 2006-2007, the authors conducted a qualitative study consisting of in-depth interviews with 12 third-year female medical students completing their first clinical clerkship. Participants were purposefully selected from a single New England medical school to represent a range of ages, ethnicities, and prior life experiences.

RESULTS

Participants (1) struggled to define their role on the wards and often defaulted to stereotypical gender roles, (2) perceived differences in the nature of their workplace relationships compared with the nature of male medical students' workplace relationships, (3) had gendered expectations of male and female physicians that shaped their interactions with clinical supervisors, (4) felt able to negotiate uncomfortable situations with patients but felt unable to negotiate uncomfortable situations with supervisors and attendings, and (5) encountered a "gender learning curve" on the wards that began to shape their self-view as future female physicians.

CONCLUSIONS

Despite increased numbers of women in medicine, issues of gender continue to have a substantial impact on the medical education of female students. Institutions can design interventions about gender issues in medicine that expand beyond a focus on sexual harassment to address the complex ways in which students are affected by issues of gender.

The meaning of mental health nurses experience of providing one-to-one observations: a phenomenological study

There has been much recent literature about the need for appropriate policies and approaches to ensure that patient's rights and standards of care are safeguarded. The focus from national policy is on suicide reduction and prevention, and the nursing literature has concentrated on the importance of engaging the patient and ensuring that there is the least amount of restriction possible. A research study was carried out to explore the perspective of mental health nurses working in these intensive situations, using a purposive sample of nursing staff from the local National Health Service Trust's acute units. A phenomenological approach to the study was chosen to allow an in-depth exploration of the issues--'seeing things up close'--using the philosophy of Husserl as a base. The key areas of enquiry were: to explore and amplify the experiences of nurses undertaking constant observations, including any effects that may have on nurses; to gain further understanding of the dynamics and processes involved; to discover information that can inform and support development needs. Individual taped interviews were carried out with six nurses working in an acute admission ward, and these were then transcribed and analysed using Giorgi's method of analysis. The results of this analysis showed that nurses are keenly aware of some of the professional and ethical tensions involved in the process of keeping patients safe while trying to promote recovery. Results have implications for policies, preparation and support of staff, and provide some further insights into the nature of this experience for nursing staff who are caring for patients who are presenting with risks to themselves.

Guidelines to support nurse-researchers reflect on role conflict in qualitative interviewing

The conduct of a qualitative research interview is a complex social interaction that has the potential to influence, or be influenced by, both the researcher and the study participant. When a researcher is identified as a professional nurse, the identification of this role has the potential to influence the researcher-participant interaction. To understand the effect of a nurse-researcher's involvement in an in-depth interview and on the data collected, issues to address include: clearly identifying the paradigmatic approach in which the research design is situated, examining the study participants' past experiences with research and the researcher's profession, establishing appropriate boundaries with participants, deciding how to introduce the role of nurse-researcher to the participant and deciding if, or when, it would be appropriate to intervene within the research context. As nurse-researchers, professional knowledge and experiences have the potential to affect relationship development with study participants and obfuscate the purpose of the research interview. It is the researcher's responsibility to participate in the activity of reflexivity to understand the effect of the nurse-researcher's involvement on the data and make decisions that protect the participant's integrity.

Emotion work and the ethics of novice insider research

This paper relates to research practice and in particular, it explores the practice of insider research in a study carried out as part of a research training fellowship. The effects of research on the researcher and the researched are discussed and extracts from transcripts and a research diary are used to illustrate ethical dilemmas that may arise from such a study. The role of the novice researcher is central to the discussion and the concept of `emotion work' is used to illustrate the hidden consequences of seemingly innocuous insider research.

The paper contributes to the body of knowledge relating to qualitative research methods, by combining reflection with emotion work and novice insider research. Despite it being largely about the novice researcher studying within her own profession, it raises important points that may be of interest to more experienced researchers working in other domains.

Nurse researcher: always a researcher, sometimes a nurse

A number of theoretical papers have highlighted the concept of the duality and dichotomy of roles when nurses are carrying out research in the clinical arena. The conflicts that can occur are between the roles of researcher and nurse and in the balance between research integrity and the welfare of the individual. There are various personal accounts in the literature of nurse researchers' experiences of unclear role expectations when doing research. There appears to be no consensus on how nurse researchers should handle these varying expectations. No comparative analysis of the reflections of a collective of nurse researchers on role expectations in different clinical contexts was found in an extensive literature search. This paper attempts to do this by analysing stories of a small group of nurse researchers in different clinical contexts. Data were analysed from written stories and audio-taped interviews with nurse researchers about moving from the researcher to the nurse role in doing clinical research. Thematic analysis indicated that the participants' reactions could be classified as either those of a nurse researcher, always the researcher, or as the nurse researcher, sometimes the nurse. There were no distinct differences in relation to research topic, methodology or context. The study highlights the fact that nurses need better research education, team and management support when conducting research and opportunities to debrief after encountering mixed role expectations in the field. Open debate amongst nurse researchers about role delineation is essential to both novices and experts for them to share their experiences and their solutions.

Impact of in-depth interviews on the interviewer: Roller coaster ride

The authors investigated the experiences of parents with children/adult children in metropolitan Sydney, Australia who were living with, or had recovered from, an eating disorder. During regular team meetings, the research assistant who conducted the interviews had described her reactions which led the research team to investigate her experience in more depth. The aim of the present paper was to explore the impact on the research assistant who conducted 22 in-depth interviews with the parents. One of the members of the research team interviewed the research assistant to elicit her reactions. The interview was content analyzed and the following themes were identified: (i). appreciation of an egalitarian model of research; (ii). the emotions expressed by the research assistant; (iii). making sense of the inexplicable and (iv). reflections and comparison to her own life role. The research team would like to advance the theory that the adoption of a formal debriefing mechanism be integrated into the qualitative research process.

Fatigue experience in advanced cancer: a phenomenological approach

This study describes the experience of fatigue in patients with advanced cancer. A phenomenological approach was adopted to allow a fuller expression of the phenomenon of fatigue in the sample of six patients. Five major themes were identified. These were physical, psychological, social and spiritual consequences of fatigue, and helpful and unhelpful coping strategies. The themes demonstrate the complexity of fatigue, which had an all-encompassing effect on patients' lives. The themes were interconnected and cannot be viewed independently. For these patients with advanced cancer the meaning of fatigue was intertwined with the process of adjusting to living with a terminal illness and ultimately death. It was impossible for them to separate the two. Coping strategies that would normally be of use to fatigued individuals were shown to have little or no benefit. Sensitive communication about fatigue and its meaning to the patient may assist adjustment and generate hope.

The psychological needs of patients receiving chemotherapy: an exploration of nurse perceptions

This study explored the perceptions of a group of registered oncology nurses about the psychological needs of patients with cancer receiving chemotherapy and how the nurses meet these. Eight nurses who provided chemotherapy and were working in a local oncology centre participated. A semi-structured interview was used to explore nurses' perceptions, and how they meet these patients' needs. The analysis of interview transcripts revealed that these nurses agreed that patients with cancer receiving chemotherapy had psychological needs. Moreover, they were conscious that some of the physical side-effects could have a psychological impact on the patients. Although nurses did not use any assessment tool for psychological assessment, they identified two main stages during the treatment when patients needed more psychological support: at the beginning and at the end of the chemotherapy. They explained how they tried to meet patients' psychological needs but they also mentioned several factors that influenced the psychological support that patients received.

Perceiving risk in dangerous situations: risks of violence among mental health inpatients

BACKGROUND

Violence in British psychiatric hospitals appears to be escalating, with nursing staff the most frequent victims of assault. There is also public concern about violence on the part of individuals with mental health problems. In this climate, assessing a patient's risk of violent behaviour has become an important part of mental health care. However, little research has been published into how mental health nurses undertake such assessments in their day-to-day clinical practice.

AIM

The study focused on how mental health nurses make assessments of risk in clinical crisis situations where there is a perceived likelihood of imminent violence. The study sought to identify skills, cognitive processes or any other mechanisms which nurses draw upon to assist in such assessments.

METHOD

Ten experienced mental health nurses working in a secure mental health environment were interviewed and data generated was analysed using a grounded theory approach. An in-depth literature search was also undertaken.

FINDINGS

It was found that, in their risk assessments, nurses rely extensively on their personal knowledge of their patients (in particular, previous history of violent behaviour; biographical data; and impact of the mental health problem on violent behaviour). Nurses 'tune in' to potentially violent situations by observing a scenario as a whole, as well as specific aspects of a patient's behaviour, whilst also searching for causes of the violent behaviour. In making clinical risk assessments, nurses often make rapid, intuitive judgements in which various possibilities are considered regarding the likelihood of violent behaviour (such as the capacity and capability of a patient to be violent and the potential in the situation). It was also found that the ability to intervene successfully in potentially violent situations reduced the level of risk that nurses felt exposed to, and here nurses draw on their knowledge of a particular patient. They also perceive lower levels of risk when working in a skilled team.

CONCLUSION

The study indicates that the development of nurse-patient relationships and working in a supportive team are perceived as protective factors against risk. Implications of the research are discussed in relation to nurse-patient relationships, particularly in the context of the current nursing climate and the way in which violent behaviour may lead to an erosion of these relationships. The importance of 'working in a team' is discussed, as is the consequence of the findings for education and development. Methodological limitations of the study are also discussed.

Research in black and white

The authors consider the methodological, interpretative, and practical issues that arise when there is a difference in ethnicity between researcher and informant in qualitative research by drawing on the academic literature and their fieldwork experiences as White researchers undertaking studies with individuals of African/Caribbean and South Asian descent. Some contemporary issues raised by "researching the other" in the context of pragmatic health services research are highlighted, including access to same-ethnicity researchers, the involvement of interpreters, and the potential for ethnocentric interpretation. The authors believe that qualitative research should be judged by the plausibility of the findings and by a critical evaluation of the way in which the research was conducted and the reflexivity of the researcher.

The benefits of being a nurse in critical social research practice

In critical social research, or research that evokes feminist or critical epistemological positions, researchers must examine their own situatedness vis-à-vis their research participants and work toward methods that break down the hierarchies inherent in the research relationship and empower research participants. Such aspects of research practices necessitate strong interpersonal skills, characteristic of many nurses. Drawing on their experiences, the authors critically appraise the benefits of nursing in critical social research practice. Nurses can move beyond their own discipline to use their skills, identity, and intersubjective way of relating with others to gain access to participants and data. Through a unique process of building meaning and interpreting data, nurse researchers are well placed to take effective actions for change.

Critical incident technique as a qualitative research method

Critical incident technique is a helpful methodology used to examine a number of issues pertinent to nursing science. It allows nurses to understand the dimensions of their role in clinical settings and their interactions with patients and other clinicians. It also helps nurses understand nursing practice in a variety of roles (e.g., clinical educator, nurse informatician, faculty member). Researchers using this methodology should review Flanagan's original assumptions and compare them to their proposed methodology to determine whether CIT is the best fit. Additionally, researchers should compare this method to phenomenology, grounded theory, or hermeneutics to determine whether these approaches are more congruent with the research question. Critical incident technique can provide insight into nursing issues when used with rigor and when appropriate rationale is provided for data collection, interpretation, and analysis.

Children visiting family and friends on adult intensive care units: the nurses' perspective

Recent surveys show that children are still restricted from visiting their critically ill family and friends on many adult intensive care units throughout the country. The purpose of this small-scale exploratory pilot study was to examine and describe the experiences and perceptions of trained nurses towards children visiting within this setting. The aim of the study was to gain greater insight and understanding into the reason why, despite evidence to support the benefits to children of visiting their critically ill family and friends, they remain discouraged and restricted. It is hoped that the study will act as an initial enquiry to generate themes and further research questions. A qualitative research approach was adopted and in-depth focused interviews used as a method of data collection. The participants of the study were trained nurses working on an adult intensive care unit in a district general hospital in England. A total of 12 individual interviews were conducted which were audiotaped in full and analysed using a method of thematic content analysis. The value of the research is to promote family-centred care within an adult intensive care environment to meet the neglected needs of the well children of the critically ill person. The findings suggest that the participants in the study attempted to offer valuable support to children visiting their critically ill family and friends, but, despite an open visiting policy, children rarely visited within this setting. The desire of the well parent to protect and shield the child from the crisis of critical illness was perceived by the participants to be the main reason why they did not visit. To provide family-centred care within an adult intensive care setting has many implications for practice and several of these important issues are discussed. These include the educational and training needs of nursing staff and the importance of adopting a collaborative team approach to providing care for the critically ill person and their family. The need to generate research and literature from within the United Kingdom's health care system has also been identified and recommendations for further studies are proposed.

Ethical and methodologic benefits of using a reflexive journal in hermeneutic-phenomenologic research

PURPOSE

To illustrate the importance of considering the researcher's written reflections on the qualitative research process as a valuable source of data and as a means of enhancing ethical and methodologic rigour.

ORGANIZING CONSTRUCT

Excerpts from the researcher's reflexive journal are presented as evidence of an audit trail. Ethical and methodologic concerns arising during the research process are outlined and the value of reflecting on these issues is addressed.

METHODS

A hermeneutic-phenomenologic study, conducted in Scotland, included in-depth interviews with six problem drinkers to explore the lived experience of their suffering. The researcher was considered to be a primary data-collection tool, whose reflections on the research process added to the contextual richness of the study. For an interpretative approach to data analysis, the researcher found metaphors to convey the participants' stories to a new audience. This intuitive, creative process was analysed and reported in the reflexive journal.

CONCLUSIONS

The researcher's self-awareness, fostered by the use of a reflexive journal, is mirrored by the participants' ability to reflect on the final interpretation of their stories and on the therapeutic benefits of the research process. The researcher's reflexive journal reveals previously hidden contextual information which enhances the prime ethical and methodologic aim of the study--to understand the lived experience of suffering by problem drinkers.

Ethical considerations in a grounded theory study on the dynamics of hope in HIV-positive adults and their significant others

The purpose of this article is to describe and reflect ethical challenges in a grounded theory study on the dynamics of hope in HIV-positive adults and their significant others. It concentrates on the justification of a research problem, sensitive research and the relationship between the researcher and the participants in data collection. The basis of ethically sound nursing research on the dynamics of hope in these two vulnerable groups lies in the relationship between the researchers and the participant. However, it is also obvious that the content, the process, the methods used and the ethics of the study cannot be divorced from this relationship. In conducting grounded theory research on the dynamics of hope in this research population, the researcher has to consider the surrounding world, that is, the reality in which these people live in hope or despair.

Unfinished business: interviewing family members of critically ill patients

This 'story from the field' emerges from qualitative research conducted with relatives of patients admitted to intensive care. A disturbing feature of researching the needs of family members of critically ill patients is the intense emotion that is often generated during the course of interviewing. For some the opportunity to talk about the experience of having a loved one in an intensive care unit was therapeutic; for others it meant anguish and despair as they relived the event that resulted in a life-threatening illness. Despite being a reasonably experienced educator and critical care nurse, I was unprepared for the intensity of feelings shown by many of the participants. I found that exposure to this kind of suffering was emotionally draining, experiencing the various roles of confidante, nurse, counsellor and researcher. It became important to share my thoughts and feelings and unwind with an independent friend and colleague as a way of debriefing. Methodological and ethical issues that arose included: generating a situation that potentially required therapeutic intervention; the impact on the 'purity' of data of becoming emotionally enmeshed; and the level of investigator preparedness when researching sensitive topics. The issue of walking away from an intensely emotional and intimate interview often leaves one with a sense of 'unfinished business'.

Fatigue in cancer: a phenomenological perspective

Fatigue is a frequently encountered symptom in cancer populations. This study aimed to describe the experience of fatigue from the perspective of cancer patients who had recently completed a course of chemotherapy. A phenomenological method was used. The themes which emerged from the data indicated both a shared and individual experience of fatigue. These incorporated: the nature of fatigue; the causes, consequences, strategies for coping with fatigue; and the trajectory of the fatigue experience. Issues arising from the nature of phenomenological inquiry and the research were also elicited from this study. An understanding of the fatigue experience for this population and the use of phenomenology have implications for the nursing profession's knowledge base and for clinical practice.

New meanings: a qualitative study of change in nursing education

This paper reports on the experiences of teachers in one college of nursing and midwifery in South East England during a period of profound and complex change. Personal perceptions and reactions are studied in the context of professional organizational influences. A phenomenological approach was used to identify and portray the personal perspectives and meanings of the respondents. Fifty semi-structured interviews with a purposeful sample of the college staff were supplemented with participant observation and documentary analysis. The data were analysed inductively, and emergent categories were confirmed and clarified through respondent validation. Findings relating to organizational, professional and personal perceptions are presented alongside the major themes of belonging, knowing and controlling. The conclusions and implications of this exploratory study are discussed, together with aspects of the researcher's role and areas for future research.

Exploring the value of clinical nursing practice: the practitioner's perspective

This paper describes a preliminary study which attempted to explore the value of nursing practice from the viewpoint of practitioners. The objective was to further knowledge and develop insights into nursing practice, identifying concepts central to therapeutic care. Integral to the study was the development of a model for reflective practice.

A qualitative study to establish the self-perceived needs of family members of patients in a general intensive care unit

Admission to an intensive care unit (ICU) invariably causes a considerable degree of distress and anxiety to both patient and family. If we profess to deliver holistic care then it is essential that intensive care nurses are able to identify the specific needs of family members and provide appropriate supportive interventions. This small study was designed to gain the perspectives of the families. Through unstructured interviews participants were invited to discuss their experiences of visiting a critically ill relative, particularly in relationship to their own needs. Interviews were tape-recorded with permission and subsequently transcribed. Thematic content analysis adapted from Glaser & Strauss' 'grounded theory' approach (1967) by Burnard (1991) occurred, with formation of six categories, exemplified by verbatim quotations. The study may contribute towards a framework for preventative, supportive and therapeutic intervention with family members in the intensive care setting.

Exploring the benefits of a subjective approach in qualitative nursing research

The increasing credibility of qualitative approaches for research in nursing has opened up new debates about methodology and rigour. Traditionally, qualitative methods have been scrutinized using some criteria that are more pertinent for quantitative research. The transition to a more subjective, reflexive approach to nursing research may be painful, but brings benefits. With the loss of scientific rigour comes the gain of eliciting true meaning, by recreating the experiences of others through co-operative enquiry. An openly subjective approach allows the researcher to be a real partner with informants, and to openly use her own experiences and reflections in order to uncover valuable meaning and to find a different type of objectivity. This paper explores some of the issues that are of concern and some of the benefits that may result from an openly subjective approach in qualitative nursing research.