An introduction to the origins, history and principles of ethnography

The advocacy process in Canadian community health nursing: A collaborative ethnography

AIMS

To shed light on the process of advocacy in the context of community health nursing, through a methodology inspired by the epistemologies of the South.

DESIGN

We conducted a collaborative ethnography in a community health centre in Canada.

METHODS

de Sousa Santos' epistemologies of the South, a typology of advocacy and main themes from historic research informed the methodology. Data were collected between 2016 and 2018 through 420 h of fieldwork observations and three group discussions, including a collective process to co-construct interpretations with participants. Twenty-one nurses participated in the study.

RESULTS

Nurses had sufficient work flexibility to practice advocacy actions focused on individuals and groups. They also engaged in attempts at policy reform in the form of defending access to appropriate care and changing the mode of care organization. However, these were curbed by bureaucracy and administrative rules, resulting in the eventual dismissal of health promotion actions and experiences of moral distress.

CONCLUSION

Despite the political climate of their work environment impeding social justice agendas, nurses' advocacy practices showed a persistence of moral values and ideals in coherence with the regional nursing legacy.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Acting at the organizational level and involving field nurses in decision making are potential avenues for increasing policy advocacy efficacy.

IMPACT

Examining contexts through another epistemic lens and methods of research drawing on history and anthropology has shed light on a process of advocacy. This research shows that organizations need to equip themselves with mechanisms to promote the sharing of realities between nurses, thereby building collective advocacy.

REPORTING METHOD

The research adheres to the EQUATOR guidelines with SRQR and COREQ methods.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

A Critical Comparison of Focused Ethnography and Interpretive Phenomenology in Nursing Research

Choosing an appropriate qualitative methodology in nursing research is a researcher's first step before beginning a study. Such a step is critical as the selected qualitative methodology should be congruent with the research questions, study assumptions, data gathering and analysis to promote the utility of such research in enhancing nursing knowledge. In this paper, we compare focused ethnography by Roper and Shapira and interpretive phenomenology by Benner. Though these methodologies are naturalistic and appear similar, both have different methodological underpinnings. The historical, ontological, epistemological, and axiological philosophy guiding each methodology are described. In addition, the methodological underpinnings of both methodologies and a justification for use in nursing research are provided. This paper will assist future researchers who aim to employ these methodologies in nursing research.

Intensive Care Nurses' Experience of Caring in Greece; A Qualitative Study

BACKGROUND

Whilst nurses and critical care services have been at the forefront of the COVID-19 pandemic, it has become more apparent that intensive care nurses are presented with challenging ethical and clinical decisions and are required to care for individuals with critical illnesses under high-pressure conditions. This is not a new phenomenon. The aim of this study, which was conducted before the outbreak of COVID-19, was to explore the experience of caring through the narratives of intensive care nurses in Greece.

METHODS

A qualitative study was conducted through in-depth, semi-structured interviews with nineteen ICU nurses in Athens. Transcripts were subjected to Braun and Clarke's thematic analysis and organised with Atlas.ti v8 QDA software.

RESULTS

The intensive care nurses' experience of caring in Greece encompassed four themes: (A) being "proximal", "co-present" and caring with empathy, (B) being "responsible" for your patient and negotiating with the doctors, (C) technology and "fighting with all you've got", and (D) "not being kept informed" and disappointment.

CONCLUSIONS

The narratives of this study highlight that ICU nurses in Greece provide patient-centred and compassionate care. Nurse leaders should develop appropriate healthcare policies so as to ensure the adequate provision of staff, specialist education, and support to nurses working in critical care. Failure to address these issues may lead to poor quality of care and negative patient outcomes.

Combining ethnography and conversation analysis to explore interaction in dementia care settings

Background

It is well established that the actions and behaviour of care home workers are fundamental to the well‐being of the people they care for. They not only deliver basic care but through their day‐to‐day presence provide an underlying continuity for residents, many of whom will have dementia or other cognitive problems. This can have many positive psychological and social benefits. A variety of ethnographic approaches have been used to explore the broader social and cultural dimensions of dementia care work. Similarly, there is a growing body of work applying micro‐level approaches such as conversation analysis (CA) to describe the interactional mechanics of specific care skills.

Strategy

We outline what ethnography and CA are, how they work as stand‐alone methodologies and how they have been used in care work and dementia care settings. A working illustration is given of how the two approaches may be integrated.

Discussion

Dementia care workers occupy a uniquely tenuous sociopolitical and professional position within healthcare. If they are to progress to a more professional status there is a pressing need for standardized systems of training to be developed. As has been common practice in most other fully professionalized sectors of healthcare, this training needs to be backed up by an understanding of how effective care work is undertaken at the micro‐level. For it to be practically relevant to care workers it also needs to have been informed by the wider social context in which it occurs.

Conclusion

We argue that elements of ethnography and CA can be usefully combined to provide the fully contextualized micro‐level descriptions of care work practice that will be needed if current moves towards the greater professionalization of care work are to continue.

Patient or Public Contribution

The authors undertake a significant amount of Patient and Public Involvement and Engagement and study codesign with members of the public, care workers and people living with dementia. Our engagement work with care staff and family carers undertaken as part of a current National Institute for Health Research study exploring naturalistic care worker skills (see acknowledgements) has been particularly relevant in shaping this article.

COVID-19 and tourism stakeholders: experience, behaviour and transformation

Purpose

The tourism sector’s fragility lends significance to mental health and wellbeing, especially amongst workers in the hotel and tourism sectors. However, stakeholders’ subjective wellbeing and mental health in these sectors due to the coronavirus disease 2019 (COVID-19) pandemic remain under-researched, especially for destinations with unique selling propositions (USPs). Thus, this study investigates the effects of the worldwide COVID-19 pandemic on various stakeholders in Kerala, India. In particular, the authors assess the mental health and welfare of those involved in the tourism sector with an eye on how the COVID-19 pandemic has influenced the field’s psychological and technical developments.

Design/methodology/approach

This study employs an ethnographic approach to understanding the idiosyncratic experiences of stakeholders using in-depth interviews (n = 68), focus group interviews (n = 3) and participant observation for 14 months. Reflexive thematic analysis was used to analyse the data.

Findings

The findings reveal the shifting perceptions in the tourism sector’s workforce by detailing various societal, technical and physical transformations, especially amongst the younger generations. The resultant psychological mapping generates a framework of the emotional perspectives of stakeholders during each stage of the pandemic. This study also highlights the urgency of crisis-management training for the workforce.

Originality/value

The COVID-19 pandemic has affected all spheres of global business, resulting in unprecedented challenges in both personal and professional life. The sector’s fragility lends significance to mental health and wellbeing, especially amongst workers in the hotel and tourism sectors. However, the subjective wellbeing and mental health of stakeholders in these sectors due to the COVID-19 pandemic remain under-researched, especially for the developing destinations with USPs.

Seeking to Understand: Qualitative Research on Sustainability of Evidence-Based Practice in Acute Care

OBJECTIVE

The aim of this study was to describe cultural characteristics, values, and beliefs that influence sustainability of an evidence-based practice (EBP) intervention in the acute care clinical setting.

BACKGROUND

There is an urgent need to identify best practices to sustain EBP to gain efficiencies in nursing care delivery and improve patient outcomes.

METHODS

A focused ethnographic qualitative study was conducted in a community hospital with nurses that used Screening, Brief Intervention, and Referral to Treatment (SBIRT).

RESULTS

Customizing the intervention to the unit culture evolved and was crucial for sustainability. Overlap in responsibilities, time, clinician confidence, and impact to workflow were noted as negative influences. The intervention was primarily viewed as a task to be checked off a list instead of a tool that informs the patient's plan of care.

CONCLUSIONS

Assessing clinician experiences, beliefs, and values of an EBP should be incorporated into a strategic sustainability plan. Clinician understanding of how an EBP can advance the patient plan of care could promote ownership of professional practice and sustainment.

Critical ethnography in maternity care research: bridging creativity and rigour - a discussion paper

Ethnography is a useful research method for maternity care research, because it can identify elements of actual practice that may be missed using non-observational research. However, because of the relative creative freedom of writing ethnography, it can be difficult for novice researchers, because there is no particular set of steps to follow. Much of the work of an ethnography is actually just watching, thinking and writing. In this paper we discuss our three individual doctoral research projects- all variations of critical ethnography-in order to present some of the creative variety of ethnography in maternity care research and to promote discussion within this field about how to maintain robust ethnographic research while keeping hold of its creative aspects. Attempts to standardise ethnographic research have the potential to curtail a very flexible methodology and constrain the knowledge generating work of the researcher. We encourage fellow maternity researchers to contribute to literature on ethnographic methodology in order to expand and refine use of this methodology in maternity care settings.

Ethnographic investigation of patient-provider communication among African American men newly diagnosed with prostate cancer: a study protocol

INTRODUCTION

In the USA, African American men bear a disproportionate burden of prostate cancer (PCa) compared with all other groups, having a higher incidence and mortality, poorer quality of life and higher dissatisfaction with care. They are also less likely to receive guideline-concordant treatment (eg, undertreatment of aggressive disease). Inadequate patient-provider communication contributes to suboptimal care, which can be exacerbated by patients' limited health literacy, providers' lack of communication skills and time constraints in low-resource, safety net settings. This study is designed to examine the communication experiences of African American patients with PCa as they undertake treatment decision-making.

METHODS AND ANALYSIS

Using an ethnographic approach, we will follow 25 African American men newly diagnosed with PCa at two public hospitals, from diagnosis through treatment decision. Data sources include: (1) audio-recorded clinic observations during urology, radiation oncology, medical oncology and primary care visits, (2) field notes from clinic observations, (3) patient surveys after clinic visits, (4) two in-depth patient interviews, (5) a provider survey, and (6) in-depth interviews with providers. We will explore patients' understanding of their diagnoses and treatment options, sources of support in decision-making, patient-provider communication and treatment decision-making processes. Audio-recorded observations and interviews will be transcribed verbatim. An iterative process of coding and team discussions will be used to thematically analyse patients' experiences and providers' perspectives, and to refine codes and identify key themes. Descriptive statistics will summarise survey data.

ETHICS AND DISSEMINATION

To our knowledge, this is the first study to examine in-depth patient-provider communication among African American patients with PCa. For a population as marginalised as African American men, an ethnographic approach allows for explication of complex sociocultural and contextual influences on healthcare processes and outcomes. Study findings will inform the development of interventions and initiatives that promote patient-centred communication, shared decision-making and guideline-concordant care. This study was approved by the University of California San Francisco and the Alameda Health System Institutional Review Boards.

Theoretical, methodological and analytical aspects of ethnographic research in obstetric nursing: an integrative review

OBJECTIVE

To characterize ethnographic research in the area of obstetric nursing regarding its theoretical, methodological and analytical aspects.

METHOD

An integrative review performed in the MEDLINE®, LILACS, BDENF and CINAHL databases, as well as the SciELO virtual library.

RESULTS

Thirty (30) articles formed the analytical corpus after screening and reading the primary references in full. The most used methods were ethno-nursing, ethnography and institutional ethnography; the immersion time in the field ranged from 12 visits to 48 months occurring in institutional contexts. The main data collection techniques were observation, individual interviews and training guides for ethno-nursing. The data were organized as themes and subthemes, analyzed through the ethno-nursing analysis guide, implementing the Theory of Diversity and Universality of Cultural Care as theoretical reference.

CONCLUSION

Ethnographic studies in the area of obstetric nursing are within the scope of microethnographies and are operationalized based on theoretical-methodological nursing references, being useful to analyze the complexity of phenomena involving obstetric nursing care, and focusing on the etic (professional) and emic (women) perspectives.