Qualitative Research in Nursing and Healthcare

Immy Holloway is Professor Emerita in the Faculty of Health and Social Sciences at Bournemouth University in the United Kingdom.

Kathleen Galvin is Professor of Nursing Practice in the School of Health Sciences at the University of Brighton, United Kingdom.

Preface xiii

About the Authors xv

Acknowledgement xvii

Part One: Introduction to Qualitative Research: Starting Out

1 The Essentials of Qualitative Research 3

What is qualitative research? 3

The characteristics of qualitative research 3

The primacy of data 4

Contextualisation 5

Immersion in the setting 5

The ‘emic’ perspective 6

Thick description 7

The research relationship 8

Insider/outsider research 9

Reflexivity 9

The place of theory in qualitative research 11

The use of qualitative research in healthcare 11

Choosing an approach for health research 13

References 14

Further Reading 16

2 The Paradigm Debate: The Place of Qualitative Research 17

Theoretical frameworks and ontological position 17

The natural science model: positivism objectivism and value neutrality 18

The paradigm debate 19

The interpretive/descriptive approach 21

Focus on postmodernism and social constructionism 23

Conflicting or complementary perspectives? 24

Final comment 25

References 25

Further Reading 26

3 Initial Steps in the Research Process 27

Selecting and formulating the research question 27

Practical issues 31

The research design and choice of approach 31

The literature review 32

Writing a research proposal 35

Access and entry to the setting 41

Summary 44

References 44

Further Reading 45

4 Ethical Issues 47

The foundational ethical framework for research 49

Ethics in qualitative research 52

Interviews and observations 53

The participant information sheet 60

Researching one’s peers 62

The research relationship 62

Research in the researcher’s workplace 64

The role of research ethics committees 64

Reviewing the research project 66

Key ethical questions: audiotaped interviews 66

Summary 70

References 70

Further Reading 72

5 Supervision of Qualitative Research 73

The responsibilities of supervisor and student 74

Writing and relationships 76

Practical aspects of supervision 78

Single or joint supervision 79

Problems with supervision 80

Academic problems 81

Final notes 82

Summary 83

References 83

Further Reading 83

Part Two: Data Collection and Sampling

6 Interviewing 87

Interviews as sources of data 87

The interview process 88

Types of interview 89

Contents vii

Practical considerations 92

Recording interview data 96

The interviewer–participant relationship 98

Problematic issues and challenges in interviewing 99

Ethical issues in interviewing 103

Summary 105

References 105

Further Reading 106

7 Observation and Documents as Sources of Data 107

Participant observation 107

The origins of participant observation 108

Immersion in culture and setting 108

Types of observation 111

Problems in observation 116

Technical procedures and practical hints 117

Documentary sources of data 118

Summary 122

References 122

Further Reading 123

8 Focus Group Research (FGR) 125

The nature and features of focus group research 125

The origin and purpose of focus groups 127

Focus group research in healthcare 127

Sample size and composition 128

Conducting focus group discussions 131

Research with online or virtual focus groups 133

Recording analysing and reporting focus group data 134

Critical comments on focus group research in healthcare 138

Summary 138

References 139

Further Reading 140

9 Sampling Strategies 141

Sampling decisions 141

A variety of sampling types 145

Inclusion and exclusion criteria 150

Sampling parameters 150

Sample size 151

Saturation 152

Giving a label to the participants 153

Summary 154

References 154

Further Reading 155

Part Three: Approaches in Qualitative Research

10 Ethnography 159

The development of ethnography 160

Ethnographic methods 162

Ethnography in healthcare 163

The main features of ethnography 165

Fieldwork 169

Doing and writing ethnography 172

Analysis 172

Interpretation 174

Pitfalls and problems 175

Summary 176

References 176

Further Reading 178

11 Grounded Theory Methodology 179

History and origin 180

Symbolic interactionism 181

The main features of grounded theory 181

Data collection theoretical sampling and analysis 183

The three main approaches 189

Using the literature 190

Integration of theory 192

Theoretical memos and fieldnotes 192

Pitfalls and problems 193

Which approach for the health researcher? 196

Summary 197

References 197

Further Reading 199

12 Narrative Inquiry 201

The nature of narrative and story 201

Narrative research 202

Narratives in health research 202

The everyday story 206

Autobiographical and biographical stories 206

Cultural stories 207

Collective stories 207

Illness narratives 208

The restitution narrative 209

The chaos narrative 210

The quest narrative 210

Narrative interviewing 211

Narrative analysis 212

Contents ix

Thematic and holistic analysis 213

Structural analysis 214

Dialogic/performance analysis 215

Visual analysis 216

Ongoing debates about narrative 216

Summary 218

References 218

Further Reading 220

13 Phenomenology 221

Intentionality and the early stages of phenomenology 222

Phases and history of the movement 223

The German phase 224

The French phase 226

Schools of phenomenology 227

The phenomenological research process: doing phenomenology 228

Grounding 228

Reflexivity and positional knowledge 229

Humanisation and the language of experience 229

Phenomenology and health research 231

Topics for phenomenological approaches 232

Choice of approach: descriptive or interpretive phenomenology 233

Procedures for data collection and analysis 235

Summary 238

References 238

Further Reading 241

14 Action Research 243

The origins of action research 244

Critical social theory 245

Action research in healthcare 246

The main features of action research 247

The methodological continuum 248

Practical steps 250

Trustworthiness in AR 252

Problems and critique 253

Summary 255

References 255

Further Reading 256

15 Additional Approaches 259

Case study research 259

Overview 260

Features and purpose of case study research 260

Conversation analysis 262

The origins of conversation analysis 263

The use of conversation analysis 263

Discourse analysis 265

Critical discourse analysis (CDA) 267

Performative social science 269

PSS in health research 270

Summary 271

References 272

Further Reading 275

Discourse Analysis 275

Further Reading 276

Performative Social Science 276

Further Reading 277

Part Four: Data Analysis and Completion

16 Data Analysis: Strategies and Procedures 281

Transcribing and sorting 283

Taking notes and writing analytic memos 284

Ordering and organising the data 285

Analytical styles 286

Coding and categorizing 287

Thematic analysis 288

Meaning and Gestalt 289

Problems of QDA 289

Inferential leaps and ‘premature closure’ 289

Collaboration in the process of analysis and interpretation 290

Computer- aided analysis of qualitative data 290

The reasons for computer use 291

Storing annotating and retrieving texts 292

Locating words phrases or segments of data 292

Naming or labelling 292

Sorting and organising 292

Identifying data units 293

Preparing diagrams 293

Approaches to qualitative computer analysis 293

Language- oriented 293

Descriptive/interpretive approaches 293

Theory building 294

The practicalities of using computer- aided analysis 294

Advantages of computer use 295

Problems and critique of computer analysis 295

Summary 296

References 297

Further Reading 298

17 Establishing Quality: Validity and Trustworthiness 299

Quality 299

Conventional criteria 300

Rigour 300

Reliability 300

Validity 301

Generalisability or external validity 302

Objectivity and subjectivity 303

The concept of validity in qualitative research 304

An alternative perspective: trustworthiness 305

Dependability 305

Credibility 305

Transferability 305

Confirmability 306

Authenticity 306

Strategies to ensure trustworthiness 307

Member checking 307

Searching for negative cases and alternative explanations 309

Peer review 310

Triangulation 310

The audit or decision trail 311

Thick description 312

Prolonged engagement 312

Reflexivity 313

Quality and creativity 313

Summary 314

References 314

Further Reading 315

18 Writing up and Publishing Qualitative Research 317

The research account 317

Use of the first person 318

The format of the report 319

Title 320

Abstract 321

Acknowledgement and dedication 323

Contents 323

Introduction 323

Entry issues and ethical considerations 324

Methodology and research design 325

Findings/results and discussion 326

Conclusion and implications 328

Referencing 330

Appendices 330

Critical assessment and evaluation 331

Guide to research evaluation 331

Publishing and presenting the research 332

Books 333

Articles 333

Types of article 334

Alternative forms of presenting or disseminating the research 335

Summary 336

References 336

Further Reading 337

Final Note 339

Glossary 341

Index 347