Monday, January 21, 2008

Qualitative Research Appraisal

By Sudipa Sarkar
Qualitative Research
The term ‘Qualitative Research’ implies the methodologies used to understand the in-depth characteristics of human behaviour, the motivation and factors governing human behaviour. Qualitative research emphasises on the causes behind various facets of human behaviour. The research methodology primarily focuses on ‘why’ and ‘how’ of the research matter unlike quantitative research focuses on ‘what’, ‘where’ and ‘when’ of the research issue. The qualitative research is aimed to cover smaller but focused area of research interest rather than larger and random samples as it is with quantitative research. During 1970s, the qualitative research approach primarily gained its recognition in western culture.

The major perspectives or characteristics of qualitative research includes the following factors –
(I) The reality is not unique or single
(II) Reality is based on individual perception which is variable over time
(III) The meaning or implication of knowledge has space and time boundary
The main theme of qualitative research is to associate and organize the reasoning process in such a manner so that the various outcomes can be arranged perceptually to make a ‘whole’. Evidently throughout the process the ‘meaning’ or inference of the incidence occurred is derived. Now, as the perception is dependent on individuals, situation and time, many different implications of a given incidence are possible. (Burns & Grove, 1993)
Quite commonly qualitative methods are used in nursing practices as they are considered as an authentic tool for developing holistic knowledge in the discipline of nursing. But most of the evidence based practices in nursing service include quantitative methods, thus it is significant to consider somewhat different critical approaches supporting the qualitative researches (Ploeg, 1999).
At initial days of nursing practices, one of the renowned researchers called Parsons (1951) proposed his theory of the sick role by emphasizing the passive, dependent role of the patient along with not being able to take responsibility in the treatment process. The theory assumed that the sick individual plays the role during his treatment process in compliance with the doctors and nurses in order to become cured (Parson, 1951). This theory gained intense criticism for various reasons including rejection of passive role of the patients, the ideal and static nature of doctor-patient relationship, stigmatization of illness, lacking sufficient support and evidence regarding disease as a result of lifestyle, chronic and long-term disease. In current scenario, patients are viewed as more active and dynamic components of the health system, where they are perceived as being responsible for their own health and treatment procedures (Burns & Groves, 1999). Being informational and concept-oriented in nature, qualitative research methods have become progressively more important as a tool for developing the knowledge of nursing especially for evidence based nursing (EBN) practices. The qualitative research analyses the concepts and phenomenon relating to nurses concern in response to actual or potential health problems (Ploeg, 1999) by the virtue of methodologies concerning the description, exploration and explanation of a particular phenomenon in question (Marshall & Rossman, 1995). The qualitative research in nursing practices covers the live-on experiences of patients and nurse. Considering the arena of chronic illness, where the theory of sick role (Parsons, 1951) was unable to provide sufficient support, qualitative research has drawn particularly significant openings of some processes for the individuals suffering from chronic diseases and its impact in life to living with. Moreover, being descriptive and analytical in nature, qualitative research has helped to regain new insights in the field of health care in understanding the process involved in receiving and giving proper care in live framework, which is evidently an essential ingredient for good nursing care (Grypdonck, 1997). Qualitative research about chronic illness provided nurses with understanding of the lived experience of patients. This understanding is essential for good nursing care.
Qualitative research depends on non-probability and purposive sampling rather than probability and random approaches (Miles & Huberman, 1994). There are various approaches governing the qualitative research such as phenomenology, ethnography, grounded theory, ethnomethodology and life history (Tesch, 1990). Among them, the most widely used varieties in qualitative research methodologies for nursing practices are (Morse & Field, 1995) –
(I) Ethnography
(II) Phenomenology
(III) Grounded theory
(I) Ethnography – The term ethnography, coined from Greek word implying ‘ethnos’ (people) and ‘graphein’ (writing), consigns the field of writing representing varying degrees of qualitative portrayal of human interaction in the context of social phenomenon, primarily based on fieldwork. In general, ethnography implies the outcome of a holistic research approach in understanding a system’s properties by virtue of dependent variables and factors. Ethnography includes the general methods of participant observation and in-depth interviewing acknowledging individual behaviours, attitudes and activities (Germain, 1993).
(II) Phenomenology – The objective of phenomenology method in qualitative research is to cover and describe the exact lived experience of the individuals in particular, but not to emphasize on establishing any theory or model on the basis of particular phenomenon (Van Manen, 1990). The phenomenological studies may cover queries relating to the description of different life-related problems as well as behaviours which may include questions like what is the lived experience of the individuals integrating chronic ulcer.
(III) Grounded Theory – The aim of this perspective is to identify the socio-psychological factors processing the system of an individual (Strauss & Corbin, 1990). It is founded as a result of symbolic interactionism identified philosophically (Chenitz & Swanson, 1986) aimed at finding answers to research questions such as the procedure of re-imaging after modification of body functions (Norris, Kunes-Connell & Spelic, 1998).

Critique the Qualitative Research
Qualitative research studies are not beyond the critical appraisal in spite of having such a major application in social studies including nursing practices. Phenomenological research conducted by Hopkins et al (2006) on patients suffering and living with pressure ulcer has been thoroughly analysed and inspected by considering the following aspects.

The Study
The purpose of the phenomenological study on patients living with pressure ulcer conducted by Hopkins et al (2006) primarily includes the exploration of the experiences of older individuals living with pressure ulcer. The study covers the area concerning loss of independence, pain, wound exudates, body image and social isolation.
Design of the Study
A Heideggerian phenomenological approach had been employed to conduct the study with eight participants of age group over 65 years of age and having a grade of 3 or 4 pressure ulcer within a month. The data had been collected during 2003-2004 from four different demographic areas of two European countries, but analysed at a central area. The methodology involves unstructured interviews in order to explore patient’s view about the world and experience assuming a direct relationship between patient’s belief and outcome of the interview session (Smith 1995).
As the study conducted in different locations, for example, three studies in UK whereas one in Belgium, so there is a language difficulty or translation bias is present that may have threatened the validity of the study itself. As the study is based on phenomenological analysis so there must be an inter-cultural context, but on the other hand, as the translation process is itself an interpretive process, hence increases the chances of miscommunication. The measure employed to minimize this bias is to enable the Interpretative Phenomenological Analysis or IPA (Smith et al, 1999). According to my point of concern, as the approach considered in the study is restricted as phenomenological in nature, the language difference can yet be eliminated by the virtue of setting it to same primary language zone or English speaking countries.

Common Ethical Issues Considered During the Study
The study had been approved by the appropriate health service research ethics committee. Participants were supplied verbal and written documents regarding the purpose and methodology of the study. They were also assured against the confidentiality of the study and anonymity thereof.
Sampling

Eight participants of age group of over 65 years of age had been recruited with a pressure ulcer of grade 3 or 4 for longer than 1 month. The patients having spinal chord injury were excluded (Langemo et al, 2000).
Data Collection and Analysis
As the data collected was based on inter-language differentiation, hence translation of data may lead to bias as the analysis was considered centrally in which rich data had been analysed to identify the theme and connections and the explorations of the world and experience.
Based on the central analysis, the study is aimed to identify the theme inscribed within the raw data obtained from the patients, which is later analysed in order to set up the inference and significance of the analysis for nursing knowledge and understanding.
Rigor
The study faced significant problems about the recruitment of the patients. These are –
(I) Age restriction
(II) Co-morbidity
(III) Interviewing bias originating from undue anxiety at the patient’s end
(IV) Location restriction
The patients showed difficulty in reporting their experience regarding the problem of pressure ulcer with that of co-morbidity (Langemo et al, 2000). Moreover, the experience of living with a pressure ulcer is basically chronic in nature, so the phenomenon cannot be easily separated with the common experience whatsoever.
Implication of the Study for the Discipline of Nursing

The study has a significant impact on future studies covering larger population, which may include –
Original study design including central and group analysis
The next phenomenological study may cover the cross-cultural setupThe study may derive the data to support and enlighten the suitability of future use in larger context. However, the methodologies and data findings may require more attention and care at the end of health care professionals in nursing service in order to assess patients’ view to establish suitable and proper management.
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1 comment:

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