Research Corner
Qualitative Research Methods: Considerations for Roads Less Traveled
Paula N. Kagan, PhD, RN
Abstract
This article explores issues in the methods and usefulness of qualitative research as applied to research questions in spinal cord injury nursing. Philosophic and pragmatic frameworks for using qualitative methods are discussed. Several qualitative studies are specified as examples of methods such as phenomenology and lived experience, hermeneutics, descriptive exploratory, community participatory action, and systematic literature review. Examples are given of the range and types of research questions accessible through qualitative methods that may enhance the scope of what is known about the experiences and conditions of spinal cord injured persons, their communities, and the nurses who care for them.
Key words: qualitative research, spinal cord injury, nursing science
Introduction
Roads less traveled provide connections to significant vistas, events, and situations that might not occur through our regular paths and routines. Perspectives, understandings, and meanings that are often missed in our usual or familiar way of doing things emerge and are illuminated with variation in our manner or method. This is particularly true in research about human beings that contributes to nursing science. The majority of nursing research about people is conducted using quantitative methodologies and nurse researchers are most familiar and comfortable with those methods. The methodology and value of conducting qualitative research is less well known and may, for some nurses, be less comfortable for several reasons.
There still exists, in nursing and other disciplines, resistance to qualitative methods by proponents of a singular, traditional, and quantitative “scientific method” approach to knowledge acquisition (Denzin & Lincoln, 2005). Qualitative research is science conducted with rigor and distinct methods to ensure credibility. It has the ability to inform policy, education, and practice with the nuanced complexities of people’s lives, while it values and encourages multiple belief and value structures, multiple types of knowledge and methodologies. A significant element of qualitative research is a connection to social action and initiatives to end social injustice, particularly regarding issues of gender, class, color, ability, and sexual orientation. In researching qualitatively, some nurses may not be comfortable working from the margins methodologically, considering social and health policy implications from a value-identified critical perspective, and placing themselves in the researcher-as-participant process that occurs in qualitative methods studies. Other nurses are looking for this approach.
The purpose of this column is to present issues that may be useful when considering the use of qualitative methodologies for answering research questions proposed by spinal cord injury nurses. Philosophical and theoretical frameworks and aims of research will be considered. Several qualitative methods will be suggested such as phenomenology and hermeneutic approaches to lived experience, descriptive exploratory, community participatory action, and systematic literature review. Examples are given of the range and types of research questions accessible through qualitative methods that may enhance the scope of what is known about the experiences and conditions of spinal cord injured persons, their communities, and the nurses who care for them.
Developing Qualitative Research
Spinal cord injury nurses know that health and quality of life is of utmost importance to their patients. Therefore, many questions that these nurses want answered are about the experiences and connected meanings of those who live with spinal cord injury. Quantitative methods assign numerical representation to the conditions and experiences of spinal cord injured persons; by contrast, qualitative research methodologies move beyond the limitations and boundaries of digital analysis to provide data that enhances understanding and reveals meaning for a person’s lived experiences. For many research questions, qualitative methods provide amazingly fresh and surprising perspectives that could not be arrived at through the traditions of quantitative methods.
Philosophical and Theoretical Framework
Many nurses realize that health is defined from the perspective of the person and family and is based on their experiences, beliefs, and values (Cody, 1995b; Parse, 1990; Parse, 1998). This is a basic philosophical idea that underpins qualitative research. It is the notion that the person, family, or community knows itself better than any other source and has vital information to share that may enhance understanding of their situation as well as enhancing clinical decision-making for nurses. More than anything else, people want to be listened to; they want to have their voices and their feelings heard (Kagan, 2007). The most common complaint from people who have experience with health care providers is that providers are not listening.
Another important idea underpinning qualitative research is that of the human science approach suggested by Dilthey back in the 19th century. Dilthey (1883/1989) specified that natural science methods do not bring to light essential data about human beings that offer understanding of relationships, values, patterns, and meanings of persons’ lives. He suggested using interpretive methods such as phenomenology, the study of lived experience as told by the persons themselves and hermeneutics, interpreting text, transcribed dialogue, or art and literature in light of a specific theoretical framework.
All research methodologies, and the researchers employing them, have a theoretical or philosophical framework operating-whether it is explicitly stated or not. With quantitative methods, this framework is frequently not specified. In these, dominant cultural and societal beliefs are assumed, particularly when analysis of the structures and systems of class, gender, race, ability, and sexual orientation are not elements of the research. With qualitative methods, however, it is preferred-and somewhat mandated-to state the standpoint of the researcher and the method. This is due in large part to the many qualitative methods arising out of theoretical frameworks whose concern is to uncover prejudice, bias, and social injustice. Denzin and Lincoln (2005) cite T. A. Schwandt (2000) and contend that qualitative inquiry is a “reformist movement” (p. x) and that all research and science is moral and political. It is not surprising that nurses, in a discipline with a strong history of social reform, are attracted to qualitative methods and the foundational values within them.
Nurses may choose among many theories and philosophical frameworks to guide their research, just as they may choose among many types of qualitative methods. Nurses seeking to build disciplinary knowledge in nursing and create nursing science should frame their studies with theories specifically developed by nurse scholars (Barrett, 2000; Parse, 2001b). Interpretation of findings will proceed based on the assumptions and principles of the theory. Nurse researchers underpinning their work with frameworks from other disciplines such as psychology, sociology, or anthropology, will contribute to the knowledge base of those disciplines.
Research Questions and Methods
The research question points to the method that is most appropriate for the study. Asking comparison questions or asking how many, how often, or to what degree, may indicate a limited view of the range that research can take and will lead the nurse appropriately to quantitative methods. When nurses critically ponder the meaning of their inquiry and their intentions for doing research, however, it may emerge that they question more deeply and differently the experiences and conditions of a particular group-such as those with spinal cord injuries-than quantification can represent. Research questions are personal and point to the researchers’ values and priorities. Qualitative researchers want to understand a person’s experiences and what meaning these experiences have for the person, the community, and society.
To facilitate this goal, nurse researchers need to identify a phenomenon, a concept, or an experience which they can ask spinal cord injured persons about. In answering the research question, the findings will not offer pathways for prediction or control of outcomes or treatment, rather it provides understanding and meaning about the phenomenon under study for a particular group of participants.
For spinal cord injury and related conditions nurses have studied phenomena such as the lived experience of having courage for spinal cord injured adults (Bournes, 2002) and the experience of happiness for children with spina bifida (Hanlon, 2004) both phenomenological and hermeneutic, utilizing the Parse research method and underpinned by the “human becoming” theory in nursing (Parse, 1998). Similarly, the meaning of living with spinal cord injury after five to ten years (DeSanto-Madeya, 2006) and the experience of spousal caring (Cheung & Hocking, 2004) were both explicated by a phenomenological-hermeneutic method. DeSanto-Madeya underpinned her study methodologically and philosophically with Benner (1994) in nursing and Cheung and Hocking with Benner and Wrubel (1989) modifying an example from the nursing literature for analysis. All of these were influenced theoretically by the existential-phenomenologist, Martin Heidegger (1962).
Seeking to understand social injustice and create change, participatory action research is often utilized in disciplines such as psychology, sociology, and women and gender studies and is one form of a group of critical social methodologies (Denzin & Lincoln, 2005). Newman (2006) made the case for conducting participatory research to understand the phenomenon of community integration of women with spinal cord injury with the aim of highlighting the value of taking action to improve health and quality of life.
In addition, two studies used the exploratory, qualitative descriptive method. One in nursing-underpinned by the Roy (Andrews & Roy, 1999) adaptation model-examined the phenomenon of participation and relational influences for partaking in therapy during inpatient rehabilitation (Puetz, 2006). Another, in the related discipline of rehabilitation health, studied quality of life for persons with high spinal cord injury residing in the community (Hammell 2004a), where no theoretical framework was specified. In the rehabilitation health and physical therapy disciplines, qualitative methods, such as systematic literature reviews, have been conducted on phenomena such as quality of life following high spinal cord injury (Hammell, 2004b) and inspiratory muscle training (Brooks, O’Brien, Geddes, Crowe & Reid, 2005).
Qualitative methods share similar processes. They are largely interpretive and participant driven and derived in that they are concerned with the context and situatedness of persons’ lives as told by the persons themselves. It is similar in the case of using art and literature and other texts as data sources. In qualitative methods the researcher and the participant are in an intersubjective process with the researcher being part of the dynamic of the study. Basic research processes include data collection through conversation, interview, or dialogue with participants, often using video or audio recording equipment and ultimately transcribed. Data collection may involve gathering texts or examples of art and literature. Extracting and synthesizing themes or essential characteristics of the phenomena under study through dwelling with the data yields the findings for the study. Finally, interpretation of the emergent themes in light of a guiding theoretical framework answers the research question and provides ideas for future research, policy, and practice.
Helpful Sources
The best way to develop a research question and select a qualitative method is threefold. First, novice researchers should find a mentor experienced in developing, conducting, and writing qualitative studies. It is important to have a guide who is an enthusiastic proponent of qualitative work, both from a philosophical perspective and a methodological perspective. Second, researchers should read qualitative studies from the area of spinal cord injury, such as those mentioned above, that will stimulate thinking relevant to their phenomenon of interest and which may lead to a question and a method. Lastly, access good sources on qualitative methods. I suggest, from the nursing discipline, Qualitative Inquiry: The Path of Sciencing (Parse, 2001). Parse, also known as the theorist who developed the “human becoming” theory (1998) presents a variety of qualitative methods, including several specific to the nursing discipline, as well as methods from the social sciences and humanities. Her descriptions are easily understood and each method is accompanied by an example of a study from the literature. The Sage Handbook of Qualitative Research, 3rd Edition, is the most comprehensive source on methods, issues, and criticism in qualitative research across disciplines. I also suggest Naturalistic Inquiry by Y. S. Lincoln and E. G. Guba.
References
Andrews, H. A. & Roy, C. (1999). The Roy adaptation model. (4th ed.). Stamford, CT: Appleton and Lange.
Barrett, E.A.M. (2002). What is nursing science? Nursing Science Quarterly, 15, 51-60.
Benner, P. (1994). The tradition and skill of interpretive phenomenology in studying health, illness, and caring practices. In P. Benner (Ed.). Interpretive phenomenology: Embodiment, caring, and ethics in health and illness. Thousand Oaks, CA: Sage.
Benner, P. & Wrubel, J. (1989). The primacy of caring: Stress, and coping in health and illness. Menlo Park, CA: Addison-Wesley.
Brooks, D., O’Brien, K., Geddes, E. L., Crowe, J., & Reid, W. D. (2005). Is inspiratory muscle training effective for individuals with cervical spinal cord injury? A qualitative systematic review. Clinical Rehabilitation, 19, 237-246.
Bournes, D. A. (2002). Having courage: A lived experience of human becoming. Nursing Science Quarterly, 15, 220-229.
Cheung, J. & Hocking, P. (2004). The experience of spousal careers of people with multiple sclerosis. Qualitative Health Research, 14(2), 153-166.
Cody, W. K. (1995b). The meaning of grieving for families living with AIDS. Nursing Science Quarterly, 8, 104-114.
Denzin, N. K. & Lincoln, Y. S. (2005). (Eds.). The Sage handbook of qualitative research. 3rd Ed. Thousand Oaks, CA: Sage Publications.
DeSanto-Madeya, S. (2006). The meaning of living with spinal cord injury 5 to 10 years after the injury. Western Journal of Nursing Research, 28(3), 265-289.
Dilthey, W. (1989). Introduction to the Human Sciences. (M. Neville & others. Trans.). Princeton, N.J: Princeton University Press. (Original work published in 1883).
Hammell. K. W. (2004a). Quality of life among people with spinal cord injury living in the community. Spinal Cord, 42, 607-620.
Hammell, K. W. (2004b). Exploring quality of life following high spinal cord injury: A review and critique. Spinal Cord, 42, 491-502.
Hanlon, A. (2004). Feeling happy: A lived experience of human becoming. Unpublished Dissertation, Loyola University Chicago.
Heidegger, M. (1962). Being and time. (J. MacQuarrie & E. Robinson, Trans.). San Francisco, CA: Harper & Row. (Original work published 1927).
Kagan, P. N. (2007). Feeling listened to: A lived experience of human becoming. Nursing Science Quarterly, (in press).
Lincoln, Y. S. & E. G. Guba (1985). Naturalistic inquiry. Thousand Oaks, CA: Sage Publications.
Newman, S. (2006). Community integration of women with spinal cord injury: A case for participatory research. SCI Nursing. Retrieved 10/30/2006. http://journal.aascin.org/2006/08/27/community-integration-of-women-with-spinal-cord-injury-a-case-for-participatory-research/
Parse, R. R. (1990). Health: A personal commitment. Nursing Science Quarterly, 3, 136-140).
Parse, R.R. (1998). The human becoming school of thought: A perspective for nurses and other health professionals. Thousand Oaks, CA: Sage Publications.
Parse, R.R. (2001a). Qualitative inquiry: The path of sciencing. Sudbury, MA: Jones & Bartlett.
Puetz, J. (2006). Relational influences on participation in therapy for persons with spinal cord injuries. Unpublished Master’s research project. DePaul University, Chicago, IL.
Schwandt, T. A. (2000). Three epistemological stances for qualitative inquiry: Interpretation, hermeneutics, and social construction. In N. K. Denzin & Y. S. Lincoln (eds.) Handbook of qualitative research (2nd ed.) 189-213. Thousand Oaks, CA: Sage.
Paula N. Kagan, PhD, RN is an assistant professor at DePaul University, Chicago, IL
Matthew Sorenson PhD, RN is an assistant professor at DePaul University, Chicago, and the editor of Research Corner. He welcomes your comments, questions and suggestions: mattsoren@earthlink.net