B. Dierckx de Casterl Academic Center of Nursing and Midwifery - - PowerPoint PPT Presentation

• B. Dierckx de Casterlé

Academic Center of Nursing and Midwifery Department of Public Health & Primary Care

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 “Qualitative research involves any research that

uses data that do not indicate ordinal values”

(Nkwi, Nyamongo & Ryan, 2001)

Functional & outcome based Type of data as determining factor

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 “Qualitative researchers are interested in

understanding the meaning people have constructed, that is, how people make sense of their world and the experiences they have in the world.” (Merriam, 2009)

Research purpose & focus ‘Finding & understanding of meaning and sense’

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 “Investigation of phenomena, typically in an

indepth and holistic fashion, through collection

• f rich narrative materials using a flexible

research design” (Polit & Beck, 2004)

 “Covers complex (social) phenomena, studied in

their natural setting, and useful for understanding the processes that are at play in a situation.”

(Morse, 1997)

Subject, aim, design, data collection, …

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 Qualitative research as umbrella concept  Description in comparison with quantitative

research

• Empirical nature and specific characteristics

 subject, aims or research questions  paradigm  design  data collection method & sampling  data analysis  outcome

In line with quantitative approach Risk of polarisation of qualitative-quantitative debate

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

When do we need a qualitative design?



Subjects explored in qualitative studies?



Specific aims & research questions? What is the role of nurses in the care for patients requesting euthanasia?

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What is the role of nurses in the care for patients requesting euthanasia?

 How many involved?  How often they perform euthanasia?  What exactly doing?  ....

“measure & count”

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What is the role of nurses in the care for patients requesting euthanasia?

 Understanding the caring process  How nurses experience being involved?  How nurse manage the process and deal with

ethical challenges?

 How nurses experience their responsability?  Which dynamics impede/facilitate the process?  …

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 Aim to gather an in-depth understanding of human

behavior / social phenomena

behavior, experiences, interactions, social processes, practices, …

 How and why questions

• Rich, narrative data (words, images, experiences, stories)

 subjective richness to understand complex issues

• Focus on daily reality / social environment of respondents

(where they live, experience, interact, give meaning to …)  to understand social phenomena as the occur spontaneously

in their own natural environment

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 Lived experience of older people living with early-

stage dementia?

 How do care providers experience lack of time and

its impact on care?

 How do nurses reason and behave in cases of

physical restraint in acute elderly care?

 How do employers experience their role and

responsibility regarding the employee’s return to work after breast cancer treatment? “Subjective reality” Use of the experienced reality to understand complex phenomena how to develop knowledge based on ‘subjective reality’?

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 Well established framework a specific group of

researchers use in their research

 Views, assumptions, concepts, values, and practices

about the nature of reality and knowledge development

• What reality is, what & how to investigate, how knowledge

can be developed, what is the value of evidence, …

 Shared by a scientific community and guiding the

community in the way they do research Different ideas bout reality & knowledge development in qualitative & quantitative approaches  different paradigms

http://www.thefreedictionary.com/paradigm; http://www.qualres.org/HomePhil-3514.html

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 Aims at mapping the objective, mathematic

reality

• by focusing on events, causal relations
• testing hypotheses, controlling and predicting

 Aims at a large, horizontal perspective on the

research phenomenon

• by questioning a lot of persons in a uniform manner
• using a clear and structured questionnair or

measure

• ethic perspective (imposed structure/frame based
• n literature & previous research)

“Positivist paradigm”

(www.qualres.org, www.celt.mmu.ac.uk, www.academia.edu)

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 Reality exists (world/phenomena = objective

reality)

• basically ordered & regular
• have causes and effects
• exist outside the knowledge of an individual (reality out

there)

> creation of the human mind (e.g. cerebrovascular accident)

• can be learned, tested & verified through scientific means

 Focus on objectivity; understanding of the

underlying causes of phenomena

• researcher independent from those/what being researched
• use of orderly, disciplined procedures (control research situation)
• test & verify information & experiences to gain confidence

(Polit & Beck, 2017; www.qualres.org, www.celt.mmu.ac.uk, www.academia.edu)

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 Understanding & interpreting the subjective reality

(meaning giving process)

• Discovering the meaning persons give to their

experiences & situation

• Discovering the underlying social processes and

interactions explaining behavior/phenomena

 Focusses on an indepth, vertical view in order to

understand the phenomenon in its complexity

 Emic perspective: focus on respondents, looking

for structure in the respondents’ experiences

“Interpretivist/constructivist paradigm”

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 Reality is not a fixed entity but a construction of the

participants

• Reality depends on the meaning given by the persons to their

experiences or situation (context-bounded)

• Reality is constructed through experiences and relationships
• No ultimate truth

 Persons studied as human beings who to a large extent

construct their world through meaning giving and meaning experiences

 Basic idea: the way persons react and behave mainly can be explained in terms of the meaning persons give at their daily life, their situations, …

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 Try to understand/interpret this subjective

reality

• Listening to or observing this subjective reality

 Subjective interactions = primary way to access them  Voices & interpretations of research participants crucial to obtain a more informed and sophisticated understanding

• Looking for patterns, structure & commonalities

 Interpretative process  Findings = product of interactions researcher – participants

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http://research-methodology.net/

Bottom up approach

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http://research-methodology.net/

Top down approach

• 1. Focus on the natural environment
• Social processes explored from the respondents’ living

world

• Taking into account the rich context of respondents’ life
• 2. Focus on a ‘holistic’ understanding of the

phenomenon

• Allowing to approach the research phenomenon in a

systematic, comprehensive and integrated way

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• 3. Open & flexible design (emergent)
• Requiring ‘open’ mind of researcher
• Allowing to adapt the research process to specific

context

 Continuous interaction between research and context  Not everything can be planned/ anticipated in advance

• 4. Continuous interaction between data

collection and data analysis

• Data collection and data analysis occurs

simultaneously and in interaction

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• 1. Focus on the natural environment
• 2. Focus on a ‘holistic’ understanding of the

context

• 3. Open & flexible design (emergent)
• 4. Continuous interaction between data

collection and data analysis High explorative power

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 In general: data collected using interviews/observations

• Focus on the respondents’ perspectives, the way they give

meaning to their life, their experiences

• Respondents are invited and stimulated to tell in detail about

their experiences or will be observed in their natural setting

 Open and flexible

• Room for unexpected events
• Guided by the data analysis

 Often mix of methods (individual/focus interviews,

• bservation, analysis of document)  data from

multiple perspectives

 Often requires intense/sustained contact with respon-

dents in their environment (rich & nuanced information)

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 To discover and understand meanings in the

specific context (indepth vertical view) Purposively selected sample

large, random sampling (generalisability)

• Looking for a mix of cases/participants/

perspectives to obtain rich and nuanced information

• Variation allowing to get an overall insight in the

complex process

• Sample size determined by principle of saturation

 Point where a sense of closure is attaint because new data/interviews do not result in new information (redundant information)

Quality > quantity of the participants

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How would you describe this statue?

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• The descriptions will vary (according to the persons’ perspectives)

but they all refer to the same object

• Every description
• is unique & ‘true’
• interesting peace of puzzle to get an understanding of the whole

Nurses’ involvement in euthanasia Understanding through exploration of nurses’ experiences

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Requires a variety of perspectives

Nurses’ involvement Man, neutral hospital, pro euthanasia, 10 years experiences palliative care, Involved in 8 euthansia cases…

‘Respecting patient’s request’ as main focus Absolutely certainty about request Ensure all procedural steps are taken Protocol as checklist

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Nurses’ involvement woman, neutral hospital, pro euthanasia, 5 years experiences geriatric care, 3 euthanasia cases, …

Able to understand patient request What is the right attitude for guiding and supporting the patient? ‘Showing respect for patient as person’ as main focus Enter into personal relationship with patient & family

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Nurses’ involvement Man, catholic hospital, contra euthanasia, 5 years experiences PST, 12 euthanasia cases, …

Intense, difficult and grave ‘Truly helping the patient to die serenely’ as main foucs Succesful when all able to make their peace with the situation

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Nurses’ involvement Woman, neutral hospital, pro euthanasia, 3 years experiences

• ncology, 2 euthanasia cases, …

First of all a good, practical organisation of the caring process What to do to make this process succesfull?

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Nurses’ involvement And so on …

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Nurses’ involvement in euthanasia

 Good sampling:

• Requires diversity in perspectives

 to make the circle round  to develop an indepth and holistic understanding of the phenomenon

• Requires the most adequate mix of

perspectives (characteristics)

 Guided by literature review & interaction between data collection & data analysis (theoretical sampling)  Quality more important than quantity of respondents

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Nurses’ involvement And so on …

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How to analyse and interprete all these diverse and nuanced data? How to use these stories to answer our research questions? How to integrate all these data without losing the integrity of each story? A huge amount of rich and divers data Every story is unique and provide us with one perspective

 Particularly challenging enterprise

• Huge amount of rich, divers and narrative data
• No universal rules or standard procedures
• Labor-intensive activity that requires riguour, creativity,

conceptual sensitivity and skills

“It is the researcher who gives meaning to the data”

 Purpose: organize, provide structure and elicit

meaning from data

 Data collection and data analysis often occur

simultanuously

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 How can you describe the

content/value of this collection?

 Impossible to describe each

pearl separately

 A relevant way to classify or

sort the pearls  structure to better understand and describe the content/value of this great diversity of pearls

 Which parameters can I use to

best describe the content?

Material, size, color, form, …

 Choice of parameters guided

by purpose (value from the

perspective of pearls collectors)

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 Purpose: to discover the underlying meanings and

develop conceptual and theoretical insights (in answer to the research question)

 How:

• Finding a relevant structure to organize, understand and

describe the phenomenon (coding framework, coding process)

• Analysing and interpreting all data within framework 

discovering underlying messages and dynamics

• Development and description of concepts & theoretical insights

Requires ‘peopleware’ rather than software

• Expertise in thinking, imagining, connecting, conceptualizing,

condensing and creating ‘ Intellectual craftmanship’(Sandelowski, 1995)

Quagol (Dierckx de Casterlé et al, International

Journal of Nursing Studies, 2012, 49, 360-371)

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 Word, themes, concepts (models & theories)  Produces knowledge in the intra- and

interpersonal field

• What health or illness feels like to patients
• Where interpretations of health and illness come from
• How experiences change under a variety of

interpersonal, historical, cultural an other conditions ...

 Comprehensive, holistic, expansive

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 Open letter to The BMJ editors on qualitative

research (BMJ, 2016; 352:i563)

• 76 senior academics from 11 countries
• Invitation to reconsider journal policy regarding

qualitative research (rejection on the grounds of low priority)

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 Good qualitative research with a clear and important

clinical message can be highly cited, is popular with readers, and enriches The BMJ’s overall contribution to the knowledge base

• 20 most influential papers (Celebration of 20 years online

presence) :

 11 commentaries or editorials  3 randomised controlled trials  3 qualitative studies  2 surveys & 1 methodological paper More citations for qualitative papers than for RCT

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 Different study designs provide complementary

perspectives

• Few research topics in clinical decision making and patient

care can be sufficiently understood through quantitative research alone

• E.g. patient safety

 RCT:Effect size of interventions to improve safety  QR: why did the observed effect occurred in some cases and not in others (qualitative systematic review based on 18 qualitative studies helps explain why)

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