Introduction to Qualitative Research
Qualitative research is a systematic, subjective approach used to describe life experiences and give them significance. It is a way to gain insights through discovering meanings. These insights are obtained not through establishing causality but through improving our comprehension of the whole.Within a holistic framework, qualitative research allows us to explore the depth, richness, and complexity inherent in phenomena. The insights from this process can guide nursing practice and aid in the important process of theory development for building nursing knowledge (Anfara & Martz, 2006; Flinders & Mills, 1993). Although qualitative research is flexible and evolving, it is a systematic and precise process that requires high skill in conceptualization, imaginative reasoning, and elegant expression.
To critically appraise studies in publications, use the findings in practice, and develop the skills needed to conduct qualitative research, you must comprehend qualitative research methodologies. Nurse researchers conducting qualitative studies are contributing important information to our body of knowledge that cannot be obtained by quantitative means. The terminology used in qualitative research and the methods of reasoning are different from those of quantitative research and are reflections of the philosophical orientations of qualitative research. The specific philosophical orientation differs with each qualitative approach and directs the methodology and interpretation of data. Although each qualitative approach is unique, there are many commonalities. To help you comprehend these methodologies, in this chapter we explore the logic underlying the qualitative approach, using gestalt change as a model. The chapter presents a general overview of the following qualitative approaches: phenomenological research, grounded theory research, ethnographic research, historical research, philosophical inquiry, and critical social theory.
THE LOGIC OF QUALITATIVE RESEARCH
The qualitative approaches are based on a holistic worldview that has the following beliefs:
1. There is not a single reality.
2. Reality, based on perceptions, is different for each person and changes over time.
3. What we know has meaning only within a given situation or context.
The reasoning process used in qualitative research involves perceptually putting pieces together to make wholes. From this process, meaning is produced. Because perception varies with the individual, many meanings are possible. You can understand this reasoning process by exploring the formation of gestalts.
GESTALTS
The concept of gestalt is closely related to holism and proposes that knowledge about a particular phenomenon is organized into a cluster of linked ideas, a gestalt. A theory is a form of gestalt. If we are trying to understand something new and are offered a theory that explains it, our reaction may be “Now that makes sense” or “Oh, I see.” The concept has “come together” for us.
One disadvantage of this process is that once we understand a phenomenon through the interpretation of a particular theory, it is difficult for us to “see” the phenomenon outside the meaning given it by that particular theory. Therefore, in addition to giving meaning, a theory can limit meaning. “Seeing” the phenomenon from the perspective of one point of view may limit our ability to see it from another point of view. For example, because Selye’s theory of stress is so familiar to us as nurses, it would be difficult to examine the phenomenon of stress without using Selye’s perception.
Experiencing Gestalt Change
One qualitative researcher, Ihde (1977), has explained the process of (1) forming a gestalt, (2) “getting outside” that gestalt, and (3) developing a new gestalt in such a way that you can experience the process. Experiencing the process is the best way to understand it.
Ihde (1977) conducted his extensive research in the area of vision. He has studied how our eyes and brain perceive an image—for example, how our eyes sometimes see one line as shorter or longer than another when the lines are actually equal in length. Ihde associated the vision of the eye with the way we “see” mentally. Consider the concrete thinking behind sayings such as “seeing makes it real,” “seeing is believing,” and “I saw it with my own eyes.” It is easy to generalize from seeing to the other senses (hearing, touching, smelling, tasting), or empirical ways of knowing, and from there to perception. In fact, we often use phrases such as “I see” or “I hear you” to mean “I understand.”
Ihde (1977) proposed that we have an initial way of perceiving (or seeing) a phenomenon that is naive and inflexible but that we believe is the one and only way of seeing the phenomenon that is real. “Seeing” occurs, however, within a specific context of beliefs, which Ihde called a natural or sedimented view. In other words, we see things from the perspective of a specific frame of reference, worldview, or theory. This is our reality, which gives us a sense of certainty, security, and control. Ihde used line drawings to demonstrate this sedimented view. Examine the following line drawing:
Most people who passively view this figure see a cube. If you continue to gaze at it, however, you will find that the cube reverses itself. The figure actually seems to move. It “jumps” and then becomes fixed again in your view. With practice, you can see first one view and then the other, and then reverse the cube again.
Ihde (1977) developed five alternative ways to view the following drawing and suggested that there are more. He referred to the smaller cube on the right as the “guide picture”:
Suppose, now, that the cube drawing is not a cube at all, but is an insect in a hexagonal opening.… Suppose I tell you that the cube is not a cube at all, but is a very oddly cut gem. The central facet (the shaded area of the guide picture) is nearest you, and all the other facets are sloping downwards and away from it.… Now, suppose I tell you that the gem is also reversible. Suppose you are now inside the gem, looking upwards, so that the central facet (the shaded area of the guide picture) is the one farthest away from you, and the oddly cut side facets are sloping down towards you. (Idhe, 1977, pp. 96–98)
Ihde proposed that to see an alternative view of the drawing, you must first deconstruct your original sedimented view. You must then reconstruct another view. This activity involves the use of intuition. He regarded this process as jumping from one gestalt to another.
Try examining the line drawing shown here. What is your sedimented view? Can you reconstruct another gestalt or view?
Ihde (1977) found that one important strategy for switching from one view of a drawing to another was to change one’s focus. Try focusing on a different point of the drawing or looking at it as two-dimensional rather than as three-dimensional. If you concentrate and gaze for a long enough time, you can experience the change in gestalt. Ihde cautioned that a new reconstruction tends to be considered odd at first and unnatural but attains stability and naturalness after a while.
Once you have accomplished this “jump,” you are no longer naive; you cannot go back to the idea that the phenomenon you have observed can be seen in only one way. You have become more open and receptive to experiencing the phenomenon; you can explore deeper layers of the phenomenon. Viewing these deeper layers requires a second-order deconstruction and an additional increase in openness. Ihde (1977) referred to this increase as ascendance to an open context. It allows you to see more depth and complexity within the phenomenon you examine; you have enlarged your capacity for insight. Ihde suggested that ascendance to the open context gives you multistability and greater control than the sedimented view.
Changing Gestalts in Nursing
Nursing has a strong traditional base. With this tradition comes a sedimented view of phenomena such as patients, illness situations, health, and nursing care and its effects. We are introduced to these sedimented views early in our nursing experiences. Now, in this era of nursing research, we are beginning to question many of these long-held ideas, and the insights gained are changing nursing practice.
For example, for many years, nurses perceived the patient as being passive, dependent, and unable to take responsibility for his or her care. Now, nurses more often view patients as participating in their care and being responsible for their health. Ascendance to the open context requires more than just switching from one sedimented view to another. The nurse functioning within an open context would be able to view the patient from a variety of perspectives, regarding him or her as passive and dependent in some ways, participating with health care providers in other ways, and directing his or her care in yet other ways.
Qualitative research provides a process through which we can examine a phenomenon outside the sedimented view. The earliest and perhaps most dramatic demonstration of the influence that qualitative research can have on nursing practice was the 4-year study conducted by Glaser and Strauss (1965, 1968, 1971), who used a qualitative approach referred to as grounded theory. This study was reported in three books titled Awareness of Dying, Time for Dying, and Status Passage. These books described the social environment of dying patients in hospitals. At that time, the gestalt commonly held was that people could not cope with knowing that they were dying and must be protected from that knowledge. The environment of care was designed to keep from a dying patient the knowledge that he or she was dying.
Glaser and Strauss examined the meanings this social environment had to the patient. The study changed our gestalt. We now saw that instead of protecting the patient, traditional care of the dying was creating loneliness and isolation. We began to “see” the patient in a new light, and our care began to change. Kubler-Ross (1969), perhaps influenced by the work of Glaser and Strauss, then began her studies of the dying using an approach similar to that of phenomenology. From this new orientation of caring for the dying, hospice care emerged, and now, the environment of care for the dying has changed.
PHILOSOPHY AND QUALITATIVE RESEARCH
Each type of qualitative research is guided by a particular philosophical stance considered a paradigm. The philosophy directs the questions we ask, the observations we make, and how we interpret the data (Munhall, 2001). The researcher does not always clearly state the philosophical stance on which the study is based; however, one can identify the stance by carefully reading the literature review, observing how the problem is presented, and examining the researcher’s methods (Sandelowski, 1993). These philosophical bases and their methodologies, developed outside nursing, will likely undergo evolutionary changes within nursing. The works of Parse (1987, 1995, 1999, 2001), Leininger (1985), Chenitz and Swanson (1986), and Artinian (1988), discussed later in the chapter, are examples of these evolutionary changes.
RIGOR IN QUALITATIVE RESEARCH
Scientific rigor is valued because it is associated with the worth of research outcomes, and studies are critically appraised as a means of judging rigor. Rigor is defined differently for qualitative research because the desired outcome is different (Burns, 1989; Dzurec, 1989; Morse, 1989; Sandelowski, 1986). In qualitative research, rigor is associated with openness, relevance (including clarity of the research question and its significance to nursing), epistemological and methodological congruence, scrupulous adherence to a philosophical perspective (methodological rigor), thoroughness in collecting data, and consideration of all the data in the analysis process, and the researcher’s self-understandings. The researcher’s self-understandings are important because qualitative research is an interactive process shaped by the researcher’s personal history, biography, gender, social class, race and ethnicity, as well as those of the study participants.
To be rigorous in conducting qualitative research, the researcher must ascend to an open context and be willing to continue to let go of sedimented views (referred to as deconstructing the sedimented views). Maintaining openness requires discipline. The researcher will be examining many dimensions of the area being studied and forming new ideas (referred to as reconstructing new ideas or views) while continuing to recognize that the present reconstruction is only one of many possible ways of organizing ideas. Critical appraisal of the rigor of qualitative studies is discussed in more detail in Chapter 26.
APPROACHES TO QUALITATIVE RESEARCH
Six approaches to qualitative research being used in nursing are presented here: phenomenological research, grounded theory research, ethnographic research, historical research, philosophical inquiry, and critical social theory. In some ways, these approaches are very different. Ethnography and historical research are broad and are the accepted methodologies for a discipline. Critical social theory is narrow in focus and controversial in its philosophical perspective. The worldview of phenomenology is also controversial. However, in each method, the purpose is to examine meaning.
Although the data are gathered through the use of an open context, this fact does not mean that the interpretation is value-free. Each approach is based on a philosophical orientation that influences the interpretation of the data. Thus, it is critical to understand the philosophy on which the method is based. In selecting a qualitative method, the researcher should consider the following questions: “What is the most appropriate methodology and why? Which method of data collection will produce the richest set of data? How should the data be analyzed? What checks should be undertaken to maximize the accuracy of the findings?” (Cutcliffe, 1997, p. 969). Each approach is discussed in relation to the philosophical orientation and nursing knowledge.
Phenomenological Research
Phenomenology is both a philosophy and a research method. The purpose of phenomenological research is to describe experiences (or phenomena) as they are lived—in phenomenological terms, to capture the “lived experience” of study participants. The philosophers from whom phenomenology emerged include Husserl, Kierkegaard, Heidegger, Marcel, Sartre, and Merleau-Ponty. The philosophical positions taken by phenomenological researchers are very different from those common in the culture and research traditions of the nursing field.
Philosophical Orientation
Phenomenologists view the person as integral with the environment. The world is shaped by the self and also shapes the self. At this point, however, phenomenologists diverge in their beliefs, based on adherence to a particular phenomenological philosopher. Taylor (1995) provided an excellent description of her search for a compatible phenomenological perspective, discussing the methods of Langeveld (1978), Heidegger (1962), Husserl (1960, 1964, 1970, 1980), and Gadamer (1975). According to Taylor (1995):
The search for the nature of a phenomenon begins with the people, in their place and time, and it leads to an explication of the aspects of a phenomenon. The nature of a phenomenon is a reflection of the nature of people as human beings, who find themselves within the context of a healthcare institution, who are living and making sense of their experiences. The language used by the people in the study not only illuminates the nature of the phenomenon of interest, but it also shows some of their own There-Being as human beings (full-text article available in the Cumulative Index to Nursing and Allied Health Literature database).
The two phenomenological philosophers most commonly adhered to in qualitative nursing research are Heidegger and Husserl, whose views of the person and their world differ (Johnson, 2000). Heideggerian phenomenologists believe that the person is a self within a body. Thus, the person is referred to as embodied. “Our bodies provide the possibility for the concrete actions of self in the world” (Leonard, 1989, p. 48). The person has a world, which is “the meaningful set of relationships, practices, and language that we have by virtue of being born into a culture” (Leonard, 1989, p. 43). The person is situated as a consequence of being shaped by his or her world and thus is constrained in the ability to establish meanings through language, culture, history, purposes, and values. Therefore, the person has only situated freedom, not total freedom. A person’s world is so pervasive that he or she usually does not notice it, unless some disruption occurs. Not only is the world of each person different, but each person’s concerns are qualitatively different. The body, the world, and the concerns, unique to each person, are the context within which that person can be understood. Heideggerians believe that the person experiences being within the framework of time. This is referred to as being-in-time. The past and the future influence the now and thus are part of being-in-time (Leonard, 1989).
Husserl developed his ideas about phenomena in an effort to resolve the conflict in thought between human sciences (primarily psychology) and the basic sciences (such as physics). Phenomena are the world of experience. They cannot be explained by examining causal relations but need to be studied as the very things they are. Phenomena occur only when there is a person who experiences the phenomenon. Thus, the experience must be described, not studied using statistics. To describe it, the researcher must experience the phenomenon in a naive way (Kvigne, Gjengedal, & Kirkevold, 2002; Sadala & Adorno, 2002).
Husseirlian phenomenologists believe that although self and world are mutually shaping, it is possible to bracket oneself from one’s beliefs, to see the world firsthand in a naive way. Heideggerians do not agree, taking the position that bracketing is not possible.
All phenomenologists agree that there is not a single reality; each individual has his or her own reality. Reality is considered subjective; thus, an experience is considered unique to the individual. This is true even for the researcher’s experiences in collecting data for a study and analyzing the data. “Truth is an interpretation of some phenomenon; the more shared that interpretation is, the more factual it seems to be, yet it remains temporal and cultural” (Munhall, 1989, p. 22). The researcher must invest considerable time exploring the various philosophical stances within phenomenology to select one compatible with his or her perspective.
Sjöström and Dahlgrem (2002) described a perspective referred to as phenomenography, which has emerged from educational research. This approach assumes that individuals experience the world differently. The focus of phenomenography is to describe these differences. This approach to research is viewed as complementary to other research perspectives. In nursing research, the focus emphasizes “the differences between how different patients experience their states and needs. The clinical implications of such an emphasis on differences would mean that professionals in health care would be prepared to take different measures to fulfill the needs of different patients” (p. 340). Interviewing is the primary data-gathering method, with the researcher interpreting immediately what the respondent is saying so that the researcher can decide about the direction of further questioning or probing. Misunderstanding the participant can threaten the quality of the data for analysis. Analysis involves categorizing data and selecting particular sections or excerpts that “convey the most significant information” (p. 341).
Nursing Knowledge and Phenomenology
Phenomenology is the philosophical base for three nursing theories: Parse’s (1999) human becoming theory, Paterson and Zderad’s (1976) theory of humanistic nursing, and Watson’s (1999) theory of caring. By virtue of the assumptions of her theory, Parse (1987, 1990) has stated that the only acceptable method of testing her theory is using qualitative research methods. She also holds that any qualitative method—phenomenological, ethnographic, exploratory, or case method—can be used because all of these methods are consistent with phenomenological theory (Parse, 1990). Parse (1999) also developed a human becoming research methodology, which “includes the processes of dialogical engagement (researcher-person dialogues), extraction-synthesis (transforming the data across levels of abstraction to the level of science), and heuristic interpretation (specifying the findings in the light of the man-living-health theory and integrating them into the language of the theory)” (p. 140).
A number of the published phenomenological nursing studies are based on the human becoming theory. Parse (1990) has regarded these studies as clarifying or substantiating her theory. The following abstract is from a study using Parse’s method.
Grounded Theory Research
Grounded theory research is an inductive research technique developed for health-related topics by Glaser and Strauss (1967). It emerged from the discipline of sociology. The term grounded means that the theory developed from the research is based on or has its roots in the data from which it was derived. As Artinian (1998, p. 5) indicated “grounded theory provides a way to transcend experience—to move it from a description of what is happening to understanding the process by which it happens.”
Philosophical Orientation
Grounded theory is based on symbolic interaction theory, which holds many views in common with phenomenology. George Herbert Mead (1934), a social psychologist, was a leader in the development of symbolic interaction theory. Symbolic interaction theory explores how people define reality and how their beliefs are related to their actions. People create reality by attaching meanings to situations. Meaning is expressed in terms of symbols, such as words, religious objects, and clothing. These symbolic meanings are the basis for actions and interactions.
Symbolic meanings are different for each individual. We cannot completely know the symbolic meanings of another individual. In social life, groups share meanings. They communicate these shared meanings to new members through socialization processes. Group life is based on consensus and shared meanings. Interaction may lead to redefinition and new meanings and can result in the redefinition of self. Because of its theoretical importance, the interaction is the focus of observation in grounded theory research.
Grounded theory has been used most frequently to study areas in which little previous research has been conducted and to gain a new viewpoint in familiar areas of research. Because of the basic quality of theory generated through this methodology, however, further theory testing is not usually needed to enhance usefulness.
Nursing Knowledge and Grounded Theory
Artinian (1988) has identified four qualitative modes of nursing inquiry within grounded theory, each used for different purposes: descriptive mode, discovery mode, emergent fit mode, and intervention mode.
The descriptive mode provides rich detail and must precede all other modes. This mode, ideal for the beginning researcher, answers questions such as “What is going on?” “How are activities organized?” “What roles are evident?” “What are the steps in a process?” and “What does a patient do in a particular setting?”
The discovery mode allows you to identify patterns in life experiences of individuals and relates the patterns to one another. Through this mode, a theory of social process, referred to as substantive theory, is developed that explains a particular social world.
Use the emergent fit mode to extend or refine substantive theory after you have developed it. This mode will enable you to focus on a selected portion of the theory, to build on previous work, or to establish a research program around a particular social process.
The intervention mode tests the relationships in the substantive theory. The fundamental question for this mode is, “How can I make something happen in such a way as to bring about new and desired states of affairs?” This mode demands deep involvement on the part of the researcher or practitioner.
The following abstract is taken from a grounded theory study.
As you can see, grounded theory research examines a much broader scope of dimensions than is usually possible with quantitative research. The reader can intuitively verify these findings through her or his own experiences. The clear, cohesive description of the phenomenon allows greater understanding and thus more control of nursing practice.
Ethnographic Research
Ethnographic research provides a mechanism for studying our own culture and that of others. The word ethnographic means “portrait of a people.” Although ethnography originated as the research methodology for the discipline of anthropology, it is now a part of the cultural research conducted by a number of other disciplines, including social psychology, sociology, political science, education, and nursing, and is also used in feminist research. Although all ethnography focuses on culture, not all cultural research is, or needs to be, ethnography. Ethnography describes and analyzes aspects of the ways of life of particular cultures, subcultures, or subculture groups. Ethnographic studies result in theories of culture. Ethnography has been associated with studies of primitive, foreign, or remote cultures. Such studies enabled the researcher to acquire new perspectives beyond his or her own ethnocentric perspective. Today, the emphasis has shifted to obtaining cultural knowledge within one’s own society (Germain, 2001). Within nursing, one of the major contributions of ethnography may be to promote culturally specific care (Baillie, 1995).
Philosophical Orientation
Anthropology, which began about the same time as the nursing discipline did, in the mid-nineteenth century, seeks to understand people: their ways of living, ways of believing, and ways of adapting to changing environmental circumstances. The philosophical basis for anthropology has not been spelled out clearly, is evolving, and needs considerable refinement (Sanday, 1983). Culture is the most central concept. Leininger (1970, pp. 48–49), a nurse anthropologist, defined culture for nursing as “a way of life belonging to a designated group of people … a blueprint for living which guides a particular group’s thoughts, actions, and sentiments … all the accumulated ways a group of people solve problems, which are reflected in the people’s language, dress, food, and a number of accumulated traditions and customs.” The purpose of anthropological research is to describe a culture through examining these various cultural characteristics.
Anthropologists study the origin of people, their past ways of living, and their ways of surviving through time. These insights increase our ability to predict the future directions of cultures and the forces that guide their destiny or may provide opportunities to influence the direction of cultural development (Leininger, 1970). We must first understand the cultural aspects of our own society before we can address issues related to health.
A number of dimensions of culture are of interest within anthropology. Material culture consists of all hand-made objects associated with a given group. Ethnoscientific ethnography focuses on the ideas, beliefs, and knowledge that a group holds; they are expressed in language and may address aspects such as symbolic referents, the network of social relations, and the beliefs reflected in social and political institutions. Cultures also have ideals that the people hold as desirable, even though they do not always live up to these standards. A relatively new approach, referred to as cognitive anthropology, asserts that culture is an adaptive system that is in the minds of people and is expressed in the language or semantic system of the group. Studies from this perspective examine observable patterns of behavior, customs, and ways of life. Anthropologists seek to discover the many parts of a whole culture and how these parts are interrelated, so that a picture of the wholeness of the culture evolves. Ethnographic research is used in nursing not just to increase ethnic cultural awareness but also to enhance the provision of quality health care for all cultures (Germain, 2001; Laugharne, 1995; Leininger, 1970).
Nursing Knowledge and Ethnography
A group of nurse scientists have developed a strategy of ethnonursing research, which emerged from Leininger’s theory of transcultural nursing (Leininger, 1985, 1990, 1991, 1997). Ethnonursing research “focuses mainly on observing and documenting interactions with people of how these daily life conditions and patterns are influencing human care, health, and nursing care practices” (Leininger, 1985, p. 238). The following abstract is taken from an ethnographic study.
Studies such as this one provide insights that can be used in many clinical situations. Reading this type of study can lead the nurse to ask different questions about patients and their behavior.
Historical Research
Historiography examines events of the past. Many historians believe that the greatest value of historical knowledge is a greater self-understanding. Historical nursing research also increases nurses’ understanding of their profession.
Philosophical Orientation
History is a very old science that dates back to the beginnings of humankind. The primary questions of history are “Where have we come from?” “Who are we?” and “Where are we going?” Although the questions do not change, the answers do.
The most ancient form of history is the myth. The myth explains origins and justifies the order of existence. In the myth, past, present, and future are not distinguishable. Myths, which are a form of storytelling, provide an image of and legitimize the existing order.
History moved beyond the myth to the chronicling of events such as great deeds, victories, and stories about people and citizens. These descriptions blurred the distinction between the real and the ideal. Historians then moved to comparing histories, selecting histories on the basis of values, and identifying patterns of regularity and change.
More recently, there has been a move to interpretive history, an effort to make sense out of it, to search for meaning. Interpretation may be accomplished by developing concepts, by explaining causality through theory development, and by generalizing to other events and other times. As Miller (1967, p. xxxi) suggested, “History is an estimate of the past from the standpoint of the present.” Looking at history from the present, historians may see their role as that of patriots, as judges and censors of morals, or as detached observers. The values contained in each of these roles are reflected in the nature of the historical interpretation.
Philosophers found that understanding humankind as a historical phenomenon held out the promise of understanding the essence of humankind. To this extent, the development of a historical method was of interest to philosophy (Pflug, 1971). Voltaire developed the initial philosophy of history and an associated research methodology (Sakmann, 1971). His strategy was to look at general lines of development rather than to offer an indiscriminate presentation of details, the common practice of historians of his period. Using this strategy, Voltaire moved history from chronicling to critical analysis. He recognized that in history there can be no certainty, but he searched for criteria by which historical truth could be ascertained.
One of the assumptions of historical philosophy is that “there is nothing new under the sun.” Because of this assumption, the historian can search throughout history for generalizations. For example, we may ask the question “What causes wars?” The historian could search throughout history for commonalities and develop a theoretical explanation of the causes of wars. The questions asked, the factors that the historian selects to look for throughout history, and the nature of the explanation are all based on a worldview (Heller, 1982).
Another assumption of historical philosophy is that we can learn from the past. The philosophy of history is a search for wisdom, with the historian examining what has been, what is, and what ought to be. Historical philosophers have attempted to identify a developmental scheme for history, to explain all events and structures as elements of the same social process. Heller (1982) identified three developmental schemes found in philosophies of history:
1. History reflects progression—the development from “lower” to “higher” stages.
2. History has a tendency to regress—development is from “higher” stages to “lower” stages; movement is toward a decrease in freedom and the self-destruction of our species.
3. History shows a repetition of developmental sequences in which patterns of progression and regression can be seen.
Fitzpatrick (2001, p. 405) made the following suggestion:
There is usually a tendency to justify historical research in professional fields like nursing from the standpoint of its helping to inform future decisions and to avoid repeating past mistakes. Such arguments have only slight merit because they serve a reductionist belief that historical facts can be distilled with a formula. History, although its goal is the establishment of fact that leads us to truth, cannot be reduced to statistical proof.
Nursing Knowledge and Historiography
Christy (1978, p. 9) asked, “How can we in nursing today possibly plan where we are going when we don’t know where we have been nor how we got here?” One criterion of a profession is that there is a knowledge base of the history of the profession that is transmitted to those entering the profession. Until recently, historical nursing research has not been a valued activity, and few nurse researchers had the skills or desire to conduct it. Therefore, our knowledge of our past is sketchy. However, there is now a growing interest in the field of historical nursing research. Sarnecky (1990) suggested that the greater interest in historiography is related to the move from a total focus on logical positivism to a broader perspective that is fully supportive of the type of knowledge provided by historical research.
The following abstract is taken from a nursing historical study.
Philosophical Inquiry
Philosophy is not generally thought of as a discipline within which one conducts research, because philosophy is not a science. Philosophy does, however, have strong links with science. Most important, philosophy guides the methods within any given science; it is the foundation of science. Furthermore, we can use philosophy to develop theories about science and to debate issues related to science. The purpose of philosophical inquiry is to perform research using intellectual analyses to clarify meanings, make values manifest, identify ethics, and study the nature of knowledge (Ellis, 1983).
Philosophical Orientation
The philosophical researcher considers an idea or issue from all perspectives by exploring the literature extensively, examining conceptual meaning, raising questions, proposing answers, and suggesting the implications of those answers. The research is guided by philosophical questions posed. As with other qualitative approaches, data collection in philosophical inquiry coincides with analysis and focuses on words. However, because philosophy attends to ideas, meaning, and abstractions, the content the researcher seeks may be implied rather than clearly stated in the literature. It may be necessary for the researcher to come to some conclusions about what the author meant in a specific text. During the analysis phase, researchers often join with colleagues to explore and debate ideas, questions, answers, and consequences. The process is cyclical, with answers generating further questions, leading to further analysis. Therefore, the thoughtful posing of questions is considered more important than the answers.
To avoid bias in their analysis, philosophers cultivate detachment from any particular type of knowledge or method. Published reports of philosophical inquiries do not describe the methodology used but focus on discussing the conclusions of the analyses. There are three categories of philosophical inquiry: foundational inquiry, philosophical analysis, and ethical analysis.
Foundational Inquiry
The foundations of a science are its philosophical bases, concepts, and theories. A new science tends to borrow elements from the foundations of other sciences, although sometimes they are a poor fit. Even those developed within the science may have problems, such as logical inconsistencies. Foundational inquiries examine the foundations for a science. The studies include analyses of the structure of a science, as well as of the process of thinking about and valuing certain phenomena held in common by the science. They are important to perform before developing theories or programs of research. The debates related to qualitative and quantitative research methods and triangulation of methods emerge from foundational inquiries.
Nursing Knowledge and Foundational Inquiry: Philosophical analyses are expected to be carried out by scientists within a particular field, such as nursing, rather than by philosophers as such. The nurse scientist who desires to perform a philosophical study would do well to consult with a philosopher. An example of a foundational analysis is presented in Chapter 23.
Purposes: The purposes for a foundational study include the following:
1. Compare different philosophical bases, different theories, and different definitions of concepts.
2. Seek common meanings in radically different theories.
3. Critically examine operational definitions of concepts.
4. Explore the relationship between the concept and the science being examined.
5. Define the boundaries of a specific science by showing what phenomena belong to the field and what do not (boundary delineation).
6. Assist in the development of programs of research capable of shaping the empirical content of the field.
7. Draw attention to differences in ways of exploring, explaining, proving, and valuing.
8. Explain the rationale or thoughtful consequences of choosing various ways to investigate phenomena.
9. Analyze the reasoning that underlies the science.
10. Describe productive reasoning activities from which the science may develop methods for conducting foundational inquiries, as well as conceiving, planning, executing, and monitoring its programs of research.
Philosophical Analysis
Because philosophical questions are critical to the process of philosophical inquiry, it is important for nurse researchers to formulate questions that are of concern to the discipline. Ellis (1983, pp. 212, 224) identified the following questions that need to be addressed in nursing from the perspective of philosophical inquiry: “What does it mean to be human? What is the meaning of dignity? What does it mean to be compassionate, humane, and caring? What is nursing?… What views of humans are appropriate, for what purpose, and for what questions?”
Nursing Knowledge and Philosophical Analysis: The following scholars have posed philosophical questions addressing foundational issues related to various qualitative perspectives. Holmes (1996) questioned the fit between phenomenological philosophy and nursing philosophy. Paley (1998) challenged the position of “lived experience” researchers that their philosophical base is Heidegger, stating that “hermeneutic studies of ‘lived experience’ are incompatible with Heidegger’s ontology, since they are thoroughly Cartesian in spirit” (p. 817).
It is an implicit assumption of LER [lived experience research] that people’s experience, and their accounts of it, cannot be challenged. That is, their interpretations of the world, as lived in, cannot be wrong, misguided, distorted, or lop-sided. How could they be?… A person’s experience is her experience and, as such, cannot be “incorrect.” To say anything else would be tantamount to denying that she had the experience, or claiming that it was not as she describes it. (Paley, 1998, p. 821)
Crotty (1996) argued that phenomenological research being conducted by North American nurses is a subjective description of the phenomenon by a third person (the researcher) and is not consistent with European phenomenological research. Phenomenology, according to Crotty, is a critical methodology that allows researchers to revisit conscious experiences, opening themselves to the emergence of new meaning or renew present meanings. Nurse researchers, he said, use descriptive methods, not critical methods. Nurse researchers uncritically accept the participant’s subjective account of the experience as the phenomenon, when it is not. He suggested that to uncritically accept what others tell us is not scholarly. He recognized that it was important for nurses to understand the subjective experiences of patients. However, in Crotty’s view, this is not phenomenology (Barkway, 2001).
Ellis (1983) suggested that many of the “nursing theories” are actually philosophies of nursing, even though they were not developed through the use of philosophical analysis. These philosophies were developed to express the essence of nursing and its desired goals. They are statements of the way nursing ought to be. Concept analyses are strengthening our nursing theories and providing conceptual definitions for our research. An example of a concept analysis using the methods of philosophical analysis is presented in Chapter 23.
These arguments and the philosophical underpinnings on which they are based are hard to understand. However, it is important to grasp these ideas. As Van der Zalm & Bergum (2000) pointed out:
Adherence by nurse researchers to a specific research tradition ultimately will determine the direction of knowledge development for nursing, and as a result, will impact on the knowledge available for utilization in practice. Thus, it is important to have an understanding of the philosophical assumptions fundamental to a research tradition, as well as an understanding of the implications that research traditions have for nursing practice. (full-text article available in CINAHL)
Ethical Inquiry
Ethics is the branch of philosophy that deals with morality. This discipline contains a set of propositions for the intellectual analysis of morality. The problems of ethics relate to obligation, rights, duty, right and wrong, conscience, justice, choice, intention, and responsibility. Ethics is a means of striving for rational ends when others are involved. The desirable rational ends are justice, generosity, trust, faithfulness, love, and friendship. These ends reflect respect for the other person. An ethical dilemma occurs when one must choose between conflicting values. In some cases, both choices are good, and in other cases, neither choice is good but one must choose even so.
Nursing Knowledge and Ethics: Curtin (1979), a nurse ethicist, claimed that the goals of nursing are not scientific; the goals are moral and to seek good. To her, nursing is not a science; it is an art. Scientific knowledge is used as a tool in the artful practice of nursing (Curtin, 1990). As such, ethical inquiry is a research method required to clarify the means and ends of nursing practice. Much of the ethical analyses in the nursing literature address the following three issues: (1) combining the roles of nurse and scientist, (2) protecting human subjects, and (3) engaging in peer and institutional review. An example of a study using ethical inquiry is presented in Chapter 23.
Critical Social Theory
Another philosophy with a unique qualitative research methodology is critical social theory. Feminist research, which is receiving growing interest in nursing, uses critical social theory methods and could be considered a subset of critical social theory. Allen (1985, p. 62) believes that critical social theory is important to nursing because nurses need to “be as conscious as possible about the constraints operating on both nurse and client.” She also has suggested that the way nurses define health, promote health, and define themselves as nurses is governed by factors explored within this philosophy (Allen, 1986).
The perspective of critical social theory has led to the development of a new approach to research called participatory research, in which representatives from the group that is being studied are included as members of the research team. This approach to research is described in Chapter 23. The intent of the research method is to give control of some aspects of the study—such as what is studied, how it is studied, and who is informed of the findings—to the participants. The study is designed to empower the participants to take control of their life situations.
Philosophical Orientation
Critical social theory contains the views of a number of philosophers, with its beginnings in Frankfurt, Germany, at the Institute for Social Research. In the 1920s and 1930s, critical social theory was influenced by the writings of Karl Marx. These philosophers, who contend that social phenomena must be examined within a historical context, believe that most societies function on the basis of closed systems of thought, which lead to patterns of domination and prevent personal growth of individuals within the society. In the late 1960s, a second generation of German philosophers, the most prominent being Habermas (1971), revised critical social theory, leading to a resurgence of interest in these ideas (Thompson, 1987):
From a critical perspective, knowledge is not something that stands alone or is produced in a vacuum by a sort of “pure” intellectual process. Instead, all knowledge is considered value laden and shaped by historic, social, political, gender, and economic conditions. Ideology—the taken-for-granted assumptions and values that usually remain hidden and unquestioned—creates a social structure that serves to oppress particular groups by limiting the options available to them. In today’s social world, these are referred to as vulnerable or marginalized populations. A fundamental assumption among critical researchers is that knowledge ought not be generated for its own sake but should be used as a form of social or cultural criticism. Critical scholars hold that oppressive structures can be changed by exposing hidden power imbalances and by assisting individuals, groups, or communities to empower themselves to take action.… A critical agenda then focuses on creating knowledge that has the potential to produce change through personal or group empowerment, alterations in social systems, or a combination of these. Implicit in this view is a valuing of people as the experts in their own lives, who have an important stake in how issues are resolved. Critical scholars … do not wish to control and predict, or to understand and describe, the world; they wish to change it. Hence, the type of knowledge sought must be capable of meeting this challenge. (Berman, Ford-Gilboe, & Campbell, 1998, p. 2)
To accomplish this goal, the researcher must construct a picture of society that exposes the prevailing system of domination, expresses the contradictions embedded in the domination, assesses society’s potential for emancipatory change, and criticizes the system in order to promote that change (Stevens, 1989).
According to Berman et al. (1998, p. 3), a critical social theory study has the following aims:
1. The study addresses an issue that is of concern to a group that is disadvantaged, oppressed, or marginalized in some way.
2. The research process or results have the potential to benefit the group, immediately or longer term.
3. The researcher’s assumptions, motivations, biases, and values are made explicit and their influence on the research process is examined.
4. Prior scholarship is critiqued in an attempt to elucidate the ways in which biases, especially those related to gender, race, and class, have distorted existing knowledge.
5. Interactions between the researcher and participants convey respect for the expertise of the participants.
An example of a study using critical social theory methods is presented in Chapter 23.
Friere’s Theory of Cultural Action
Friere (1972), a Brazilian educator, used critical social theory methodology to develop a theory of cultural action through his experiences in attacking illiteracy in his country. Friere’s theory is beginning to attract the interest of nurse researchers. In Friere’s view, the world is not a static and closed order but a problem to be worked on and solved. It is his conviction that every human being, no matter how “ignorant” or submerged in the “culture of silence,” is capable of looking critically at the world in a dialogical encounter with others. “Provided with the proper tools for such an encounter, he can gradually perceive his personal and social reality as well as the contradictions in it, become conscious of his own perception of that reality, and deal critically with it” (Shaull, 1972, p. 12).
“Dialogue cannot exist, however, in the absence of a profound love for the world and for men” (Friere, 1972, p. 77). Redefining the world is an act of creation and is not possible if it is not infused with love:
Love is an act of courage, not of fear, love is commitment to other men.… If I do not love the world—if I do not love life—if I do not love men—I cannot enter into dialogue. On the other hand, dialogue cannot exist without humility.… How can I dialogue if I always project ignorance onto others and never perceive my own? How can I dialogue if I regard myself as a case apart from other men?… Dialogue further requires an intense faith in man, faith in his power to make and remake, to create and re-create, faith in his vocation to be more fully human. (Friere, 1972, pp. 78–79)
Shaull (1972) pointed out that a peasant can facilitate this process for his or her neighbor more effectively than a teacher brought in from outside.
In his book Pedagogy of the Oppressed, Friere (1972) described the behavior of both the oppressed group and the oppressors. He described an act of oppression as any act that prevents a person from being more fully human. In his view, both the oppressed and the oppressor must be liberated. If not, the liberated oppressed will simply become oppressors, because both oppressors and oppressed fear freedom, autonomy, and responsibility. However, a person cannot be liberated by others but must liberate himself or herself. For Friere, the fight against oppression is an act of love.
Friere (1972) pointed out that education can be a tool of conformity to present social situations or an instrument of liberation. He has advocated working with groups, which leads to cultural synthesis, rather than trying to manipulate groups, which leads to cultural invasion. In a true educational experience, both teacher and student learn, and all grow as a consequence. This type of education is the practice of freedom. Friere’s ideas are currently being applied to nursing situations.
Feminist Research
Feminist research is considered by some to emerge from critical social theory. According to Rafael (1997):
Feminism is based on the premise that gender is a central construct in a society that privileges men and marginalizes women.… Feminist perspectives seek to equalize the power relations between men and women.… Critical social feminism emphasizes the social action required to bring about changes in social structures that are oppressive to women, whereas poststructural … feminism seeks to expose patriarchal power relations in societal institutions, particularly those that generate knowledge. (p. 34)
Feminist researchers use a broad range of research methodologies, both qualitative and quantitative. Although some feminists see themselves as speaking for all women, others, such as Baber and Allen (1992, p. 19) have claimed that “there is no woman’s voice, no woman’s story, but rather a multitude of voices that sometimes speak together but often must speak separately.” Glass and Davis (1998, p. 49) have held that “there is not one [philosophical] explanation for women’s or nurses’ oppression. Therefore, while general strategies aimed at transforming oppressive states may be appropriate in some contexts, consideration should always be given to individualized and context-specific experiences and subsequent strategies.”
Sigsworth (1995), basing ideas on those of Harding (1987), has suggested the following methodological conditions for feminist research:
1. Feminist research should be based on women’s experiences, and the validity of women’s perceptions as the “truth” for them should be recognized.
2. Artificial dichotomies and sharp boundaries are suspect in research involving women and other human beings. They should be carefully scrutinized as reflecting a logical positivist approach to research.
3. The context and relationship of phenomena, such as history and concurrent events, should always be considered in designing, conducting, and interpreting research.
4. Researchers should recognize that the questions asked are at least as important as the answers obtained.
5. Researchers should address questions that women want answered (i.e., the research should be for women).
6. The researcher’s point of view (i.e., biases, background, and ethnic and social class) should be treated as part of the data. This involves ensuring that the researcher is on a plane with the person being researched. (Sigsworth, 1995, p. 897)
Nursing Knowledge and Critical Social Theory
Cody (1998), using a foundational analysis approach, expressed the following concern about the use of critical social theory in nursing research and practice:
Critical theorists seek to inspire their readers to action, either instrumental or communicative, toward social change in the direction of freedom and justice. In recent years nurse scholars have explicated critical theory in relation to the practice of nursing, the role of the nurse in society, the fact that most nurses are women, and the relation between nurses and those who are oppressed.… For those espousing the use of critical theory in nursing, action on the part of the nurse should promote emancipation from oppressive sociocultural systems.…
I would like to invite nurses who have considered using critical theories to guide their practice to consider an alternative. Critical theory evolved from sociology, and the phenomena of concern to critical theorists are, in the main, sociological phenomena—the dynamics of social systems, the rules that underpin stability and change in societies, and so on. Most scholars would concede that the goal of nursing and the goal of critical theory are different. The first plank of the American Nurses’ Association Code for Nurses (1985) states in essence that the nurse provides care to any client without regard to individual or health-related characteristics that may offend the nurse. How does one, then, ethically, turn a critical eye on the reasoning, discourse, and practices of one’s client? Much of the literature on critical theory that has appeared in nursing journals could be said to reflect the sociology of healthcare systems. Little or no literature on critical theory in nursing has linked critical theory to the theoretical discourse on self-care, interpersonal relations in nursing, goal attainment in nursing, the person as an adaptive biopsychosocial system, the conservation principles, humanistic nursology, cultural care, human-environment field patterning, human becoming, health as expanding consciousness, transpersonal caring, or nursing as caring. (Cody, 1998, pp. 44–45)
More on Qualitative Research Methods
Strategies prescribed for the design and implementation of each of the qualitative methods are described in Chapter 23. In addition, content related to qualitative research methods is provided in Chapter 5 (Research Problem and Purpose), Chapter 6 (Review of Relevant Literature), Chapter 7 (Frameworks), Chapter 8 (Objectives, Questions, and Hypotheses), Chapter 9 (Ethics in Research), Chapter 14 (Sampling), Chapter 15 (Measurement Concepts), Chapter 17 (Collecting and Managing Data), Chapter 25 (Disseminating Research Findings), Chapter 26 (Critical Appraisal of Nursing Studies), Chapter 27 (Strategies for Promoting an Evidence-Based Practice in Nursing), Chapter 28 (Writing Research Proposals), and Chapter 29 (Seeking Funding for Research). In addition, Chapter 12 (Outcomes Research) includes discussion of the use of qualitative studies, often triangulated with quantitative studies, to determine the outcomes of patient care. Chapter 13 (Intervention Research) describes a new method of designing and testing the effectiveness of nursing interventions using a combination of qualitative and quantitative methods.
SUMMARY
• The qualitative approach’s concepts and methods of reasoning are very different from those of quantitative research.
• Some major concepts important to qualitative research are gestalt, sedimented view, and open context.
• Qualitative research requires the rigorous implementation of qualitative research techniques, such as openness, scrupulous adherence to a philosophical perspective, thoroughness in collecting data, and inclusion of all the data in the theory development phase.
• The goal of phenomenological research is to describe experiences as they are lived.
• Grounded theory is an approach for discovering what problems exist in a social scene and how the persons involved handle them.
• Ethnographic research is the investigation of cultures through an in-depth study of the members of the culture.
• Historical research is a narrative description or analysis of events that occurred in the remote or recent past.
• Philosophical inquiry consists of three types: foundational studies, philosophical analysis, and ethical analysis.
• Critical social theory involves analysis of systems of thought that lead to patterns of domination and prevent personal growth of individuals within a society.
Allen, D.G. Nursing research and social control: Alternative models of science that emphasizes understanding and emancipation. Image: The Journal of Nursing Scholarship. 1985;17(2):58–64.
Allen, D.G. Using philosophical and historical methodologies to understand the concept of health. In: Chinn P.L., ed. Nursing research methodology: Issues and implementation. Rockville, MD: Aspen; 1986:157–168.
Anfara, V.A., Jr., Mertz, N.T. Theoretical frameworks in qualitative research. Thousand Oaks, CA: Sage, 2006.
Artinian, B.M. Qualitative modes of inquiry. Western Journal of Nursing Research. 1988;10(2):138–149.
Artinian, B.M. Grounded theory research: Its value for nursing. Nursing Science Quarterly. 1998;11(1):5–6.
Baber, K.M., Allen, K.R. Women and families: Feminist reconstructions. New York: Guilford Press, 1992.
Baillie, L. Ethnography and nursing research: A critical appraisal. Nurse Researcher. 1995;3(2):5–21.
Barkway, P. Michael Crotty and nursing phenomenology: Criticism or critique. Nursing Inquiry. 2001;8(3):191–195.
Benedict, S., Georges, J.M. Nurses and the sterilization experiments of Auschwitz: A postmodernist perspective. Nursing Inquiry. 2006;13(4):277–288.
Berman, H., Ford-Gilboe, M., Campbell, J.C. Combining stories and numbers: A methodologic approach for a critical nursing science. Advances in Nursing Science. 1998;21(1):1–15.
Burns, N. Standards for qualitative research. Nursing Science Quarterly. 1989;2(1):44–52.
Chenitz, W.C., Swanson, J.M. Surfacing nursing process: A method for generating nursing theory from practice. Journal of Advanced Nursing. 1984;9(7):205–215.
Chenitz, W.C., Swanson, J.M. From practice to grounded theory: Qualitative research in nursing. Menlo Park, CA: Addison-Wesley, 1986.
Christy, T.E. The hope of history. In: Fitzpatrick M.L., ed. Historical studies in nursing. New York: Teachers College; 1978:3–11.
Cody, W.K. Critical theory and nursing science: Freedom in theory and practice. Nursing Science Quarterly. 1998;11(2):44–46.
Crotty, M. Phenomenology and nursing research. Melbourne, Australia: Churchill Livingstone, 1996.
Curtin, L.L. The nurse as advocate: A philosophical foundation for nursing. Advances in Nursing Science. 1979;1(3):1–10.
Curtin, L.L. Integrating practice with philosophy, theory and methods of inquiry. In Proceedings: Symposium on knowledge development: I. Establishing the linkages between philosophy, theory, methods of inquiry and practice. University of Rhode Island College of Nursing; 1990. September 6–9, 1990
Cutcliffe, J. Qualitative research in nursing: A quest for quality. British Journal of Nursing. 1997;6(17):969.
Dzurec, L.C. The necessity and evolution of multiple paradigms for nursing research. Advances in Nursing Science. 1989;11(4):69–77.
Ellis, R., Philosophic inquiry. Werley, H.H., Fitzpatrick, J.J., eds., Annual review of nursing research, Vol. I. New York: Springer, 1983:211–228.
Fitzpatrick, M.L. Historical research: The method. In: Munhall P., ed. Nursing research: A qualitative perspective. (3rd ed.). Sudbury, MA: Jones & Bartlett; 2001:403–416.
Flinders D.J., Mills G.E., eds. Theory and concepts in qualitative research: Perceptions from the field. New York: Teacher’s College Press, 1993.
Friere, P. Pedagogy of the oppressed. New York: Herder & Herder, 1972. (M. B. Ramos, Trans.)
Gadamer, H.G. Truth and method. New York: Seabury, 1975. (G. Braden & J. Cumming, Trans.)
Germain, C.P. Ethnography: The method. In: Munhall P., ed. Nursing research: A qualitative perspective. 3rd ed. Jones & Bartlett: Sudbury, MA; 2001:277–306.
Glaser, B.G., Strauss, A. Awareness of dying. Chicago: Aldine, 1965.
Glaser, B.G., Strauss, A. The discovery of grounded theory: Strategies for qualitative research. Chicago: Aldine, 1967.
Glaser, B.G., Strauss, A. Time for dying. Chicago: Aldine, 1968.
Glaser, B.G., Strauss, A. Status passage. London: Routledge & Kegan Paul, 1971.
Glass, N., Davis, K. An emancipatory impulse: A feminist postmodern integrated turning point in nursing research. Advances in Nursing Science. 1998;21(1):43–52.
Habermas, J. Knowledge and human interests. Boston: Beacon, 1971. (J. J. Shapiro, Trans.)
Harding, S. Feminism and methodology. Bloomington, IN: Open University Press, 1987.
Heidegger, M. Being and time. New York: Harper & Row, 1962. (J. Macquarrie & E. Robinson, Trans.)
Heller, A. A theory of history. London: Routledge & Kegan Paul, 1982.
Holmes, C.A. The politics of phenomenological concepts in nursing. Journal of Advanced Nursing. 1996;24(3):579–587.
Husserl, E. Cartesian meditations: An introduction to phenomenology. The Hague, Netherlands: Martinus Nijhoff, 1960. (D. Carins, Trans.)
Husserl, E. The idea of phenomenology. The Hague, Netherlands: Martinus Nijhoff, 1964. (W P. Alston & G. Nakhnikian, Trans.)
Husserl, E. The crisis of the European sciences and transcendental phenomenology. Evanston, IL: Northwestern University Press, 1970.
Husserl, E. Phenomenology and the foundations of the sciences. The Hague, Netherlands: Martinus Nijhoff, 1980. (T. E. Klein & W. E. Pohl, Trans.)
Ihde, D. Experimental phenomenology: An introduction. New York: Putnam, 1977.
Johnson, M.E. Heidegger and meaning: Implications for phenomenological research. Nursing Philosophy. 2000;1(2):134–146.
Jonas-Simpson, C., Mitchell, G.H., Fisher, A., Jones, G., Linscott, J. The experience of being listened to: A qualitative study of older adults in long-term care settings. Journal of Gerontological Nursing. 2006;32(1):46–53.
Kelly, L.E., Patterson, B.J. Childhood nutrition: Perceptions of caretakers in a low-income urban setting. Journal of School Health. 2006;22(6):345–351.
Kubler-Ross, E. On death and dying. New York: Macmillan, 1969.
Kvigne, K., Gjengedal, E., Kirkevold, M. Gaining access to the life-world of women suffering from stroke: Methodological issues in empirical phenomenological studies. Journal of Advanced Nursing. 2002;40(1):61–68.
Langeveld, M.J. The stillness of the secret place. Phenomenology and Pedagogy. 1978;1(1):181–189.
Laugharne, C. Ethnography: Research method or philosophy. Nurse Researcher. 1995;3(2):54.
Leininger, M.M. Nursing and anthropology: Two worlds to blend. New York: Wiley, 1970.
Leininger, M.M. Qualitative research methods in nursing. Orlando: Grune & Stratton, 1985.
Leininger, M.M. Ethnomethods: The philosophic and epistemic bases to explicate transcultural nursing knowledge. Journal of Transcultural Nursing. 1990;1(2):40–51.
Leininger, M.M. Ethnonursing: A research method with enablers to study the theory of culture care. New York: National League for Nursing, 1991;73–117. (NLN Publication #15–2402)
Leininger, M.M. Transcultural nursing research to transform nursing education and practice: 40 years. Image: The Journal of Nursing Scholarship. 1997;29(4):341–347.
Leonard, V.W. A Heideggerian phenomenologic perspective on the concept of the person. Advances in Nursing Science. 1989;11(4):40–55.
Mead, G.H. Mind, self and society. Chicago: University of Chicago Press, 1934.
Miller, P.S. Introduction. In: Fitzsimons M.A., Pundt A.G., Nowell C.E., eds. The development of historiography. Port Washington, NY: Kennikat; 1967:xxv–xxxii.
Morse, J.M. Qualitative nursing research: A free-for all? In: Morse J.M., ed. Qualitative nursing research: A contemporary dialogue. Rockville, MD: Aspen; 1989:14–22.
Munhall, P.L. Philosophical ponderings on qualitative research methods in nursing. Nursing Science Quarterly. 1989;2(1):20–28.
Munhall, P.L. Nursing research: A qualitative perspective, 3rd ed. Sudbury, MA: Jones & Bartlett; 2001.
Paley, J. Misinterpretive phenomenology: Heidegger, ontology and nursing research. Journal of Advanced Nursing. 1998;27(4):817–824.
Parse, R.R. Nursing science: Major paradigms, theories, and critiques. Philadelphia: W.B. Saunders, 1987.
Parse, R.R. Health: A personal commitment. Nursing Science Quarterly. 1990;3(3):136–140.
Parse, R.R. Illuminations: The human becoming theory in practice and research. New York: National League for Nursing, 1995.
Parse, R.R. Hope: An international human becoming perspective. New York: National League for Nursing, 1999.
Parse, R.R. Qualitative inquiry: The path of sciencing. New York: National League for Nursing, 2001.
Paterson, J.G., Zderad, L.T. Humanistic nursing. New York: Wiley, 1976.
Pflug, G. The development of historical method in the eighteenth century. In: Pflug G., Sakmann P., Unger R., eds. History and theory: Studies in the philosophy of history. Middletown, CT: Wesleyan University Press; 1971:1–23.
Rafael, A.R.F. Advocacy oral history: A research methodology for social activism in nursing. Advances in Nursing Science. 1997;20(2):32–44.
Sadala, M.L.A., Adorno, R.C.F. Phenomenology as a method to investigate the experience lived: A perspective from Husserl and Merleau Ponty’s thought. Journal of Advanced Nursing. 2002;37(3):282–293.
Sakmann, P. The problems of historical method and of philosophy of history in Voltaire [1906]. In: Pflug G., Sakmann P., Unger R., eds. History and theory: Studies in the philosophy of history. Middletown, CT: Wesleyan University Press; 1971:24–59.
Sanday, P., The ethnographic paradigm(s). Van Maanen J., ed. Qualitative methodology. Sage: Beverly Hills, CA, 1983:19–36. (Original work published 1979, in Administrative Science Quarterly, 24, 527–538.)
Sandelowski, M. The problem of rigor in qualitative research. Advances in Nursing Science. 1986;8(3):27–37.
Sandelowski, M. Theory unmasked: The uses and guises of theory in qualitative research. Research in Nursing & Health. 1993;16(3):213–218.
Sarnecky, M.T. Historiography: A legitimate research methodology for nursing. Advances in Nursing Science. 1990;12(4):1–10.
Sigsworth, J. Feminist research: Its relevance to nursing. Journal of Advanced Nursing. 1995;22(5):896–899.
Sjöström, B., Dahlgrem, L.O. Applying phenomenography in nursing research. Journal of Advanced Nursing. 2002;40(3):339–345.
Stevens, P.E. A critical social reconceptualization of environment in nursing: Implications for methodology. Advances in Nursing Science. 1989;11(4):56–68.
Taylor, B. Interpreting phenomenology for nursing research. Nurse Researcher. 1995;3(2):66–79.
Thompson, J.L. Critical scholarship: The critique of domination in nursing. Advances in Nursing Science. 1987;10(1):27–38.
Thrasher, C., Purc-Stephenson, R.J. Integrating nurse practitioners into Canadian emergency departments: A qualitative study of barriers and recommendations. Journal of the Canadian Association of Emergency Physicians. 2007;9(4):275–281.
Van der Zalm, J.E., Bergum, V. Hermeneutic phenomenology: Providing living knowledge for nursing practice. Journal of Advanced Nursing. 2000;31(1):211.
Watson, J. Nursing: Human science and human care: A theory of nursing. Boston: Jones & Bartlett, 1999.