Guest editorial: What's common with qualitative nursing research these days?

Abstract

When I went to Taiwan in 2005 for the International Council of Nurses (ICN) Conference, I paid particular attention to any posters reporting qualitative nursing research – the extensive display of posters was changed daily and reports of qualitative research featured often. In addition, as much as was possible with many concurrent sessions being offered, I tried to listen to presentations that reported qualitative research. Although abstracts submitted for consideration as conference presentations or posters are usually either peer reviewed or committee reviewed, there can be a different level of scrutiny compared with that of manuscripts reporting research in some detail when submitted to peer-review journals. However, when reading a poster or listening to a presentation at a conference, usually there is enough detail discernible to help identify and understand trends in qualitative nursing research. The ICN conference, because of the sheer bulk of posters and presentations, provided a smorgasbord for this purpose. Regarding posters, there was a slight swaying toward studies being reported from Asian nations, but most regions of the world were represented and presentations featured studies from around the globe. Overall, clinically orientated questions relevant to nursing practice were most prevalent, with fewer studies focusing on education, management and professional issues. Amongst qualitative approaches used were ethnographies, case studies, historical research and a smattering of discourse analyses. There were qualitative components to some mixed methods research, with more mixed modes than previously discerned at conferences, so that is a trend. However, the majority of qualitative studies could be categorized into one of three groups that are presented to follow with discernible trends pertinent to each category mentioned. Phenomenology remains popular, although it was not always acknowledged what form of phenomenology was applied, which hindered evaluation. As could be expected, as the tradition of phenomenology does not have set processes for data analysis, the analysis steps arose from the oft-selected work of such as van Kaam (1959)), Benner (1985), Giorgi (1985), van Manen (1990) and Colaizzi (1978), with the latter two most common. Here and there was a hint that creativity was being applied either to analysis step variation or to forms of reporting results, but the usual outcomes of themes and sub-themes were reported. Sample size ranged from four to 20 participants. Rich insights into human experiences relevant to nursing care were evident. Grounded Theory (GT) is still popular amongst nurse researchers, which is to be expected since ‘cut its teeth’ in the milieu of nursing research in the 1960s. Glaserian GT (classic mode –Glaser & Strauss 1967) and Straussian GT [Strauss and Corbin's (1990, 1998 mode] featured with just some use of overtly constructivist formulations of GT that either cited Charmaz (2000) as an influence, or did not refer to anyone's mode in particular. GT studies tended to research either patients, nurses or, dually, patients and nurses, although patients’ significant others occasionally were target participants. Action and interaction were usually the foci, but not exclusively. Symbolic interactionism was often cited as a theoretical perspective or framework, despite contemporary methodological forums about GT having identified that this is not necessary and can be limiting of an ‘emergent’ theory (Glaser 2005). However, there were examples of finitely crafted, parsimonious, substantive GTs that can productively direct the selection of nursing actions and interactions. By far the most common type of qualitative research reported was a large, somewhat nebulous group that could be categorized as descriptive and/or exploratory qualitative research. Some of these studies actually used one or both of those terms, but other classifications chosen by the researcher/s included ‘qualitative research with content analysis’, ‘qualitative inquiry’, ‘qualitative research’, or a ‘qualitative study’. Interestingly, although a variety of research processes were applied to these studies, it was not unusual to see snippets from GT method used productively like open and axial coding, constant comparative data analysis and ‘theoretical sampling’. Some justifiably claimed using a ‘GT approach’ to data collection and analysis. Of concern, however, were a number of studies that claimed to be phenomenology or GT that seemed rather to be descriptive and/or exploratory in outcome. Some, supposedly, phenomenological studies listed themes and sub-themes (or categories and sub-categories) identifying, describing and exploring aspects or impact of an event or situation – claimed to be an experience – but did not provide understanding illuminative of human experience or the meaning of that experience, and tended to be devoid of existential elements. These were not actually phenomenology. When reports of supposed GT seemed to require the alternative label of descriptive and/or exploratory research, the claim for having produced ‘theory’ was questionable because the product was a form of conceptual ordering, which is the second of three levels in theory development (Strauss & Corbin 1998). The first level of theorizing (description – concept identification) was evident as well as the ordering of concepts into hierarchal, linked categories (through exploration of dimensions), but not evident in these sort of studies was a fully explanatory scheme that had systematically integrated concepts with refined relationship statements (Strauss & Corbin 1998) – that is, explaining why as well as what, when and how. I am not suggesting that descriptive and/or exploratory qualitative research studies are inferior to fully developed GTs or to a richly illuminative phenomenology because, as with those studies, descriptive and or exploratory qualitative research can also offer nurses much to consider and to apply. For instance, describing and exploring potential problems that might be caused to older people having day surgery, or listing and describing a hierarchy of potential issues for parents with a disabled child who is unhealthy, can assist assessment and planning of quality nursing care – and increase empathetic understanding that enhances a nurse's caring support of patients and their significant others. Obviously, descriptive and/or exploratory research is common, even perhaps prime amongst qualitative nursing research in this era; researchers of nursing want to do it, can do it and can do it well, even though the research may be variously labelled or even inappropriately labelled. In published reports of nursing research, the category of descriptive exploratory qualitative research is also featuring (e.g. Gallagher & Truglio-Londrigan 2004), or there may be a labelling of method as either ‘descriptive’ (e.g. Tse et al. 2005) or ‘exploratory’ (e.g. Manias et al. 2005), or classified with some other generic term. Other watchers of qualitative nursing research like Sandelowski and Barraso (2003) have noted a form of qualitative nursing research being named ‘descriptive/exploratory’ or more generically as simply ‘qualitative’, ‘interpretive’ or ‘naturalistic’. Is this the embryonic genesis of a unique method for nursing research? Perhaps not, as anecdotal evidence suggests that similar method is being applied within other disciplines. Perhaps so, however, if careful consideration is given amongst the growing mass of qualitative nurse researchers for doing this form of qualitative research not only well, but in a way that particularly facilitates quality outcomes directly applicable to nursing practice and tangential areas of nurse activity. Thorne et al. (1997) have explicated a method recommended especially for nursing research that they use, which is entitled ‘interpretive description’, so there are signs that this quest has commenced. I am wondering, however, if we do not need, overtly, to acknowledge this large portion of qualitative nursing research and ensure that our texts and courses about nursing research acknowledge this group, facilitating recognition of what is happening in reality. Additionally, it might be time for qualitative methodologists to champion some broad criteria regarding production of a quality study.