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Section Two

Research
appreciation and
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Chapter
6

Common qualitative methods

Dean Whitehead

Key terms Learning outcomes

descriptive exploratory After reading this chapter, you should be
emancipatory able to:
ethnography describe the common types of
qualitative research approaches in
grounded theory
relation to nursing and midwifery issues
interpretive discuss the appropriateness of
phenomenology qualitative frameworks, theories and
qualitative philosophies
qualitative meta-synthesis/analysis describe the value of the knowledge
gained from qualitative research for
research methods practice
identify the types of health-related
issues that are best explored by the
use of qualitative research.

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Nursing and Midwifery Research 4e

Introduction
Qualitative research refers to a series of both different and related methodologies that cluster
under a paradigmatic umbrella (see Chapter 2). No one approach governs qualitative research
and so permits multiple ways of exploring different phenomena. Qualitative researchers
therefore have a range of research approaches available to them. Which approach researchers
choose to adopt usually depends on the nature of the study and the type of knowledge the
researcher wishes to uncover. Today, the most common form of qualitative enquiry undertaken
in nursing and midwifery is that of a descriptive exploratory approach. This is in quite stark
contrast to the last edition of this book when the three most common qualitative research
approaches were phenomenology, grounded theory and ethnography. They are still commonly
adopted and, proportionally, they still rank in this order. Each of these approaches holds a set of
related but differing ontological (being-related), epistemological (knowledge-related) and
methodological beliefs. It is these beliefs that inform and shape qualitative research studies.
One of the main qualities of qualitative research is that it involves a close relationship
between the researcher and participant. This is quite different from research conducted within
the quantitative paradigm, where there is frequently no direct contact with participants.
Research participants, in qualitative research, are therefore viewed as knowers and participators.
That is, they are viewed as having the knowledge that the researcher seeks to uncover. This is
because the participants will have been selected on the basis that they are part of the
phenomena, environment or culture that the researcher is examining or that they have lived
through an experience from which relevant opinions, values or beliefs have emerged (see
sampling in Chapter 7).
Qualitative methods are governed by specific philosophical or theoretical positions and
frameworks. It is necessary to explore these in some detail if we are to understand how, why and
when such research is undertaken. Such exploration is necessary because studies may report that
they have occurred under the umbrella of qualitative research, but do not specifically state
which type (see later in this chapter). Here there may be an assumption by the author/s that the
reader can accurately interpret the specific approach from the described study information.
An appreciation of the more common qualitative methods will help the reader to make a
more informed decision as to what method/s has been used, even if it is not stated. This
chapter, then, takes the reader through the more common qualitative approaches in health-
related research. It is important to note here that this chapter focuses mainly on the theoretical
and philosophical positions, frameworks and processes of the most common qualitative
methods. The following chapters, 7 and 8, deal with the specifics of qualitative research process
and design, such as sampling techniques, data collection and data analysis.

Why is qualitative non-human (i.e. a specific drug or clinical

research useful?
Quantitative research (see Chapters 913),
through the collection and analysis of numerical
data, generally informs us of how often, when or
how effective particular nursing and midwifery
interventions or treatments are. This information
relates directly to the research participants,
subjects or elements, which often may be
interventions such as a wound dressing or
catheter product being tested). What quantitative
research does not intend to do, however, is to
understand personal experiences, interpretations
and opinions from the point of view of research
participants. Instead, this is the place and
intention of qualitative research.
Qualitative research, over the years, has proven
very useful to the disciplines of nursing and

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midwifery. Both professions share similar beliefs
about individuals and their relationship to the
care environment. Qualitative research generally
adopts an interpretive and naturalistic approach
to viewing the world and its phenomena. This
means that qualitative research is designed to
help us understand naturally occurring social
events through exploring the attitudes, beliefs,
meanings, values and experiences of research
participants. The intention is to produce rich
narrative (spoken or observed) data that allow us
to interpret the essence of what it is that has
been said or observed. This is where qualitative
research possesses the greatest potential to be
useful. It has the potential, through such inquiry
with its chosen participants, to raise awareness of
the need for change or intervention.
Different qualitative methodologies broadly
share many similar properties. While sharing
properties, different qualitative approaches
explore experiences and phenomena in different
ways; generally producing different types of
research outcomes. For this reason, much of this
chapter is devoted to the most common research
traditions used in nursing and midwifery-related
qualitative research and the exploration of
how they are structured and influence nursing
and midwifery practice.
1 Tutorial Trigger
Choose a health topic that you think
would be best explored using a
qualitative approach and think of a
suitable research question (see Chapter 4) to
investigate that issue.
Points to ponder
Qualitative methods offer researchers the
opportunity to gather rich information from
the chosen participants (population) and, at
the same time, develop close and
meaningful relationships.
Qualitative research is best used where the
researcher wishes to gain insights into the
way that nurses and midwives, their
patients, their caregivers and their
colleagues engage and interact with each
other. In other words, to gain insights into
the way that they define, interpret and
analyse different situations, events,
experiences and phenomena.
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6 Common qualitative methods
The main approaches to
qualitative research
Descriptive exploratory
Since the last edition of this text there has been
quite a dramatic turnaround in terms of what
is now the most common form of qualitative
enquiry in nursing and midwifery studies. It was
mentioned in the 2007 chapter (almost as a
footnote) that:
Annells (2007) argues that this form of
descriptive exploratory methodology is fast
emerging in nursing and midwifery research
and could even take over as the most common
qualitative approach in the future.
It was a bold claim at the time, but that
prediction has come about in a relatively short
period of time. Whereas phenomenology,
grounded theory and ethnographical approaches
(in that rank order) were the most common
approaches in the mid part of the last decade,
they have now been notably overtaken by
descriptive exploratory approaches.
There are two sides to the debate about the
rapid development of the descriptive exploratory
approach. For those who see it as a threat, they
view researchers as possibly either opting for the
simplest option, or that they simply do not
understand other more complex traditional
approaches to qualitative research. On the other
hand, some researchers view the situation as
liberating. Therefore, those who support
descriptive exploratory approaches feel that they
do not have to be shackled by the conventions
of traditional approaches, allowing a greater
degree of freedom in expressing and reporting
their findings. Sometimes, however, authors
appear to compensate against the claim that
descriptive exploratory approaches are a simpler
and more manageable form of qualitative
enquiry by adding more complex philosophical/
theoretical frameworks to their studies. For
instance, Dempsey (2008) adopts Parses
humanbecoming philosophical position as the
theoretical perspective for her qualitative
descriptive exploratory study exploring
confinement with 13 volunteer adult men,
incarcerated in the same mental health unit of a
US medium-security prison.
Descriptive exploratory methodology is not so
much a specific approach, but more a general
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Nursing and Midwifery Research 4e
approach that usually adopts common aspects of
all qualitative approaches. In effect, descriptive
exploratory researchers collect rich narrative data
from small sample populations (see Chapter 7)
and analyse that data using broad free-form
thematic/content analysis methods (see Chapter
8). Compared to the following sections,
particularly with phenomenology for instance,
there is not a great deal that can be discussed
with regard to descriptive exploratory
approaches. They adopt generic (general)
qualitative principles and, therefore, are not
usually governed by complex theoretical or
philosophical positions that require more careful
detailing and exploration. It appears that authors
might be trying to convince research consumers
that the approach is more complicated than it
actually is. For instance, Drey et al. (2012, in
press) describe their descriptive exploratory study
on patients adherence to antiparkinsonian
medication as an in-depth qualitative study.
As referred to earlier, some authors do not
describe their qualitative approaches as
descriptive exploratory. Perhaps a reason for this
is that most research is, by nature, descriptive
(both qualitative and quantitative) and most
qualitative approaches are of an exploratory
nature. For instance, McKenna et al. (2011
p 682) conducted 11 focus groups with 46 key
academic midwives across Australia on the
subject of clinical simulation, and simply stated
A qualitative design was employed . Their
title qualifies the approach as a A qualitative
examination of perceptions of leaders. Similarly,
Sweet and Glover (2012, in press), in their
exploration of the Flinders University (Adelaide)
midwifery continuity-of-care program, simply
stated a qualitative study was conducted. Crowe
et al. (2010) also make the same claim about
their New Zealand-based study on the impact of
lower back pain, with the title Self-management
and chronic low back pain: a qualitative study.
Another variation on descriptive exploratory
approaches lies in the use of terms such as an
interpretative approach. For instance, Shih and
Honey (2011), in their qualitative study on the
impact of dialysis on rural-based Mori and their
families, use this term. Another variation occurs
in Wilkes et al.s (2011) Australian study of the
experiences and expectations of adolescent young
expectant fathers where the researchers describe
their study as a narrative inquiry.
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Evidence-based practice tip
When adopting a descriptive exploratory
approach to qualitative studies, it is best that
the researcher offers a clear reason why the
method has been chosen and why the
particular method best addresses the
purposes of the study. This further validates
the study and defends its position, where
others may potentially challenge its
evidence-base.
Research in brief
Huntington et al. (2011) explored nurses
perceptions of the reality of practice based on
data from the Nurses and Midwives e-cohort
Study. It examined the workforce
characteristics, such as worklife balance and
health of nurses. They performed a qualitative
analysis of data from a cohort of Australian,
New Zealand and UK-based nurses. Of the
7604 participants, 1909 provided qualitative
comments related to nursing practice;
thematic analysis resulted in four ordered
themes (see Chapter 8): embodied care
which discussed the impact of work on the
nurses physical and emotional health;
quantity/quality care which addressed
increasing pressures of work and ability to
provide quality care; organisational care
raising the seeming lack of support from
management; and (un)collegial/self care
where bullying and professional relationships
were uncovered.
Research in brief
Qualitative descriptive research can be used
in culturally based studies. Ryan and Wilson
(2010) describe their New Zealand study that
utilised a Kaupapa Maori methodology to
investigate child-to-mother violence. They
found that Maori mothers, where abused by
their child, chose to protect their child. They
do report, however, that the mothers reached
a point after which they undertook a new
journey of telling their story to others,
reconnecting with indigenous roots and
engaging in healing activities. The study also
highlighted the lack of support that these
mothers were offered by health professionals.
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2 Tutorial Trigger
What reasons do you think most
likely explain the rapid and recent
emergence and popularity of
qualitative descriptive exploratory approaches
to research?
Traditional approaches
to qualitative research
As has already been hinted at in this chapter,
more established (traditional) approaches to
qualitative research are generally far more
complex than the recently popular descriptive
exploratory approaches just discussed. They are
usually governed by longstanding theoretical and
philosophical positions that have evolved over
many years alongside (often) longstanding
critical debate and comparison. This is
particularly the case with phenomenology. With
these facts in mind, it is therefore necessary to
explore the more common traditional qualitative
methods in some detail, as follows.
Phenomenology
Origins and philosophical underpinnings
Phenomenology, as a framework for research
inquiry, has been widely embraced by health
professional researchers. It is seen as a way of
understanding phenomena that occur within
and outside where health professionals work.
It is still one of the most common qualitative
methods adopted by nursing and midwifery
researchers and, therefore, a focus of this chapter.
Phenomenology, however, is one of the most
philosophically challenging of all the qualitative
approaches. Because of the wide variations in
what makes up and describes phenomenological
research, Norlyk and Harder (2010) advise
caution before choosing.
Phenomenology is designed to discover
phenomena and unearth previously unnoticed or
overlooked issues, as it explores the experience
and meaning of phenomena. Phenomenology,
therefore, reveals meanings that appear hidden
or identifies the impact of a phenomenon, rather
than making inferences. At the same time, this
approach provides rich descriptions that aid
understanding. The result of uncovering this
knowledge is that researchers may better
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6 Common qualitative methods
understand the possibilities embedded in the
experience of phenomena.
Phenomenology remains popular in nursing
and midwifery research because it reflects values
and beliefs that are common to both disciplines. It
allows questions to be explored that are important
to them both. Certain questions are most often
asked. These tend to focus on understanding
experiences of phenomena related to health and
illness, treatment and care from the viewpoint
of both those cared for and those providing care.
For instance, McBride-Henry (2010) investigated
New Zealand womens interpretations of their
breastfeeding experiences providing insights into
how health professionals might support women to
prolong breastfeeding. Similarly, Bigwood and
Crowes (2008) New Zealand study on physical
restraint in acute inpatient mental health service
settings examined mental health nurses
experiences of physical restraint and how it
impacted on their clients. They found that,
despite it being an integral part of their role,
they were very uncomfortable with the role.
The goal of phenomenology is to develop an
understanding of a phenomenon through the
specific human experience of the phenomenon,
in order to better understand that experience of
being in that life-world. It serves to understand a
persons experiences rather than to provide causal
explanation of those experiences. The process of
phenomenological research, therefore, does not
break down the experience that is being studied.
Instead, it provides descriptions that are rich and
full and interpretations that exactly describe what
it means to be a person in their particular world.
The phenomenological researcher is committed to
understanding the experience of the phenomena
as a whole, rather than parts of that experience.
Phenomenology, therefore, is mostly used to
develop pathic understanding. This type of
understanding is useful for understanding care
and in guiding nursing and midwifery actions
concerned with feelings/emotions, interactions,
meanings of experiences and responses to
phenomena. Researchers find phenomenology
particularly useful for the study of those
phenomena that do not lend themselves easily
to the processes of quantification, control or
comparison. Beck and Watson (2008), for
example, use a phenomenological approach to
investigate the impact of birth trauma on
mothers breastfeeding experiences. The approach
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Nursing and Midwifery Research 4e
provides the description required to capture the
traumatic experience of a difficult birth and a
mothers duty to provide for their newborn.
Emerging themes, such as proving oneself as a
mother: sheer determination to succeed, making
up for an awful arrival: atonement to the baby,
helping to heal mentally: time-out for the pain in
ones head and just one more thing to be
violated vividly highlights this point.
Research in brief
Kelly and Ahern (2008) describe their Brisbane-
based phenomenological study of student
nurses preparing for registered practice. The
main themes to emerge were: This is nursing
(with sub-themes of discovering nursing
culture and language); Eating their young
(with sub-themes of power games, hierarchy
and bitchiness); and Not really prepared (with
sub-themes of role conflict, thrown in at the
deep-end and double-reality shock). These
self-explanatory themes and sub-themes, even
without reading the whole study, serve to
identify that the undergraduate nursing
experience was not always a comfortable one.
Points to ponder
Phenomena can be understood through
the experiences that people have of them.
Phenomenology provides an understanding
of people and their relationships with their
worlds.
Language is accepted as a means for
understanding others experience of
phenomena.
Phenomenology was first a general
philosophy but has subsequently been used as a
structured approach to research inquiry (Earle
2010). While phenomenology has provided
health professionals with many riches, in terms of
understanding human existence and experience,
it also provides challenges to the researcher. This
is mainly due to the many different philosophical
schools of thought and subsequent interpretations
that have emerged since the end of the twentieth
century. A phenomenologist, by necessity,
requires an overall understanding of several
different philosophical schools of thought.
Alongside this, they must also possess an
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in-depth knowledge of their adopted
philosophical framework in order to produce
research that is true to the chosen framework.
The two most common phenomenological
schools of philosophy, adopted by both nurses
and midwives, have emerged from the Husserlian
and Heideggerian tradition and occasionally
from the works of Gadamer (Paley 1998).
Other popular, but less used, philosophical
interpretations have emerged such as those of
van Manen (1984), Merleau-Ponty (Dowling
2007) and Crotty (Barkway 2001). Reference to
the just-mentioned citations will assist in giving a
useful overview of these other philosophical
schools. In some cases, such as in the study by
Lyneham et al. (2008), they conducted a mixed
phenomenological method that used a van
Manen-based approach, but also a Gadamerian-
based analysis. The participants were 14
experienced emergency nurses interviewed across
five Australian states about how intuition
influenced their practice. Due to its popularity,
a number of articles offer a detailed and
insightful account of many of the different
phenomenological schools to aid understanding
(i.e. Dowling 2007; McConnell-Henry et al.
2009; Earle 2010). This section provides a basic
overview of some key concepts that need to be
considered when undertaking phenomenological
research. These key concepts have implications
for how research studies, using certain
phenomenological approaches, are conducted.
The trick to knowing
phenomenology
To some extent, the reader of this chapter
may find the philosophical elements of
phenomenological research confusing. They
can appear overly complex. Conducting and
critiquing phenomenological research is not an
easy task, but there are certain ways to make it
easier. One way is to know and understand that
it requires a commitment to philosophical
understanding. Therefore, researchers and readers
need to be able to:
reflect on what it means to be a person in the
world
reflect on ones own experience and explore
ones own understandings of a phenomenon
think beyond the proving of facts towards a
desire to explore the experiences of self and
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others of a phenomenon in a particular
context
have sufficient understanding of the
phenomenological methodology and
framework in order to understand how it
informs the method of the study and the
findings of the study.
In this chapter the presentation of the
traditional philosophies can only be quite brief.
However, to help simplify matters, some
phenomenological researchers have devised
step-by-step procedures to help interpret and
analyse the collected language (data). The two
main authors are Giorgi (1997) (see the next
Research in brief ) and Colaizzi (1978) (see
Chapter 8). Reference to their seminal work and
nursing studies that adopt their principles may
provide further clarity.
Research in brief
Kvigne et al. (2005) use a Giorgi-inspired
phenomenological method to research the
nature of nursing care and rehabilitation of
female stroke survivors from the perspective of
14 hospital-based nurses. The analysis of the
data used the Giorgi-related steps of
1. gaining a sense of the whole
2. distinguishing the text into meaningful units
3. generating essential aspects and themes and
4. synthesising the essential aspect of
understandings and reflections into a
consistent statement.
Husserlian phenomenology
Phenomenology, as a philosophical movement,
has its origins in Ancient Greek philosophy. It is,
however, the German philosopher Husserl
(18591938) who is credited as the founder of
the twentieth century phenomenological
movement. Husserls desire was to seek an
alternative to positivism (see Chapter 2) that
would integrate the world of science alongside
the real life-world (lebenswelt) of people (Sadala
& Adorno 2002). For Husserl, human beings
were subjects in a world of objects and it was the
study of the consciousness of those objects that
he called phenomenology. From this focus, he
developed one of the two main schools of
phenomenology (descriptive phenomenology) and
was primarily interested in the question, What
do we know ? (Koivisto et al. 2002). Husserl
Schneider_1374_Chapter 6_main.indd 109
6 Common qualitative methods
moved philosophical discussion from the
question of whether or not objects in our
conscious awareness had a separate existence, to
the systematic analysis of consciousness and its
objects. He aimed to separate out (bracket)
mood, thoughts, memories and emotions to
focus on conscious awareness of objects. He
believed that understanding about intuition and
judgment (therefore, logic and truth also)
emerged as a result of reflecting upon experiences
of life (Dahlberg et al. 2001). Husserls
phenomenology is epistemological in nature (see
Chapter 3). That is, it is concerned with asking
questions of knowledge about objects gained
through conscious awareness. Husserl concluded
that essences, as the things that define
experience, exist within the conscious experiences
of people and that this consciousness (and its
intention) is presented by people to the world
(Sadala & Adorno 2002).
Research in brief
Dohertys (2010) study describes the lived
experience of midwifery clients throughout the
life span. A phenomenological approach in the
tradition of Husserl was employed. This is
described in the context that the clients
experiences reflected essential structures
embedded in human phenomena and that to
understand their social reality, their knowledge
(consciousness) formed the essence of the
data. In-depth interviews were conducted with
a purposive sample of 12 midwifery clients. The
research question was: What has been your
experience with midwifery care? Interviews
were audio-recorded and transcribed verbatim.
Data saturation was achieved and analysis
procedures from Colaizzi (see Chapter 7) were
used. Five themes emerged from the data: 1)
decision to seek midwifery care; 2) working
together in a therapeutic alliance; 3)
formulating a birth plan; 4) childbirth
education; and 5) nurse-midwives as primary
healthcare providers throughout the life span.
They recommend that health professionals
listen to the voices of midwifery clients around
a midwifery model of care that includes
recognition of life-span issues.
Heideggerian phenomenology
Heidegger (18891976), who was a pupil and
colleague of Husserl, questioned the relationship
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Nursing and Midwifery Research 4e
between consciousness and objects and so moved
significantly from Husserls interpretations.
Heideggers views helped to form the other main
school of phenomenological philosophy
(interpretive phenomenology). For Heidegger, the
practical situatedness of human experience was
his most important claim. Heidegger focused his
efforts on the study of a persons position related
to their human experience and towards the
understanding of the necessary conditions for
people being or existing in their world. As such,
Heideggerian phenomenology is ontological (see
Chapter 3). This means that it hopes to
understand the conditions whereby human
beings can understand their existence and,
therefore, the nature and the meaning of being.
The notion of being or being-in-this-world
is central to Heideggers interpretations and is
referred to by Heidegger in the commonly used
context of dasein (Heidegger 1962 p 67). The
German verb dasein means to exist, although
there are other variations in interpretation. It is a
contraction of the correct form of das and sein
(das meaning the and sein meaning being).
Therefore, Heidegger suggested that people are
aware of their own existence and question what
it means to be them in or outside their own
world. This is connected to the concept of self
which is, in turn, linked to the wider position of
the persons place in their community, world and
the cosmos. Therefore, people are capable of
questioning the meaning of their experiences of
being. They can interpret their different worlds
by comparing with others around them. People
can reflect on the meaning of their experience
and can look forward to other possibilities of
being. James and Chapman (2009) describe the
experiences of undergraduate Australian nurses
during their first clinical placement. Their
adopted Heideggerian lens allowed them to see
that the experience, for most, was overwhelming
and, reflecting on those experiences, had some
students question their continuation in nursing.
Heidegger also described dasein as something
that exists in a world that is familiar and that is
understood by people. This world has horizons
that contain pre-understandings used to assist us
make sense of our situations. This notion lends
itself to the commonly used term hermeneutics.
Hermeneutic phenomenology provides a
framework that defines a view of persons and
their being-in-the-world. It does so through
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questioning the collected data (text) and moving
from parts to the whole of this text, in which
each part gives the other parts meaning (see
Chapter 8). It also defines how meaning and
language are understood and, therefore, how
knowledge about humans and their world is
subjective, temporal (of time and worldly) and
historical. This hermeneutic circle (Heidegger
1962 p 119) describes the historical, cultural and
personal interpretations from which human
understanding is developed.
The hermeneutic circle is not a static thing; it
is dynamic and fluid. Therefore, the assumptions
contained in understanding are challenged
by new understandings. Through making
background assumptions visible, in language, the
testing of assumptions is possible. The process is
kaleidoscopic, as different patterns emerge from
taken-for-granted understandings. People come
to phenomenological research with a history of
culture and experience that is bound in language.
This process of understanding brings together
perspectives influenced by past and current
events and presented in a shared language. For
instance, Whitehead (2002a) refers to the
phenomenological nod that he experienced
when investigating the academic assignment
writing experiences of a group of student nurses.
This nod confirmed that the students
experiences were very similar to his past
experiences and describes how they relate to the
current and future experiences of both parties.
Also important to Heidegger (1962 p 386)
was the notion that being in the world is always
understood in terms of temporality. Temporality
refers to the fact that life, as it is lived now,
cannot be separated from the historical
experience of living a life and the potential for
that life in the future. Temporality is therefore
directly related to the meaning of life
experience. In summary, Heideggerian
philosophy has at its core the relationships
between self, being, meaning, existence and
temporality. For those who require a deeper
understanding of Heideggers interpretive
phenomenology, Mackey (2005) provides a
comprehensive description and analysis.
Gadamerian phenomenology
While Heidegger viewed phenomenology and
hermeneutics as one and the same, Gadamer
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challenged this. Gadamer (1976) wanted to
expand the ideas of Heidegger and his concept
of the hermeneutic circle. He did this through
suggesting that the realisation of self occurs in
a circle of understanding. Wood and Giddings
(2005), in interviewing New Zealand-based
Research Fellow Brian Phillips, discuss the
nature and intention of his PhD study. In this
study, he used Gadamerian hermeneutics to
interpret mens experiences of suicidality and
the relationship of masculinity in shaping their
beliefs and understanding of this phenomenon.
For this level of self-realisation to occur,
the researcher does not simply examine the
language of the participant to discover
Heideggers dasein. Instead, they bring their
own interpretation and understanding from
their own personal world. Therefore, self-
understanding does not emerge from transparency
of oneself, but through the tendencies and
motivations that are exposed in the language
spoken. Turners (2005) study of hope, seen
through the eyes of Australian youth, adopts this
philosophy of understanding. The participants
describe this process as including: identification
of the researchers pre-understandings of the
explored phenomenon, adopting an attitude of
Bildung (remaining open to meaning),
identification of prejudices and expectations of
the whole, using prejudices to develop horizons
and fusion/blending of these horizons to identify
explored phenomenon.
Research in brief
McCloud et al. (2011) investigated 18 South
Australian patients experience of the surgical
procedure of vitreo-retinal day surgery. They
adopted a Gadamerian approach against the
context that people experience the world
through language, and language was the
conduit for understanding and knowledge
development. This process uncovered four
constitutive themes: those of the physical
Self; the psychological Self; the historically-
located Self; and the Self located in the
community. These themes were located in the
context of human need. It should be noted
that Self is inflected to stress the concept.
The patient experiences included pain,
nausea, problematical self-care and
psychological angst.
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6 Common qualitative methods
3 Tutorial Trigger
Referring back to tutorial trigger 1,
can you identify a specific
phenomenological approach that
would best suit you? Would you have to adjust
your initial research question?
Points to ponder
The process of phenomenological
interpretation involves both an awareness
of the pre-understandings that the
researcher brings to the study and close
reading of the gathered text.
Phenomenological writing is a creative
process that reaches beyond narrative
description to reveal meaning and
understanding.
4
Tutorial Trigger
When critically reviewing a
phenomenological study what would
you expect to see that would
suggest an effective phenomenological
process had been applied?
Grounded theory
Origins and theoretical
underpinnings
Grounded theory refers to the method initially
developed and introduced by Glaser and Strauss
(1967), and further discussed and developed by
them and other colleagues (Corbin & Strauss
1990; Glaser 1999; Strauss & Corbin 1998).
Glaser and Strauss, two non-health professional
sociologists working in a US-based department
of nursing doctoral studies in the 1960s, devised
techniques for generating theory about social
processes so that the theory became grounded.
The theories are grounded by the fact that
theory begins and emerges through analysing
collected data. The data are collected from
human action and interaction as they occur
over time. This is through speaking with and
listening to those who are engaged in the
action and interaction and sometimes from
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Nursing and Midwifery Research 4e
documents relating to the action and interaction.
Essentially, grounded theory is designed to
develop theoretical explanation for socially
constructed events. It ideally generates
hypotheses for further research (see Chapter 4).
Theory grounded in this way is often thought
to produce more useful outcomes than those
emerging from pure theorising alone.
Therefore, knowledge may increase through
generating new theories, rather than analysing
data within existing theories (Heath & Cowley
2004). Grounded theory is a widely used
qualitative methodology in nursing and
midwifery research, especially as a means to
inductively separate clinical issues of importance
by creating meaning about those issues through
the analysis and modelling of theory (Mills
et al. 2006).
Grounded theory is associated by many with
the notion of symbolic interactionism a term
coined by Blumer in 1937 (Neill 2006). This
process aligns an interactionist approach
alongside naturalistic inquiry to develop theory.
This is where individuals are known to share
culturally orientated understandings of their
world, where understandings are shaped by
similar beliefs, values and attitudes and
determine how individuals behave according to
how they interpret the world around them.
People are seen as being both self-aware and
aware of others and, therefore, can adapt their
social interactions and situational behaviour to
shape meaning and society (Heath & Cowley
2004). In this sense, the focus lies with the
symbolic meanings that are uncovered by
peoples interactions, actions and resulting
consequences. This is linked to the fact that
many grounded theory research questions start
with the intention of asking How do people
?. For instance, Whitehead (2002b p 199)
broadly asks the question, in his grounded
theory study, How do nursing students
prepare for their current and ongoing health
promotion role?
The purpose and process of
grounded theory
Grounded theory, as a research methodology, is
popular among nurse and midwifery researchers.
Perhaps this is because it is not just focused on
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Schneider_1374_Chapter 6_main.indd 112
social processes, but has also evolved to explain
human action and interaction in clinically
related issues of social, psycho-social or
spiritual dimensions of life. The classic
grounded theory method, as formulated and
published originally by Glaser and Strauss
(1967), has been modified so that there are now
multiple versions (e.g. Corbin & Strauss 1996;
Strauss & Corbin 1998; Charmaz 2000).
Different versions primarily reflect different ideas
about how data are analysed to the point that a
theory results. This said, some other ideas
relating to the method differ. Most commonly,
in nursing and midwifery research, either classic
grounded theory, or the more recent Strauss and
Corbin (1990, 1998) version, is used. Reference
to Heath and Cowleys (2004) seminal paper, on
comparing Glaser and Strausss versions of
grounded theory, will give the reader additional
insight and understanding. A more recent article
by Chen and Boore (2009) does similar, with the
added benefit of including wider works by both
Corbin and Charmaz. Whole research texts are
devoted to just the works of single contemporary
grounded theorists. Artinian et al.s (2009) text
titled Glaserian Grounded Theory in Nursing
Research is a good example.
In grounded theory development, according
to Strauss and Corbin (1998), there are three
levels:
1) description using language to convey ideas
that intend to describe aspects of the action
and interaction
2) conceptual ordering organising ideas into
abstract concepts and grouping (classifying)
these into like-groups (categories) and possibly
sub-groups (subcategories) in order to
make sense of action and interaction (see
Chapter 8)
3) an explanatory scheme identifies explanatory
relationships between the categories (and
includes also the levels of description and
conceptual ordering).
Grounded theory research, according to the
area of interest, tends to concentrate on either
the patient, the nurse or midwife involved in
patient action and interaction, or both. A good
example is Dahlen et al.s (2010) study of novice
birthing theorising first-time Australian mothers
experiences of birth. The focus here was on the
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patients/clients. The 19 participants shared a core
common experience of seeing themselves as
novices reacting to the unknown. Bonners
(2007) study, on the other hand, focuses on
nurses as participants, in their study of 17
Australian expert nephrology nurses
understanding of the role of knowledge in their
practice. Hyltons (2005) New Zealand-based
study sought to theorise the experiences of a
sample of predominantly Mori enrolled nurses
(ENs) as they made the transition from this role
towards full registration within a degree
program.
Research in brief
Mills et al. (2008) describe their Australia-wide
study of nine rural nurses experiences of
mentoring nurses. The design was intended as
a reflexive, constructivist grounded theory
approach to investigate the dilemma of
initiating, settling and retaining new and
novice nurses to isolated rural areas. They
found that new or novice nurses were quick to
gain the support of experienced nurses,
especially in either wanting to demonstrate
their potential or when experiencing critical
incidents. The themes that emerged were
getting to know a stranger, looking after
each other, the importance of a name and
building a foundation.
Strauss and Corbin (1998 p 25) define
theorising as the act of constructing, from data,
an explanatory scheme that systematically
integrates various concepts through statements
of relationship. A grounded theory is most
likely to be a middle-range theory. That is, it is
more than some working hypotheses used in
everyday life, but not an all-inclusive grand
theory, beyond the context of human action
and interaction (Glaser & Strauss 1967).
Grounded theory is also usually context-
dependent and often substantive, where the
resulting theory may be about seeking solutions
to a problem (see Carlsson et al. in the Research
in brief ).
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6 Common qualitative methods
Research in brief
Carlsson et al. (2009) report their grounded
theory study on 18 womens experiences of
seeking care and being admitted during the
latent phase of labour. Self-explanatory
categories emerged from the analysis of the
collected interview data. The core category
that emerged was handing over
responsibility, and the five additional
categories were: longing to complete the
pregnancy; having difficulty managing the
uncertainty; having difficulty enduring the
slow progress; suffering from pain to no
avail; and oscillating between powerfulness
and powerlessness. The study highlighted
obvious dilemmas with the then current model
of care. It highlighted that midwives have an
important role in assisting women with coping
during the latent phase of labour, and in
giving the women opportunity to hand over
responsibility. They recommended that the
care should include validation of experienced
pain and confirmation of the normality of the
slow process, information and support.
It is generally agreed that the framework for a
grounded theory is that which is developed from
data analysed to form and support the grounded
theory. That is, the theoretical framework
evolves during the research itself (Strauss &
Corbin 1990 p 49). Grounded theory research
can be conducted according to a variety of
perspectives, but with the primary ones being
objectivism and constructivism. Objectivism
considers that, as in the natural sciences, there
are realities/truths/facts (an object) to be
revealed. Objectivist grounded theory aims to
find and uncover what is believed to be there
(to be real) about human action and interaction.
In contrast, constructivism considers that, in
human social science, there are multiple
constructed realities that are determined
according to the opinion of the person
experiencing the situation and the person
theorising. Constructivist grounded theorists
view their research product (theory) as
representing one of multiple realities about what
may be happening regarding human action and
interaction. The researchers theorising lens is
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Nursing and Midwifery Research 4e
shaped by factors such as culture, political
ideology and moral stance.
While the variety of grounded theory versions
can be frustrating for someone planning a
grounded theory research project, this situation
does provide choice. To adapt methods is also
common (Glaser 1999). Lastly, it is also
important to understand that, although grounded
theory research analyses mostly qualitative data,
quantitative type data can also be collected and
analysed. Grounded theory is commonly viewed
as the methodology that most closely bridges the
paradigm gap/tension between quantitative and
qualitative research (see Chapter 2).
5
Tutorial Trigger
Referring back to tutorial trigger 1,
could you use a grounded theory
method to investigate your chosen
clinical issue? Would you have to adjust your
initial research question?
Points to ponder
Some grounded theory research may not
fully construct a theory (as an explanatory
theme) but may offer conceptual ordering
about human action and interaction
process.
Grounded theory research may be
conducted according to a variety of
philosophical perspectives about what can
be known concerning human action and
interaction, and how it can be known.
Different approaches will provide different
outcomes for practice.
Ethnography
Origins and theoretical
underpinnings
The term ethnography originates from the
Greek ethnos (custom, culture, group) and the
Latin graphia (drawing, writing or description).
Therefore it is concerned with describing a
custom, group or culture. Ethnography, as the
descriptive study of cultures, has emerged as a
sub-set of anthropological research (the study of
humankind) over the years. Brewer (2000)
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Schneider_1374_Chapter 6_main.indd 114
explains that ethnography is not a particular data
collection method, but a style of research with
the objective to understand the activities and
meanings of a social group.
Research in brief
Bland (2007), using a critical ethnography,
examined the concept of comfort for New
Zealand-based clients in residential aged care
facilities. It required 90-days of fieldwork,
interviews with 27 residents and 28 staff
and extensive examination of facility
documentation. Bland found that residents
could be betwixt and between comfort
simultaneously, which contradicted the
constraints of an observed one-size-fits-all
care delivery approach.
Fundamental to ethnography is the concept of
culture. It is known that different cultural groups
(human societies) view relationships and
meanings differently. Culture then emerges from
knowledge learned and shared. Subsequently,
interactions and behaviours are interpreted and
understood by its members. Ethnography is
considered holistic, in this sense, as it aims to
understand the behaviour of a group of people
within the context of their own culture. For
instance, Walshs (2006) study used ethnography
to study the intuitive nesting and matresence
behaviours of pregnant mothers, as the mothers
assessed the suitability of birth centres. They
found that the environment invoked a nesting
response and a nurturing orientation of
becoming mother (matresence). This resulted in
a common bond between mothers. This type of
understanding and outcome is achieved over
long periods of observation (see Chapter 7), the
gathering of many kinds of data and employing
multiple methods and hypotheses to cover all
aspects of forming a picture of the social whole
(Fetterman 2000). This is to say that behaviours
and events are studied in relation to other factors
that may influence or generate the events and
behaviours. One of the main strengths of
ethnographic research is in the emic (insider
reality/perspective) and etic (outsider reality/
perspective) interpretations of phenomena. An
ethnographic researcher may have access to both
perspectives, depending on their level of
involvement within the culture.
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Research in brief
Hunter et al.s (2008) ethnographic study,
conducted in an Australian neonatal intensive
care unit, looked to observe how nurses
learned practices with and from each other
over a period of 12-months of observed
fieldwork. They found a variety of complex and
multi-layered forms of learning existed
between staff, with the main ones being
informal, incidental, interpersonal and
interactive. In particular, they discovered that
the interactive and interpersonal modes of
learning included codified and tacit
knowledge, as well as intuitive understanding
of how we do things around here.
Point to ponder
Ethnography allows in-depth inquiry of a
phenomenon within its cultural context.
Evidence-based practice tip
Nurses and midwives can conduct
ethnography to promote relationships,
understanding and collaboration with other
healthcare professions to enhance teamwork
for the benefit of the patient.
The purpose and process
of ethnography
A central belief related to ethnographic process is
that individuals experiences are socially
organised. As such, the researcher examines these
experiences and then proceeds to explore how
broader social relationships have shaped them. In
order to do this, all ethnographers have to enter
a research site to conduct their study, be it in a
community setting or a hospital unit etc. The
research setting is the conceptual field and the
conduct of research in the field is known as
fieldwork. The selection of the field depends on
the research topic. In many nursing and
midwifery examples, the site is chosen on the
basis of convenience and/or familiarity. Manias
and Streets (2001) study provides a typical
example. Their research on nursedoctor
Schneider_1374_Chapter 6_main.indd 115
6 Common qualitative methods
interactions during ward rounds occurred in a
critical care unit because one of the researchers
was a staff member of the unit. While some
studies require one site for research, there are
studies that may require multiple sites. Liu
et al.s (2012, in press) study of medication
communication between nurses and patients was
conducted in two separate medical wards of a
Melbourne metropolitan hospital. One ward
contained longer-term patients with complex
medical issues, while the other (a medical
assessment ward) contained shorter-term patients
due to be discharged within 48 hours. The
intention was to compare different divergent
practices to maximise transferability of the
findings.
Points to ponder
In ethnography, substantial fieldwork is vital
for adequate sampling of people and
events over time.
The different types of data gathered in
ethnographic research help to provide the
richness in description and interpretation.
Evidence-based practice tip
When conducting ethnographic research, the
researcher must be theoretically informed. This
is needed either to guide the study or to
recognise emerging theories for testing, as
well as to be able to build on existing theories
related to the practice setting.
6
Tutorial Trigger
Referring back again to tutorial
trigger 1, could you use an
ethnographic method to investigate
your chosen clinical issue? Would you have to
adjust your initial research question?
Other common
qualitative methods
The four most common methodologies described
so far are all categorised in the interpretive
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Nursing and Midwifery Research 4e
tradition of qualitative research (see Chapter 2).
There are other less common research methods
of note that are relevant to nursing and
midwifery research. Two of these are categorised
under the heading of critical/emancipatory
research. The first, feminist research, is already
covered in Chapter 2. The second, action
research, is covered in Chapter 14. One other,
also covered in Chapter 14, is the Delphi
technique. In Chapter 14, however, the common
case is argued that mixed method approaches,
such as action research and Delphi, do not come
under the umbrella of just qualitative research,
but are, in fact, part of a separate paradigm.
They are briefly mentioned here, however,
because many nursing and midwifery researchers
do classify them purely as qualitative. That
debate aside, this leaves one particular once-
common qualitative methodology of note
(although others will argue that there are several
more but beyond the scope of this chapter):
that of historical research.
Historical research
Historical research has been used for many years
by nursing and midwifery researchers. It has
many uses and a number of different forms.
Historical research is most useful when
comparing social systems to see what is common
across societies and in the study of long-term
societal change and connections between
divergent social factors (Yuginovich 2000). For
many, historical research simply provides the lens
by which the past can be viewed, both positive
and negative, in relation to current and future
events and cycles. It is known that nursing and
midwifery practice has long been influenced by
ongoing, repetitive trends, and that these trends
either change or repeat with each new generation
(Kirby 2004).
Most health professionals will appreciate why,
at times, it is useful to look back at past events
in our healthcare history. To do so provides a
form of reference where we can identify if we
have learnt and moved on from past mistakes,
are in a position to re-learn or if it is appropriate
to repeat events of the past. In Madsens (2005)
historical analysis of twentieth century untrained
nursing staff in a district of Queensland, she
states that findings could influence current
relationships between professional nurses and
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others who undertake nursing work. In
investigating more recent history, Biedermann
et al. (2001) used oral history interviews to
explore the wartime experiences of living
Australian Army nurses serving in the Vietnam
War (19671971). While not directly impacting
on practice, the findings assist current knowledge
on what it is like for nurses working in war
environments.
With historical research, data are collected and
analysed from a variety of sources. With more
recent history, this may be from interviews with
the living related to those who have died some
time ago. This could be those directly involved
in investigated events or from descendants/
relatives of those passed on. More likely is that
the historical reference is from archived written
sources; that is, personal/official letters, diaries,
journals, reports, documents, meeting minutes,
and so forth. For instance, Meehans (2003)
study of the Irish system of careful nurses of the
nineteenth century included the study of letters,
biographies, diaries and British Crimean War
army correspondence. Other forms of historical
representations are from the visual arts and
might include paintings, drawings, cartoons and
photographs. Mander and Marshall (2003) used
historical analysis to study seven paintings (from
15501676) depicting dead babies, and compare
them to recent photographs, noting similarities
in the way that they were viewed. They reported
that, back at this time and perhaps through such
open representations, mothers and families
reacted better to such events.
Most of the studies reported in this section
are, ironically, some of the most up-to-date
examples. As with feminist research, historical
research has recently fallen out of favour.
However, it is still worth mentioning these
approaches because, as with history itself,
research vogues often repeat themselves; out of
favour one moment and in favour the next. For
more current writing on historical research,
readers are more likely to find this in whole texts
on the subject, such as Mason et al.s (2011) text
on the history of the nursing profession.
Keeping up with qualitative
developments
Different interpretations of using and combining
common and less common qualitative
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approaches have emerged, as we look to
investigate different clinical issues in different
ways. For instance, Schneider (2002) explored
models of care that women experienced during
their pregnancy. Two qualitative research
approaches were incorporated in the same study;
namely, grounded theory and a feminist
phenomenological interviewing technique,
sometimes called phenomenological interviewing.
This method refers to an interviewee-guided
investigation of a lived experience that asks
almost no prepared questions. In the study,
elements of three models of care were identified:
a medical/technocratic model; a midwifery
model; and a feminist perspective model. In
some instances, there was blurring and
overlapping of models.
Henderson (2005) set the scene for combining
the methodologies of dramaturgy,
ethnomethodology and ethnography. Bradbury-
Jones et al. (2009) explore the congruence of
using focus groups in phenomenological studies,
and ask the question is it an oxymoron?
Cutcliffe et al. (2006) presented a modified
grounded theory study, while Perry et al. (2006)
apply a novel approach to feminist ethnography.
However, it is worth bearing in mind that only
experienced researchers should take on
developing novel approaches to studies, especially
when different methods and philosophies are
adopted. Novice researchers should also be
warned about taking on novel approaches in
their studies that others have developed. It is
generally safer to adopt established contemporary
approaches.
Qualitative meta-synthesis
Another relatively recent and still emerging
phenomenon in qualitative research has been the
often contentious development of qualitative
meta-synthesis. The term meta-synthesis is used to
distinguish this approach from quantitative
meta-analysis (see Chapter 3). Meta-synthesis
may be used just to integrate the findings of
qualitative studies alone or it may also be used to
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6 Common qualitative methods
integrate the findings from both quantitative and
qualitative studies. There are many approaches to
meta-synthesis and a review of meta-synthesis
methods for qualitative research lists
approximately 10 methods (Barnett-Page &
Thomas 2009), resulting in different terms
associated with it, such as meta-summary.
Whatever the approach, researchers essentially
follow a method where all qualitative studies that
exist on a particular topic are searched and
reviewed and then matrices (tables) are used to
compare studies and create a new interpretation
of the collected data. Recent examples are those
of Duggleby et al.s (2012) meta-synthesis of
hope in older adults with chronic illness and
Goethals et al.s (2012) meta-synthesis of nurses
decision-making in cases of the physical restraint
of patients.
Summary
In turn, the common qualitative methodologies
of descriptive exploratory, phenomenology,
grounded theory and ethnography have been
explored in this chapter. Other less common,
but important, qualitative traditions are also
discussed. Each is an important approach in its
own right. Appreciation of them all will assist
the beginning researcher in deciding which
method fits which research task best. Qualitative
research represents a historically important part
of nursing and midwifery research. Its place in
nursing research is assured and, if anything, is
stronger today than at any time previously. This
is especially so with the emergence of mixed-
methods research (see Chapter 14). Nursing
and midwifery have an interest in maintaining
this qualitative tradition, as the disciplines
look to gain the methodological advantage
that accompanies the building on and further
development of qualitative method, rigour,
scope and outcome. The following two
chapters explore and describe method-specific
design processes as they apply to qualitative
research.
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Nursing and Midwifery Research 4e

Key points
The four most common qualitative methods for nursing and midwifery research are
descriptive exploratory, phenomenology, grounded theory and ethnography.
Qualitative research is by nature usually interpretive, emic, naturalistic and holistic.
Qualitative methods aim to help us understand naturally occurring social phenomena
through exploring the attitudes, beliefs, meanings, values and experiences of the research
participants.
Nurse and midwifery researchers and theorists are continually adapting and
recontextualising qualitative methods and techniques, as a means to explore new
phenomena in new ways.

Learning activities
1. Qualitative researchs main aim is to: 4. Husserlian phenomenology is associated
a) investigate issues that quantitative with:
research is unable to a) lebenswelt, epistemology, bracketing,
b) understand naturally occurring social descriptive phenomenology
phenomena b) lebenswelt, ontology, bracketing,
c) include participants in the research interpretive phenomenology
d) determine what patients think about c) dasein, epistemology, bracketing,
nurses. descriptive phenomenology
2. Qualitative research, by its nature, is d) dasein, ontology, bracketing, interpretive
usually: phenomenology.
a) deductive, emic, naturalistic and holistic 5. Heideggerian phenomenology is associated
with:
b) interpretive, etic, naturalistic and holistic
a) lebenswelt, epistemology, descriptive
c) interpretive, emic, naturalistic and
phenomenology
holistic
b) lebenswelt, ontology, interpretive
d) deductive, etic, naturalistic and holistic.
phenomenology
3. According to many, the main advantage of
c) dasein, epistemology, descriptive
qualitative descriptive exploratory
phenomenology
approaches to research is:
d) dasein, ontology, interpretive
a) they are easier to manage
phenomenology.
b) they dont use complicated terminology
c) they do not limit the researcher to a
particular philosophical worldview
d) they can incorporate a variety of different
perspectives.

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6. The hermeneutic circle describes:
a) the fact that life experiences go around
and around
b) the fact that life cycles go around and
around
c) the historical, cultural and personal
preconceptions from which
understanding is developed
d) the process by which all life is
understood.
7. Grounded theory aims to:
a) develop a well-rounded theory for use in
later research
b) develop theoretical explanation for
socially constructed events and ideally
generate hypothesis for further research
c) develop a rationale for linking qualitative
findings to quantitative findings
d) develop theoretical explanation for
experimentally constructed events and
ideally generate hypothesis for further
research.
Additional resources
Balls P 2009 Phenomenology in nursing research:
methodology, interviewing and transcribing.
Online. Available: http://www.nursingtimes.net/
nursing-practice-clinical-research/phenomenology-
in-nursing-research-methodology-interviewing-and-
transcribing/5005138.article
Denzin N K, Lincoln Y S 2005 (eds) The Sage
Handbook of Qualitative Research, 3rd edn. Sage
Publications, Thousand Oaks, California, USA
Grounded Theory Institute (with a focus on facilitating
classic grounded theory method). Online. Available:
http://www.groundedtheory.com
Grounded Theory Online. Online. Available: http://
www.groundedtheoryonline.com/what-is-grounded-
theory/classic-grounded-theory
Norlyk A, Harder I 2010 What makes
phenomenological research phenomenological? An
analysis of peer-reviewed empirical nursing studies.
Qualitative Health Research 20:42031
Qualitative research in nursing 2012 Online. Available:
http://nursingplanet.com/research/qualitative_
research.html
Schneider_1374_Chapter 6_main.indd 119
6 Common qualitative methods
8. Grounded theory originates from and has
been further developed by:
a) Strauss and Corbin
b) Strauss and Chopin
c) Glaser and Corbin
d) Glaser and Strauss.
9. Ethnography has its origins in:
a) quantitative research
b) feminist research
c) historical research
d) anthropology.
10. Ethnography typically includes:
a) the study of cultures, fieldwork, surveys,
insider/outsider reality
b) the study of cultures, fieldwork,
observation, insider/outsider reality
c) the study of individuals, fieldwork,
observation, insider/outsider reality
d) the study of individuals, laboratory work,
observation, insider/outsider reality.
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