Practice Matters

Understanding qualitative research

Chances are, when you think of research, you think of things that can be counted. That is, you think of quantitative research—an objective study with careful measurements and tight controls on the research process.
But not everything that counts can be counted, especially in nursing. Our interactions are influenced by our awareness of the feelings, beliefs, values, and the distinct perspectives of each person. To evaluate these concepts in their contexts, we need qualitative research.
Focused on discovery and description, qualitative nursing research views the patient, the family, and the nurse as interactive partners in a social framework. The purpose of qualitative inquiry is to understand how people create meaning in their worlds and make sense of particular situations.

Crafting problem and purpose statements
The problem statement indicates the direction of the study, and the purpose statement indicates the focus and may identify the approach. Well-constructed problem and purpose statements do the following:
• describe the researchable problem and clearly express the study’s purpose
• clearly and succinctly identify key concepts of interest to be studied
• define the population to be studied and the study setting
• justify the study as a means of generating new knowledge.

Qualitative approaches
Qualitative approaches include phenomenological research, grounded theory, ethnographic research, and historical methods. These approaches are based on a holistic worldview that incorporates these ideas:
• There is not a single reality.
• Reality is based on perceptions that are different for each person and change over time.
• What we know has mean­ing only within a given situation or context.
The reasoning process in qualitative research involves perceptually putting pieces together to make integrated wholes. Because perceptions vary, many different meanings are possible.

Reviewing the literature
The purpose and timing of the literature review vary, depending on the type of study.  Phenomenological researchers review the literature after they collect and analyze their data, so the research is not influenced by preconceived notions. These researchers use the literature review to compare their findings with the literature to determine current knowledge of a phenomenon.
Grounded theory researchers may perform a minimal literature review at the start of their study. Then, they review the literature throughout the study to explain, support, and extend the theory developed through their research.
Ethnographic researchers perform an extensive review of the literature early in the study to provide a general understanding of variables in a selected culture. Historical researchers use information gained from an extensive literature review and other sources to explain how a phenomenon has developed over a particular time period.

Sample selection and size
Qualitative research focuses on discovering meaning and multiple realities, so sampling is based on obtaining adequate, appropriate information. Research may start with a small, nonrandom sample, such as a group of people who know the phenomenon under study and can provide rich descriptions of it. As research unfolds, the researchers may select participants based on early findings. For example, early study participants may make referrals to other potential study participants who meet the researchers’ criteria.
Sample size in qualitative research depends on the purpose of the inquiry, the quality of the information, and the sampling strategy. There are no firmly established rules or criteria. Sampling continues until no new information can be collected.

Protecting the participants
In our positions of trust, we have a great deal of influence over patients who are vulnerable because of their health concerns. We must use our influence prudently. We need to ensure that our potential study participants are capable of granting informed consent and that they have all the information they need to do so.
In qualitative research, consent becomes a dynamic interactive process. One approach to informed consent is process consent, in which the participants can renegotiate the consent if an unanticipated event occurs. By providing an opportunity to reconsider the consent agreement, the nurse-researcher confirms her role as an advocate and proceeds in the best interest of all participants.


Reviewing the findings
Critiquing qualitative studies involves evaluating the researchers’ expertise and the quality of the study. One goal is to ensure that the participants’ experience is accurately represented, which may take the form of returning to the participants after the study to validate the reported findings. To judge the rigor of their science, nurse-researchers using qualitative methods may apply these criteria:
• Dependability: Are changes or surprises in the phenomenon accurately and adequately documented?
• Confirmability: Is the phenomenon viewed objectively and are the interpretations confirmed with research participants?
• Transferability: Can findings and results be transferred to other settings, situations, and populations?
Qualitative research can provide nurses with an understanding of the experiences of others. This holistic, individual approach to research and knowledge can only broaden and deepen the art of nursing.

Selected references
Burns N, Grove S. The Practice of Nursing Research: Conduct, Critique, and Utilization. 5th ed. St. Louis, Mo: Elsevier; 2005.
Lincoln YS, Guba G. Naturalistic Inquiry. Newbury Park, Calif: Sage; 1985.
Munhall PL. Nursing Research: A Qualitative Perspective. 3rd ed. Sudbury, Mass: Jones and Bartlett; 2001.
Nieswaidomy RM. Foundations of Nursing Research.  5th ed. Upper Saddle River, NJ: Prentice Hall; 2008.
For a complete list of selected references, visit www.AmericanNurse Today.com.

Mary Ann Remshardt, MSN, EdD, RN, is an Associate Professor of Nursing,  and Deborah Lynn Flowers, MS, PhD, RN, is a Professor of Nursing. Both teach at East Central University (South Campus) in Durant, Oklahoma.

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