Fundamentals of Qualitative Phenomenological Nursing Research. Brigitte S. Cypress

care? Morse (2012) articulates: “Humanizing encompasses a perspective on attitudes, beliefs, expectations, practices, and behaviors that influence the quality of care, administration of that care, conditions judged to warrant (or not warrant) empathetic care, responses to care, and therapeutics, and anticipated and actual outcomes of patient or community care” (pp. 54–55).

      Conducting research should be sort of a social justice project. Denzin (2010) recognizes making social justice a public agenda within qualitative inquiry. He emphasizes that qualitative inquiry can contribute to social justice through: (i) identifying different definitions of a problem and/or situation that is being evaluated with some agreement that change is required; (ii) locating the assumptions held by policy‐makers, clients, welfare workers, online professionals, and other interested parties and showing them to be correct or incorrect; (iii) identifying the strategic points of interventions and thus enabling them to be evaluated and improved; (iv) suggesting alternative moral points of view from which the problem, the policy, and the program can be interpreted and assessed; and (v) exposing the limits of statistics and statistical evaluations using the more qualitative materials furnished by this approach (pp. 24–25).

1.2 Who Does Qualitative Research?

Qualitative research is done by researchers in the social sciences, as well as by practitioners in fields that concern themselves with issues related to human behavior and functioning. These are health professionals who are able to identify a research question and recognize the particular context and situation that will achieve the best answers to it. According to Morse (2012), the qualitative health researcher should be an expert methodologist who has an understanding of illness, the patient's condition, and staff roles and relationships, and who can balance the clinical situation from different perspectives (p. 23). A qualitative researcher also requires theoretical and social sensibility, interactional skills, the ability to maintain analytical distance while drawing upon past experience, and theoretical knowledge to interpret what they observe.

1.3 What Are the Characteristics of Qualitative Research?

      Creswell (2012) discusses how qualitative research studies today involve closer attention to the interpretive nature of inquiry, and situation within the political, social, and cultural context of the researchers, participants, and readers. He presents several characteristics of qualitative research, as follows: (i) natural setting: data are collected face‐to‐face in the field at the site where participants experience the phenomenon under study; the inquiry should also be conducted in a way that does not disturb the natural context of the phenomenon; (ii) researcher as key instrument: the researchers collect the data themselves rather than relying on instruments developed by others; (iii) multiple sources of data: the researchers gather multiple forms of data, including interviews, observations, and document examination, rather than rely on a single source; (iv) inductive data analysis: data are organized into abstract units of information (“bottom‐up” or moving from specific to general), working back and forth between the themes and the database until a comprehensive set of themes is established, and ending up with general conclusions or theories; (v) participant's meanings: the researchers keep a focus on learning the meaning that the participants hold about the phenomenon, and not the meaning that they bring to the study themselves; (vi) emergent design: the initial plan for the study cannot be tightly prescribed, but must be emergent; all phases of the process may change or shift after the researchers enter the field and begin to collect data; (vii) theoretical lens: use of a “lens” to view the study, such as the concept of culture, gender, race, or class differences, or the social, political, or historical context of the problem under study; (viii) interpretive inquiry: a form of inquiry in which the researchers make an interpretation of what they see, hear, and understand, which cannot be separated from their own background, history, context, and prior understanding; and (ix) holistic account: reporting multiple perspectives, identifying the many factors involved in the situation, and sketching the larger picture that emerges (Creswell 2012).

1.4 What Are the Methods Frequently Used in Qualitative Research?

The research question dictates the method to be used for a qualitative study. Qualitative and quantitative questions are distinct, and serve different purposes. Some of the different types of qualitative research that will be discussed in this chapter are: phenomenology, grounded theory, ethnography, case study, and narrative research. Researchers from different disciplines use different approaches depending on what the purpose of their study is.

      Narrative research begins with the experiences as expressed in the lived and told stories of individuals. Narrative is a spoken word or written text giving an account of an event/action chronologically connected. Examples of this approach are biographical studies, autobiographies, and life stories. Kvangarsnes et al. (2013) explored patient perceptions of chronic obstructive pulmonary disease (COPD ) exacerbation and patient experiences of relations with health personnel during care and treatment using narrative research design. They conducted ten in‐depth qualitative interviews with patients who had been admitted to two intensive care units (ICUs ) in Western Norway during the autumn of 2009 and the spring of 2010, and used narrative analysis and theories on trust and power to analyze the results. The patients perceived that they were completely dependent on others during the acute phase. Some stated that they had experienced an altered perception of reality and had not understood how serious their situation was. Although the patients trusted the health personnel in helping them breathe, they also told stories about care deficiencies and situations in which they felt neglected. This study shows that patients with an acute exacerbation of COPD often feel wholly dependent on health personnel during the exacerbation and, as a result, experience extreme vulnerability.

      Where a narrative approach explores the life of a single person, a phenomenological study describes the meaning for several individuals of their lived experiences of a phenomenon. Phenomenology is the most inductive of all qualitative methods. It involves the study of the lived experiences of persons, the view that these experiences are conscious ones, and the development of descriptions of the essences of these experiences, not explanations or analysis. There are several different types of phenomenological approach, namely: descriptive‐transcendental (Husserl, Giorgi), interpretive/hermeneutic (Heidegger, Gadamer, Jean‐Luc Nancy, Van Manen), descriptive‐hermeneutic (Merleau‐Ponty, van Manen), empirical‐transcendental (Moustakas), and existential‐embodied (Sarte, Heidegger, Merleau‐Ponty). A phenomenological study conducted by Cypress (2014) explored the lived experiences of nurses, patients, and family members during critical illness in an emergency department (ED ). Data were collected over a six‐month period by means of in‐depth interviews, and thematic analysis was done using van Manen's (1990) descriptive‐ hermeneutic phenomenological approach. The findings indicate that the patients' and their family members' perceptions of the nurses in the ED related to their critical thinking skills, communication, sensitivity, and caring abilities. Nurses identified that response to a patient's physiological deficit is paramount in the ED, and that involving the patient and their family in the human care processes will help attain this goal.

While phenomenology aims to illuminate themes and describe the meaning of the lived experiences of a number of individuals, grounded theory attempts to move beyond description and to generate or discover a theory, an abstract analytical schema of a process or interaction shaped by the views of a large number of participants. This qualitative method was developed by Glaser and Strauss in 1967. Other grounded theorists followed, including Clarke (2005), who relies on post‐modern perspectives, and Charmaz (2006), who relies on constructivist approach. Gallagher et al. (2015) collected and analyzed qualitative data using grounded theory to understand nurses' EOL decision‐making practices in five ICUs in different cultural contexts. Interviews were conducted with 51 experienced ICU nurses on university or hospital premises in five countries. The comparative analysis within and across data generated by the different research teams enabled the researchers to develop a deeper understanding of EOL decision‐making practices in the ICU. The core category that emerged was “negotiated reorienting.” Gallagher et al. (2015) stated: “Whilst nurses do not make the ‘ultimate’ EOL decisions,