Fundamentals of Qualitative Phenomenological Nursing Research. Brigitte S. Cypress

coaxing, information cuing and voice enabling); and emotional holding (creating time‐space, and comfort giving)” (p. 794).

      Although a grounded theory approach examines a number of individuals to develop a hypothesis, participants are not studied as one unit. Ethnography, meanwhile, uses a larger number of individuals and focuses on an entire cultural group as a single unit of analysis, describing and interpreting their shared and learned patterns of values, behaviors, beliefs, and language. There are many forms of ethnography, namely: confessional, life history, auto‐ethnography, feminist, ethnographic novels, visual ethnography found in photography, and video and electronic media. Price (2013) explored what aspects affect registered healthcare professionals' ability to care for patients within the technological environment of a critical care unit. They utilized ethnography to focus on the cultural elements within a given situation. Data collection involved participant observation, document review, and semi‐structured interviews with the nineteen study participants. An overarching theme of the “crafting process” was developed, with subthemes of “vigilance,” “focus of attention,” “being present,” and “expectations,” with an ultimate goal of achieving the best interests for the individual patient.

      A culture‐sharing group in ethnography can be considered a case, but its aim is to ascertain how the culture works rather than to understand one or more specific cases within a bounded system. Creswell (2012) defines case study research as an approach in which the researcher explores a bounded system (a case) or multiple bounded systems (cases) over time through detailed in‐depth data collection involving multiple sources of information and reports a case description and case‐based themes (p. 73). In terms of intent, there are three types of case study: single instrumental, collective or multiple, and intrinsic. Hyde‐Wyatt (2014) studied spinally injured patients on sedation in the ICU. A reflection‐on‐action exercise was carried out when a spinally injured patient became physically active during a sedation hold. This was attributed to hyperactive delirium. Reflection on this incident led to a literature search for guidance on the likelihood of delirium causing secondary spinal injury in patients with unstable fractures. Through a case study approach, the research was reviewed in relation to a particular patient. This case study illustrated that there was a knowledge deficit when it came to managing the combination of the patient's spinal injury and delirium. Sedation cessation episodes are an essential part of patient care in the ICU. For spinally injured patients, these may need to be modified to sedation reductions to prevent sudden wakening and uncontrolled movement should they be experiencing hyperactive delirium.

1.5 What Is the Process of Conceptualizing and Designing a Qualitative Research Inquiry?

      Designing a qualitative inquiry is not a fully structured, rigid process. Even books and experts vary in their understanding and guidance. Conducting a qualitative study is extremely difficult (Morse 2012, p. 76). Sometimes, there is concern about access and the qualitative procedures involved in data collection, including disclosure of participants' identities and confidentiality of data. Nevertheless, qualitative research involves a rigorous and scientific process that serves as a guide for researchers who are planning to embark on a journey and complete a naturalistic investigation.

      Unlike quantitative research, which involves a fairly linear process, qualitative studies have a flexible approach and flow of activities. The researchers do not know in advance exactly how the study will unfold (Hyde‐Wyatt 2014). The process of designing a qualitative study thus does not begin with the methods – which in fact is the easiest part of naturalistic inquiries (Creswell 2012). Qualitative researchers instead usually begin with a broad topic focusing on one aspect of a phenomenon about which little is known. The phenomenon may be one in the “real world,” a gap in the literature, or past findings of investigations (e.g., in the area of social and human sciences) (Creswell 2012). A fairly broad question is then posed, in order to allow the focus to be delineated; this can then be sharpened when the study is underway.

      Once the research question has been posed, the researchers should conduct a brief literature review to inform the question and to help establish the significance of the problem. There is a continuous debate about the value of doing a literature review prior to collecting data, and how much of one should be done. Some believe that knowledge about findings of previous studies might influence the conceptualization of the phenomenon of interest, which ideally should be illuminated by the participants rather than by prior findings (Polit and Beck 2014). A grounded theory investigator, for example, may make a point of not conducting a review of literature before beginning their study to avoid “contamination” of the data with preconceived concepts and notions about what might be relevant (Borbasi and Jackson 2012).

After the literature review, the researchers must identify an appropriate site for the study. Selecting and gaining entry to a site requires knowledge of settings in which participants in their lifeworld are experiencing the phenomenon under study. For example, research in the area of health is a very broad topic. A researcher should determine definitions, concepts, scopes, and theories about health that will be used for the proposed qualitative inquiry. Health can be perceived as the absence or presence of illness, or as the physical, psychosocial, psychological, or spiritual health of individuals, families, or groups (Morse 2012). Morse (2012) states that “Research into the intimate, experiential and interpersonal aspects of illness, into caring for the ill, and into seeking and maintaining wellness introduces extraordinary methodological challenges” (p. 89). Thus, knowledge about the characteristics of the participants who will be recruited for the study and the specific context of the settings (i.e., hospital/institution, community/outpatient) in which they are located at the time when research will be conducted is important. In order to gain entry to the site, the ethical aspect of the study should also be addressed. Approval from the appropriate institutional review board (IRB ) and informed consent from the participants must be obtained. Qualitative studies have special ethical concerns because of the more intimate nature of the relationship that typically develop between researchers and participants (Polit and Beck 2014). The researchers must develop specific plans addressing these issues.

      After addressing the ethical concerns and gaining entry to the site, an overall approach should be planned and developed. Although the researchers might plan for a specific approach to be used, the design can be emergent during the course of data collection. Modifications may be made as the need arises. It is rare that a qualitative study has a rigidly structured design that prohibits changes while in the field (Polit and Beck 2014), but the purposes, questions, and methods of research must nonetheless be interconnected and interrelated so that the study appears as a cohesive whole rather than fragmented isolated parts (Creswell 2007, p. 42). For example, patients in hospitals have limited abilities related to their medical condition and the contextual features of the hospital setting. A patient's condition may thus demand a different method be used because of fatigue, interruptions due to treatments or physicians' rounds, and visitors. In this context, the study will require modifications of methods, and study participation will have the lowest priority at the specific moment and time (Morse 2012).

      In qualitative studies, sampling, data collection, and analysis – including interpretation – take place repetitively. The sampling method usually used is purposive. Qualitative researchers employ rigorous data collection procedures involving interviewing and observing them (individuals, focus groups, or an entire culture) in order to explore the phenomenon under study. The discussions and observations are loosely structured, allowing the participants a full range of beliefs, feelings, and behaviors (Polit and Beck 2014). Other types of information that can be collected are documents, photographs, audio‐visual materials, sounds, emails, text messages, and computer software.

      The backbone of qualitative research is extensive collection of data from multiple sources (Creswell 2012). After organizing and storing the data, the researchers will try to make sense of them, working inductively from particulars to more general perspectives until categories, codes, and themes emerge and are illuminated, which can be used to build a rich description of the phenomenon of interest (Creswell 2012; Polit and Beck 2014). The researchers will analyze the data using multiple levels of abstraction. Analysis and interpretation are ongoing concurrent activities that