The Qualitative Research Approaches in Nursing Guide to Phenomenology Ethnomethodology and Symbolic Interactionism. Qualitative research approaches, such as phenomenology, ethnomethodology, and symbolic interactionism, are valuable in nursing for understanding patient experiences and social contexts. Phenomenology focuses on lived experiences, ethnomethodology examines how social order emerges, and symbolic interactionism explores how individuals create meaning through interactions.
What is Qualitative Research Approaches in Nursing Guide to Phenomenology Ethnomethodology and Symbolic Interactionism
Why Qualitative Research Matters in Nursing
Phenomenology: This approach seeks to describe and interpret the essential structures of lived experience. In nursing, it can be used to understand patients’ experiences with illness, pain, or hospitalization, as well as nurses’ experiences with patient care. Researchers following this approach attempt to eliminate their own biases and assumptions to understand the essence of the phenomenon from the perspective of those affected.
Ethnomethodology: This approach focuses on how people create and maintain social order in their daily lives. In nursing, it can be used to examine how nurses and patients interact in specific situations, such as bedside care or procedures. Ethnomethodology examines the methods and practices people use to understand and navigate social situations.
Symbolic Interactionism: This approach explores how people create and interpret meaning through social interaction. In nursing, it can be used to understand how patients and nurses communicate, how they perceive their roles, and how they construct their understanding of illness and health. Symbolic interactionism emphasizes the role of symbols and shared meanings in shaping social behavior.
The Foundation of Naturalistic Research in Nursing
What Are Qualitative, Naturalistic Approaches?
There are many variants of qualitative, naturalistic approaches (Jacob, 1987; Hitchcock and Hughes, 1995). Here we focus on three significant ‘traditions’ in this style of research—phenomenology, ethnomethodology and symbolic interactionism.
Three Key Qualitative Research Traditions for Nursing
1. Phenomenology: Understanding the Patient Experience
What Is Phenomenology?
In its broadest meaning, phenomenology is a theoretical point of view that advocates the study of direct experience taken at face value; and one which sees behavior as determined by the phenomena of experience rather than by external, objective and physically described reality (English and English, 1958). Although phenomenologists differ among themselves on particular issues, there is fairly general agreement on the following points identified by Curtis (1978) which can be taken as distinguishing features of their philosophical viewpoint:
- a belief in the importance, and in a sense the primacy, of subjective consciousness;
- an understanding of consciousness as active, as meaning bestowing; and
- a claim that there are certain essential structures to consciousness of which we gain direct knowledge by a certain kind of reflection.
Exactly what these structures are is a point about which phenomenologists have differed. Various strands of development may be traced in the phenomenological movement: we shall briefly examine two of them—the transcendental phenomenology of Husserl; and existential phenomenology, of which Schutz is perhaps the most characteristic representative.
Types of Phenomenological Approaches
Husserl’s Transcendental Phenomenology
Husserl, regarded by many as the founder of phenomenology, was concerned with investigating the source of the foundation of science and with questioning the commonsense, ‘taken-for granted’ assumptions of everyday life (see Burrelland Morgan, 1979). To do this, he set about opening up a new direction in the analysis of consciousness. His catch-phrase was ‘back to the things!’ which for him meant finding out how things appear directly to us rather than through the media of cultural and symbolic structures. In other words, we are asked to look beyond the details of everyday life to the essences un deerling them.
To do this, Husserl exhorts us to ‘put the world in brackets’ or free ourselves from our usual ways of perceiving the world. What is left over from this reduction is our conscious ness of which there are three elements—the ‘I’ who thinks, the mental acts of this thinking subject, and the intentional objects of these mental acts. The aim, then, of this method of Epoché, as Husserl called it, is the dismembering of the constitution of objects in such a way as to free us from all preconceptions about the world (see Warnock, 1970).
Schutz’s Existential Phenomenology
Schutz was concerned with relating Husserl’s ideas to the issues of sociology and to the scientific study of social behavior. Of central concern to him was the problem of understanding the meaning structure of the world of everyday life. The origins of meaning he thus sought in the ‘stream of consciousness’—basically an un broken stream of lived experiences which have no meaning in themselves. One can only impute meaning to them retrospectively, by the process of turning back on oneself and looking at what has been going on.
In other words, meaning can be accounted for in this way by the concept of reflexivity. For Schutz, the attribution of meaning reflexively is dependent on the people identifying the purpose or goal they seek (see Burrell and Morgan, 1979). According to Schutz, the way we understand the behavior of others is dependent on a process of gyrification by means of which the observer makes use of concepts resembling ‘ideal types’ to make sense of what people do.
These concepts are derived from our experience of everyday life and it is through them, claims Schutz that we classify and organize our everyday world. As Burrell and Morgan observe, ‘The typifications are learned through our biographical situation. They are handed to us according to our social context. Knowledge of everyday life is thus socially ordered. The notion of gyrification is thus…an inherent feature of our everyday world’ (Burrell and Morgan, 1979).
The fund of everyday knowledge by means of which we are able to typify other people’s behavior and come to terms with social reality varies from situation to situation. We thus live in a world of multiple realities: The social actor shifts between these provinces of meaning in the course of his everyday life. As he shifts from the world of work to that of home and leisure or to the world of religious experience, different ground rules are brought into play.
While it is within the normal competence of the acting individual to shift from one sphere to another, to do so calls for a ‘leap of consciousness’ to overcome the differences between the different worlds. (Burrell and Morgan, 1979) Like phenomenology, ethnomethodology is concerned with the world of everyday life.
Applications in Nursing Practice
These qualitative approaches offer different perspectives for exploring the complex realities of nursing practice and go beyond numerical data to understand the subjective experiences and social dynamics in healthcare settings.
2. Ethnomethodology: Studying Everyday Healthcare Interactions
Understanding Ethnomethodology
In the words of its proponent, Harold Garfinkel, it sets out ‘to treat practical activities, practical circumstances, and practical sociological reasoning’s as topics of empirical study, and by paying to the most commonplace activities of daily life the attention usually accorded extraordinary events, seeks to learn about them as phenomena in their own right’ (Garfinkel, 1967).
He maintains that students of the social world must doubt the reality of that world; and that in failing to view human behavior more skeptically, sociologists have created an ordered social reality that bears little relationship to the real thing. He thereby challenges the basic sociological concept of order. Ethnomethodology, then, is concerned with how people make sense of their everyday world.
More especially, it is directed at the mechanisms by which participants achieve and sustain interaction in a social encounter—the assumptions they make, the conventions they utilize, and the practices they adopt. Ethnomethodology thus seeks to understand social accomplishments in their own terms; it is concerned to understand them from within (see Burrell and Morgan, 1979).
Key Concepts in Ethnomethodology
Indexicality and Reflexivity
In identifying the ‘taken-for-granted’ assumptions characterizing any social situation and the ways in which the people involved make their activities rationally accountable, ethno-methodologists use notions like ‘indexicality’ and ‘reflexivity’. Indexicality refers to the ways in which actions and statements are related to the social contexts producing them; and to the way their meanings are shared by the participants but not necessarily stated explicitly.
Indexical expressions are thus the designations imputed to a particular social occasion by the participants in order to locate the event in the sphere of reality. Reflexivity, on the other hand, refers to the way in which all accounts of social settings—descriptions, analyses, criticisms, etc.—and the social settings occasioning them are mutually interdependent.
Two Types of Ethnomethodological Studies
It is convenient to distinguish between two types of ethno-methodologists: linguistic and situational. The linguistic ethno-methodologists focus upon the use of language and the ways in which conversations in everyday life are structured. Their analyses make much use of the unstated ‘taken-for-granted’ meanings, the use of indexical expressions and the way in which a conversation convey much more than is actually said.
The situational ethno-methodologists cast their view over a wider range of social activity and seek to understand the ways in which people negotiate the social contexts in which they find themselves. They are concerned to understand how people make sense of and or der their environment. As part of their empirical method, ethno methodologists may consciously and deliberately disrupt or question the ordered ‘taken-for-granted’ elements in everyday situations in order to reveal the underlying processes at work.
The substance of ethnomethodology thus largely comprises a set of specific techniques and approaches to be used in the study of what Garfinkel has described as the ‘awesome indexicality’ of everyday life. It is geared to empirical study, and the stress which its practitioners place upon the uniqueness of the situation encountered, projects its essentially relativist standpoint.
A commitment to the development of methodology and field-work has occupied first place in the interests of its adherents, so that related issues of ontology, epistemology and the nature of human beings have received less attention than perhaps they deserve. Essentially, the notion of symbolic interactionism derives from the work of G.H.Mead (1934).
3. Symbolic Interactionism: How Meaning Shapes Healthcare Behaviors
Origins and Foundation
Although subsequently to be associated with such noted researchers as Blumer, Hughes, Becker and Goffman, the term does not represent a unified perspective in that it does not embrace a common set of assumptions and concepts accepted by all who subscribe to the approach. For our purposes, however, it is possible to identify three basic postulates. These have been set out by Woods (1979) as follows.
Three Basic Postulates of Symbolic Interactionism
First, human beings act towards things on the basis of the meanings they have for them. Humans inhabit two different worlds: the ‘natural’ world wherein they are organisms of drives and instincts and where the external world exists independently of them, and the social world where the existence of symbols, like language, enables them to give meaning to object. This attribution of meanings, this interpreting, is what makes them distinctively human and social.
Interactionists therefore focus on the world of subjective meanings and the symbols by which they are produced and represented. This means not making any prior assumptions about what is going on in an institution, and taking seriously, indeed giving priority to, inmates’ own accounts. Thus, if pupils appear preoccupied for too much of the time—‘being bored’, ‘mucking about’, ‘having a laugh’, etc. the interactionist is keen to explore the properties and dimensions of these processes.
Second, this attribution of meaning to objects through symbols is a continuous process. Action is not simply a consequence of psychological attributes such as drives, attitudes, or personalities, or determined by external social facts such as social structure or roles, but results from a continuous process of meaning attribution which is always emerging in a state of flux and subject to change. The individual constructs, modifies, pieces together, and weighs up the pros and cons and bargains.
Third, this process takes place in a social context. Individuals align their actions to those of others. They do this by ‘taking the role of the other’, by making indications to ‘themselves’ about the likely responses of ‘others’. They construct how others wish or might act in certain circumstances, and how they themselves might act. They might try to ‘manage’ the impressions others have of them, put on a ‘performance’, try to influence others’ ‘definition of the situation’.
Instead of focusing on the individual, then, and his or her personality characteristics, or on how the social structure or social situation causes individual behavior, symbolic interactionists direct their attention at the nature of interaction, the dynamic activities taking place between people. In focusing on the interaction itself as a unit of study, the symbolic interactionist creates a more active image of the human being and rejects the image of the passive, determined organism.
Individuals interact; societies are made up of interacting individuals. People are constantly undergoing change in interaction and society is changing through inter action. Interaction implies human beings acting in relation to each other, taking each other into account, acting, perceiving, interpreting, and acting again. Hence, a more dynamic and active human being emerges rather than an actor merely responding to others.
Key Emphases in Symbolic Interactionism
Woods (1983:15–16) summarizes key emphases of symbolic interaction thus:
- individuals as constructors of their own actions;
- the various components of the self and how they interact; the indications made to self, meanings attributed, interpretive mechanisms, definitions of the situation; in short, the world of subjective meanings, and the symbols by which they are produced and rep resented;
- the process of negotiation, by which meanings are continually being constructed;
- the social context in which they occur and whence they derive;
- by taking the ‘role of the other’—a dynamic concept involving the construction of how others wish to or might act in a certain circumstance, and how individuals themselves might act—individuals align their actions to those of others.
Why These Approaches Work Well in Healthcare Settings
Natural Fit for Clinical Environments
A characteristic common to the phenomenological, ethnomethodological and symbolic interactionist perspectives—and one which makes them singularly attractive to the would-be educational researcher—is the way they fit naturally to the kind of concentrated action found in classrooms and schools. Yet another shared characteristic is the manner in which they are able to preserve the integrity of the situation where they are employed. This is to say that the influence of the researcher in structuring, analyzing and interpreting the situation is present to a much smaller degree than would be the case with a more traditionally oriented research approach.
Critics have wasted little time in pointing out what they regard as weaknesses in these newer qualitative perspectives. They argue that while it is undeniable that our understanding of the actions of our fellow-beings necessarily requires knowledge of their intentions, this, surely, cannot be said to comprise the purpose of a social science.
Understanding the Limitations: Critical Perspectives
Common Criticisms of Interpretive Approaches
The Question of Objectivity
As Rex has observed: Whilst patterns of social reactions and institutions may be the product of the actors’ definitions of the situations there is also the possibility that those actors might be falsely conscious and that sociologists have an obligation to seek an objective perspective which is not necessarily that of any of the participating actors at all… We need not be confined purely and simply to that…social reality which is made available to us by participant ac tors themselves. (Rex, 1974)
Giddens similarly argues against the likely relativism of this paradigm: No specific person can possess detailed knowledge of anything more than the particular sector of society in which he participates, so that there still remains the task of making into an explicit and comprehensive body of knowledge that which is only known in a partial way by lay actors themselves. (Giddens, 1976).
Methodological Concerns
While these more recent perspectives have presented models of people that are more in keeping with common experience, their methodologies are by no means above reproof. Some argue that advocates of an anti-positivist stance have gone too far in abandoning scientific procedures of verification and in giving up hope of discovering useful generalizations about behavior (see Mead, 1934).
Are there not dangers, it is suggested, in rejecting the approach of physics in-favour of methods more akin to literature, biography and journalism? Some specific criticisms of the methodologies used are well directed: If the carefully controlled interviews used in social surveys are inaccurate, how about the uncontrolled interviews favored by the (newer perspectives)?
If sophisticated ethological studies of behavior are not good enough, are participant observation studies any better? (Argyle, 1978) And what of the insistence of the interpretive methodologies on the use of verbal accounts to get at the meaning of events, rules and intentions? Are there not dangers? Subjective reports are sometimes incomplete and they are sometimes misleading. (Bernstein, 1974).
The Structure vs. Agency Debate
Bernstein’s criticism is directed at the overriding concern of phenomenologists and ethno-methodologists with the meanings of situations and the ways in which these meanings are negotiated by the actors involved. What is overlooked about such negotiated meanings, observes Bernstein, is that they ‘presuppose a structure of meanings (and their history) wider than the area of negotiation. Situated activities presuppose a situation; they presuppose relationships between situations; they presuppose sets of situations’ (Bernstein, 1974).
Bernstein’s point is that the very process whereby one interprets and defines a situation is itself a product of the circumstances in which one is placed. One important factor in such circumstances that must be considered is the power of others to impose their own definitions of situations upon participants. Doctors’ consulting rooms and headteachers’ studies are locations in which inequalities in power are regularly imposed upon unequal participants.
The ability of certain individuals, groups, classes and authorities to persuade others to accept their definitions of situations demonstrates that while—as ethno-methodologists insist—social structure is a consequence of the ways in which we perceive social relations, it is clearly more than this. Conceiving of social structure as external to ourselves helps us take its self-evident effects upon our daily lives into our understanding of the social behavior going on about us.
Here is rehearsed the tension between agency and structure of social theorists (Layder, 1994); the danger of interactionist and interpretive approaches is their relative neglect of the power of external-structural—forces to shape behavior and events. There is a risk in interpretive approaches that they become hermetically sealed from the world outside the participants’ theatre of activity—they put artificial boundaries around subjects’ behavior.
Balancing Micro and Macro Perspectives
Just as positivistic theories can be criticized for their macro-sociological persuasion, so interpretive and qualitative can be criticized for their narrowly micro-sociological persuasion.
Conclusion
Qualitative nursing research explores the complexity of human experiences related to health and illness, providing valuable information for improving medical care and practice. It focuses on understanding the “what,” “how,” and “why” of experiences, rather than simply quantifying data. This approach complements quantitative research, allows for a deeper understanding of the patient’s perspective, and contributes to evidence-based practice.
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