Ethnography in Nursing Research

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Janice M. Roper & Jill Shapira

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  • Methods in Nursing Research

    SERIES EDITOR

    Pamela Brink, R.N., Ph.D.

    The purpose of the Methods in Nursing Research series is to provide basic references to designs, methods, and sampling procedures not readily available in other formats. Each book is designed to be a complete reference to any single topic.

    Books in This Series …

    Ethnography in Nursing Research

    Janice M. Roper

    Jill Shapira

    Forthcoming:

    Hermeneutic Phenomenological Research

    Marlene Z. Cohen

    Richard H. Steeves

    David L. Kahn

    Copyright

    View Copyright Page

    Series Editor's Foreword

    This is the first of a series of books on research methods in nursing. The purpose of the series is to provide basic references to designs, methods, and sampling procedures not readily available in other formats. The books are designed to be a complete reference to any single topic and can be used without further explanation or help from a tutor.

    This first text, Ethnography in Nursing Research, is an excellent example of what the series is expected to accomplish. Many educators and researchers have a very confused notion about ethnography, a research design developed by anthropologists for anthropologists. The design is based upon participant observation as the primary data collection method supported and enhanced by other data collection methods such as interviewing, available data, artifacts and so on. In fact, ethnography is the original “mixed method” and as such has the strength of longitudinal research and triangulation of methods.

    Some nurse researchers assume that they are doing an ethnography if they are using the interviewing style described by James E Spradley, when in fact they are using a single data collection method developed for a specific kind of ethnography. Others believe that if they are using a data analysis technique used by anthropologists, that they are doing ethnography. Neither of these beliefs are true, as this text shows.

    Janice Roper and Jill Shapira, both trained anthropologists, have produced an excellent work on doing ethnography in a hospital setting. Drawing on their combined considerable experience, they explain what an ethnography is and what it is not, how it has evolved in nursing, and how it is used by nurses in a hospital setting. The book can stand alone as a guide and a reference to ethnography as a research method. I believe you will find it a very useful, as well as highly readable, book.

    Pamela J.Brink, R.N., Ph.D.

    Preface

    This book is written for nurses who have little or no experience conducting ethnographic studies. We write this book from our own experiences as researchers and clinicians. Many of the examples provided are from our own background. JR is a researcher who has conducted qualitative research as an investigator in a large metropolitan medical center. Specifically, her qualitative work has encompassed an observation study in an admissions area, ethnographic analysis of the use of restraints and seclusion in an intensive care psychiatric unit, and use of combined ethnographic methods and quantitative methods in a study of agitated behaviors in Alzheimer's disease patients and the impact of these behaviors on caregivers (with JS). In addition, she teaches research to nursing staff at the medical center, with an emphasis on qualitative research methods. Last, she is currently a member of one of the human subjects subcommittees' institutional review boards (IRBs) in the center.

    The research experience of JS includes a longitudinal study of spouses acting as caregivers that focused on a qualitative analysis of open-ended interviews, an ethnographic study in the emergency room, coinvestigation with JR on the agitation study, and currently a focused ethnography on the phenomenon of agitation in one surgical intensive care unit as part of her doctoral study in anthropology, where she has recently been advanced to candidacy.

    Our research efforts have been developed from clinical questions that puzzled us. The projects focused on distinct problems, and we formulated research questions before conducting the studies. These research experiences were confined to medical center settings and were considered problems relevant to patient care and supported by nursing services. Finally, we both worked within our own nursing “culture” to gain insights into common occurrences and taken-for-granted everyday events.

    This book is about ethnographic methods, that style of research introduced to us by Dr. Pamela Brink. Ethnography is a process of learning about people by learning from them. The concept of ethnography developed within the tradition of anthropology, as lone anthropologists went into “the field” to study “exotic” people. Ethnographers use three methods to describe cultural entities and groups of people. By observing what is happening, participating in activities and then asking the “natives” about what is seen and what is being done (interviewing), and examining existing documents, the ethnographer gains a deep understanding of the practices and beliefs of the group.

    We assume that you have no or minimal experience with the methodology of ethnography. We also assume that you have had a beginning-level introduction to research, either through academic courses or by participating in the conduct of someone else's study. Thus, we have not defined usual research terms except as they apply to ethnographic research. We also assume that you will have a mentor or advisor to assist you with learning the conduct of the ethnographic methods and analysis of your ethnographic data. Ethnography is a methodology that requires experience. It cannot be learned adequately from books and journals.

    We believe that the concepts and descriptions of methods described in this book apply to research in all settings, whether in a familiar place with one's own cultural group or among a group of people with different beliefs and perspectives of the world. The book is meant to be read consecutively, but each chapter has enough detail to be read alone. Chapters 2, 6, 7, and 8 are about the actual conduct of ethnographic research, the analysis and interpretation of the data from your fieldwork, and ethical issues in ethnographic research. Chapters 3, 4, and 5 describe the processes related to putting your ideas into writing and gaining access to the “field.” So depending on your level of knowledge in relation to these broad subject areas, you might find it beneficial to read selected chapters according to your needs.

    The overview of ethnography presented in Chapter 1 includes a discussion of how traditional classical ethnographic concepts become more focused in many studies. In Chapter 2, we present an overview of ethnographic methods. (For more detail about the methods, the reader is referred to Chapter 6.) In Chapter 3, we outline important issues to consider and tasks to perform before writing the research proposal, including formulating an appropriate research question, negotiating with the potential field site, and deciding on the need for funding. Concrete suggestions for writing the research proposal and special considerations of ethnographic studies are discussed in Chapter 4. In Chapter 5, we delineate steps in obtaining formal institutional approval. We have placed in Chapter 6 a detailed description of how to collect information in ethnographic studies. Specific techniques of sampling people and events, observation, and interviewing informants are provided. General methods used to analyze participant observation data are included in Chapter 7. Chapter 8 discusses ethical considerations related to the role of being an ethnographer and the reflexivity associated with this research process. In Chapter 9, an annotated bibliography, we have abstracted information from ethnographic studies conducted by nurses. Many of these are also referenced in the text.

    We view ethnography as a very personal experience, one that requires time, commitment, and dedication. In this book, we have presented an overview of the ethnographic process and methods that we hope will help you. We wish you success in your endeavors to learn from others.

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    Author Index

    About the Authors

    Janice M. Roper, Ph.D., is currently Director of the Nursing Research Program at the Veterans Administration Greater Los Angeles Healthcare System (VAGLAHS). In this role, she provides consultation, supervision, mentoring, and the coordination of nursing research as well as the conduct of research. She is currently an Assistant Clinical Professor at UCLA. As part of her promotion of nursing research, she teaches classes on research and on qualitative methodology. Her research focuses primarily on nursing issues related to chronic illness, using both quantitative and qualitative methodologies. Her master's thesis and doctoral dissertation used qualitative methodologies. The latter was an ethnography on the use of physical restraints in a psychiatric inpatient setting. She received her doctorate in anthropology from the University of California (UCLA), her master's from UCLA, and her baccalaureate from California State University, Los Angeles. She has published in refereed journals and has presented her research findings at national conferences. She is a reviewer for the Western Journal of Nursing Research and is a board member and reviewer for the Journal of Transcultural Nursing.

    Jill Shapira, an adult nurse practitioner, has clinical practices at both the UCLA Alzheimer's Disease Center and the Veterans Administration Greater Los Angeles Healthcare System. She assists patients with dementia and their families to manage agitated behaviors and other projects and publications she utilizes a qualitative perspective when describing the impact of dementia on individuals. She is also Assistant Clinical Professor at the UCLA School of Nursing. She received her master's and baccalaureate degrees in nursing from UCLA, where she is currently completing fieldwork for a Ph.D. in medical anthropology. Her ethnography explores the world of nurses in one surgical intensive care unit as they interact with patients; how nurses move between and within their individual and nursing subcultures when caring for patients is the focus of study. Through these clinical and research activities she has learned to appreciate and privilege the experiences patients and study participants share with her.


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