Número de profesionales

Extended participant observation of the phenomenon forms a significant part of ethnographic methods and aims to help the researcher learn and expose the perspectives held by the study population (Spradley 1980). Evidence suggests participant observation advances understandings of the physical, social and cultural contexts of the participants within the study setting by observing and participating in the daily activities under investigation (Burden 1998; Manias and Street 2001; Hill 2003; Savage and Scott 2005; Dixon-Woods et al. 2012), in particular the study of Deitrick et al. (2012) in relation to rounding. Burden (1998); Hill (2003) and Savage and Scott (2005) have provided nursing research with high quality examples of ethnographic studies which utilised observation/participant observation as a method of first hand data collection.

The aim of participant observation is to understand the meaning of behaviour, language and interaction of a culture sharing group. Lowenberg (1993) promotes the interactive nature of participant observation and the value of their everyday accounts of the social situation, particularly the challenge of examining the often taken for granted assumptions of other participants.

Burden (1998 p18) defined her role as a ‘participant-as-observer’ gathering information from discussions with new mothers following her initial introduction to them as a midwife offering advice on antenatal care. Not all the ethnographic studies reviewed defined their degree of participant observation (Mannis and Street; Hill 2003; Savage and Scott 2005; Dixon-wood et al. 2012) however Spradley (1980) offers a range or types of participant observation which facilitate the collection of data. The study by Burden (1998) has a high degree of involvement allowing for active participation observation whereas an observer who has no involvement with their study subjects or activities is nonparticipant. To provide for complete participation observation means a high degree of involvement in the study setting, the researcher seeks to become integrated into the group and its activities (Robson 2011). This was not realistically manageable within the resources of my study. A low level of involvement in participant observation appeared a more attainable approach. Passive participation (Spradley 1980 p59) allows observation at the scene of the activity with a

105

limited degree of interaction. Passive participation enables close observation of the phenomena (participating on a round with a ward nurse) with some limited interaction within the study scene (limited patient interaction) and note taking.

The challenge of ethnographic data collection can be a feeling of being overwhelmed with the process of observation and recording (Spradley 1980). To overcome this Spradley (1980 p82) identifies nine major dimensions of social situation which are designed to guide participant observation, these are:

1. Space – physical place 2. Actors – people involved

3. Activities – related acts people do

4. Objects – physical things that are present 5. Acts – single actions people do

6. Events – related activities people carry out 7. Time – sequencing over time

8. Goal – thing people are trying to accomplish 9. Feelings – emotions felt and expressed

The nine dimensions create a framework for increased awareness crucial to the effective collection of rich field data and the basis for describing a culture (Spradley 1980). The framework provides the ability to focus on detail in a broad and complex social setting. Indeed, Burden (1998) found this particularly useful to collect data regarding curtain positioning strategies within the maternity ward environment to record a detailed picture of that particular social situation.

Informed by Spradley’s dimensional framework (1980) I generated a descriptive matrix (appendix 3) for rounding based on the concepts gleaned from the current literature and my own reflexivity with implementing and performing rounding in practice. Before adopting the matrix within the research the content and structure was peer reviewed and adapted, based on the critique by patients and staff to ensure the tool presented a grounded and comprehensive perspective (appendix 4).

106

To determine an appropriate length of time for participant observation I reviewed similar studies and identified wide variation (Burden 1998; Manias and Street 2001; Hill 2003; Savage and Scott 2005 Deitrick et al. 2012; Dixon-Woods et al. 2012). The time periods reflected the differing size of the studies (table 11). Dixon-Woods et al. (2012) was an extensive multicentre study generating the largest amount of participant observation time (855 hours in total) compared to Deitrick et al. (2012) a single centre study which generated 48 hours of observation, and used as a benchmark to inform the development of a realistic rounding study.

This ethnographic study observation was planned to take place over a four-week period, comparable size and length to Deitrick et al. (2012). Rounding would be observed at least forty times during the study period, generating approximately forty hours of rounding practice observation, which has previously generated rich data (Savage and Scott 2005; Deitrick et al. 2012).

Table 11: The time period of participant observation within nursing ethnographic studies

Study Length of Participant Observation

1 Burden (1998) 12 episodes over an extended time period, actual hours of observation not stated, Single site, 1 maternity ward 2 Manais and

Street (2001)

6 participating nurse, observed during the course of one shift on three occasions, total 18 episodes, Single site, 1 ICU 3 Hill (2003) 18 hours, Single site, 1 ICU

4 Savage and Scott (2005)

10 episodes, maximum of 4 hours per episode, maximum 40 hours, Single site, 1 medical ward

5 Deitrick et al. (2012)

48 hours of observation over a 4-week period, Single site, 2 surgical wards

6 Dixon-Woods et al. (2012)

855 hours approx. 48 hours per Intensive Care Unit, 17 sites, 17 ICUs

Data within ethnographic methods can be generated through ‘field notes’ (Hammersley and Atkinson 2007 p141) a simple technique ethnographer’s designed to record field note data is a ‘double entry notebook’ (Driscoll 2011 p153). The double entry notebook assists the observer recording what is actually occurring from what is their interpretation of those facts (Driscoll 2011). Raw or ‘concrete’ data what the observer saw is separated from what the

107

observer thought or interpreted, subjective observation to ensure specific detail is recorded (Spradley 1980 p68). Therefore, I developed a specific field note record based on separating the concrete observation from the interpretive observation (Appendix 5).