This research employed a sequential mixed methodology approach in order to study the emerging perceptions of caring. Using a sequential paradigm provided a framework for comparing and analysing differences in caring perceptions between patients and health care professionals. To facilitate an ethnographic perspective of the phenomenon, there was a need to reconstitute mixed methodology from the everyday experiences of the individual subjects. It was the desire to understand the everyday lived experiences of the subjects in relation to care and caring which guided the implementation of mixed methodology and as such the process and data collection were implicitly blended in the everyday reality (LeCompte and Schensul, 2010).This thesis used the ethnographic research tradition which emerged from the field of anthropology mainly from the works of Bronislaw, Malinowski, Robert Park and Franz Boas (Jacob, 1987; Kirk and Miller, 1986).The meaning of ethnography is literally ‘a portrait of a people’ and is considered a written description of a given culture inclusive of beliefs, behaviours and customs collected through the process of fieldwork (Harris & Johnson, 2000).
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Described as a social sciences research method, ethnography is dependent upon close-up, personal experience and under certain conditions researcher participation as well as observation. In typical ethnographic research, data collection is usually threefold: interviews, observation and documentation. From these, three types of data is created: quotations, descriptions and document excerpts resulting in the production of narrative description (LeCompte and Schensul, 1999). Narrative description frequently includes charts, diagrams and other artefacts which are all used by the researcher to convey the story (Hammersley, 1991).
Ethnography lends itself well to exploratory research drawing upon a mixture of quantitative and qualitative methodologies and consequently moves fluently from ‘learning’ to ‘testing’ (Agar, 1996) together with emerging and changing research problems, perspectives and theories.
Through ethnographic study the researcher is able to gain insight into the everyday experiences of individuals by using interview and observation to obtain a holistic portrait of the subjects, revealing how people depict and organize their world (Fraenkel and Wallen, 2006). Ethnography has its earliest roots in social anthropology, with a traditional focus on small communities which were thought to share specific cultural beliefs and practices.
This traditional focus has now progressed to encompass new settings and indeed the development of theoretical perspectives eliminate theories about social coherence challenging the traditional view that “culture” is a matter of shared beliefs and practices. Signalling the existence of differences within social groups, with some social scientists argue that “culture” indicates a process of struggle to establish meaning on the part of the individuals who do not have equal access to power (Wright, 1998).
In the field of research today the majority of ethnographers would conclude that the term ethnography can be applied to any small scale social research study performed in everyday settings; employing several methods, the design develops throughout the study; with a focus on the meaning of the individuals’ actions and explanations, rather than their quantification (Hammersley, 2007).
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Furthermore, ethnography is viewed as contextual and reflexive, with the important emphasis placed upon the context in understanding events and meanings giving consideration to the effects of the researcher and the research strategy on findings and importantly combining the perspectives of both the researcher and the researched. Reflexivity a relatively contemporary addition to the philosophical matrix of qualitative research signifies the researcher's part in the social world that is being investigated. The subtle balance between the critical thinking of the researcher and the researcher’s interaction with the research environment is essential to the reflexive process (Lamb and Huttlinger, 1989). In ethnographic research being an active participant in the data collection and analysis is key (Aamodt, 1982) and therefore the professional nursing experience equipped the researcher with the ability to collect and analysis the data from a research and professional perspective. This insider vision of the phenomena being studied is an inductive process as data originates from observation, interviews and participant observation.
Through the development of descriptive themes and patterns derived from the informant’s perspective and the interpretation of data obtained from the real world of practice, the insider perspective can be exposed. Leininger (1988) views these approaches as necessary for the generation of nursing knowledge stating that using the informant’s perspective can help generate theory which can lead to more accurate and reliable findings.
One of the advantages of the researcher having extensive experience in the field of nursing meant that large volumes of descriptive data relating to the context of health care practice did not require collection and therefore more focus could be given to the data related to the aims of the study. Ethnographic research is open to bias and subjectivity, but this aside it allows a richer vein of data to be appraised. (Hammersley and Atkinson, 2007 p.16; Morse and Boyle, 1994).
In relation to health care, ethnography can be applied in a number of different ways. It has been viewed as a means of accessing beliefs and practices, allowing these to be analysed in the context in which they occur and so helping to understand the behaviour that surrounds health and illness (Morse and Boyle, 1994; Morse and Field, 1996). It is
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therefore of specific value in obtaining patients' views on the experience of illness or delivery of service, recognised as central to a modernised NHS. Ethnography can demonstrate how cultural practices can influence the effectiveness of therapeutic interventions (Prout, 1996) and how ethnocentric assumptions made by health care professionals can hinder effective health promotion (Galanti, 2000; Montgomery, 1993). Within the context of healthcare, ethnography is considered valuable for several reasons, in particular exploring the cultural perspectives of patients affected by illness and more interestingly cultures of health care workers.
Since ethnographic research is undertaken in natural surroundings and aims to discover the lived reality, ethnographers can spend long periods of time with a particular group of individuals (Leedy and Ormrod, 2012) As a result certain challenges may arise;
Observer bias: The researcher's own subjectivity may influence the objectivity of the data. In ethnographic research, the people being studied are described by the researcher through his/her own cultural thought system; the researcher uses his own terminology to report observations.
Impact of observer: The presence of the observer, and the interaction between the observer and the people being studied, may result in changes in the behaviour of the people being studied.
Manipulation by subjects: The people under observation, consciously or unconsciously, may display or act out certain behaviours in order to please the researcher, they may not perform naturally.
Ethics: Researchers are often faced with ethical issues during their research. They have to decide whether or not to interfere when encountering behaviour that they consider unethical.
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