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Participant observation has been the principal data collection method in ethnographic studies (Baillie 1995, Simmons 2007). Spradley (1980 p. 54) describes it has having two purposes; for the researcher to engage in appropriate activities within the field; and to observe the people, their behaviours, and the physical characteristics of the field.

Participant observation can be overt or covert. Explicit covert observation methods, where the research subjects have no knowledge of the

surveillance and therefore have not consented, may be considered a violation of a person’s autonomy and could be deemed unethical in many situations. However Baillie (1995) suggests it is not always possible to conduct participant observation overtly. Ethnographic researchers do not always have control over who comes into the setting, and it may be unrealistic even to aspire to the written consent of all those who enter the field (Murphy & Dingwall 2010 p. 342).

The levels of observation described in ethnographical research are participant only, participant-as-observer, observer-as-participant, and observer only (Gold 1958). These are said to be a continuum with

participant only at one end (the most involvement in the research setting), and observer only (the least involvement) at the other. Most studies will have researchers moving from one point to another along this line during the data collection, though Roper and Shapira (2000 p. 21) state most

ethnography is undertaken with the researcher as participant-as-observer or observer-as-participant.

Ethnographers assert field notes should also include observations of the physical environment, and researchers should also take note of the lighting in the setting, the colours seen, the smell of the environment, the

temperature and the weather, the background sounds and activities, and the non verbal clues of the participants rather than rely solely on people and conversations (Baillie 1995, Spradley 1980 p. 78).

As participant-as-observer, the nurse researcher should move between that of nurse and that of observer seamlessly (Roper & Shapira 2000 p. 21). Kite (1999) however writes that as a relative insider to the research environment she found it impossible to perform research as a participant-as-observer. Though she thought at the beginning of the research process she was achieving this role, she discovered through reflexivity she was a ‘peripheral observer’. This may be because of her strong personality which comes across even in the article, but it could be other nurse researchers have experienced this problem, but perhaps not reflected on it with such insight.

Bailey (2007) describes a struggle to see where her role as a nurse ends and her role as a researcher begins.

A participant-as-observer will be expected to play an active part in the clinical environment, and yet continue to observe the setting. A lack of recent

clinical experience in the area may make some nurse researchers anxious undertaking the participant role (Bailey 2007), and the observer/researcher role may be more difficult for clinical staff to warm to. Researchers may be treated with suspicion or assigned a ‘senior’ role (Simmons 2007). A

learning and comfort gradient has been described as the observational study goes from beginning to end, but the stress of being both participant and observer, with differing degrees of emotional involvement and required detachment, may leave the researcher continuously under pressure (Gerrish 1997).

Observation in an ethnography, whatever degree of participation is required, is demanding, and loss of concentration can mean loss of data (Briggs 2003). Researchers have used different strategies to overcome this. Briggs (2003) used non-participant observation periods of four hours to investigate pain management interactions in postoperative patients. Non participant observation of four hours was used again as part of a study examining ‘caring for’ behaviours in ward environments (Henderson et al. 2007).

Participant observation was used to examine children’s pain, with

observation periods lasting from two to eight hours (Woodgate & Kristjanson 1996). Brown and McCormack (2006) however, did around the clock

used for postoperative patients. A study to investigate the barriers to effective pain management undertook observation on five complete shifts, covering both day, evening and night shifts, however there is no mention in the published report regarding breaks (Dihle et al. 2006) and to maintain

concentration for an entire shift seems difficult. Two-hour periods of observation at six fixed times were used to assess pain management strategies in Australia (Manias 2003b, Manias et al. 2004b, 2005).

4.8.1.1 Observations in this study

For this study it was considered likely to be through a combination of the participant-as-observer and observer-as-participant roles, a continual assessment of which role best suited any given situation, with informal

conversations to clarify questions which arise, would be the most appropriate data collection route. There were 157 hours of observations, from December 2008 to August 2009. This covered every day of the week, and all hours of the day from 0700 to 2200. Observation sessions ranged from 2 to 4 hours, depending on what sort of activity was being observed. For example a drug round may be observed in the morning lasting up to 2.5 hours, while in the afternoon observations might occur with the nurse in charge for around 3 hours. Breaks were had either with the observed staff member, or alone, at the end of the activity. Break times were a good occasion to reflect on the field notes, completing details which were not able to be written down in entirety during the observation.

The observations begun with me working as a full participant in a Health Care Assistant role. A white tunic was worn, suitable for clinical work, though not the uniform of any of the ward staff. Working as participant-only can limit the interaction with the field, however it is a way of becoming known and credible in a professional field (Simmons 2007). After a few shifts this role changed to being assigned at handover to one of the registered nurses to observe the drug round. This became an important opportunity for data collection, as it is a rich source of potential pain management interaction.

After about five months of observations (94 hours), it became obvious little non participant observation was occurring as the research appeared fixed in participant mode. I had been fully accepted by the staff on Newcastle Ward, and was frequently given patient and ward duties to do, which while

maintaining an insider place in the ward team, limited observations.

Reflecting on this, and following a discussions with my supervisors and the ward staff, I began wearing smart office clothes instead of the uniform tunic. Wearing smart office clothes ensured a distance from the clinical work could be maintained, and while still able to assist with small tasks, I was no longer expected to play an active part in the ward setting.

Typically I would be assigned or would attach myself to a staff member to observe for a period of time. This might typically involve a task such as a drug round or a medication round, or observing the ‘sister in charge’ as the ward co-ordinator. On occasion observations would take place in a single position in the ward, (a bay, the nurses’ station, the clinical room).

The literature regarding observations has been reviewed and how

observations were used in this study has been presented. Observations are part of the data collected in field notes. How field notes are used in

ethnography, and in this study, are presented in the next section.