Ethnography: Principles, Practice and Potential: Nursing Standard May 2015
Ethnography: Principles, Practice and Potential: Nursing Standard May 2015
Ethnography: Principles, Practice and Potential: Nursing Standard May 2015
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BOX 1
Examples of ethnographic studies in nursing and health care
The Social Meaning of Surgery (Fox 1992) participant observation and focus groups were used to
Observational and interview data were collected explore the nature of stress in paediatric intensive care
over an 18-month period in the operating theatres nurses in one hospital in Nova Scotia, Canada.
of an English general hospital to undertake an Conducting critical ethnography in long-term
in-depth description of practice, power and status in residential care: experiences of a novice researcher in
surgical practice. the field (Baumbusch 2011) An account of experiences
Rethinking ethnography: reconstructing nursing as a novice researcher undertaking ethnographic
relationships (Manias and Street 2001) This discusses research (using participant observation, in-depth
some of the methodological challenges encountered interviews, documentary analysis and quantitative
during a critical ethnography of nurse-nurse and data) to explore the organisation of long-term
nurse-doctor interactions in a critical care setting in residential care in British Columbia, Canada.
Victoria, Australia, including researcher-participant An ethnographic study of main events during
subjectivity, reflexivity and ‘truth’. hospitalisation: perceptions of nurses and patients
Evidence based guidelines or collectively constructed (Coughlin 2012) Participant observation and
‘mindlines’? Ethnographic study of knowledge unstructured interviews were used to explore
management in primary care (Gabbay and le May patients’ and nurses’ perceptions of the care provided
2004) Non-participant observation, semi-structured in a large teaching hospital in the United States.
interviews and documentary review were used to An ethnographic study exploring the role of
explore how GPs and practice nurses derive their ward-based advanced nurse practitioners in an acute
individual and collective healthcare decisions. medical setting (Williamson et al 2012) Participant
Using participant observation to immerse observation and interviews with five ward-based
oneself in the field. The relevance and importance advanced nurse practitioners (ANPs) in a large
of ethnography for illuminating the role of emotions teaching hospital in England was undertaken to
in nursing practice (Allan 2006) Using participant explore the role of the ANPs and their effect on
observation, informal conversations with staff and patient care and nursing practice.
patients and semi-structured interviews in a fertility Turning over patient turnover: an ethnographic study
clinic, this study explored the nursing role in infertility of admissions, discharges and transfers (Jennings et
nursing in the context of theories of caring and al 2013) Field work (lengthy participant observation,
emotion. It also explored the use of ethnography in interviews and document review) was undertaken in
illuminating the role of emotions. two medical and surgical units in the US to explore
An institutional ethnography of nurses’ stress turbulence and change and, in particular, patient
(McGibbon et al 2010) In-depth interviews, turnover, admissions, discharges and transfers.
for a range of interpretations. In returning to the shapes the individual can be understood as the
example of dementia support for families, if we are individual-cultural dialectic (Draper 2000).
not able to step back and take time to understand Returning to the earlier topic of dementia,
families’ attitudes to dementia and how these the emic perspective will include the individual’s
might influence their ongoing relationships with a attitudes towards dementia, informed by their
loved one, we risk devising support strategies that previous experience of knowing someone with
are misunderstood and therefore misdirected. dementia and how this now influences their
interaction with a loved one with the condition.
Investigating culture The etic perspective is the way in which society
Culture is not a fixed entity or finite concrete thing; demonstrates its values towards people with
rather, it is the medium or context within which we dementia, how it portrays them in the media and
engage in the complexities of everyday life. It is much the decisions it makes about resource allocation
more than race or ethnicity and includes language, for their health and social care. Our individual
behaviours, relationships, art, music, cuisine: experiences of dementia will be shaped by
the collectively valued ways in which we live. It both prevailing attitudes in society but, in turn,
shapes and is shaped by our individual actions and perhaps through campaigning for more effective
behaviour. Ethnography seeks to understand this person-centred approaches, this emic perspective
culture through a process of ‘thick’ (Geertz 1973) can influence societal changes and ultimately
or rich description – that is, detailed description of reshape the collective (etic) perspective.
the ins and outs of everyday life (Draper 2004).
Thus, ethnography is about studying people’s Role of the researcher
lives in the everyday contexts in which they live A key principle associated with ethnography
(Hammersley and Atkinson 2007). It describes is its focus on the influence of the researcher.
people in their cultural context and attempts to Assumptions about the nature of knowledge
understand how that culture is made up, how people inform how knowledge is described, explained
interact with it, the relationship between the or generated. Research methods associated
individual and the societal and, in the context of with positivism, randomised controlled trials
health and illness, how these come to be culturally for example, pursue the goal of ‘objectivity’
defined and understood. In essence, ethnography is and attempt to eliminate sources of ‘bias’,
concerned with ‘learning about people by learning one example of which is the influence of the
from people’ (Cruz and Higginbottom 2013). researcher. The aim is to ‘decontaminate’
In describing culture, ethnography is concerned or ‘bracket’ the influence of the researcher to
with taken-for-granted things, things that are render the research scientific and objective.
so ingrained and ‘automatic’ that we perhaps However, bracketing the influence of the
fail to realise their impact on our individual and researcher in this way is impossible, because
societal or collective experience. Thus, one of the investigation of the world can never be devoid
purposes of ethnography is to make the familiar of the influence of the investigator. All research
strange. An illustration might be Coughlin’s approaches, from initial ideas through to decisions
(2012) work on how events that we might take for about design, method and analysis, bear the
granted as nurses have significant impact on the influence of the researcher (Draper 2000). In other
experiences of our patients (Box 1). words, the position of the researcher is never
An important feature of ethnography is the neutral. Ethnography makes the influence of the
interplay between the individual (or emic) and the researcher explicit, rather than trying to erase it
societal (or etic), and how the two both inform and (Cruz and Higginbottom 2013).
are informed by each other. The emic perspective Recognition of the researcher’s influence is
refers to the insider’s point of view: the reality achieved through the researcher acknowledging
seen, experienced, understood and expressed by the ways in which their particular cultural beliefs,
the individual. It is an explanation of events from attitudes and assumptions shape their approach
the individual’s point of view. The etic perspective to the design, execution and interpretation of the
relates to the larger collective or societal picture. research. It acknowledges that the researcher, as a
However, these two perspectives are not principal instrument of data collection (McGarry
mutually exclusive. Individual performance and 2007), has as much a role in the research as the
understanding is informed by collective cultural participants being studied.
understandings and, in turn, individual and private Reflexivity is therefore considered to be central
experience can contribute to collective meanings to the ethnographic endeavour; ethnographers
of cultural practice. The way in which the ‘recognise that they are unable to put their own
individual shapes the collective and the collective knowledge of the social world to one side in
All such approaches to data collection are biographies and influence on the interpretive process
designed to explore both emic and etic dimensions – is a key feature of ethnographic writing, which is
– that is, the individual and collective experiences, often characterised by writing in the first person.
and the relationship between them. Ethnographic writing can therefore be described
as ‘messy writing’, but it should provide as rich an
Anna conducts interviews In addition to observing account as possible, including making ‘the writer a
how care is organised on the wards, Anna part of the writing project’ (Denzin 1997).
conducts semi-structured interviews with some
patients, carers and staff to try and uncover their Anna writes her report Anna’s research report
attitudes towards dementia and their views about is written predominantly in the first person,
the organisation of care. This helps her in her to signify her influencing role as the researcher.
analysis of the culture of care on the two wards. She also includes an autobiographical section
where she describes her role as a dementia
Operationalising reflexivity specialist nurse and makes explicit the
Reflexivity, the researcher’s acknowledgement of assumptions, values and beliefs she holds about
how he or she shapes and influences the research, dementia. In addition to including descriptions
can be exercised in a number of different ways. of her observations and interview quotations
First, researchers can explicitly describe their own from participants, she also occasionally makes
historical and cultural contexts and how these have reference to entries in her research diary.
influenced or shaped the research by writing this
into the research report (or ethnography). Second,
research diaries can be used to capture reflexive Potential
thoughts and observations in an attempt to achieve As we have seen, ethnography can be used to
a critical distance. Entries made in research diaries investigate and illuminate the complexities of
can be subsequently incorporated into the final the social world. It can help us understand both
written ethnography and are often considered individual and collective experiences and is
legitimate data in themselves. Third, because therefore highly appropriate for use in nursing
ethnography is not only a process but also a product and healthcare practices. It can be used by a
(the ethnography), reflexivity is an important aspect range of stakeholder groups to explore a wide
of the way in which the ethnography is written. variety of issues, including the experiences and
The reflexive ethnographer is concerned with management of care, professional identities, power
the ethnographic text and the extent to which it relations and education. However, relatively little
‘represents the reality of the participants’ (Manias ethnographic research is done by nurses in their
and Street 2001), and how the ‘researcher self’ own settings (Cudmore and Sondermeyer 2007).
is part of this. Writing the self in the ethnography McGarry (2007) argues that more research needs
– acknowledging our histories, assumptions, to take place where nursing happens. Ethnography
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