Caroline French – PhD Student
Queen Mary University of London
My nursing career has taken me from a staff nurse role to an aspiring qualitative nurse researcher. Now, doing my PhD, I often come across qualitative research papers which make me think ‘this could have really helped me care for that patient’. This has led me to reflect on how my understanding of qualitative research and its value has developed, and to lament that so much important qualitative research is probably lost to the very nurses who could use it to the greatest benefit.
I am troubled because qualitative research may be confusing to clinical nurses due to the off-putting language and concepts in which it is usually wrapped. I remember how frustrated and alienated I felt by many of the philosophical and methodological debates at a nursing research conference several years ago. Although I was interested, enthusiastic, and had some basic knowledge, I found a lot of the discussions impossible to grasp, and ended up leaving disillusioned with the whole endeavour of qualitative research.
It has also taken me a long time to understand how qualitative findings can be used in practice, which, as a nurse, I feel is important. I have found a lot of qualitative research frustrating as it seems to provide rich descriptions of things which seem obvious, but about which seemingly ‘little is known’. For example, I saw a presentation of an ethnography of nurses’ night work. I found it fascinating as it completely resonated with my experience as a nurse. However, I found myself questioning why it needed lengthy and potentially expensive qualitative research to describe something that nurses do indeed already know. Nonetheless, I also found it frustrating when such ‘obvious’ qualitative findings were then obscured in unfamiliar sociological theories. I found the idea of having lots of data, and then spending months ‘working’ on different concepts and theories completely alien to my understanding of research. I felt the focus on which concepts and theories to apply, rather than how their research would inform or improve practice – seemed like research for the sake of academia. Again, I could see no useful application to practice.
Nonetheless, somewhat ironically, I have since found it very challenging to articulate the potential applications of my own qualitative research. I was asked for ‘key messages’, and did not feel confident to give any. I felt that my recommendations were a further layer of analysis – I had analysed data to get findings, and now I was analysing findings to draw recommendations. I was concerned that these were my perceptions, and that they could be wrong. I also found that as I disseminated my research, my own understanding and interpretation of the data, findings, and subsequently the recommendations, evolved. I also found people took their own meaning from my findings and their use to their own practice. This made me doubt the legitimacy and accuracy of my research.
Only now, a few years on, from a mixture of studying, doing, opportunistic learning, conversations, and ‘aha’ moments – along with interest and motivation – do I feel that I have a decent understanding of qualitative research and why it is useful. I understand why ontology and epistemology are important, and can understand and contribute to academic debates. I understand that seemingly obvious findings may not be obvious to others, and that using qualitative research to highlight them may benefit those who are disadvantaged. I understand that theory is important to enable us to describe and explain phenomena using a common language, and is a starting point for developing interventions for clinical practice, in the same way basic science in the laboratory contributes to physiological theories underpinning drugs. I understand how the same piece of qualitative research might contribute differently to people’s own understanding in the context of own experiences, and feel comfortable with such pragmatic use of knowledge.
However, for the vast majority of nurses who have not studied and thought about qualitative research as I have done, valuable qualitative research may be lost. I have heard anecdotes about nurses at qualitative research presentations being much more interested in hearing patients’ own voices, such as through direct quotes or video stories, than in the surrounding methods and analysis. A researcher colleague undertaking a qualitative analysis of online patient support forums reflected how just reading the raw data made her change her clinical practice. So, despite my understanding of and appreciation for qualitative research, I often wonder whether simply giving nurses time to collect and reflect on some ‘raw qualitative data’ would have a greater impact on practice?