Journal of Nursing Education

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EDUCATIONAL INNOVATIONS 

Sparking Students' Interest in the Clinical Relevance of Qualitative Research

Eileen J Porter, PhD, RN

Abstract

In teaching qualitative research methods to students in clinical disciplines, faculty face many interesting challenges. Typically, these challenges have been specified in relation to methodological steps or activities. For instance, Hutchinson and Webb (1991) addressed these three sets of problems: (a) "teaching students to gather data and begin analysis," (b) "helping students to make sense of the information they have gathered," and (c) "helping students present their findings in a clear and logical manner" (p. 302). However, before initiating teaching strategies to achieve these goals, there is another, more fundamental issue to which instructors of qualitative research must attend.

This basic challenge to teachers of qualitative methods is that of sparking the interest of students who know very little about qualitative research or its potential clinical applicability. Before graduate students in nursing are encouraged to learn specific qualitative research techniques, they need to come to value the relevance of qualitative research to their discipline. If students can see clinical utility in the outcomes of qualitative studies, they are more likely to earnestly and thoughtfully engage in learning how to gather qualitative data, make sense of data, and present findings clearly.

To engender understanding of the clinical relevance of qualitative research, instructors can adopt various approaches, including asking students to read qualitative studies in their own areas of clinical specialization. My strategy is purely practical in origin; I have found it successful to trade upon nurses' tendency to identify with other nurses. With Thorne (1991), I believe it is important to "validate . . . the inherent clinical orientation" (p. 195) of the qualitative researcher.

So, before I aim to teach about qualitative research approaches, I set the stage for students to identify with me as a nurse and to identify with nurses with whom I have discussed the results of my descriptive phenomenological research with older widows. To students, I explain how my clinical background prompted me to value a particular qualitative method, and I share what other nurses have told me about the clinical relevance of my phenomenological studies. When I tell students this story, I hook a metaphor to it. I explain that being a descriptive phenomenological researcher is like being a heliograph: "A device for sending messages or signaling by flashing the sun's rays from a mirror" (Neufeldt, 1997). In this essay, I discuss how I invoke the heliograph metaphor to stimulate students' interest in qualitative methods.

AN OVERVIEW OF THE TEACHING STRATEGY

I begin by explaining to students why I chose a particular qualitative method to study a particular clinical population, and I discuss my first study with that group. I decided to study older widows' experience of living alone because such women had been characterized primarily in the literature by Activities of Daily Living (ADL) scores, for instance (Porter, 1995). As a nurse, I believed that their unique messages about living alone had been stifled. Inspired by Husserl's (1913/1962) descriptive phenomenology (Porter, 1998), I undertook such a study of older widows' experience of living alone at home (project approved by the IRB, University of Wisconsin). In a series of intensive interviews with seven widows, I noted that none of them mentioned their ADL scores. The signals to which I attended were structures of their experience, which they considered real features of their lives. These structures, or phenomena of living alone at home, include "making aloneness acceptable," "reducing my risks," and "sustaining myself" (Porter, 1994).

Having explained to the students my rationale for doing phenomenological work with older widows and my results, I discuss why I elected to share those results with gerontological nurses during one-on-one…

In teaching qualitative research methods to students in clinical disciplines, faculty face many interesting challenges. Typically, these challenges have been specified in relation to methodological steps or activities. For instance, Hutchinson and Webb (1991) addressed these three sets of problems: (a) "teaching students to gather data and begin analysis," (b) "helping students to make sense of the information they have gathered," and (c) "helping students present their findings in a clear and logical manner" (p. 302). However, before initiating teaching strategies to achieve these goals, there is another, more fundamental issue to which instructors of qualitative research must attend.

This basic challenge to teachers of qualitative methods is that of sparking the interest of students who know very little about qualitative research or its potential clinical applicability. Before graduate students in nursing are encouraged to learn specific qualitative research techniques, they need to come to value the relevance of qualitative research to their discipline. If students can see clinical utility in the outcomes of qualitative studies, they are more likely to earnestly and thoughtfully engage in learning how to gather qualitative data, make sense of data, and present findings clearly.

To engender understanding of the clinical relevance of qualitative research, instructors can adopt various approaches, including asking students to read qualitative studies in their own areas of clinical specialization. My strategy is purely practical in origin; I have found it successful to trade upon nurses' tendency to identify with other nurses. With Thorne (1991), I believe it is important to "validate . . . the inherent clinical orientation" (p. 195) of the qualitative researcher.

So, before I aim to teach about qualitative research approaches, I set the stage for students to identify with me as a nurse and to identify with nurses with whom I have discussed the results of my descriptive phenomenological research with older widows. To students, I explain how my clinical background prompted me to value a particular qualitative method, and I share what other nurses have told me about the clinical relevance of my phenomenological studies. When I tell students this story, I hook a metaphor to it. I explain that being a descriptive phenomenological researcher is like being a heliograph: "A device for sending messages or signaling by flashing the sun's rays from a mirror" (Neufeldt, 1997). In this essay, I discuss how I invoke the heliograph metaphor to stimulate students' interest in qualitative methods.

AN OVERVIEW OF THE TEACHING STRATEGY

I begin by explaining to students why I chose a particular qualitative method to study a particular clinical population, and I discuss my first study with that group. I decided to study older widows' experience of living alone because such women had been characterized primarily in the literature by Activities of Daily Living (ADL) scores, for instance (Porter, 1995). As a nurse, I believed that their unique messages about living alone had been stifled. Inspired by Husserl's (1913/1962) descriptive phenomenology (Porter, 1998), I undertook such a study of older widows' experience of living alone at home (project approved by the IRB, University of Wisconsin). In a series of intensive interviews with seven widows, I noted that none of them mentioned their ADL scores. The signals to which I attended were structures of their experience, which they considered real features of their lives. These structures, or phenomena of living alone at home, include "making aloneness acceptable," "reducing my risks," and "sustaining myself" (Porter, 1994).

Having explained to the students my rationale for doing phenomenological work with older widows and my results, I discuss why I elected to share those results with gerontological nurses during one-on-one interviews. Although most researchers state clinical implications of findings as recommendations for nursing intervention, I believed that this rather prescriptive approach was inconsistent with Husserl's (1913/1962) assertions that each person "enjoys different appearances of the things" (p. 95) and that results of phenomenological study convey unique meanings to individuals. Upon that philosophical basis, I concluded that each nurse could derive unique clinical implications from the phenomena of living alone at home.

Accordingly, I undertook a phenomenological study with three community-based gerontological nurses, each of whom had practiced at least 10 years. I conducted individual, tape-recorded interviews about the phenomena of the experience of living alone. I asked each nurse to comment on each phenomenon and to share any apparent, pertinent "clinical implications," defining the term as "ideas, suggested by the findings of nursing research, that may be used to inform or guide nursing practice with specific persons." Through analysis of transcripts of my interviews with the nurses, I intuited two major structures of their experience of our dialogue: "discovering that it hits home" and "spanning the distance." Several weeks after the interviews, I sent each nurse a letter describing these structures, asking her to review it prior to a particular date. Thereafter, I telephoned to discuss the consistency between the structures and the nurse's experiences of our dialogue; all agreed that these phenomena captured their experience.

Finally, I explain to students that by initiating dialogue with the three clinicians about the phenomena of living alone at home, I acted as a heliograph- sending the older widows' messages about their experience to other nurses. To illustrate that point, I describe the two phenomena that structured the nurses' experience of dialogue with me. In the next section of this essay, I review the examples I share with students about the structures of the nurses' experience.

THE NURSES' EXPERIENCE OF DIALOGUE

Discovering that it hits home. To point out the clinical relevance of phenomenological research, I share with students the nature of the nurses' experience of our dialogue. For instance, the nurses noted consistencies between their own understanding of older widows and the phenomena of living alone. As one nurse said, "Wow, this is really just real understandable. It hits home. It's not so philosophical that you can't see the real meaning behind it." Through the phenomena of living alone, the nurses were reminded of older widows with whom they had worked. Of the fact that I had used the older widows' exact words to illustrate the phenomena, one nurse said, "I think that makes it seem more real, that these are real people we are talking about . . . like this is really true and this is what people are saying." In several cases, the nurses gave examples of the phenomena before I could do so. I had been talking with one nurse about "reducing my risks" (Porter, 1994), explaining that one of its components was "negotiating reliance," when she said, "Yes, you see that people will save things to take down to the basement and when someone comes they will ask them to do it." Her example was remarkably identical to the story I was prepared to relate to her, about an older widow, who took advantage of the opportunity to receive help from a son-in-law. "Bobby will come to the door, and FIl say, *Bob, how did you know I was waiting for you? Can you run this [to the basement]?"

I share with the students other evidence that for the nurses, the phenomena of living alone "hit home." Although they had observed examples of the phenomena as they had worked with older widows, the nurses previously had no names for their observations. After I described the phenomenon of "monitoring my performance," in which the widows appraised their success in fulfilling the responsibilities of living at home alone, one nurse said, "I thought that task monitoring was really interesting. I've come across it. I know what you are talking about but I never picked up on it before." She proceeded to give a meaningful example of task monitoring from her own practice: having monitored her driving performance, one older widow had concluded that she should no longer drive.

Spanning the distance. Again, to emphasize the clinical utility of descriptive phenomenology, I tell students that the nurses highlighted similarities between my experience as a researcher with older widows and their experiences as nurses with older widows. About my role as a researcher, one nurse said, "You were not just somebody on the outside looking in." Indeed, the nurses were "finding that she came across what I have come across." On occasion, the muses asked me, "Did you come across X?" When I mentioned the phenomenon of reducing the risk of falling by relying on structural features of the home such as walls and furniture, one nurse asked, "Did you find that this was a deliberate, planned thing that they knew that they were going to grab on to this corner of the couch and then the doorknob?" She, too, had found that older women had "place[d] furniture where it could be grabbed ... in lieu of a cane or a walker." In several cases, the nurses adopted the terminology of the phenomena of living alone, such as "negotiating reliance," as they described some of their own experiences with older widows.

The nurses' clinical implications. Finally, I explain to the students that from the phenomena older widows' experience of living alone at home, each nurse derived unique clinical implications. Husserl's (1913/1962) perspective on the uniqueness of each person's understanding was underscored by one of the nurses who commented about the phenomena of living alone at home. She said, "This everybody can interpret in their own way." Indeed, the implications they created were clearly linked to their own particular practice of nursing. One nurse said, "[Because of this conversation], I think [I have] more of an awareness of what you find in these women. This is kind of how it is. I think they are all kind of dealing with these [issues]. I think [we should] be sure that we are presenting or touching on all of these areas. Not just limiting ourselves to . . . Sure, I have my outline for hygiene, bathing, shopping, and safety. But there's just different areas in here [outline of the phenomena]. [It's] more complete."

As one nurse said of the phenomena of living alone, "We have to realize that these are the priorities of the person." Another nurse said, "If you came out with these things as being the four big things for a person to stay alone in their own home, and I think you've got a lot here, then, I would just use this . . . and by evaluating, looking, and listening, [I would determine], how much of this do they already have? What is the foundation? How much can I build on? How much can I encourage? I think what I would do is use this as a guide for however we can help them."

CONCLUSION

Enabling students to identify with a novice researcher. To conclude this discussion with students about the value of clinician-researcher dialogue, I always share a particularly meaningful comment about the phenomena of living alone at home. The comment was made by a nurse who had been a clinical preceptor for my undergraduate nursing students. She said that she was "really surprised" when she first looked at the list of phenomena. "I know that you have a tendency to use bigger words, [but this is not like] real research and big terms. And you know, for a lot of people, the things that are more basic . . . hit home ... I have a hard time with big words . . . like 'phenomena' . . . And there's other nurses out there like me. So, this is just real concrete, concise and down to just being where it's at and what it is." In this remark, I tell students, I continue to find evidence that I had successfully conveyed to other nurses the widows' messages about living alone.

Well after I had finished my interviews with the nurses about the older widows, I realized that one phenomenon of their experience of our dialogue, "spanning the distance," was contingent on the other phenomenon, "discovering that it hits home." I realized that the nurses could span the distance between their nursing and my research experience because they had discovered that the older widows' data hit home- that the phenomena made sense. Likewise, I believe that students need to discover that the results of qualitative work "hit home" before they can bridge the gap between their potentially discrepant understanding of qualitative research and "what research is supposed to be." Helping students to span this distance, by sparking their interest in the clinical relevance of qualitative research, is the initial challenge faced by those of us who would teach them to inquire.

REFERENCES

  • Husserl, E. (1962). Ideas: General introduction to pure phenomenology (W.R.B. Gibson, Trans.). New York: Macmillan. (Original work published 1913)
  • Hutchinson, S.A, & Webb, R.B. (1991). Teaching qualitative research: Potential problems and possible solutions. In J.M. Morse (Ed.), Qualitative nursing research: A contemporary dialogue (rev. ed) (pp. 301-321). Newbury Park, CA Sage.
  • Neufeldt, V. (Ed.). (1997). Webster's new world college dictionary. New York: Macmillan.
  • Porter, E.J. (1994). Older widows' experience of living alone at home. Image: Journal of Nursing Scholarship, 26, 19-24.
  • Porter, E.J. (1995). A phenomenological alternative to the "ADL Research Tradition." Journal of Aging and Health, 7, 24-45.
  • Porter, E.J. (1998). On "being inspired" by Husserl's phenomenology: Reflections on Omerya exposition of phenomenology as a method for nursing research. Advances in Nursing Science, 21(1), 19-28.
  • Thorne, S.E. (1991). Methodological orthodoxy in qualitative nursing research: Analysis of the issues. Qualitative Health Research, 1, 178-199.

10.3928/0148-4834-20001101-11

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