Qualitative descriptive designs draw from tenets of Naturalistic Inquiry which is embedded in the constructivist paradigm (Lincolin & Guba, 1989). Constructivism, as understood through the work of Egon Guba and Yvonne Lincolin (Lincolin & Guba 1985; 1989; Guba 1990) aims to carry out research in natural settings seeking to examine and understand the variety of constructions that people have within their social world. The inquiry aim of understanding and reconstruction (Denzin & Lincolin, 2000) fit with the research aim. This chapter will outline the underpinning assumptions of Naturalistic Inquiry and the Qualitative descriptive methodology framework. A description of the research methods and processes follows.
Theoretical perspective – Constructivism and naturalistic inquiry
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Paradigm is a term that has generated confusion in the literature (Weaver & Olson 2006; Guba, 1990) therefore it is helpful to consider what is meant by the term paradigm at the outset. Guba defines paradigm as a “basic set of beliefs that guides action, whether of the everyday garden variety or action taken in connection with disciplined enquiry” (1990, p.17). The paradigm provides a framework for the researcher and assists with making order out of chaos (Giddings & Grant, 2002). It specifies and permeates every act associated with the inquiry to the degree “such that any consideration even remotely attached to the inquiry process demands rethinking to bring decision into line with the worldview embodied in the paradigm itself” (Lincolin in Guba, the paradigm dialogue, 1990, p.81)
In considering the qualitative paradigm Munhall describes philosophical underpinnings for qualitative research methods as reflecting “beliefs, values and assumptions about the nature of human beings, the nature of the environment and the interaction between the two (2007, p.99). Broadly speaking qualitative research approaches are described as inductive compared to deductive quantitative paradigms, involving the use of different methods of discovering and different ways of reporting the truth of these discoveries (Munhall, 2007). Lincolin and Guba (1985) proposed naturalistic inquiry as an alternative constructivist methodology to challenge the analytical/empiricist thought of the positivistic paradigm. According to Guba because the evolution of human beings involves capacity for interpretation and ability to construct reality study of the human world should be conducted differently to that of the natural or physical world (1990). So in that case human perception cannot be deemed conclusively ‘real’ it is ‘made up’ and shaped by the individual’s interaction with society and culture in the minds of the constructivist (Patton, 2002). Therefore within the context of naturalistic inquiry, the world and reality are seen as human constructs that cannot be considered and appreciated in isolation from their context (Patton, 2002; Lincolin and Guba, 1985).
From this perspective reality is understood as being constructed in the mind of individuals. People understand and experience their world differently according to their perceptions, expectations, values, culture, and relationships. Viewing and understanding of the world through a constructivist lens becomes clear when the axioms are expanded.
The ontological axiom
Crotty neatly defines Ontology as “the study of being” (1998, p.10). Dealing with the nature of existence and the structure of reality Ontology provides a particular way of viewing and understanding the world that with epistemology underpins each theoretical perspective (Crotty, 1998). Ontology adds the ‘what is’ view while epistemology adds ‘what it means to know’ to the theoretical perspective (Crotty, 1998).
If we consider the concept of reality in constructivism we find that within a naturalistic inquiry reality is a social and therefore multiple construction (Guba & Lincolin, 1994), Relativism provides recognition that an individual’s understanding of the world may be quite different from one another (Crotty, 1998). Relativism also considers understanding of the world may be impossible to differentiate from another’s understanding of the world therefore creating many and varied ways of knowing, sets of meaning and separate realities (Crotty, 1988). Therefore relativist ontology is supported in constructivism. It follows that constructivist researchers believe that social reality exists as individual’s experience it and as it has meaning for them. This means that within in any research there will always be many different interpretations that can be made.
Authors suggest that looking for generalizations is not meaningful when studying human behaviour because it is impossible “to imagine that all human activity is completely determined by one universal set of relationships” (Lincolin & Guba, 1985; Guba & Lincolin 1989, p.94). Therefore it follows that generalising the findings of research is one of the aims of the research carried out in a scientific realm. Generalisations are defined as “truth statements of enduring value that are context-free” (Lincolin & Guba 1982, p.238), and timeless. Qualitative researchers dispute the view that generalisations are possible due to the fact that the research is undertaken by human beings and inextricably linked to a particular context (Crabtree & Miller, 1999, Lincolin & Guba, 1985). Suggesting instead the uniqueness of the settings being studied is particularly valued. As an implicit part of constructivist inquiry the researcher reports and makes sense of the uniqueness discovered in each new setting under study.
Likewise the concept of causality has been criticised with many researchers stating that it does not account for what is occurring in complex social situations (Heron, 1981, Lincolin & Guba 1985). Causality is rejected with the argument that because “all entities are in a state of mutual simultaneous shaping…. it is impossible to distinguish causes from effects” (Lincolin and Guba, 1985, p.37). Mutual simultaneous shaping refers to the process of that all things influence each other and that “causes and effects are inextricably intertwined” (Guba & Lincolin, 1982, p.242). The belief is that many different outcomes could be produced by the same cause, and “explanations are at best “here-and-now” accounts that represent a “photographic slice of life” (Guba & Lincolin 1989, p.98).
This orientation to research differs markedly from traditional modes of inquiry where a single or a minimum number of correct viewpoints is sought. Because the ontological belief is that there are socially constructed multiple realities finding a singular, verifiable reality and truth is not possible (Patton, 2002). Lincolin and Guba describe that view that truth “emerges as a composite picture of how people think” (1985, p.80). Consequently in order to carry out the research in a holistic manner as suggested by Lincolin and Guba (1985) the researcher cannot discard divergent or conflicting constructions of reality while trying to pull together a level of understanding. It follows that inclusion of each person’s experiences and the context in which they occurred are considered and incorporated into the emerging construction(s) in this mode of research (Appleton & King, 2002).
The epistemological axiom
Already established is the dynamic relativist ontology the next question to consider is where constructivism sits epistemologically? Epistemology is “the branch of philosophy concerned with the nature of knowledge, its possibility, scope and general basis” (Hamlyn, 1995, p. 245). In other words epistemology is concerned with the manner of how we study the world and how knowledge of the world is obtained (Patton, 2002). Epistemology or the theory of knowledge is driven by three main questions; what is knowledge, what can we know and, how do we know what we know? (Greco, 1999). The questions that epistemological concerns pose are important in orienting: the research approach, the underlying assumptions, and in how the research outcomes are presented (Crotty, 1998).
Discussion regarding the distinction between ontology and epistemology becomes unnecessary in this paradigm. Study findings are “the creation of the process of interaction” (Guba 1990, p.27) between the researcher and the study participants therefore Ontology and epistemology are interwoven and it becomes impossible to consider one without the other (Guba, 1990). Guba and Lincolin explain that “it is precisely their interaction that creates the data which will emerge from the inquiry” (1989, p.88). Creating the meanings or findings between researcher and participants requires a transactional/subjectivist dynamic approach when considering the phenomena being researched compared with the subject/object dualism in the positivistic paradigm (Guba & Lincolin, 1994). Not only does there have to be interaction but it must be meaningful interaction which can only take place with the cooperation of the participants. Therefore the constructivist position epistemologically in relation to what is known, what can be known and how do we know, is the belief that people construct meanings about the world through interactive experiences with others.
If a subjective interactive approach underpins the research then the place of values in the research must be considered. Values are seen as essential in knowledge creation in the constructivist paradigm. In the context of inquiry values are “the moral principles or accepted standards of a person or group” (Collins, 1993, p.1310). Constructivist inquirers argue that facts are both “value-laden” and “theory laden” (Guba & Lincolin 1989, p.105). Four ways are proposed by Guba and Lincolin (1982) in which values influence constructivist inquiry. Initially the researcher’s own beliefs and values will influence the area to be investigated. Secondly, the particular theoretical paradigm and methodology selected to guide the overall inquiry process will have roots in both “assumptions and value position(s)” (Guba & Lincolin 1982, p.243). Thirdly, the research will be influenced by the presence of values ingrained in the study setting. Fourthly, the beliefs of all groups represented in a study should be recognized as influential and “deserve equal consideration in shaping constructions” (Guba & Lincolin 1994, p.114). The impact of values and the role they play in the research are encapsulated in the choice of methodology and the research design. The “mutual shaping” referred to by Lincolin & Guba (1985) is influenced by both the researcher’s and respondents’ own value systems.
A criticism of this perspective is the focus on the importance of the individual view rather than the impact of society as a whole (Pawson & Tilley, 1997) However, this critique fails to understand constructivism does recognize the complex interplay that helps to form, develop and alter an individual’s constructions of any phenomena (Lincolin & Guba, 2000). Lincoln and Guba recognise that “multiple knowledges” can exist together and that a range of views may emerge during a naturalistic inquiry (1994, p.113). Likewise this focus of the individual’s perception and viewpoint in practical terms this makes it a challenge to achieve a single explanation for complex phenomena because of the belief of multiple intangible realities. Therefore the research will attempt to illustrate each substantial consensus viewpoint separately. Accordingly the researcher must accept participant’s beliefs and values may be very different from the researcher’s own.
The methodological axiom
Ideally in line with this research ontology, methodologically the researcher studies real- world situations as they unfold naturally instead of (manipulating research outcomes a priori) in seeking for cause and effect outcomes (Lincolin & Guba, 1985, p. ). Methods were chosen that would holistically capture realities and meanings.
The relationship between the researcher, the research, and the participant is important on several levels. The relationship with the participant and hence the construction of data and meanings is alluded to above. The relationship of the researcher with the research incorporates another layer of relationships. This is central to a naturalistic inquiry that the researcher is not seen as a neutral spectator in the research (Denzin, Smith, & Deemer). Lincolin and Guba (1985) refer to ‘human researchers as instruments’. As such researchers are recognised as bringing a responsive approach to the research and data through the use of effective interpersonal skills (Crabtree & Miller, 1999). Data collection procedures can be adapted where necessary through the use of creative and intuitive processes. Interaction continues with the process of data analysis when the researcher seeks convergent and divergent viewpoints and explanations for any discrepancies. Incorporated in the concept of ‘human researcher’s as instruments’ is recognition of and valuing the ‘tacit’ knowledge the researcher bring to the methodology (Lincolin and Guba, 1985).
Understandably then texts based on interviews and observations are mutual, contextual and value bound (Lincolin and Guba, 1985). For that reason, the research takes the position that multiple meanings and some degree of interpretation are always involved in the analysis of a text. Sandelowski and Barroso (2002) suggest because the data are “constructed entities” they cannot be separated from findings. Here, the so called raw data of qualitative research – e.g., the interview transcript and the field notes – are not pre- given, but rather are already interpretive products. As Wolcott (1994, pp4-5) observed, although “Everything has the potential to be data……nothing becomes data without the intervention of a researcher who takes notes – often makes note – of some things to the exclusion of others.” Research findings in qualitative research are variously conceived as both a process and product in which the researcher is deeply and unavoidably implicated.
In a distinct move from the positivist paradigm the principle of “human researcher as instrument” incorporates the development phase of the research encouraging the inquirer to discuss topics or issues prior to their investigation with fellow practitioners (Lincolin & Guba, 1985). Carrying out this process assists with refining the inquirer’s thinking before contemplating access to the field (Lincolin and Guba, 1985).
The next section of the thesis will focus on the research methodology and design.
Research questions and aims
The research question, “What is the role of the mental health nurse in the criminal court in the New Zealand context?” sought information in order to understand and make visible contemporary nursing practice at the criminal justice mental health interface in New Zealand.
The following questions were developed regarding the CLN role.
1. What are their nursing backgrounds and professional experience?
2. What are their daily professional activities?
3. What ethical tensions do they experience and how do they manage them?
4. What are their education and training needs?
Methodology
The research methodology is chosen to answer the question “How should the researcher go about gathering the knowledge to answer the research question?” (Guba, 1990, p. 18). Qualitative descriptive methodology as outlined by Sandelowski (2000a, 2000b) fit these criteria and was deemed the appropriate methodology that through rich description would allow the nurses perspective to be heard and themes to emerge from the data. The aim of a naturalist inquiry is to understand peoples constructed meaning of truth and reality. These underpinning assumptions mean that the nurses’ voice is given precedence in the research.
Qualitative descriptive methodology provides the ability to utilise a mixture of sampling and data collection tools and re-presentation techniques to guide the research (Sandelowski, 2000b). Given the paucity of literature and information regarding this nursing role in the New Zealand context it was fitting that the methods applied for the initial foray into this area enabled broad exploration and descriptive elements to the approach as well as the ability to examine aspects of the nursing practice in depth.
Of particular relevance for this research Qualitative descriptive designs provide an existing framework for practice based research, which are particularly appropriate for nursing and policy development (Sandelowski, 2000b). Lincolin and Guba’s (1985) naturalistic inquiry paradigm, used in this study, depicts multiple constructed realities as limitless perspectives or worldviews that bring people’s understanding together. The court liaison nurses realities are multiple, constructed, interactive and inseparable in the realms of health, education and the criminal justice system. This necessitates understanding that this inquiry is value bound, as detailed by Lincolin and Guba (1985), and as such this methodology is described as a particularly useful approach for nursing practitioners who are considering entering their clinical area of expertise as a researcher. The choice of research topic and methodology was influenced by my past experience with and present concerns from knowing and working with CLNs, as well as a strong desire to make visible the paradigm of nursing in the criminal justice system.
An important feature in the decision to use this methodology related to the evolving nature of constructivist inquiry that supports the inquirer to discuss topics or issues for investigation with fellow practitioners in order to assist with clarifying the inquirer’s thinking before commencing the research and this means that initial research plans are not finite (Lincolin & Guba, 1985). Following this process as researcher assisted with refining the research proposal and continued throughout the study.
Similarly the purposive sampling strategy used in Qualitative descriptive designs (Sandelowski, 2000b, Patton, 2002) and working with the participants to construct an understanding of the key issues assisted with firming the researcher’s ideas about the progression of the study. Ongoing analysis enabled the researcher to interact with the data to “oil the wheels” (Appleton and King 1997) of thought and facilitated consideration of diverse interpretations.
Notwithstanding any clinical expertise demonstrating transparency and adherence to the principles of the research is vital if the research is to be considered worthy and useful.
Design Credibility
“Rigour” is a term associated with the positivist paradigm and way of thinking (Crabtree & Miller, 1999). Rigour is described as “the means by which we demonstrate integrity and competence, a way of demonstrating the legitimacy of the research process” (Tobin & Begley, 2004, p, 390). The overall thrust of this research is qualitative therefore the overall integrity of the research will be judged by mechanisms applicable to a study undertaken in the qualitative paradigm. Lincolin suggests that “In a constructivist inquiry, process is only one means of determining the utility, responsibility, and fidelity of the inquiry. Action and understanding were other components of the judgements regarding the goodness of any inquiry” (Lincolin, 1990). Therefore several steps inherent in qualitative descriptive methodology were applied throughout the research to demonstrate credibility. According to Sandelowski descriptive and interpretive validity demonstrate the research is true to it aims (2000b). Evidence of research credibility is provided throughout the thesis.
The aim of the research was to present a truthful and accurate account of the nurse’s perspectives (Sandelowski, 2000b). Most importantly to represent in a straight forward manner what the nurses considered to be the crucial aspects of their role, knowledge and needs. To achieve this end Koch and Harrington (1998) refer to the necessity of ongoing conversation between the inquirer, the nurses and the research to reach agreement. Sandelowski (2000b) contributes, that although it is unlikely that all the data within the inquiry will be reported on, what is described should represent a consensual view of the data. This is known as Descriptive validity, a valid description of events that most people (including researcher and participants) observing the same event would agree is accurate (Maxwell, 1992). Planning is an essential component in enhancing credibility of the research. The sequential nature of the research was designed to enhance credibility in initially eliciting key themes in the survey and building on these in the next two phases. The processes of seeking verification were established prior to the study and adhered to. The checking and verification processes in place, returning of transcripts to participants and monitoring of feedback were part of systems involved in maintaining a research audit trail.
It must also be recognised all decisions involve choice and inevitably interpretation on the part of the researcher (Sandelowski, 2000b). Interpretive validity takes descriptive validity to another level and refers to the valid description of the meaning participants found from the events or circumstances they are describing that those participants would agree is accurate (Maxwell, 1992).
Patton (2002, p.563) refers to triangulation methods as means of reducing systematic bias and distortion during data analyses phases thereby ensuring credibility. The research used triangulation in terms of member checking (triangulation by review by inquiry participants), independent analysis (triangulation with multiple analysts) and data from on phase of the research not only informing the next phase by also confirming data (methods triangulation).
Two phases of the research involved quantitative elements therefore rigour in respect of these elements was reviewed using internal validity and reliability as the key issues integral to rigor of quantitative research (LoBiondo-Wood and Haber, 2006). Verification strategies with respect to the tools were employed by seeking advice and assistance from experts in the relevant areas. The process of piloting and checking the tools can be found under the section headed Piloting of tools.
Internal validity is the degree to which a study reflects or assesses the specific concept that is under measurement, and can be assessed in terms of internal and external validity (LoBiondo-Wood and Haber, 2006). Internal validity is considered met when the design of the study is congruent with the aims of the research. The survey questionnaire was designed to capture a broad understanding of this cohort of nurses and functions of their role this was congruent with the aims of the research. The data collection instruments used in phase 3 further developed the aims of the study by recording in detail the functions and daily nursing practice. Therefore the tools met criteria for internal validity.
External validity refers to the extent with which the results of the study are generalisable or transferable (Polit et al, 2001). External validity is not applicable to this research. The research was positioned in an overall framework of a Naturalistic Inquiry therefore generalisability of the study of this unique nursing role was never the intention.
Auditability is a concept used in qualitative research to support dependability or reliability (the quantitative equivalent.) Auditability refers to the circumstances by which one researcher can follow the analysis pattern of another (Guba & Lincolin, 1981). This means another researcher should be able to arrive at similar conclusions using the available documents and raw data. In other words an audit trail was laid down (Polit, Beck, & Hungler, 2001). All aspects of the research were described in the methodology section and all tools are listed in Appendix….
Researcher values
Because findings in qualitative studies are partly composed of the knowledge, beliefs, and everything the researchers are and bring into the research (Sandelowski & Barroso, 1998) acknowledgement of the researchers values based on personal and professional experience is central to ensuring self awareness of prior opinions and biases. The researcher practised in the court liaison nurse role from 2002 to 2008 and continues to have a professional interest in the court liaison nurse role.
The underpinning assumptions for qualitative descriptive methodology fit with the researcher’s views regarding reality in that the researcher believes in multiple experientially based constructed realities. It was central to the researcher’s values that the clinical skills of the nurses were acknowledged and valued in this study. It is not possible to eliminate bias but a reflexive process ensured transparency. Reflexivity is described in Munhall as the “process by which researchers recognise that they are an integral part of the research process and vice versa” (2007, p. 318). Reflective processes were established to ensure a thorough approach to the research. These included:
Research supervision
The supervisory role was crucial in ensuring the research process was systematic and logical and that an adequate audit trail congruent with the methodology was being laid down. A process of regular reflexive supervision took place to assist with transparency – one supervisor with clinical expertise in forensic mental health and research- questioned my motivation for certain aspects of the study at times, guided me back to the literature, and encouraged me to provide justification for my thinking ensuring there were no seemingly hidden agendas. The researcher was able to call on the expertise of other supervisors; methodological expertise and extensive knowledge of the law/mental health interface. Any pre-existing notions I came with were challenged. Notwithstanding the expertise the researcher was able to draw on from the supervisors the personal expertise that the participants bought to the research also contributed to the reflexive process.
In addition to regular individual supervision sessions, a yearly presentation of progress with fellow DHSc candidates and their supervisors provided a safe but challenging forum to discuss work and defend the research design. Field notes were kept regarding interviews and discussed with supervisors during debriefing post interviews. Reflective notes were kept by the researcher throughout the study and discussed with supervisors.
Research presentation
Presentation to groups with familiar with the context (nursing colleagues and court liaison nurses) allowed for reviewing and checking the credibility of the research as well as critical examination of the researchers thinking and analysis.
The use of qualitative descriptive methodology provided the means for the contemplation of multiple and complex issues within the CLN role. Reflection, writing, literature and further dialogue and refinement of issues with the participants and with key people outside the study have served as conduits for fine tuning the development of the research process and thematic analysis. Informal and formal feedback about the findings as they developed assisted with keeping the project on track and real.
Research Design
Qualitative descriptive research methodology design meets the aim of providing a description without embellishment, in language that would deem the research useful in practice for the nurses (Sandelowski, 2000b). This incorporated the use of robust data collection techniques, the documentation of research procedures including details of methodology, and the data analysis procedures. In line with this approach purposive sampling and inductive data analysis were chosen. This section details the mixed methods used within the qualitative descriptive methodology framework.
Mixed methods
A word about using mixed methods. Mixed method designs use quantitative and qualitative methods within a single project (Tashakkori & Teddlie, 2003). The use of mixed methods allows the researcher to approach the phenomenon being studied from different angles to allow a more complete understanding of the topic than could be gained from using a single method (Giddings & Grant, 2007). Traditionally qualitative and quantitative approaches have been associated with discrete paradigms. Quantitative with the dominant empirical positivist “scientific method” paradigm and the qualitative “human science” paradigm concerned with the social world from which meaning is derived (Haase & Myers, 1988; Duzurec & Abraham, 1993). The differences in underpinning assumptions between the constructivist paradigm and quantitative positivist paradigm relating to the nature of; reality, relationships, truth statements and values are incorporated in the axioms of constructivism as outlined earlier. A common aim of both qualitative and quantitative research is in reaching for understanding of the world we live in. Demonstrating lack of understanding of the orientation of an approach or blurring of paradigms is a major critique of using mixed methods ( ) but as Sandelowski (200?) and others (Dzurec & Abraham, 1993; Morse, 2005; Giddings, 2006) suggest in research that has paid careful attention to its orientation and underpinning assumptions this need not be the case. At worst mixed methods described as “positivism dressed as drag” to be avoided (Giddings & Grant, 2007).
In support of using mixed methods Dzurec and Abraham refer to inquiry being about understanding and explanation and in order to achieve this integration of qualitative and quantitative methods can be used (1993). So instead of viewing the use of mixed methods as mergers or combinations of world views or paradigms, qualitative descriptive methodology involves the explicit framing of the inquiry in two or more world views which are distinct from each other (Sandelowksi, 2000a). This is possible “Because techniques are not linked to either paradigms or methods, combinations at the technique level permit innovative uses of a range of techniques for a variety of purposes” (Sandelowski, p.248 2000a). Combining techniques is not to be confused with what Sandelowski (2000?) refers to as qualitative descriptive research drawing on “hues, tones and texture” (p, 337) from other theoretical perspectives. Meaning that features of the “re-presentation” of individuals’ words or experiences may employ aspects of another style e.g. phenomenological (Sandelowski, 2000?, p. 337). Accordingly the overall research design sits within the constructivist paradigm, but the techniques used to gather data employ quantitative and qualitative techniques.
In keeping with the aims of qualitative descriptive research Data collection is “typically directed toward discovering the, who, what, and where of events or experiences, or their basic nature and shape (Sandelowski pg 338 2000b). To achieve this end three methods were employed: postal survey questionnaire; in-depth interviews; and a data collection activity. Data collection occurred in a sequential manner. Data gathered in the survey was used to develop phase two and three of the study, in this way each method mutually enriching each subsequent method and providing a depth of understanding that would not have been possible using one method. One aspect of the study led into and informed the other. Individual semi-structured in-depth interviews then further explored key themes to come from the survey and the nurses perspectives of the role. This method ensured the fleshing out with rich data regarding the main issues that came out of the survey. The final method, a data collection tool, designed to capture the day to day activities that the nurse carried out, thereby constructing a comprehensive picture of this nursing role.
