- Email: [email protected]
Qualitative nursing research: A contemporary dialogue
330
BOOK REPYEWS
of process that needs to be developed, as well as the kinds of problems that may arise, with tips for their avoidance. As a practical manual for action research it is a good guide. I would recommend it to action researchers in nursing, cautioning the reader to establish a critical view in regard to its efficacy in theorizing about social relations. R.N., PH.D. Research Fell0 w, Faculty of Nursing, Deakin University, Geelong, Victoria 3217, Australia
HEATHER GIBB,
Qualitative Nursing Research: A Contemporary Dialogue (Revised Edn). J. Morse (Ed.). Sage London, Newbury Park, New Delhi (1991). Price f34.00 cloth, f15.95 paperback. A symposium held in Chicago in 1987 by “leading qualitative methodologists” serves as the context for this thoughtful collection of 17 papers on qualitative nursing research which was first published in 1989. As the Editor, Janice Morse of the University of Alberta says, “the development of qualitative research is accelerating at a breathtaking speed”. It is this acceleration, as well as the overall quality of this book, which gives rise to this revised edition so soon after publication of the first. There are only a few substantial revisions to the first edition, but they are useful and important. Janice Morse’s chapter on strategies for sampling contains a new section on group interviews and their appropriateness. In her chapter “Issues of Reliability and Validity”, Pamela Brink adds two very helpful sections in which she compares how the concepts of reliability and validity are treated differently in other qualitative research texts. Kathleen Knafl and Bonnie Breitmayer enhance their concluding discussion of triangulation and a solid bibliography on grant writing is added by Toni Tripp-Reimer and Marlene Zichi Cohen to their chapter “Funding Strategies for Qualitative Research”. Moving through the book the reader will find the chapters to be, for the most part, of high quality. Some, like Vangie Bergum’s “Being a Phenomenological Researcher”, shine in their clarity and resonance. There is much that is useful here. Some practical pointers are offered in the various chapters, such as schedules for research projects, tips for interviewing and access, suggestions for getting qualitative research through institutional review boards, and how to teach qualitative research methods. Thought-provoking issues are raised, such as Brink’s notion that nursing practice as a process demands longitudinal research. Morse’s aim, to address some of the gaps in the qualitative text books, is well met. Graduate students and experienced researchers alike will find the book useful. It is one that a researcher can, in the spirit of dialogue, repeatedly return to in order to explore the questions which arise in the reading. Engaging in dialogue is made easier by the book’s
BOOK REWEUS
331
format. Papers forming the chapters were discussed at the Chicago symposium and were subsequently revised for publication, incorporating the participants’ comments. Each chapter is preceded by excerpts of dialogue from the discussion. Some of the most interesting points are raised in these excerpts; however, they are not always satisfactorily carried through in the chapters. All of the contributors and most of the literature cited are from Canada and the U.S.A. This should not diminish the book’s usefulness to an international audience, but it probably contributes to the particular flavour of the dialogue begun in the book. The starting point for the dialogue, thankfully, is not the value of qualitative research, nor the need for it. Instead, the starting point is the “ ‘vexing’ problems with difficult concepts”. The dialogue concentrates on resolving issues and problems in using qualitative methods. Unfortunately, the papers stay, for the most part, with solving puzzles and developing answers to questions. The larger questions inherent in examining meaning in human experience, the raison d’etre of qualitative research, remain unasked. For instance, there is little discussion of the advocacy which inevitably accompanies scientific endeavour, when attention is directed on one aspect instead of another. Absent in the main, is substantial dialogue on the interconnection between the ontological and epistemological grounding of the methods and the concomitant issues and problems of method. Nevertheless, there is some discussion in the chapters on fundamental issues of epistemology which inevitably face qualitative researchers. Morse argues for a critical analysis of methods borrowed from other disciplines for their assumptive and epistemological biases. She suggests that nursing’s particular character and domain may have different epistemological commitments which should be reflected in the research methods. Such a critical analysis is partly realized in the chapters by Joan Anderson on the phenomenological perspective and Agnes Aamodt on generating nursing knowledge through ethnography. Throughout the book, too frequently a particular interpretation of the philosophical tradition underpinning a particular approach or method appears to be unquestioned. A concern for rigour in method remains at the forefront. If we are to advance theory from nursing’s ontological and epistemological base, it would seem necessary to engage in a broader conversation amongst qualitative researchers. If the dialogue stays at the level of method and technique, some of the most vexing problems may never be addressed. The importance of a broader understanding is perhaps what Morse and others are alluding to when they speak of the problems of muddling methods. It is also perhaps implicit in the statements by several contributors about the need for qualitative methods to be used with caution by novice researchers. Unfortunately, these most important points do not receive the exploration they merit. Morse’s comments in this revised edition make it clear that qualitative research is moving beyond the idea, particularly prevalent in North America, that qualitative studies constitute the preliminary stage on the way to quantitative research. The establishment of strong qualitative research programs bya the book’s contributors and by researchers in other countries, is noteworthy. It indicates the increasing recognition in nursing of the value of qualitative approaches-in developing theory, in providing rich descriptions of experience, in revealing the structure and process of nursing care and in uncovering the knowledge in clinical practice. In the development of such studies in nursing, we have only begun to see the tip of the iceberg. With greater acceptance of qualitative approaches, it is increasingly important that the stance of critical reflection so characteristic of research on meaning in experience, does
331
BOOh’ RE L’IE CC’S
not diminish. Continuing dialogue is needed, at the puzzle solving level and just as importantly, between the practical and the philosophical. Such dialogue is needed not only to ensure methodological rigour, but also to keep the central questions of meaning and experience in the foreground. Qualitative Nursing Research: A Contemporary Dialogue makes an important contribution to the developing body of knowledge in the exploration of meaning in experience in health and illness and in nursing. The next turn of the conversation will be welcomed. MARTHA L. P. MACLEOD,
R.N., B.A., M.A., Ph.D.
Project Adviser-Nursing, St. Boniface General Hospital, Winnipeg, Manitoba, Canada R2H 2A6
Primary Care Research: Traditional and Innovative Approaches. Peter G. Norton, Moira Stewart, Fred Tudiver, Martin Bass and Earl Dunn (Eds). Sage Publications, London (1991). Price f29.95 cloth, f 16.75 paperback.
This book is the first in a series of monographs of methods to understand, evaluate and improve primary care. This first book addresses three general issues in primary care research. Firstly, the important question to ask, the appropriate method to use for different kinds of questions and the standards for qualitative and quantitative primary health care research. This book examines some basic methods that have been and can be used to study questions facing researchers in what is called the maturing discipline of primary cart research. Many chapters give a summary of research methods while others contain examples that would be useful to those planning studies of their own. An important element of the book are those chapters which look at the standards which are appropriate to primary care research, and this material is very useful not only to investigators but also to reviewers of grant applications and papers submitted for publication. There are two chapters out of a total of 14 which have a particular focus on nursing. One is on “Primary Care Nursing, a Model for Research”. In this chapter the author Toula Gerace sets out a range of models which may be used in primary health care nursing research. Four concepts which are identified and which are seen as central to nursing theories are those of the person, the environment, health and nursing. It is argued that the Newman Systems model and the Alan Nursing model are the ones that best lend themselves to this area of nursing practice. Five broad areas of study are identified in primary care nursing research, i.e. health, illness, family, education and role. The area which would seem to be missing in this is that of the nurse’s role with the community. A second chapter in the book looks at “Primary Health Care, a Nursing Model”, and is written by Hall, Roth, Edge and Pann. This is a report on a study carried out in Canada
BOOK REPYEWS
of process that needs to be developed, as well as the kinds of problems that may arise, with tips for their avoidance. As a practical manual for action research it is a good guide. I would recommend it to action researchers in nursing, cautioning the reader to establish a critical view in regard to its efficacy in theorizing about social relations. R.N., PH.D. Research Fell0 w, Faculty of Nursing, Deakin University, Geelong, Victoria 3217, Australia
HEATHER GIBB,
Qualitative Nursing Research: A Contemporary Dialogue (Revised Edn). J. Morse (Ed.). Sage London, Newbury Park, New Delhi (1991). Price f34.00 cloth, f15.95 paperback. A symposium held in Chicago in 1987 by “leading qualitative methodologists” serves as the context for this thoughtful collection of 17 papers on qualitative nursing research which was first published in 1989. As the Editor, Janice Morse of the University of Alberta says, “the development of qualitative research is accelerating at a breathtaking speed”. It is this acceleration, as well as the overall quality of this book, which gives rise to this revised edition so soon after publication of the first. There are only a few substantial revisions to the first edition, but they are useful and important. Janice Morse’s chapter on strategies for sampling contains a new section on group interviews and their appropriateness. In her chapter “Issues of Reliability and Validity”, Pamela Brink adds two very helpful sections in which she compares how the concepts of reliability and validity are treated differently in other qualitative research texts. Kathleen Knafl and Bonnie Breitmayer enhance their concluding discussion of triangulation and a solid bibliography on grant writing is added by Toni Tripp-Reimer and Marlene Zichi Cohen to their chapter “Funding Strategies for Qualitative Research”. Moving through the book the reader will find the chapters to be, for the most part, of high quality. Some, like Vangie Bergum’s “Being a Phenomenological Researcher”, shine in their clarity and resonance. There is much that is useful here. Some practical pointers are offered in the various chapters, such as schedules for research projects, tips for interviewing and access, suggestions for getting qualitative research through institutional review boards, and how to teach qualitative research methods. Thought-provoking issues are raised, such as Brink’s notion that nursing practice as a process demands longitudinal research. Morse’s aim, to address some of the gaps in the qualitative text books, is well met. Graduate students and experienced researchers alike will find the book useful. It is one that a researcher can, in the spirit of dialogue, repeatedly return to in order to explore the questions which arise in the reading. Engaging in dialogue is made easier by the book’s
BOOK REWEUS
331
format. Papers forming the chapters were discussed at the Chicago symposium and were subsequently revised for publication, incorporating the participants’ comments. Each chapter is preceded by excerpts of dialogue from the discussion. Some of the most interesting points are raised in these excerpts; however, they are not always satisfactorily carried through in the chapters. All of the contributors and most of the literature cited are from Canada and the U.S.A. This should not diminish the book’s usefulness to an international audience, but it probably contributes to the particular flavour of the dialogue begun in the book. The starting point for the dialogue, thankfully, is not the value of qualitative research, nor the need for it. Instead, the starting point is the “ ‘vexing’ problems with difficult concepts”. The dialogue concentrates on resolving issues and problems in using qualitative methods. Unfortunately, the papers stay, for the most part, with solving puzzles and developing answers to questions. The larger questions inherent in examining meaning in human experience, the raison d’etre of qualitative research, remain unasked. For instance, there is little discussion of the advocacy which inevitably accompanies scientific endeavour, when attention is directed on one aspect instead of another. Absent in the main, is substantial dialogue on the interconnection between the ontological and epistemological grounding of the methods and the concomitant issues and problems of method. Nevertheless, there is some discussion in the chapters on fundamental issues of epistemology which inevitably face qualitative researchers. Morse argues for a critical analysis of methods borrowed from other disciplines for their assumptive and epistemological biases. She suggests that nursing’s particular character and domain may have different epistemological commitments which should be reflected in the research methods. Such a critical analysis is partly realized in the chapters by Joan Anderson on the phenomenological perspective and Agnes Aamodt on generating nursing knowledge through ethnography. Throughout the book, too frequently a particular interpretation of the philosophical tradition underpinning a particular approach or method appears to be unquestioned. A concern for rigour in method remains at the forefront. If we are to advance theory from nursing’s ontological and epistemological base, it would seem necessary to engage in a broader conversation amongst qualitative researchers. If the dialogue stays at the level of method and technique, some of the most vexing problems may never be addressed. The importance of a broader understanding is perhaps what Morse and others are alluding to when they speak of the problems of muddling methods. It is also perhaps implicit in the statements by several contributors about the need for qualitative methods to be used with caution by novice researchers. Unfortunately, these most important points do not receive the exploration they merit. Morse’s comments in this revised edition make it clear that qualitative research is moving beyond the idea, particularly prevalent in North America, that qualitative studies constitute the preliminary stage on the way to quantitative research. The establishment of strong qualitative research programs bya the book’s contributors and by researchers in other countries, is noteworthy. It indicates the increasing recognition in nursing of the value of qualitative approaches-in developing theory, in providing rich descriptions of experience, in revealing the structure and process of nursing care and in uncovering the knowledge in clinical practice. In the development of such studies in nursing, we have only begun to see the tip of the iceberg. With greater acceptance of qualitative approaches, it is increasingly important that the stance of critical reflection so characteristic of research on meaning in experience, does
331
BOOh’ RE L’IE CC’S
not diminish. Continuing dialogue is needed, at the puzzle solving level and just as importantly, between the practical and the philosophical. Such dialogue is needed not only to ensure methodological rigour, but also to keep the central questions of meaning and experience in the foreground. Qualitative Nursing Research: A Contemporary Dialogue makes an important contribution to the developing body of knowledge in the exploration of meaning in experience in health and illness and in nursing. The next turn of the conversation will be welcomed. MARTHA L. P. MACLEOD,
R.N., B.A., M.A., Ph.D.
Project Adviser-Nursing, St. Boniface General Hospital, Winnipeg, Manitoba, Canada R2H 2A6
Primary Care Research: Traditional and Innovative Approaches. Peter G. Norton, Moira Stewart, Fred Tudiver, Martin Bass and Earl Dunn (Eds). Sage Publications, London (1991). Price f29.95 cloth, f 16.75 paperback.
This book is the first in a series of monographs of methods to understand, evaluate and improve primary care. This first book addresses three general issues in primary care research. Firstly, the important question to ask, the appropriate method to use for different kinds of questions and the standards for qualitative and quantitative primary health care research. This book examines some basic methods that have been and can be used to study questions facing researchers in what is called the maturing discipline of primary cart research. Many chapters give a summary of research methods while others contain examples that would be useful to those planning studies of their own. An important element of the book are those chapters which look at the standards which are appropriate to primary care research, and this material is very useful not only to investigators but also to reviewers of grant applications and papers submitted for publication. There are two chapters out of a total of 14 which have a particular focus on nursing. One is on “Primary Care Nursing, a Model for Research”. In this chapter the author Toula Gerace sets out a range of models which may be used in primary health care nursing research. Four concepts which are identified and which are seen as central to nursing theories are those of the person, the environment, health and nursing. It is argued that the Newman Systems model and the Alan Nursing model are the ones that best lend themselves to this area of nursing practice. Five broad areas of study are identified in primary care nursing research, i.e. health, illness, family, education and role. The area which would seem to be missing in this is that of the nurse’s role with the community. A second chapter in the book looks at “Primary Health Care, a Nursing Model”, and is written by Hall, Roth, Edge and Pann. This is a report on a study carried out in Canada