ENTRAR            

 


 

INDEX DE ENFERMERIA Journal (digital edition) ISSN: 1699-5988

 

 

 

QUALITATIVE METHODOLOGY

Comment this work

 Related documents

 Click on author to see biography summary

 Spanish version

 Go to Summary

 

 

Send mail to the author 

 

 

 

 

An Approach to Nursing Care from an Ethnographic Focus

Erick Landeros-Olvera,1 María Claudia Morales-Rodríguez,1 María del Carmen Martínez-Reyes1
1Autonomous Distinguished University of Puebla School of Nursing. Mexico

Mail delivery: 1500 Gonzalitos Norte, Mitras Centro, Zip Code 64460. Monterrey Nuevo Leon, Mexico

Manuscript received by 12.2.2010
Manuscript accepted by 17.7.2010

Index de Enfermería [Index Enferm] 2010; 19(2-3): 187-190

 

 

 

 

 

 

 

How to cite this document

 

 

Landeros Olvera, Erick; Morales Rodríguez, María Claudia; Martínez Reyes, María del Carmen. An Approach to Nursing Care from an Ethnographic Focus. Index de Enfermería [Index Enferm] (digital edition) 2010; 19(2-3). In </index-enfermeria/v19n2-3/7297e.php> Consulted by

 

 

 

Abstract

Ethnography initiates as a method anthropology uses to approach cultural groups detached from the researcher. It starts from the qualitative paradigm to understand health phenomena subjectivity, aiming to complement the quantitative research traditional method. Since university upbringing, nursing students perform field work, and during their practice already as professionals, it is common the contact with the environmental reality of the people who suffer some illness; "the ethnographer is in the place of the facts". Since nursing has the health personnel who spent more time in contact with patients, it is recognized that the relation strictly clinical relation boundary between a nurse and a patient is surpassed by the daily coexistence, and this makes the nurse to be in touch with those matters not measurable within the health and illness process and allows information to flow and to obtain evidence for care. The purpose of this essay is to show the ethnography basis as a research field that nursing can use and develop to contribute relevant knowledge in understanding health conducts of different human groups. Ethnography background and characteristics and the methodology will be approached, as well as its relation with health and nursing sciences.
Key-words: Ethnography/ Nursing/ Sciences.

 

 

 

 

 

 

 

Introduction

    Nursing is considered as a scientific discipline which goal is human groups health care; some activities it performs are: healthy life styles promotion, chronic diseases and epidemics prevention, support for people with disabilities, help in physical and psychological rehabilitation, provide care to people suffering cancer, AIDS, or other infectious diseases, provide care for a safe maternity, intervene in immunization programs, provide care for a healthy feeding, among many others. All these nursing activities are developed inside a hospital area, within the community and in the family contexts, all these, where health phenomena develop.1 It is acknowledged that nurses' experiences are vast although unfortunately not known, since most of them are not published;2 all that material represents direct experiences with people in order to understand, from the patient point of view, how he/she acts consequently in the face of any phenomenon affecting his/her health. Despite these areas, nowadays, constitute opportunities to develop knowledge from the qualitative point of view, most published nursing evidence is ruled by the traditional or quantitative paradigm, which validity is supported by mathematical explanation, form this perspective, all phenomena can be measured or counted and what matters is data.3
    There is, however, complementary evidence to the health-illness phenomenon of human groups where methodologies that are in charge of what can not be measured or counted are applied, such as perception and experience in the face of a phenomenon, the conducts subjectivity. This is known as the qualitative paradigm, which has an outstanding place as a legitimate way to acquire knowledge.
4 The main characteristic of the qualitative methodology is that it incorporates the people's point of view and not only the organic. The way to proceed in this paradigm has its particularities underpinned mainly by the founded theory, phenomenology and ethnography.5 Regarding this last it systematically studies the human groups daily existence, putting an emphasis on the cultural patterns comprehension; it is interested is the subjects behaviour within the environment where they develop their social interaction, without determining its causes nor making predictions.6 Several disciplines have opted the ethnography because it supports their epistemological nature in their daily relation with human groups, for example, anthropology, sociology, social work, and nursing. Regarding this last, its daily contact with patients as persons and not only as a clinical entity, place it in a privileged plate for developing ethnographic research and get knowledge around the paradigm that distinguishes the profession: person, health, environment and nursing care.7
    The purpose of this essay is to show ethnography basis as a research field nursing can use and develop in order to contribute relevant knowledge to health conducts comprehension within different human groups. Here ethnography characteristics and background, the methodology, its relation with health and nursing sciences will be approached.

Ethnography backgrounds and characteristics

    Acknowledgement given to phenomena multi-causality has led to incorporate new health research methods;8 the use of qualitative research has been felt as a need to understand health subjective aspects; one of the most evident causes is that not only the bio-medical focus (traditionally a quantitative one) is absolutely true, it needs to be complementary in order to understand in a most global way the conducts of those who suffer some illness. On the matter, ethnography emerged as a methodical alternative inside the research traditional process, its contribution has shown to be worthy due the relation between the researcher and the participant inserted in the cultural environment where health phenomena develop (as happens in the nursing practice with its patients). This relationship among actors makes ethnography a method that denotes the equality as human beings; searching comprehension more than statistical explanation, participants are not reduced to mere variables, they are not manipulated, it has not an interventionist character and prefers descriptions in a natural language, just in the middle of where facts are realized.9

What is ethnography?

    When we refer to ethnography we understand it as the research method by which the way of life of a concrete social unity is learned, the analytic description or reconstruction of the culture interpretative character, life forms and social structure are pursued.5 Ethnography is the emphasis on the process of unveil cultural knowledge in the holistic analysis of societies.9

How does the ethnographic method take place?

    Although ethnography is a term for referring to human groups detached from the investigator10 the data collection main method is the observation of the participant: "The ethnographer participates in the people's daily life during a relatively large time, watching what happens, listening to what is said, asking things".11 This means that his/her coexistence with specific cultural groups require of a large time to perform direct observation that he/she can verify continuously. During this process hypothesis are made in situ, this is, in the same place where the people are living the phenomenon of interest.9
    Ethnography instruments are the open and semi-structured interview, photography, audio and video recordings, but most of all participant observation, meaning that the researcher is the main inquiry instrument;
12 reflexibility turns the researcher into an actor in his/her study and into the inquiry instrument with which he/she constructs the design, as a product of the decisions he/she makes. Practicing the participant observation does not involve the researcher in interventions that influence the natural process of events but it does turn he/she in a part of the context; what makes this method valuable is the outcome verification through the observation of the daily things and events, it is a process with an evolutional character.13
    To come by entering into the field (understand as the scene where the investigation will be carried on: school, health centre, hospital, community, among many others), requires a process sometimes long and rigorous; according to Taylor and Bodgan,13 depends on the accessibility, if it is public or private, on the time of the researcher participation and on his/her prejudices when facing reality, because it is common that what he/she would find is not part of what he/she considers right or viable; this is a mayor problem that doesn't allow to clarify ideas about what is he/she perceiving.
    According to Amezcua,
8 in order to get the group "acceptance" one needs to negotiate and outline one's own roll; this requires to enter into the field with some ingenuousness and to offer a participation in the daily life basic tasks in order to be accepted as "one more into de group". for example, certain rolls the researcher can perform, such as car driver, reading a paper for someone who cannot read, writing a letter for someone that cannot write, collaborating occasionally in some job, etc. The researcher daily participation allows participants attitudes during the process not to be conditioned by his/her presence en the scene. Of course, this attitude of the participants regularly is not instantaneous, but when a comprehension and trust bond is finally established between the researcher and the study subject, information and true messages "flow" so data of interest according to the research purpose are built; this is named "rapport", where even the language at this level is natural, this is, informers express themselves as if the researcher is one of them, using slang language and attitudes without pretending.

Ethnography and health

    Human health is influenced by beliefs and cultural traditions reflected on the conducts affected by the individuals within their environment. In other words, health is shared by a cultural group that shares one same geographical place, or it can be a different place, but they are sharing the same common experience, for example, a chronic disease such as hypertension, diabetes mellitus, obesity, cancer.12 Although the positivist paradigm held a strong influence on all the past century sciences process, qualitative research in health area was not left in an hegemonic way at charge of medicine, its profile was multi-disciplinary, where multiple themes developed were taken from different points of view; not only medical anthropology carried on flexible studies, but sociology, psychology, and nursing among others retake this post-positivist orientation in different database. Each one of them has performed field research with its own terminology, which places each one of them in a unique and little explored context. Today there are every day more qualitative specialists acknowledged worldwide dedicated to public health and whose outcomes have given birth to alternative models.14

Ethnography and nursing

    All along the past century nursing research developed in different stages marked mainly by positivism; however, nursing adapted itself very well to natural methods such as ethnography that is a qualitative-kind research that represents an opportunities field for nursing professional to foundament his/her care based on what people say, think and manifest. The first nurse who claim her preference for the qualitative paradigm was Leininger, an anthropologist who develop the trans-cultural care theory.15 This Ph nurse is author of recognized qualitative work, the creator of ethno-nursing, an ethnography -derived current with the purpose of understanding behaviours about health conducts that are derived form the socio-cultural context in which human groups develop.8
    The nurse direct contact and cohabitation with the patient places him/her on a privileged position when trying to understand health phenomena that cannot be explained by mathematics, such as perceptions, experiences, speculations, meanings and attributes of the patients in the face of a certain disease; these areas has not been explored from the care perspective. The tradition of cohabitate with human groups makes the nurses social interaction something relatively easy to retake, since nurses are a socially accepted group due its helping attention in order to preserve and recover health. Research themes that are quantitatively complex to treat and that nursing can complement under the ethnographic focus are vast; some examples are: sexual diseases problems prevention such as AIDS, family violence in elder adults with chronic diseases, emotional wearing in carers of people with Alzheimer disease, feeding disorders in children with obesity and overweight and their parents, also in meanings of having a chronic disease in the case of patients with hypertension and diabetes and how they act because of it, abortion and drug addiction in adolescents, primary carers of pregnant adolescents, hospitalized patient's family satisfaction for the health personnel services, among many more themes.
    The way in which the nurse uses the ethnographic method to perform an investigation depends a lot of the place where he/she develops professionally. For example, community nurse is characterized by observing people's health conducts or that what conditions their conduct, so this allows to give meanings to healthy, or unhealthy, lifestyles. Community nurses try to understand these meanings before putting into effect health interventions, that is, they try not to modify the context where social groups develop in order to deepen into a health phenomenon culturally specific. To achieve that, the ethnographic method requires the nurse to cohabitate the time enough within the environment where facts develop; for example, if the objective is understanding the meanings of having a chronic disease as obesity, the nurse has to cohabit with the one who suffers obesity, his/her family, friends, and close persons within the environment that promotes obesity. It is clear that for ethno-nursing there are no a priori hypothesis, "variables are discovered on time". In a quantitative paradigm study with the purpose of measuring health status perception in people with or without obesity in Mexico's capital city,
16 discussion rendered interesting data that could not be answered by measurement instruments: people with obesity don't perceive their fat excess as a disease and, in fact, self-care and lifestyle capacities are similar to those of people with a normal weight. Maybe this means that obesity is a health phenomenon culturally accepted and without importance to health from the view of those who suffer it and not from the view of what scientific literature indicates. In order to inquire on this phenomenon, ethno-nursing would be ideal to investigate the meaning people give to obesity and to know if this meaning is really different from that of people with normal weight. In order to try explaining this phenomenon, it would be necessary cohabit with a small number of people with and without obesity within the environment that promotes the obesity where they develop, where instruments are the participant observation, the non structured interview, the recordings, video, and notes, materials all that will be used to analyze deeply the obesity phenomenon in an attempt to understand it. Figure 1 summarizes the ethnographic method characteristics.

Conclusion

    Qualitative social research within health scope constitutes an increasing effort for generating scientific knowledge and for searching solution to diverse problems that affect populations.17 Understanding health phenomena that cannot be explained through the mathematical language such as beliefs and values of people within their environment -specially if they are sick- represent knowledge voids that require to be explored from the ethnography view. Do it so can contribute enormously to the user's satisfaction and to propose new health attention strategies, and not only the coverage based on an attendance list to a traditional community talk; biomedical perspective must be complemented. Despite the ethnographic focus is little used by nursing, it is a kind of research that can be developed in an extraordinary way in the care practice and can contribute from another angle to evidence-based nursing. According to Janice Morse (2007),18 if the researcher knows only one method, he/she will only have one way to solve the problem or to approach reality. Ethnography allows obtaining human data inside a natural context, without restrictions, in a daily manner, which originates a better comprehension and a mayor deepening of the meaning of health for the individual, family or community.

Acknowledgement

    To Elisa Castro Sánchez PhD, Nursing Sciences PhD professor at UANL, for her contributions to the document.

References

1. De La Cuesta, B. Investigación Cualitativa y Enfermería. Index de Enfermería, 2000; 28-29: 7-8.
2. Landeros Olvera E, Amezcua M. Enfermería basada en evidencia: principios básicos. Revista Mexicana de Enfermería Cardiológica; 2005 Vol. 13 N° 1-2: 65-66.
3. Landeros Olvera E, Salazar González B, Cruz Quevedo E. La influencia del positivismo en la investigación y práctica de enfermería. Index de Enfermería, 2009; 18(4): 263-266.
4. Fuentes M, López S. La investigación social en salud: comunicaciones recientes en SPM, en: Salud Pública de México, 2005; 47(1):5-7.
5. Rodríguez G., Gil F, García J. Metodología de la investigación cualitativa, 1996 Aljibe: Málaga.
6. Mercado F, Lizardi A, Villaseñor M. Investigación Cualitativa en salud en América Latina. Una aproximación. En: Mercado, F., Gastaldo, D., Calderón, C. (Comps.) (2002b). Paradigmas y diseños de la investigación cualitativa en salud. Una antología iberoamericana. Universidad de Guadalajara: Guadalajara, México, 2002; pp. 133-157.
7. Fawcett, J. Analysis and evaluation of contemporary nursing knowledge. In: Nursing Models and Theories, F.A. Davis Company Philadelphia, 2000.
8. Amezcua M. "El trabajo de campo etnográfico en salud: una aproximación a la observación participante". Index de Enfermería, España, Granada, 2000; 30:30-35.
9. Hammersley M, Atkinson P. Etnografía: métodos de investigación. Edición Castellana, Barcelona: Piados, 1994.
10. García G. De etnógrafos y etnografías: el acercamiento al conocimiento cotidiano y de sentido común como instrumento de interpretación metodológica en las Ciencias Sociales. En: Perspectivas Sociales, 2005; 7(1): 151-173.
11. De la Cuesta B. Estrategias cualitativas más usadas en el campo de la salud. Nure Investigación, 2006; N° 26, nov-dic.
12. De la Cuesta B. El investigador como instrumento flexible de la indagación. International Journal of Qualitative Methods, 2003; 2(4).
13. Taylor S, Bodgan R. La observación participante. Preparación del trabajo de campo. En: Introducción a los métodos cualitativos de investigación. Barcelona: Paidós Básica; 1987, 37, pp.31-132.
14. Nigenda G, Langer A. Métodos cualitativos para la investigación en salud pública. Situación actual y perspectivas. En: Mercado, F.J., Gastaldo, D., Calderón, C. (Comps.) (2002b). Paradigmas y diseños de la investigación cualitativa en salud. Una antología iberoamericana. Universidad de Guadalajara: Guadalajara, México, 2002; pp. 191-207.
15. Leininger M. Nursing an Antropology: Two Worlds to Blend. Transcultural Nursing: Concepts, Theories and Practices. New York: John Wiley Sons, 1970.
16. Landeros Olvera E, Gallegos Cabriales E. Capacidades de autocuidado y percepción del estado de salud en personas con y sin obesidad. Revista Mexicana de Enfermería Cardiológica, 2005; 13(1-2): 20-24.
17. Castro S. Salud, Nutrición y Alimentación: Investigación Cualitativa. Ed. Tendencias. Universidad Autónoma de Nuevo León, México, 2009; pp.9.
18. Morse, Janice M. What is the domain of qualitative health research? Qualitative Health Research, 2007; 17, 715-71.

 

 

Go up 

 

 

error on connection