Transcript ETHICAL ISSUES IN EMERGENCY DEPARTMENT RESEARCH

School of Nursing & Midwifery
Research Conference 2013
Gerard White
PhD Research Fellow
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To describe a novel approach to managing the issue of
preconception and coding bias in grounded theory research.
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Grounded Theory is the most popular and widely used
qualitative research method (Bryant & Charmaz, 2007)
and is particularly popular in nursing studies (Artinian et
al, 2009; Holloway& Wheeler, 2004).
Practice professions such as Nursing facilitate familiarity
with contemporary issues in the area of study (Schreiber
et al, 2001). However, this may lead to a narrowing of the
researcher’s viewpoint by focusing his attention on preconceived theories and ideas (Glaser, 1992; Glaser &
Strauss, 1967).
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We unconsciously bring assumptions about the topic into
the research process (Parahoo, 2006).
These assumptions may bias data interpretation (Glaser,
1978).
Professionals are expected to be familiar with the
literature in their field of practice (Strauss& Corbin,
1998; Charmaz, 2006).
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Use knowledge and experience to inform research (Baker
et al, 1992)
Background knowledge provides theoretical sensitivity
(Walls et al, 2010).
Researcher’s knowledge and experience inform the coconstruction of findings (Charmaz, 2007)
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Bracketing
Avoiding substantive literature
Keeping open mind
Use of open and grand tour questions (Simmonds cited in
Glaser, 2012)
Use of constant comparative method
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Bracketing is a scientific process in which
presuppositions and biases are held in abeyance (Gearing,
2004).
Bracketing mitigates against preconception that may taint
research (Tufford & Newman, 2013).
Importance of recognising preconceptions prior to
undertaking research (Tufford & Newman, 2013),
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Writing memos (Cutcliffe, 2003)
Bracketing interviews (Rolls and Relf, 2006)
Reflexive journals (Ahern, 1999)
All of these methods require knowledge of what
preconceptions we have or may have!
How to address what preconceptions we don’t know
about?
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Delay literature review until after data collection and
analysis to prevent framing the problem (Glaser, 1998;
Hamill & Sinclair, 2010).
Avoid other data sources until theory is well formulated
to avoid pre-empting the theory (Glaser, 1998).
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Subjecting researcher to same grand tour questions will
allow freedom to express biases, preconceptions whether
recognised or not in a more normal conversational
manner.
Self interview or memo become data to compare with
field data (Glaser, 1998).
Timing of interview is important
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Constantly compare text within self-interview for
emergent codes.
Compare these codes to existing codes in the theory.
Also compare text within self interview to text from other
interviews for emergent codes.
This validates, alters or rejects the bias (Fernandez,
2005).
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Vulnerable people on trolleys for days at a time. A
crowded physical environment with numerous
challenges.
The typical environment..noise..patients stacked one next
to the other on trolleys...on a corridor..its cold, noisy,
constant interruption. No privacy. Temporary screens
around them. Patients examined on corridors with no
screens.
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In my clinical practice the most obvious thing is firstly
the length of time that patients have to wait to be seen.
That would be the first thing that I find quite hard to deal
with. The second thing would be when you are trying to
look after a patient or manage a patient and there isn't a
suitable environment. Things like not having a trolley
when you know that patients are unwell and need a safe
environment with perhaps a cardiac monitor and a trolley,
there simple aren't any, so you find yourself managing
patients in an environment that is both frustrating to me
and to the patient. Perhaps some kind of a plastic chair.
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You find yourself apologising. You are constantly
apologising to patients saying this is the best we can
do..apologising for sub-optimal conditions.
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I apologise a lot of the time I find myself just apologising
just saying sorry for the fact that they had to wait so long.
sorry for the fact that I have had to put them in an
environment that is uncomfortable, hot smelly. I
apologise for having to put them on a plastic chair next to
a stranger that could be intoxicated. I usually deal with
the situation by apologising.
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“Morale is at an all time low. Peoples’ pay and conditions
are being cut. I personally feel that pay and conditions
should not be cut and that nurses fare worse when
compared to other professions....
It seems to be done in an unfair manner in that nurses are
hit more than other profession because we do more nights
and out of hours work.”
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Code of “ Pay and conditions”
Code of “Fairness”
Code of “Victimisation”
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Several theoretical biases from the researcher were
identified using self interview. The identified
preconception was managed by using the constant
comparative method of data analysis to check if the
potential bias or preconception 'patterned out' i.e. if it was
supported or refuted by the research data. Some of these
biases were supported by the data and more were not.
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Self interview and the constant comparison process of
data analysis can be used together to manage
preconception while conducting grounded theory nursing
research.
This is just one of many approaches to managing
preconception.
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This paper forms part of a School of Nursing and
Midwifery study which is supported by the College of
Medicine and Health PhD Fellowship scheme.
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Ahern, K.J., (1999) ‘Pearls, Pith, and Provocation: Ten Tips for Reflexive Bracketing’. Qualitative Health Research 9(3) 407-11.
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Artinian, B., Giske, T., & Cone, P. (Eds.). (2009). Glaserian grounded theory in nursing research: Trusting emergence. New York: Springer.Baker,
C., Wuest, J., Stern, PN (1992) Method slurring: the grounded theory/phenomenology example. Journal of Advanced Nursing.17(11) 1355-1360.
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Bryant, A., & Charmaz, K. (2007). Introduction. grounded theory research: Methods and practices. In A. Bryant & K. Charmaz (Eds.), The SAGE
handbook of grounded theory (pp. 1–28). London: Sage.
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Charmaz, K (2007) Constructing grounded theory: A practical guide through qualitative analysis. Sage, London.
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Cutcliffe, J. (2003) Reconsidering reflexivity: introducing the case for intellectual entrepreneurship. Qualitative Health Research 13 (1), 136-148.
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Fernandez, WD (2005) The grounded theory method and case study data in IS research: issues and design. In: Hart, D., McGregor, S. (eds)
Informations systems foundations: Constructing and criticising. ANU E Press, Canberra, Australia.
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Gearing, R. (2004) ‘Bracketing in research: A typology’. Qualitative Health Research, 14(10):1429-52.
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Glaser, B.G. (1978) Theoretical Sensitivity: Advances in the methodology of grounded theory. Sociology Press, Mill Valley, California.
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Glaser, B.G. (1992) Basics of grounded theory analysis: Emergence versus forcing. Sociology Press, Mill Valley, California.
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Glaser , B.G. (1998) Doing Grounded Theory: Issues and discussion. Sociology Press, Mill Valley, California.
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Glaser, B.G. & Strauss, A.L. (1967) The discovery of grounded theory: Strategies for qualitative research. Aldine, Chicago.
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Hamill, C. & Sinclair, H. (2010) Bracketing-practical considerations in Husserlian phenomenological research. Nurse Researcher, 17(2) 16-24.
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Holloway, I. & Wheeler, S. (1995) Ethical issues in qualitative nursing research. Nursing Ethics,; 2 (3): 223-32.
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Parahoo, K. (2006) Nursing research: principles, process and issues. (2 nd ed) Palgrave/Macmillan, Basingstoke.
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Rolls, L. & Relf , M. (2006) ‘Bracketing Interviews: Addressing methodological challenges in qualitative interviewing in bereavement and palliative
care’, Mortality 11(3): 286-305.
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Schreiber, R.S. & Stern P.N. (2001) Using grounded theory in nursing. Springer, New York.
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Simmonds, O. cited in Glaser, B.G. (2012) Stop. Write! Writing grounded theory. The Grounded Theory Review. 11(1) 2-11.
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Strauss, A.L. & Corbin, J. (1998) Basics of qualitative research: Techniques and procedures for developing grounded theory (2nd ed). Sage, Thousand
Oaks, California.
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Tufford, L. & Newman, P. (2013) Bracketing in Qualitative Research. Qualitative Social Work. 0(0) 1-17.
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Walls, P., Parahoo, K., Fleming, P. (2010) The role and place of knowledge and literature in grounded theory. Nurse Researcher 17(4), 8-17.
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