Qualitative Research: Observational methods in health care settings

Abstract

Research roles In an attempt to minimise the impact on the environment being studied the researcher sometimes adopts a “participant observer” role, becoming involved in the activities taking place while also observing them. The degree of participation varies according to the nature of the setting and the research questions, but broadly corresponds to the first two research roles described in Gold's typology (box 1).2 There are obviously important ethical considerations about the decision to conduct covert research, and for this reason examples of this type of observational study are rare. However, its use may be justified in some settings, and it has been used to research sensitive topics such as homosexuality3 and difficult to access areas such as fascist organisations4 and football hooliganism.5 Overt research—Gold's “participant as observer”—may pose fewer ethical dilemmas, but this may be offset by the group or individuals reacting to being observed. At its most basic, having a researcher observing actions may stimulate modifications in behaviour or action—the so-called “Hawthorne effect,”6 or encourage introspection or self questioning among those being researched. In his classic study of street gangs in the United States, Whyte recounted how a key group member said, “You've slowed me up plenty since you've been down here. Now when I do something I have to think what Bill Whyte would want to know about it and how I can explain it. Before I used to do things by instinct.”7 In addition to these potential problems for the subjects of observational research, there are important considerations for researchers “entering the field.” In essence these involve “getting in and getting out.” In the initial phases there may be problems gaining access to a setting, and then in striking up sufficient rapport and empathy with the group to enable research to be conducted. In medical settings, such as a hospital ward, this may involve negotiating with several different staff groups ranging from consultants and junior doctors, to nurse managers, staff nurses, social workers, and auxiliary professions. Once “inside” there is the problem of avoiding “going native”; that is, becoming so immersed in the group culture that the research agenda is lost, or that it becomes extremely difficult or emotionally draining to exit the field and conclude the data collection. Observation of transactions with patients presenting to casualty departments found that staff classified patients into “normal rubbish” (the inappropriate attenders) and “good” patients, who were viewed as more deserving. **FIGURE OMITTED**