Moustakas (1994) recommends a very specific formula in the organisation of a research report. Required sections are: Introduction and statement of topic and outline, Review of relevant literature, Conceptual framework of the model, Methodology, Presentation of data ending with Summary, implications and Outcomes. Riemen’s (1986) study follows this structure closely, and contains all of these recommended components.
Riemen (1986) presents her study, very much like a scientific report. She clearly states the problem, highlights the design her study will to take, defines the terms she will use throughout and details sample selection and interview techniques employed. Through this combined with both a theoretical overview of how she will analyse the data, and a step by step breakdown of how data was actually manipulated, the author provides a reliable template, from which her research could be accurately repeated.
Ethically, the author states that following an explanation of purpose, informed, written consent was obtained from all participants in the study. There is anonymity for the participants in terms if identification in the published study, and although some direct quotes are given, gender is the only identifying information is supplied. However she does not mention at any time a level of risk assessment for the participants. Given the very emotive nature of the study, where personal issues may have come to the fore, it would have been advisable. It is presumed that no aftercare or counselling was offered.
Moustakas (1994) emphasises the importance of bracketing, where the researcher sets aside all preconceived perceptions of the phenomenon to be studied, in order to best understand the experiences of participants in the study. Riemen (1986) clearly makes the reader aware of this requirement, but falls somewhat short of disclosing her feelings on the subject. She states only a belief that she believes, there exists an essential structure of a caring interaction, a structure absent in the non-caring interaction.
Riemen (1986) studies a single phenomen, the nurse-client caring interaction and poses the central question “What is essential for the experience to be described by the client as being a caring interaction?”
In her paper she explains clearly, the transition from this central question to the five exploratory prompts given to each participant during the interviews. The prompts were, in brief; Describe a caring interaction with a nurse, Explain how it felt, Describe a non-caring interaction, Explain how it felt, Continue until you have discussed your feelings completely. The prompts are open-ended, clear, concise and very much in layman’s terms, allowing the participant to feel at ease, under no pressure, but able to give maximum feedback. Patton (1990) stated of interviews, it was crucial to hear both what was said and unsaid. In the same vain the researcher probed further when necessary, asking additional questions as a means to clarify a participants response whilst the interview took place. This served two purposes in that it provided on the spot validation of the reasearcher’s interpretation, but also helped the participant more fully understand the degree of detail desired.
Riemen’s (1986) data analysis is thorough and logical. She references the analysis method as that developed by Colaizzi (1978), although it is similar to that later published by Moustakas (1994). She succinctly summarises the move from transcribed interviews, to significant statement selection, through formulation of meaningful statements, before clustering common themes and advancing exhaustive descriptions for both the caring and non-caring interactions. This type of analysis allows the raw interview material, to become more explicit, specifically in terms of psychological meaning. This aspect of transformation reveals meaning of the lived experience which may not necessarily have been clearly articulated. The use of tables to present each stage of the transformation both guides the reader through each level analysis and allows them to follow the author’s logic in taking each step. This is immediately more useful to the reader than large volumes of descriptive and interpretative text. The necessary high level of correlation (or fit) between the initial statements and the final descriptions (Smith, 2003) is apparent.
Whilst the author gives good account of data analysis trail, both explaining in detail the procedure to be followed, and displaying this in her own work, mention of an audit trail / researcher track is notably absent. The audit trail, thought by Miles and Huberman (1994) to be crucial to the validation process, would contain such information as the researchers thoughts and observations throughout the study, and form a means of tracing both findings and emergence of theories. The author makes no mention of such recordings.
Willig (2001) states that reflexivity requires the researcher’s awareness of their personal contribution to the construction of meanings throughout the research process. And an acknowledgement of the impossibility of remaining “outside of”the subject matter whilst conducting research. This is again apparent by its absence in this study, with only a brief mention in the summary of a concern that significant meanings and themes extracted were representative of the participant interviews.
The researcher validated the information herself by a process of back referencing the original descriptions at each stage of analysis. In addition, when the data analysis had been completed the researcher the took the results back to 8 of the 10 participants to allow participant validation of the study findings as recommended by Humphrey, cited in Moustakas (1994). This facilitated both an accuracy check and the solicitation of any commentary based on the researcher’s interpretation of the information.
Yardley, cited in Smith (2003) argues a key test of the validity of any research is whether it actually tells anything new or important or is useful. As stated by the author, the nurse-client caring interaction had not previously been explored from the client’s perspective. This study set out to and achieved just that. The author in addition to presenting her findings, exhaustive descriptions of both the caring and non-caring interaction, details exactly how and where these findings may be used in future nursing development. She details nursing teaching, research practice and theory as areas where her findings may be usefully employed.
Guba and Lincoln (1989) suggest that the transferability of any qualitative findings is dependant upon the degree of similarity between given contexts. One assumes, in the case of the current study, that the nurse-client caring interaction is generalisable throughout the developed world. However given the subtle differences in expectations of the said interaction noted between genders, perhaps the age of the participants or type and duration of their illness are also factors of which note, which would impact the transferability of the author’s findings. The study is now more than 20 years old, medicine has moved on, nursing methodologies also, but significantly, the public’s expectations may also be higher. Where in 1986 the study may have been widely transferable, additional reasearch would be needed for future use.
To encapsulate, this was on the whole a succinct and easily read phenomenology. The author introduced the probelm, paid detailed attention to the philosophical aspects behind the study and to the procedures of the phenomenological research method. Her “treatment of data” was clear and concise, enabling the study to flow logically from the introduction, method and techniques employed through to her discussion and conclusion.
However, a lack of attention to the author’s preconceptions toward the caring interactions, and any concerns or thoughts throughout the study is apparent. In addition, no mention is made as to the types of future research which could further deepen and extend knowledge on the topic, which given the time spent on such a detailed piece of work, the researcher has essentially become an expert on the topic, and should recognise and acknowledge areas for future research.
Moustakas (1994) contends that phenomenology offers a way of interrelating subjective and objective factors, of “witnessing and lifting out the qualities, constituents and significant horizons of experience” to allow a deep exploration of the everyday components of human experience. On this final note it would appear Riemen successfully achieved what she set out what to do at the start, to achieve a clear understanding of the essential structure of the nurse / client interaction (or experience) from the prospective of the client.
References
Creswell, J. W. (1998) Qualitative Inquiry and Research Design: Choosing among five Traditions. London; Sage
Denzin, N. and Lincon, Y. (1994). The Handbook of Qualitative Research. London; Sage.
Guba, E. and Lincoln, Y. (1989). Fourth generation Evaluation. Newbury Park, Calif.; Sage
Lopez, K. A. and Willis, D. G. (2004). Descriptive Versus Interpretive Phenomenology: Their contributions to Nursing Knowledge. Qualitative Health Research, 14(5), 726-735.
Moustakas, C. (1994). Phenomenological Research Methods. Thousand Oaks, Calif.; Sage.
Miles, M.B. and Huberman, A.M. (1984). Qualitative data analysis: a sourcebook of new methods. London; Sage.
Patton, M.Q. (1990). Qualitative research and evaluation methods. London; Sage.
Smith J.A.(2003). Qualitative Psychology. A Practical Guide to Research Methods. London; Sage.
Willig, C. (2001). Introducing qualitative research in psychology: Adventures in theory and method. Birmingham; Open University Press.
