Research

DIMENSION

Qualitative Research
The ‘‘What,’’ ‘‘Why,’’ ‘‘Who,’’ and ‘‘How’’!
Brigitte S. Cypress, EdD, RN, CCRN

There has been a general view of qualitative research as a lower level

form of inquiry and the diverse conceptualizations of what it is, its use
or utility, its users, the process of how it is conducted, and its scientific
merit. This fragmented understanding and varied ways in which
qualitative research is conceived, synthesized, and presented have a
myriad of implications in demonstrating and enhancing the utilization
of its findings and the ways and skills required in transforming
knowledge gained from it. The purpose of this article is to define
qualitative research and discuss its significance in research, the
questions it addresses, its characteristics, methods and criteria for rigor,
and the type of results it can offer. A framework for understanding
the ‘‘what,’’ ‘‘why,’’ ‘‘who,’’ and ‘‘how’’ of qualitative research; the
different approaches; and the strategies to achieve trustworthiness are
presented. Qualitative research provides insights into health-related
phenomena and seeks to understand and interpret subjective
experience and thus humanizes health care and can enrich further
research inquiries and be made clearer and more rigorous as it is
relevant to the perspective and goals of nursing.
Keywords: Goals of nursing, Health care, Qualitative research
[DIMENS CRIT CARE NURS. 2015;34(6):356/361]

Qualitative research methods began to appear in nurs- One conducts a qualitative study to uncover the nature of
ing in 1960s and 1970s amid cautious and reluctant ac- the person’s experiences with a phenomenon in context-
ceptance. In the 1980s, qualitative health research emerged as specific conditions such as illness (acute and chronic), ad-
a distinctive domain and mode of inquiry.1 Qualitative re- diction, loss, disability, and end of life. Qualitative research
search refers to any kind of research that produces findings is used to explore, uncover, describe, and understand what
not arrived at by means of statistical analysis or other means lies behind any phenomenon about which maybe little is
of quantification.2,3 It uses a naturalistic approach that seeks known. This deeper understanding of the phenomenon in
to understand phenomena about persons’ lives, stories, and its specific context can be attained only through a quali-
behavior including those related to health, organizational tative inquiry than mere numbers and statistical models
functioning, social movements, or interactional relationships. could provide using a quantitative approach. Qualitative
Qualitative research is underpinned by several theoretical inquiry represents a legitimate mode of social and human
perspectives, namely, constructivist-interpretive, critical, science exploration, without apology or comparisons to
postpositivist, poststructural/postmodern, and feminism.4 quantitative research.5

356 Dimensions of Critical Care Nursing Vol. 34 / No. 6 DOI: 10.1097/DCC.0000000000000150

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 Qualitative Research

This article describes what is qualitative research meth- in turn, contributed to the growing interest of incorpo-
odology, the ‘‘what,’’ ‘‘why,’’ ‘‘who,’’ and ‘‘how,’’ including rating qualitative health research findings into evidence-
its components. The aim is to simplify the terminology and based practice.
process of qualitative inquiry to enable novice readers of Morse10 asserted that there are other reasons for con-
research to better understand the concepts involved. ducting a qualitative inquiry. Others believe that the role
of qualitative inquiry is to provide hypothesis and research
WHY DO QUALITATIVE RESEARCH? questions that can be posed from the findings of quali-
The tradition of using qualitative methods to study human tative research studies. Qualitative research can also serve
phenomena is grounded in the social sciences.6 This meth- as a foundation from which surveys and questionnaires
odological revolution has made way for a more interpre- could be developed, thus increasing its validity that would
tative approach because aspects of human values, culture, produce models for quantitative testing. But, what is really
and relationships are not described fully using quantita- the most important function of qualitative inquiry? Ac-
tive research methods. Unlike quantitative researchers who cording to Morse,10 this key function is the moral imperative
seek causal determination, prediction, and generalization of of qualitative inquiry to humanize health care. She stated,
findings, qualitative researchers allow for the phenomenon ‘‘The social justice agenda of qualitative health research
of interest to unfold naturally,7 strive to explore, describe is one that humanizes health care.’’10(p52) So, what is
and understand it, and delve into a colorful, deep, con- humanizing health care? Morse10 stated, ‘‘Humanizing
textual world of interpretations.8 Thus, the practice of encompasses a perspective on attitudes, beliefs, expecta-
qualitative research has expanded to clinical settings be- tions, practices, and behaviors that influence the quality
cause empirical approaches have proven to be inadequate of care, administration of that care, conditions judged to
in answering questions related to human subjectivity where warrant (or not warrant) empathetic care, responses to care
interpretation is involved.9 Consequently, qualitative health and therapeutics, and anticipated and actual outcomes of
research is a research approach to exploring health and patient or community care.’’10(pp54,55)
illness as they are perceived by the people themselves rather Conducting research should be sort of a social justice
than from the researcher’s perspective.10 Morse10 further project.10 Denzin11 recognizes making social justice a public
stated that ‘‘Researchers use qualitative research methods agenda within qualitative inquiry. He emphasized that quali-
to illicit emotions and perspectives, beliefs and values, ac- tative inquiry can contribute to social justice through (a)
tions, and behaviors and to understand the participant’s identifying different definitions of a problem and/or sit-
responses to health and illness and the meanings they uation that is being evaluated with some agreement that
construct about the experience.’’10(p21) It provides a rich change is required; (b) the assumptions that are held by
inductive description that necessitates interpretations. policy makers, clients, welfare workers, online professionals,
Researchers in the health care arena, practitioners, and policy and other interested parties can be located and shown to be
makers are increasingly pressed to translate these findings for correct or incorrect; (c) strategic points of interventions can be
practice, put them to use, and evaluate how useful they ac- identified and thus evaluated and improved; (d) suggest
tually are in effecting desired change with goal of improv- alternative moral points of view from which the problem,
ing public health and reducing disparities in health care the policy, and the program can be interpreted and assessed;
delivery.1 Even though qualitative research has been used and (e) the limits of statistics and statistical evaluations can
for many decades, and it is in fact flourishing, it is not be exposed with the more qualitative materials furnished
free of criticisms from experts with impoverished view of by this approach.11
the methodology.
Despite the current urgency of the utilization of quali- WHO DOES QUALITATIVE RESEARCH?
tative methodologies in research studies, questions are raised Qualitative research is done by researchers in the social
for its lack of objectivity, generalizability, utility, and its sciences as well as by practitioners in fields that concern
tendency to be anecdotal.1 Critics continue to make these themselves with issues related to human behavior and
charges related to their limited understanding of qualitative functioning.3 They are also health professionals who are
designs, approaches, and methods. Sandelowski1 asserted able to identify a research question and able to recognize
that the current urgency about the utility of qualitative the particular context and situation that would achieve
research findings is the result of several converging trends the best answers.10 According to Morse,10 the qualita-
in health care research that include the elevation of practical tive health researcher should be an expert methodologist
over basic knowledge as the highest form of knowledge, the who should have the understanding of illness, the patient’s
proliferation of qualitative health research studies, and the condition, and the staff roles and relationships and able to
rise of evidence-based practice as a paradigm and method- balance the clinical situation from different perspectives.10(p23)
ology for health care.1 Consequently, these events have, A qualitative researcher also requires theoretical and social

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 Qualitative Research

sensibility, interactional skills, and the ability to maintain Researchers from different disciplines use these approaches
analytical distance while drawing upon past experience depending on what the purpose of the study is.
and theoretical knowledge to interpret what is seen or Narrative research begins with the experiences as ex-
observed.3 pressed in lived and told stories of individuals. Narrative is
a spoken word or written text giving an account of an
WHAT ARE THE CHARACTERISTICS OF event/action chronologically connected. Some examples of
QUALITATIVE RESEARCH? this approach are biographical studies, autobiographies,
Creswell12 discussed that qualitative research studies today and life stories. Kvangarsnes et al13 explored the patient
involve closer attention to the interpretive nature of inquiry perceptions of chronic obstructive pulmonary disease ex-
and situating the study within the political, social, and cul- acerbation and their experiences of their relations with
tural context of the researchers, participants, and readers of health personnel during care and treatment using narra-
the study. He presented several characteristics of qualitative tive research design. Ten in-depth qualitative interviews
research, which are (a) natural setting: data are collected were conducted with patients who had been admitted to
face-to-face in the field at the site where participants ex- 2 intensive care units (ICUs) in Western Norway during
perience the phenomenon under study; the inquiry should the autumn of 2009 and the spring of 2010. Narrative
be conducted in a way that does not disturb the natural analysis and theories on trust and power were used to
context of the phenomenon; (b) researcher as key instru- analyze the interviews. The patients perceived that they
ment: the researchers collect the data themselves rather were completely dependent on others during the acute phase.
than relying on instruments developed by others; (c) mul- Some stated that they had experienced an altered perception
tiple sources of data: researchers gather multiple forms of of reality and had not understood how serious their sit-
data including interviews, observations, and examining uation was. Although the patients trusted the health per-
documents rather than rely on a single source; (d) induc- sonnel in helping them breathe, they also told stories about
tive data analysis: data are organized into abstract units care deficiencies and situations in which they felt neglected.
of information (‘‘bottom-up’’ or moving from specific to This study shows that patients with an acute exacerbation
general), working back and forth between the themes and of chronic obstructive pulmonary disease often feel wholly
the database until a comprehensive set of themes is estab- dependent on health personnel during the exacerbation
lished and ending up with general conclusions or theories; and, as a result, experience extreme vulnerability.
(e) participant’s meanings: the researchers keep a focus on Whereas a narrative approach explores the life of a
learning the meaning that the participants hold about the single person, a phenomenological study describes the
phenomenon, not the meaning that the researchers bring to meaning for several individuals of their lived experiences
the study; (f ) emergent design: the initial plan for the study of a phenomenon.12 Phenomenology is the most inductive
cannot be tightly prescribed; rather, it is emergent, and all of all qualitative methods.10 The philosophical assump-
phases of the process may change or shift after the re- tions of phenomenology rest on some common grounds:
searchers enter the field and begin to collect the data; (g) the study of the lived experiences of persons, the view that
theoretical lens: use of a ‘‘lens’’ to view the study such as these experiences are conscious ones and the development
the concept of culture, gender, race or class differences, of descriptions of the essences of these experiences, not ex-
and social, political, or historical context of the problem planations or analysis.12 There are different types of phenom-
under study; (h) interpretive inquiry: a form of inquiry in enological approaches, namely, descriptive-transcendental
which researchers make interpretation of what they see, (Husserl, Giorgi), interpretive/hermeneutic (Heidegger,
hear, and understand that cannot be separated from their Gadamer, Jen-Luc Nancy), descriptive-hermeneutic (van
own background, history, context, and prior understand- Manen), empirical-transcendental (Moustakas), and existential
ing; (i) holistic account: reporting multiple perspectives, (Sarte, Heidegger, Merleau-Ponty). A phenomenological
identifying the many factors involved in a situation, and study conducted by Cypress14 explored the lived experi-
sketching the larger picture that emerges.12 ences of nurses, patients, and family members during
critical illness in the emergency department (ED). Data were
WHAT ARE THE METHODS FREQUENTLY collected over a 6-month period by means of in-depth in-
USED IN QUALITATIVE RESEARCH? terviews, and thematic analysis was done using van
The research question dictates the method to be used for Manen’s15 hermeneutic-phenomenological approach. The
a qualitative study. Qualitative and quantitative questions findings of this qualitative phenomenological study indicate
are distinct and serve different purposes.10 Some of the that the patient’s and family member’s perception of the nurses
different types of qualitative research that will be dis- in the ED relates to their critical thinking skills, commu-
cussed in this article are phenomenology, grounded nication, sensitivity, and caring abilities. Nurses of this study
theory, ethnography, case study, and narrative research. identified that response to the patient’s physiological deficit is

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 Qualitative Research

paramount in the ED, and involving the patients and families a bounded system (a case) or multiple bounded systems
in the human care processes will help attain this goal. (cases) over time through detailed in-depth data collec-
While phenomenology aims to illuminate themes and tion involving multiple sources of information and re-
describe the meaning of lived experiences of a number ports a case description and case-based themes.12(p73) In
of individuals, grounded theory has the intent to move terms of intent, there are 3 types of case study: single
beyond description and to generate or discover a theory, instrumental, collective or multiple, and the intrinsic case
an abstract analytical schema of a process, or interaction study. Hyde-Wyatt21 studied spinally injured patients on
shaped by the views of a large number of participants.12 sedation in the ICU. A reflection-on-action exercise was
This qualitative method was developed by Glaser and carried out when a spinally injured patient became physically
Strauss16 in 1967. Other grounded theorists followed, active during a sedation hold. This was attributed to hy-
including Clarke,17 who relies on postmodern perspectives, peractive delirium. Reflection on this incident led to a lit-
and Charmaz,18 on constructivist approach. Gallagher erature search for guidance on the likelihood of delirium
et al19 collected and analyzed qualitative data using causing secondary spinal injury in patients with unstable
grounded theory to understand nurses’ end-of-life (EOL) fractures. Through a case study approach, the research was
decision-making practices in 5 ICUs in different cultural reviewed in relation to a particular patient. This case study
contexts. Interviews were conducted with 51 experienced illustrated that there was a knowledge deficit when it came to
ICU nurses in university or hospital premises in 5 countries. managing the combination of the patient’s spinal injury and
The comparative analysis of the data within and across data delirium. Sedation cessation episodes are an essential part of
generated by the different research teams enabled researchers patient care on intensive care. For spinally injured patients,
to develop a deeper understanding of EOL decision-making these may need to be modified to sedation reductions to
practices in the ICU. The core category that emerged was prevent sudden wakening and uncontrolled movement
‘‘negotiated reorienting.’’ Gallagher et al19 stated, ‘‘Whilst should the patient be experiencing hyperactive delirium.
nurses do not make the ‘ultimate’ EOL decisions, they en-
gage in 2 core practices: consensus seeking (involving coaxing, WHAT IS THE PROCESS OF
information cuing and voice enabling) and emotional holding CONCEPTUALIZING AND DESIGNING A
(creating time-space and comfort giving).’’19(p794) QUALITATIVE RESEARCH?
Although a grounded theory approach examines a Designing a qualitative is not a fully structured, rigid pro-
number of individuals to develop a theory, participants are cess. Even books and experts vary in their understanding
not studied as 1 unit. Ethnography uses a larger number of and guides in the ‘‘how to’’ perspective of a qualitative
individuals and focuses on an entire cultural group as 1 inquiry. Conducting a qualitative study is also extremely
unit of analysis. This qualitative approach describes and difficult.10 Sometimes there is concern about access and
interprets the shared and learned patters of values, be- the qualitative procedures involved in data collection
haviors, beliefs, and language of a cultural-sharing group.12 including disclosure of participant’s identity and confi-
There are many forms of ethnography, namely, confes- dentiality of data. Nevertheless, qualitative research in-
sional, life history, autoethnography, feminist, ethnographic volves a rigorous and scientific process that serves as guide
novels, visual ethnography found in photography and video, for researchers who are planning to embark on a journey
and electronic media. Price20 explored what aspects affect and complete a naturalistic inquiry.
registered health care professionals’ ability to care for Unlike quantitative research that involves a fairly
patients within the technological environment of a critical linear process, qualitative studies have a flexible approach
care unit. Ethnography was utilized to focus on the cul- and flow of activities, and the researchers do not know in
tural elements within a situation. Data collection involved advance exactly how the study will unfold.22 The process
participant observation, document review, and semistruc- of designing a qualitative study does not begin with the
tured interviews. Nineteen participants took part in the methodsVwhich in fact is the easiest part of naturalistic
study. An overarching theme of the ‘‘crafting process’’ was research.12 Qualitative researchers usually begin with a
developed with subthemes of ‘‘vigilance,’’ ‘‘focus of at- broad topic focusing on 1 aspect or a phenomenon of
tention,’’ ‘‘being present,’’ and ‘‘expectations,’’ with the which little is known. The phenomenon may be one in
ultimate goal of achieving the best interests for the indi- the ‘‘real world,’’ a gap in the literature, or past findings
vidual patient. of investigations, for example, in the area of social and
A culture-sharing group in ethnography can be con- human sciences.12 A fairly broad question is then posed
sidered a case, but its aim is to ascertain how the culture to be able to allow the focus to be delineated and shar-
works rather than understanding 1 or more specific cases pened once the study is underway.
within a bounded system. Creswell12 defines case study Once the research question is posed, the researchers
research as an approach in which the researcher explores should conduct a brief literature review to inform the

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 Qualitative Research

question asked and to help establish the significance of and the contextual features of a hospital. A patient’s con-
the problem. There is a continuous debate about the value dition may demand a different method be used because of
of doing a literature review prior to collecting of data and patient fatigue, the interruptions of data collection for
how much of it should be done. Some believe that knowl- treatments, or physician’s rounds and visitors. In this con-
edge about findings of previous studies might influence the text, the study requires modifications of methods, and par-
conceptualization of the phenomenon of interest, which ticipation in a research study has the lowest priority at this
ideally should be illuminated from the participants rather specific moment and time.10
than on prior findings.22 A grounded theory investigator, In qualitative studies, sampling, data collection, and
for example, may make a point of not conducting a review analysis including interpretation take place repetitively.
of literature before beginning the study to avoid ‘‘contam- The sampling method usually used is purposive. Qualita-
ination’’ of the data with preconceived concepts and notions tive researchers use rigorous data collection procedures by
about what might be relevant.2 After the review of literature, talking to participants face-to-face, interviewing, and ob-
the researchers must identify an appropriate site for the serving them (individual, focus groups, or an entire culture)
study to be conducted. to be able to explore the phenomenon under study. The
Selecting and gaining entry to the site require knowl- discussions and observations are loosely structured, allow-
edge of settings in which participants in their lifeworld are ing participants full range of beliefs, feelings, and behav-
experiencing the phenomenon under study. For example, iors.22 Other types of information that can be collected
research in the area of health is a very broad topic. A re- are documents, photographs, audiovisual materials, sounds,
searcher should determine definitions, concepts, scope, e-mail massages, digital text messages, and computer soft-
and theories about health that will be used for the pro- ware. The backbone of qualitative research is extensive
posed qualitative inquiry. Health can be perceived as ab- collection of data from multiple sources of information.12
sence or presence of illness, physical, psychosocial, After organizing and storing the data, the researcher will try
psychological, and spiritual health of individuals, families, to make sense of the data, working inductively from par-
or groups.10 Morse10 further stated that ‘‘Research into ticulars to more general perspectives until categories, codes,
the intimate, experiential and interpersonal aspects of ill- and themes emerge and are illuminated, which are used to
ness, into caring for the ill, and into seeking and main- build a rich description of the phenomenon.12,22 The re-
taining wellness introduces extraordinary methodological searcher analyzes data using multiple levels of abstraction.
challenges.’’10(p89) Thus, knowledge about the character- Analysis and interpretation are ongoing concurrent activ-
istics of participants who will be recruited for the study ities that guide the researchers about the kinds of questions
and the specific context of the settings (ie, hospital/ to ask or observations to make. The kinds of data gathered
institution, community/outpatient) where they are at the become increasingly meaningful as the theory emerges.
time when research will be conducted is important. To be When themes and categories become repetitive and redun-
able to gain entry to the site, the ethical aspect of the study dant and no new information can be gleaned, the re-
should also be addressed. Approval from the institution’s searcher has reached data saturation and thus stops
institutional review board and informed consent from the collecting data and recruitment of participants.22 Trust-
participants must be obtained. Qualitative studies have worthiness of the data and rigor have to be then estab-
special ethical concerns involved because of the more inti- lished. Steps have to be taken to confirm that the findings
mate nature of the relationship that typically develop be- accurately reflect the experiences and perceptions of par-
tween researchers and participants.22 The researchers ticipants rather than the researcher’s viewpoints. Some of
must develop specific plans addressing these issues. After the strategies that can be used are validation techniques
addressing the ethical concerns and gaining entry to the that include confirming and triangulating data from sev-
site, an overall approach should be planned and developed. eral sources, going back to participants, sharing prelim-
It has been previously addressed that even though the inary interpretations with them, asking them whether the
researchers plan for a specific approach to be used, the researcher’s thematic analysis is consistent with their ex-
design can be emergent during the course of data col- periences,22(p55) and having other expert researchers review
lection. Modifications are made as the need arises. It is the procedures undertaken and interpretations made.12
rare that a qualitative study has rigidly structured de-
sign that will prohibit changes while in the field,22 but FINAL THOUGHTS
being aware that the purposes, questions, and methods Qualitative research uses a naturalistic approach that seeks
of research are all interconnected and interrelated so that to understand phenomena in context-specific settings,
the study appears as a cohesive whole rather than frag- attempting to make sense of it and interpreting in terms
mented isolated parts.5 For example, patients in hospi- of meaning people bring to them. It contributes to the
tals have limited abilities related to their medical condition humanizing of health care as it addresses content about

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 Qualitative Research

health and illness. Qualitative research does not have firm 12. Creswell JW. Qualitative Inquiry and Research Design: Choos-
or rigid guidelines and takes time to conduct. Some of the ing Among Five Approaches. 3rd ed. Thousand Oaks, CA: Sage;
2012.
methods for a qualitative inquiry are narrative research, 13. Kvangarsnes M, Torheim H, Hole T, Öhlund LS. Narratives
phenomenology, grounded theory, case study, and ethnog- of breathlessness in chronic obstructive pulmonary disease.
raphy. Although the study design emerges during the in- J Clin Nurs. 2013;22(21-22):3062-3070.
14. Cypress BS. The emergency room: experiences of patients,
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Press; 1990.
Ethical decisions and considerations for rigor and trustwor- 16. Glaser BG, Strauss AL. The Discovery of Grounded Theory:
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2nd ed. Thousand Oaks, CA: Sage Publications; 2001. Brigitte S. Cypress, EdD, RN, CCRN, is assistant professor at Lehman
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