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Qualitative Research

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Qualitative Research Challenges and Dilemmas

Brigitte S. Cypress, EdD, RN, CCRN

Considering the inductive nature of qualitative studies, the research process can be

challenging to novices and doctoral students at every step. Appropriate planning

should be in place before the commencement of the fieldwork, as well as to be

able to address any methodological contingencies that emerge during the process.

Challenges and dilemmas occur at different stages of the endeavor, namely, when

selecting a topic, exploring the literature, selecting the setting, protecting the rights

of participants, choosing a methodology and a research design, and collecting,

managing, and analyzing data. This article aims to illuminate the quandaries of

a naturalistic inquiry and to teach and recommend approaches to better address

them. Providing researchers with the necessary and appropriate skills may help

provide applicable and trustworthy study findings and outcomes. Hence, these

recommendations need to be well defined and presented.

Keywords: Challenges, Dilemmas, Qualitative research

[DIMENS CRIT CARE NURS. 2019;38(5): 264-270]

I have been conducting, teaching, and writing about qual- itative research for a number of years. There are many dif- ferent stories that research students and novices can tell

about their experiences of the challenges and dilemmas that arise before, during, and after the laborious process of carrying out a naturalistic inquiry. Many testimonies are typical, for investigators encounter varied circumstances unique to their studies. There is also amyriad of suggestions and pointers present in the literature on how to address the quandaries of these investigations. It helps to revisit and make familiar to early researchers the hurdles and issues related to qualitative studies. The purpose of this article is to expand the skills of qualitative research in the context of the practical problems that doctoral students and beginners face in different phases of the endeavor, namely, selecting a topic, exploring the literature, selecting the setting, having an ethical perspective, choosing a methodology and a research design, and collecting, managing, and ana- lyzing data.

ensions of Critical Care Nursing Vol. 38 / No. 5

CONCEPTUALIZING AND STARTING A NEW QUALITATIVE STUDY

Selecting a Topic Qualitative research is conducted when little is known about a phenomenon or the present knowledge or theories about it may be biased. The researcher aims to develop a rich and context-bound understanding of the poorly un- derstood phenomenon in a naturalistic setting.1,2 Think- ing, defining, and deciding what phenomenon to study is the hardest step of a qualitative research endeavor.3

Research problems do not arise out of a clear blue sky.4

This is usually the first challenge encountered by novices and new researchers. Many doctoral students are often “lost” in this first step of a naturalistic study resulting in a delayed, long, and agonizing journey of completing their dissertation and the program. How does a new researcher decide on a topic? What phenomena important to nursing lend themselves to a qualitative inquiry?

DOI: 10.1097/DCC.0000000000000374

Qualitative Research

Research is a time-consuming enterprise; thus, curios- ity about and interest in a topic are essential to a project's success.1 Selecting a research topic to be studied through qualitative methods is also a very risky activity. This is be- cause it involves committing yourself to a particular course of action rather than reiterating spoon-fed “critiques.”4 At the most basic level, research topics originate with the investigator's interests. Morse and Field2(p45) (1995) en- courage questions such as “What articles catch my eye when I am in the library?” and “What topics do I con- stantly think about and often discuss in general conversa- tions?”. There are other explicit sources that can help in finding a study topic and eventually a phenomenon. One can consider significant experiences that have occurred in clinical practice or observation that is not documented in the literature, or gaps in patient care literature recommen- dations and the actual practice.2 Ideas can also come from gaps in the nursing literature in general, global social or political issues such as health disparities, theories, and ideas from external sources such as a funding agency's re- search priorities.1 At times, investigators who already have a program of research may get inspiration from their own findings. Morse and Field2(p45) (1995) stated:

Finding a topic takes some self-examination, and discussing one's ideas with colleagues and experienced qualitative researchers is essential. The researcher must find the topic chosen to be fascinating because working 6 months on a boring topic converts what should be an exciting activity into drudgery.

Once a topic is decided, it is important to identify and try state to the phenomenon and to pose a research question. Table 1 presents examples of the phenomenon and research questions from previously conducted qualitative studies.

The next step is to find out what is already known about the topic. What are the challenges that doctoral stu- dents and new researchers face when conducting a litera- ture search and review?

TABLE 1 Questions to Ask if to Use Qualitative

Should I Use Qualitative Research?

1. What exactly am I trying to find out or understand?

2. What kind of focus on my topic do I want to achieve? Do I want to study a phenom

and systematic comparisons and in accounting for variance? Does the phenomen

3. How have other researchers dealt with this topic? To what extent do I wish to al

4. What practical considerations should swaymy choice? How long might my study ta

want to use? Will my planned population be accessible and available?

5. Will we learn more about this topic using a qualitative methodology? What will

6. What seems to work best for me? Am I committed to a particular research mode

what a good piece of research looks like?

Adapted from Silverman4.

Exploring the Literature Opinions about the literature review in qualitative re- search vary. For example, no literature review is conducted in a grounded theory study.1,2,5 The researcher typically begins to collect the data before searching what is in the literature. Phenomenologists and ethnographers under- take a preliminary review of literature at the outset of the study. Phenomenological studies do not require a thor- ough literature search about the phenomenon, and eth- nographic research needs some familiarity of what is out there to help the investigators shape their ideas about a cultural problem before entering the field.1 Questions usu- ally asked are “What is the current evidence on this re- search problem?”, “What do you have to say critically about what is already known?”, and “Where will you find what you need to read?”.

A researcher has to be prepared before indulging on a literature search about the phenomenon at hand. Some of the issues to think about are as follows: (a) What discipline relates to my topic? (b) How can I focus my topic to make my searchmore precise? (c)What are themain indexes and abstracts relevant to my topic? (d) What means of record- ing will be most efficient for many tasks such as cross- referencing?4 Knowing where to find the literature is the second aspect to consider. There are many potential sources of information, but online searching on the World Wide Web and databases are the ones that present some chal- lenges to a novice investigator. A new researcher can be in a labyrinth and myriad of endless articles and studies that may result in panic, and as stated by some, “There's so much! Howwill I find the time?”—or getting no “hits” while searching for anything on the topic. Familiarity with computer searches, and good online and skimming/reading skills are needed including knowing which databases and what keywords to use, and being able to “fillet” publica- tions according to your own agenda and criteria.4 Another challenge is how to stay focused and have a critical perspective

Research

enon or a situation in detail? Or am I mainly interested in making standardized

on lend itself to study by qualitative methodology?

ign my study with this literature?

ke? Do I have resources to study it this way? Can I get access to the participants I

be the knowledge payoff in choosing this methodology?

l that implies a particular research methodology? Do I have a gut feeling about

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in doing the review. Aside from knowing what to look for, one should remember that the goal of a thorough literature search and review is to appreciate and advance knowledge by keeping inmind the questions that need to be answered. How far and how much literature should be searched? This is another question that presents a challenge to novice qualitative researchers.

A common doctoral student's research trajectory sug- gests and aims for a completed literature review during or at the end of the first year. Programs at this point expect that the student should have a good idea of relevant work carried out by others, but it will be necessary to keep up with the new literature throughout the process so that the latest de- velopment on the topic is taken into account.4 In qualitative research though, completing a thorough literature survey in a year andwriting it up canmean a lot of wasted effort. Until the naturalistic inquirer has completed the data analysis, no one is certain what of the literature is relevant. It is recom- mended that the bulk of the literature reading be conducted around the data collection and analysis.4

Selecting a Setting and “Getting In” Qualitative researchers usually collect data in real-world, naturalistic settings—the types of place where information or data are gathered such as hospitals, homes, or commu- nities. Obtaining access to the field site is at times not easy. Research settings can be closed or private, and openor public. Closed settings are controlled by gatekeepers. Access to open settingsmay be freely available but not alwayswithout dif- ficulty, either practical or ethical. For example, should the researcher be intruding upon vulnerable minorities or groups and public records? Depending on the phenomenon at hand or research problem and the contingencies of the set- ting, access can be overt or covert. Data collection needs to be as overt as possible. In overt access, the impression the investigator gives is very important. There are always con- cerns about what kind of person the researcher ismore than with the study itself. The organization will gauge whether the investigator can be trusted and perhaps also how easily he or she can be exploited and manipulated. “Getting in” involves gaining, building, and maintaining trust with the participants and the institution.2 Naturalistic inquirers should avoid giving impressions that might pose an obsta- cle to access and positively convey a perception that is ap- propriate to the situation. Being nonjudgmental is often a key to acceptance in many settings including other subcul- tures.4 It is also critical to learn about power structure, politics, and conflicts within an institution and to demon- strate political, institutional, and personal neutrality.2

Ethical Dilemmas Qualitative researchers prefer to get close to the people and situations they are studying.4When one is studying people's

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behavior and perception or asking questions, not only the values of the inquirer have to be faced but also those of the participants. FromMason6 (1996), Silverman4(p258) (2005) discussed 2 ways in which ethical issues impinge upon the naturalistic investigator: (a) the rich and detailed character of qualitative research can mean intimate engagement with the public and private lives of individuals, and (b) the changing directions and access during a qualitative study mean that new and unexpected dilemma are likely to arise during the course of the study. To clarify and address these problems, investigators should be clear what the purpose of the research is, examine which individuals or groups might be interested or affected, and consider the implica- tions for these parties. Consulting ethical guidelines to clarify procedures is also paramount, as well as expressing explicitly on the informed consent the intention and de- tailed process of the investigation. Qualitative studies re- quire repeated contact with participants; thus, it is difficult to obtainmeaningful informed consent at the outset. The re- search design evolves as data are gathered that assessing all risks cannot be totally ensured at the beginning of the study. Consent may be an ongoing process and is continuously negotiated. This is called consent process.

Confidentiality and anonymity in qualitative research are the other challenges that researchers encounter. Confi- dentiality is salient in naturalistic studies because of its in-depth nature, and anonymity is rarely possible.1 Con- fidentiality does not necessarily preclude intrusion, as anonymity by itself is not enough to protect a person's pri- vacy or prevent disclosure of personal issues. Inquirers should refrain from soliciting private information that is not closely related to the research question.6 It is also diffi- cult for investigators to adequately disguise participants in their reports. Qualitative researchers must take extra pre- cautions to safeguard their identity and prevent a breach of confidentiality. There are several effective strategies to protect personal information, for instance, securing of data storage methods, removal of identifier components, biographical detail amendments, and pseudonyms (appli- cable to names of individuals, places, and organizations).6

It is also good to offer debriefing sessions to allow them to ask questions and voice complaints. Offering feedback to the participants and the settings is beneficial. Making re- ferrals to appropriate health, social, or psychological ser- vices should be conducted as the need arises. The rights of special vulnerable groupsmay also need extra protection.

Vulnerable populations are at times incapable of giv- ing fully informed consent or may be at a high risk for unintended adverse effects of the study. Examples of groups that are considered vulnerable are children, mentally or emotionally disabled people, severely or critically ill or physically impaired people, terminally ill people, those who are institutionalized, prisoners, and pregnant women.

Qualitative Research

In qualitative research, participants are usually interviewed and observed by the researcher to collect data about the phenomenon. Researchers should pay particular attention to the ethical dimensions of a study more so among these groups, and the proposal is usually subjected to external re- view and the institutional reviewboard. Protective consider- ations for the vulnerable population should be explicitly stated in the institutional review board proposal or proto- col. When highly sensitive issues are concerned, children and other vulnerable individuals should have access to an advocate who is present during initial phases of the study and, ideally, during data gathering sessions.6

CHOOSING A METHODOLOGY AND A RESEARCH DESIGN Amethodology is a general approach to studying research topics.4 One of the common mistakes of doctoral students and novices is choosing a methodology (quantitative vs qualitative) before the research topic or phenomenon is clearly established. A well-delineated phenomenon and an appropriately posed research question imply the suitable methodology for the proposed study. This simply means not to make an early decision about which methodology to use—or as whatMiles andHuberman7(p42) (1984) stated, “Knowing what you want to find out leads inexorably to the question of how you will get that information.” The re- search should be driven by the research question, and an appropriate methodology should be selected accordingly.2

If the study aim is a deeper understanding of a “poorly understood” phenomenon that is not amenable to measure- ment and quantification, then a qualitative research method- ology is an appropriate choice. Naturalistic inquirers should always keep inmind that qualitative researchusually answers questions pertaining to “what the experience is like.” It provides the reader with an understanding and enables others to make sense of reality.2 There are questions that need to be answered before deciding whether to use a

TABLE 2 Phenomena and Research Questions in

Phenomenon and Research Question Examples

1. The Lived Experiences of Newly Qualified Nurses on Clinical Placement during t

Kelly, 2007)

What are the lived experiences of newly qualified nurses on clinical placement du

2. Nurses’ Experiences of Recruitment and Migration From Developing Countries

What are the nurses’ experiences of recruitment and migration from developing c

3. Experiences of Homeless People in the Health Care Delivery System (Martins, 2

What are the experiences of homeless people in the health care delivery system?

4. Nursing Students’ Lived Experiences of Empowerment and Being Valued (Brad

What are the nursing students’ lived experiences of empowerment and being val

5. Nurses’ Experience With Nursing Research and Its Integration in Practice (Dup

What are the nurses’ experience with nursing research and its integration in prac

qualitative methodology or not. These questions are pre- sented in Table 2.

The researcher should selectively and correctly choose an approach according to the nature of the problem and what is known about the phenomenon to be studied. Other factors such as the maturity of the concept, constraints of the setting, and the researcher's ability and agenda should be considered.2 Methodological choice for the study ac- cording to Morse and Field2(p15) (1995) also has threats to the validity of the investigation and may result to loss of generalizability and increased cost. They further stated:

Perhaps the most common problem in the inappropri- ate use of method is using inductive research design and qualitative methods when a considerable amount is known about the topic. Alternatively, it is equally in- valid to use deductive research design and quantitative methods when too little is known about the topic. In the first case, researchers develop a conceptual frame- work and then analyze qualitative data according to the categories in the framework rather than derive the categories inductively from the data…. A researcher who knows enough about the topic to be able to create a conceptual framework and identify variables should be using quantitative methods.

Novice researchers have some confusion about the role of theories in both quantitative and qualitative research. Theories guide both methodologies at a different stage in the study process. In inductive research (qualitative), the investigator examines the data for patterns and relation- ships, develops and tests the hypothesis to generate theory, or uses developed theories to explain the data. Quantita- tive researchers work deductively by testing the developed theory.2 Although the goal of qualitative research is to develop a theory, not all may have a theory as the end product of the endeavor. A grounded theory design specif- ically aims to develop a midrange theory that describes a process and is the final product of the study. It is one approach in which the research is inductively driven,

Qualitative Studies

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although both induction and deduction are used to de- velop the theory.

Given then that the phenomenon is best studied using a qualitative methodology, how does a naturalistic in- quirer select the “best” or most appropriate research de- sign? Some novices encounter this dilemma. The answer to this question depends on the qualification of the re- searcher, what one wishes to know, what the expected out- comes of the research will be, the constraints of the setting, the participants, and the resources available to the investi- gator.2 Theory is almost always present and embedded in qualitative research traditions.1 A conceptualization of a specific phenomenon under study is called substantive the- ory as per Sandelowski8 (1993). Phenomenologists, for example, are committed to a theoretical naiveté and try to hold preconceived views of the phenomenon in check but are guided by a framework that focuses their inquiry on certain aspects of a person's lifeworld (ie, lived experi- ences). Ethnographers, on the other hand, bring a cultural perspective to their studies, which helps shape their field- work. Ethnography is conducted if the purpose of the re- search is to describe a setting or a community. If the aim is to describe the types of health care professionals in the community, then ethnoscience is amore suitable approach.2

Ideational and materialistic theories are 2 examples of cul- tural theories that they adopt in ethnographic investiga- tions.1 Phenomenology, ethnography, and grounded theory ethnoscience are some examples of qualitative research designs. Each answers different questions; the methods are distinct, and the results provide a different perspective on the phenomenon.2 There is an appropriate research design for every question, and selecting the best approach is the most important decision in the research process.2 An expert qualitative researcher and mentor is needed to guide and help the novice pivot along with the difficult and lengthy journey of a naturalistic inquiry.

COLLECTING, MANAGING, AND ANALYZING DATA Qualitative research introduces moral and ethical prob- lems during data collection and analysis. First is the focus on the appropriate types of sources of qualitative data that include interviews, observation, documents, artifacts, images, and emergent sources such as social networking interactions.9 The principal investigator is the “sole instru- ment” of the study who is trained and fully responsible to gather and analyze the data. It is also more difficult to use research assistants to conduct unstructured interviews and to assist with data analysis.2 Novices as interviewers may lack confidence and experience in starting, conducting, and maintaining a comfortable and fruitful interaction including dealing with “sensitive topics” and the complex

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tasks of analyzing and interpreting data. Over time, the effectiveness and efficiency of data collection vary. Morse and Field2 (1995) presented that fieldwork has different stages. Initially, data collection is inefficient and not fo- cused because researcher comprehension is low accompa- nied by confusion and bewilderment. Credibility as a researcher has to be established within the setting includ- ing acquiring skills of being present, trusted, and neutral. The naturalistic inquirer has to fit into the setting. The se- lection of dress may influence one's acceptance, as well as observing etiquette, such as the correct form of address to participants. The way investigators present themselves to participants or groupsmay be crucial to subsequent accep- tance resulting in quality data and subsequent rigor of the study.2 Other issues could arise related to human subject participation such as lack of willingness and rapport, con- cerns about the confidentiality of information and privacy, and interview pitfalls.

Qualitative interviews are unstructured and intimate in nature that participants may share other information not pertaining to the phenomenon under study. They may verbalize some allegations or complaints about the staff or the services, unwanted negative behaviors and atti- tudes, unethical or illegal conduct, and social injustices. Simply, they may verbalize things they never intended to tell, and interviews thus can become a “confession.”10

From the investigators' perspective, data collection can be- come a time of intense emotional strain resulting in total preoccupation with the research process and subsequent lack of sleep.2 The researcher has the responsibility to pace the data collection carefully, follow professional standards, and protect the information by virtue of being a researcher who is present and neutral and is a witness, to know when to keep silent or do nothing and when to report. Develop- ment of personal relationships with participants may be inevitable while collecting certain data. Therefore, inquirers should seriously consider the potential impact they may have on the participants and vice versa.6 It is important not to get too close to participants or “suffer” with them. This involvement may result in the researcher not being able to view the data analytically and thus affect the research process.

Qualitative researchers should consider the amount of “distance” from the setting. Generally, nurses, for exam- ple, should not conduct studies in the unit in which they work. There can be a confusion of role as an employee, researcher, or staff, which can cause immense dilemma resulting in misunderstandings, and possible violation of privacy and confidentiality of information. According to Morse and Field2 (1995), of the greatest concern is that data analysis may be impeded because of the investigator's familiarity with the setting. Nurses may not record data on some behaviors because it is may be normative and

Qualitative Research

therefore beyond awareness. If the naturalistic inquirer has no choice but to collect data in the work setting, precau- tions must be observed. Be aware of role conflict. Let the staff and patients know when you are in your researcher or staff role. Strategies for emotional distancing need to be considered and adopted if the research topic or partici- pants have the potential to be emotionally challenging. The researcher must be aware of the phenomenon and the purpose of the study. Avoid topics that might cause discomfort among the participants. Sanjari et al11(p4)

(2014) stated: Researchers should always be aware of the precise rea- son for involvement in a study in order to prevent unde- sirable personal issues. The probability of exposure to vicarious trauma as a result of the interviews needs to be evaluated. Interviewers should be properly sched- uled to provide the researcher with sufficient recovery time and reduce the risk of emotional exhaustion, while allowing ample time for analysis of the objective and emotional aspects of the research. It is also necessary for the researcher to be familiar with signs of extreme fatigue and be prepared to take necessary measures be- fore too much harm is done.

Most importantly, listen and learn the language and values of the group. Make notes on everything, even if it does not seem useful and relevant at that particular time, so a more accurate picture of the context of research will be obtained. No feedback should be given to the staff until the research is completed, and do not share field notes.2

Field notes are beneficial for the researcher to go back to during data analysis.

The challenge of qualitative analysis is to transform data into findings. No formula exists for that transforma- tion. Direction and guidance are available, but the final destination remains unique for each inquirer, known only when—and if—arrived at.10 Before themes are illuminated, the first dilemma encountered is making sense of massive amounts of data or to “get a sense of the whole.”Doctoral students and novice researchers face the difficult task of reducing the volume of raw information, sifting the trivial from the significant, identifying significant patterns, and constructing a framework for communicating the essence of what the data reveal.9 There is no test of significance to run that determines whether a finding is worthy of attention, and no ways exist of perfectly replicating the inquirer's analytical thought processes. The best advice is for the investigators equipped with their full intellect to do their best to fairly represent data and communicate what it reveals given the purpose of the study. Qualitative inquiry depends, at every stage, on the skills, training, in- sights, and capabilities of the investigator.10 One barrier to credible qualitative findings stems from the suspicion that the analyst has shaped results according to her or his predispositions and biases. One strategy to avoid this

involves discussing predispositions and making biases ex- plicit, to the extent possible. In phenomenological studies, for example, the inquirer engages in epoche or bracketing.

AFTERTHOUGHTS Effective qualitative research can be undertaken on the basis of “keeping it simple,” adhering to the methodolog- ical steps but at the same time being reasonably flexible, and to address issues that arise before and during the pro- cess. Patton10 (2015) presented some suggestions for grad- uate students considering a qualitative dissertation that he put together from responses he gathered from different people. Find an adviser who will support you in embarking on a tough, long haul or journey of completing a disserta- tion. Even novice qualitative researchers need an expert researcher and mentor to guide and support them. Joining a support group will also help. Being with peers who are “in the same boat” as you will allow you to talk about your research together on a regular basis, share knowledge and brainstorm, problem solve, and partake in each other's successes, thus lessening the stress. Prepare to be changed. Looking deeply at other people's lives will force you to look deeply at yourself. Be sure that you are prepared to deal with the controversies of doing qualitative research. Under- stand the paradigms and politics. Researchers should not elect to use qualitative methodology because they feel that it is easier (this is amisconception); rather, keep inmind that there is an appropriate approach for every research problem or phenomenon. Do it because you want to and are con- vinced that it is right for you. Qualitative research is time consuming, intimate, and intense. You will need to find your questions interesting if you want to be “sane” during the process and at the end. Be sure that a qualitative design fits the research question. Study qualitative inquiry. There are lots of different approaches and a lot to know. Learn and embrace methodology and design. Qualitative designs follow a different logic from quantitative research. Practice interviewing and observation skills. Do lots of interviews. Spend a lot of time doing practice fieldwork observations. Get feedback from someone who is really good with interviewing and observation. Naturalistic inquiry takes skill. Figure out how you will conduct the qualitative anal- ysis before you gather data. It is often harder to analyze qualitative data than quantitative data. No software can analyze your data. You have to analyze your data. Data analysis software is available as a tool that provides an al- ternative, complementary, and adjunct way to organizing, examining, and understanding data.12 Have a road map from beginning to end to guide you in completing a qual- itative research endeavor.10 Finally, conducting qualitative research is also not always a single-person endeavor.Work- ing in teams has some advantages. The naturalistic inquirer

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can benefit from the collective ideas, expertise, skill, labor, and energy that team members bring. Teams also advance the academic goals of learning from others, and it is espe- cially good for gathering and analyzing large amounts of qualitative data.13

CONCLUSIONS As qualitative research continues to be conducted by ex- perts and novices alike, more dialogue is needed to en- hance the quality of the work being produced. This article discussed the challenges and dilemmas that new researchers encounter in different stages of a naturalistic inquiry, in- cluding suggestions to better address the identified issues. Recommendations and approaches presented in some de- tail in selecting a topic, exploring the literature, selecting the setting, having an ethical perspective, choosing ameth- odology and a research design, and collecting, managing, and analyzing the data based on the literature from experts in the field. This article wasmeant to provide guidance and support for thosewho plan to embark on designing a qual- itative study for the first time including those who are new inquirers of qualitative research.

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ABOUT THE AUTHOR

Brigitte S. Cypress, EdD, RN, CCRN, is an associate professor at School of Nursing, Rutgers, The State University of New Jersey.

The author has disclosed that she has no significant relationship with, or financial interest in, any commercial companies pertaining to this article.

Address correspondence and reprint requests to: Brigitte S. Cypress, EdD, RN, CCRN, P.O. Box 2205, Pocono Summit, PA, 18346 ([email protected]).

eb. Take CE tests on-line, peruse back issues, .dccnjournal.com.

mailto:[email protected]