Choosing a methodology

The following section will briefly describe three main qualitative strategies and explain the rationale for choosing case study as research methodology/strategy to answer the questions of this research. Strengths and weaknesses of phenomenology, grounded theory and case study will also be discussed in this section.

Phenomenology as a qualitative research methodology is based on philosophy in the 19th and early 20th _{century in particular the ideas of the mathematician and philosopher Husserl}

(1859-1938) and Heidegger (1889-1976) who focused on ontological questions of meaning and lived experience (Poat et al, 2007). In psychological phenomenology, Giorgi and Colazzi developed phenomenological research approaches rooted in the ideas of Husserl (Poat et al, 2007). The aim of a phenomenological approach is to describe accurately the lived experiences of people and not to generate theories or models of the phenomenon being studied (Ploeg, 1999). It is a method and a philosophy that assumes people are able to express their experiences and the meaning of these in their lives (Talbot, 1995). As it focuses on accounts of lived experiences of those being studied, in-depth interviews are the most common means of data collection. The role of the researcher is to describe events as perceived and expressed by participants. This is achieved through the bracketing of researcher values and beliefs to prevent them influencing the description of the individuals’ experiences. Four aspects of lived experience are of interest to phenomenologists; lived space, lived body, lived time and lived human relation (Polit and Beck, 2007).

In general, there are two schools of phenomenology: descriptive and interpretive (Nicholls, 2009; Talbot, 1995). Descriptive phenomenology emphasizes the description of the meaning of human

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experience. Descriptive phenomenological studies involve four steps: bracketing, intuiting, analyzing and describing (Talbot, 1995). Bracketing involves the researcher identifying any preconceived opinions, beliefs and values about the phenomenon of interest (Spezaile and Carpenter, 2007). Intuiting is realized when the investigator remains open to meanings of the experience as described by the informants (Spezaile and Carpenter, 2007). Following analysis of data the researcher comes to define and understand the phenomenon (Spezaile and Carpenter, 2007). A more recent approach in phenomenology, the hermeneutical interpretive approach, has emerged, which uses the experiences of people as a tool for better understanding the social, cultural and or historical context in which those experiences occur (Polit and Beck, 2007). Hermeneutic inquiry often focuses on how socially and historically conditioned individuals interpret the world within their given context (Ploeg, 1999).

Grounded theory was developed by Glaser and Strauss in 1960 and is founded philosophically on Symbolic Interactionism (Poat et al, 2007). Symbolic interactionism is the theoretical base for grounded theory research which believes that relationship between a person and society is constructed through constant interactive communications (Talbot, 1995). Distinctive principles of grounded theory comprise theoretical sampling and constant comparative methods (Poat et al, 2007).

The purpose of grounded theory is to discover social-psychological processes from the perspective of human interaction (Ploeg, 1999) and the epistemological assumption that people are engaged in social roles and processes of interaction and behaviors (Speziale and Carpenter, 2007). Grounded theory is an approach to studying social processes and social structures (Polit and Beck, 2007) and generating comprehensive explanation of phenomena that are grounded in reality (Talbot, 1995). According to Speziale and Carpenter (2007) grounded theorists assume

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that individuals create their reality by assigning meaning to circumstances. Such meanings are communicated through symbols, e.g. words and dress (symbolic interaction theory). Grounded theorist study such symbols and interactions and examine how these may change to develop theory about social processes (Speziale and Carpenter, 2007). Data from a grounded theory study may come from many sources. In-depth interviews are the most common data source, but observational methods and existing documents may also be used. (Polit and Beck, 2007). The ultimate aim of grounded theory research is to develop a new theory or refine an existing theory about a particular phenomenon of interest by conducting a grounded empirical study on that subject (Speziale and Carpenter 2006).

A case study is an intensive, in-depth form of investigation (Hancock and Algozzine, 2006) when the boundaries between the phenomenon and the context are not clearly evident (Yin, 2003). The unit of analysis is a critical factor in the case study; it is typically a system of action rather than an individual or group of individuals (Tellis, 1997).

Case study is based on the use of multiple methods of data collection (Keyzer, 2000). It focuses on giving full description of the selected phenomenon which can involve individuals, groups, institutions and communities (Keyzer, 2000). One purpose of case study is to expand the understanding of phenomena about which little is known (Fitzpatrick and Wallace, 2006).

While Yin (2003) advocates the use of questions such as “how and why”, Stake (1995) favors the use of what he calls “issues” to define data gathering activities. Stake (1995) asserts that issues are problems about which people disagree, complicated problems within situations and contexts. He further adds that issue questions are issue statements that provide a powerful conceptual structure for organizing the study of the case. Stake (1995) differentiates between

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issue statements/questions and information questions. The issue questions/statement directs the researcher to choose information questions to describe the case. Issue statements may be stated in any form that is helpful and appropriate to the research. “It is not a research question, it is the research question” (Stake, 1995, p17).

As with other methodologies, case study research is not perfect. Critics question the transferability of case study findings (Yin, 2003). In case study research transferability of findings can be enhanced by paying attention to detail when describing the context and the methodological aspects of the study (Anthony and Jack, 2009). Other shortcomings include the fact that case study is prone to biases as its methodological guidelines remain underdeveloped and therefore, case study research may lack rigour (Anthony and Jack, 2009). To overcome such shortcomings in case study methodology, Yin (2003) advocates the use of clear methods of sampling, data collection, and analysis as well as audit trail.

Table 3.3 provides a summary of the main strengths and weaknesses of phenomenology, grounded theory and case study methodologies. However, choosing between phenomenology, grounded theory and case study was very challenging and therefore the choice of case study as a research methodology was justified as follows:-

Although phenomenology is a well-established research methodology, it was rejected for this study as it would have focused on the experiences of ONPs ignoring the views of other stakeholders who may have been very influential in the development and evolution of the role.In Nursing, research topics appropriate for phenomenology are those related to human’s life experiences including, happiness, bereavement, being a charge nurse, commitment, or meaning of becoming a nurse. In addition, the aim of the study is more concerned with the phenomenon

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of ONP role development rather than solely exploring participants’ (ONPs) life experiences. Furthermore, phenomenology as a research methodology does not provide explanation and conceptualization of the phenomenon under study (Speziale and Carpenter, 2007). The main aim of this study was to provide an insight and understanding of APN phenomenon by means of holistic examination. Phenomenology would have fallen short from archiving such aim.

Although case study and grounded theory have their roots in sociology, they have different goals. Initially grounded theory appeared to be the perfect approach to take however, grounded theory is more suitable to describe social processes and develop substantive theories related to the participants’ experiences. Although grounded theory promotes creativity and is a well-established rigorous methodology, its main aim is to develop or test theory. The aim of the research was not to develop or test a specific substantive theory related to the experiences of the ONPs, but to explore, describe and understand the evolution of the phenomenon (evolution of APN in Palestine) holistically and from perspectives of multiple stakeholders. In addition, the research aims to capture the experience of ONPs and other stakeholders in the evolution of APN to be able to explore the phenomenon in a bounded system. On the other hand, case studies are multi-perspective analysis (Tellis, 1997). This means the researcher can consider not just the voice of the ONPs but also the relevant stakeholders and the interaction between them. Furthermore, case study is the method of choice as the data collected about APN roles has come from various sources and is the preferred method when the research is focused on a specific unique bounded system (Yin, 2003). Thus, case study methodology has provided a holistic account of the evolution of ONP roles in Palestine. In this study, case study was undertaken in contemporary real-life context where the phenomenon of interest is interdependent or enmeshed

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with context of study (Yin, 2003) and therefore case study is the method of choice when multiple perspectives and a holistic account need to be recognized (Walshe et al, 2004).

Furthermore, health care developments are complex, context dependent and multidimensional (Walshe et al, 2004) and such characteristics mirror the advantages of case study strategy. In addition, case study fits well with the meta-paradigm of nursing (person, environment, health and nursing) (Gangeness and Yurkovicka, 2006) and must be conducted within the context of the individual or group of individuals because beliefs and values are essential elements in defining and influencing the behavior and experience of people (Fitzpatrick and Wallace, 2006). In addition, case study as a research methodology has provided the researcher with an intensive but flexible approach to answer the research questions. The holistic view of the case study method has enabled the researcher to recognize the interdependencies and historical-contextual boundaries of the natural environment providing an advantage over other research methods which dissect the parts of the whole situation (Stake, 2005). All this has favored the use of case study as a research methodology/strategy.

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