Objectivity, sensitivity and subjectivity

In grounded theory, the methodology requires the researcher to collect data and analyse it in alternating sequences (Strauss & Corbin, 1998; Corbin & Strauss, 2008). The problem that arises during this process is the researcher’s immersion in the data, which requires a balance between objectivity, subjectivity and sensitivity, and this is necessary to avoid bias. Objectivity is necessary to reach an accurate and impartial interpretation of events, while sensitivity is required to understand the meanings in the data and identify the concepts and the connections. It is important that the researcher maintains a level of critical subjectivity; the researcher must be self-critical and explicit (Reason & Heron, 1995).

In qualitative research, objectivity means having an understanding, while recognising that the researcher’s understandings are sometimes based on values, the level of education and experience, and these might be quite different from those of the participants (Cheek, 1996). To maintain objectivity the researcher kept an openness, a willingness to listen and observe what the participants did and then represented this as accurately as possible (Strauss & Corbin, 1998; Corbin & Strauss, 2008). One technique to assist with objectivity was to gather data utilising several points of reference. In this study three methods were employed to collect data: participants were interviewed, there were periods of observation, and patient files were examined. Data were collected in order to gain insight into multiple and varied representations of the phenomenon. For instance, inexperienced nursing and medical staff were sometimes unsure of what to do when patients refused therapy. Occasionally their first responses demonstrated a tendency to ignore the refusal and if patients equivocated, participants would seek out their peers to discuss the matter. This contrasts with more experienced staff who were more likely to recognise and explore patients’ cues. Therefore, it was important that data were collected from respondents with varying degrees of experience and insight. Data were also collected from different areas of the acute care sector, from medical and surgical areas to the specialised intensive care area. The differing settings allowed for variations of behaviour to enable insight into how respondents negotiated situations, to allow the meaning of differing behaviour to emerge. The more persons, places and events that are interviewed or observed, the more the researcher is able to check interpretation

against alternative explanations of events, while also discovering properties and dimensional ranges of concepts (Strauss & Corbin, 1998; Corbin & Strauss, 2008). Another analytical strategy involved occasionally checking the researcher’s assumptions with respondents. This enabled the researcher to explain to participants what she thought was going on and then ask participants if that is what matched their experiences. For instance, when patients indicated a refusal of therapy to a nurse at the bedside it was more common for that nurse to engage the support of other nurses, rather than go directly to one of the medical staff with that information. This appeared to represent a professional division along hierarchical lines. The researcher was uncertain as to the reasons for this; was it for convenience, or adherence to expected practice by unit managers, or did the nurses “feel” they could not go directly to medical staff? Many nursing respondents confirmed that this was how they dealt with the situation because they believed that they were more likely to successfully promote patient decisions with the medical staff if more nurses, especially senior ones, were aware and involved, and the notification to other nurses enabled different nurses to approach patients and clarify, and then confirm patient wishes.

To foster theoretical sensitivity, researchers must constantly challenge their personal theories and biases against the data (Schreiber, 2001). Qualitative researchers must, however, attempt to disregard their own wishes to achieve a more rigorous outcome (Holloway, 1997). In order to achieve this, during the fieldwork the researcher compiled notes, including thoughts about analysis, method and points requiring clarification. A range of strategies can be used during the study to enhance self- reflection (Olshansky, 1996) to check interpretations and allow the researcher to gain clearer insight into the phenomenon, yet distinguish these from the researcher’s own beliefs. In addition, time was allocated to discuss responses with the researcher’s supervisors, and at various stages of the study, findings were presented to peers. Theoretical memos were also extremely useful as they provided an internal dialogue for the researcher to raise tentative ideas and provisional categories and then compare findings (Strauss, 1987). Memos guide the researcher away from the data to

allow abstract thinking, then when returning to the data, to ground these abstractions into reality (Strauss & Corbin, 1998; Corbin & Strauss, 2008).

Insights into the data do not occur haphazardly. Researchers often have a familiarity with the topic and literature before they begin the research project (Srauss & Corbin, 1998). Charmaz (2006) argues that sensitising concepts and disciplinary perspectives can be used as tentative tools for developing ideas about processes the researcher finds in the data, but they provide a place to start, not to end. Being sensitive to the area of study provides vantage points that can intensify examination of the research topic, but it can also result in the ignoring of other aspects and thus allow a degree of bias (Schreiber, 2001). The knowledge and theories with which researchers have familiarity inform the research in many ways, even if they emerge unselfconsciously (Sandelowski, 1993). In order to minimise the possibility of introducing bias into the study, it is necessary to examine at the outset the researcher’s preconceived assumptions about the phenomenon under study.

Three broad factors influenced the researcher’s assumptions regarding the topic studied. The first influence was her professional experience as a registered nurse in Australia and the United Kingdom. Working in the acute care sector, alongside other nurses and medical practitioners, assisting patients with therapy and decisions was commonplace. The second influence was the researcher’s education in the law, particularly at the post graduate level, the existence of specific medico-legal principles, designed to impact on the practice of health professionals. The third influence was the researcher’s academic experience, researching and teaching the law in the context of health care delivery to a range of health professionals.