Research methods evaluated

A number of quantitative research methods were considered for use in this study. This included traditional quantitative methods of ascertaining people’s values like ranking, rating or rating and ranking. Other quantitative research methods like Discrete Choice Experiments and the Delphi approach were also considered for use in this study because they have been successfully utilised in other fields to ascertain the relative importance that people place on different things (Mead and Moseley 2001; Mazzanti 2003; Gerard and Lattimer 2005). So, every conceivable quantitative research method was considered for use in this study. Each individual quantitative research method was appraised for its suitability to obtain data which would answer the research question. Ultimately, quantitative research methods were deemed to be inappropriate for this study. Quantitative research methods were deselected because they are primarily designed to test a theory (Bottorff 1997; Creswell 2003).

Quantitative research methods are also used to answer questions such as the research question in this study, but their use would have been inappropriate in this instance. This is because the objective of this study which was to generate a theory on the value that nurses place on pressure ulcer prevention and not to test a theory. The use of a quantitative research approach was also rejected because it would have required the adoption of an objectivist stance, which was incompatible with ascertaining a personal value like the value that nurses place on pressure ulcer prevention.

Qualitative research methods were then evaluated for their suitability for this research study. This evaluation considered their properties with particular emphasis on their suitability for ascertaining personal values. Qualitative research methods are used to provide a detailed and complex understanding of a topic that has not been investigated before (Creswell 2007; Richards and Morse 2007). This suggested that qualitative research methods were ideal for this study because it was exploring a topic that had not been

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previously investigated. The use of qualitative research methods also creates theories that take into account complex, contextual factors that explain the actions that people take as well as the motivation that underpins these actions (Patton 2002; Creswell 2007). The ability of qualitative research methods to take into account complex and contextual factors meant that they were better suited for this study compared to quantitative research methods because these factors affect a person’s values and value systems (Goodwin 2001; Pekki- Erikkila 2003).

The majority of quantitative value studies have a high level of methodological rigour, but they have largely focused on people’s world values and not their personal values. Despite this, the few qualitative value studies which have been undertaken have provided a number of valuable insights into the nature of the relationship between people’s values and context. As a result, qualitative research methods are perceived to be the best way of ascertaining personal values by a number of value researchers like Goodwin (2001), Pekki-Erikkila (2003) and Crumbie (2005). This suggested that a qualitative research method would be ideal for this study because the value that a nurse place on pressure ulcer prevention is a personal value.

The examination of qualitative research methods also indicated that they are uniquely suited for studies on nursing values. A small number of value studies in nursing have used a qualitative approach, but these studies have highlighted some of the values that lie within nursing practice (Goodwin 2001; Crumbie 2005). The results of these studies also indicate that qualitative research methods provide greater scope for data based definitions of nursing values compared to quantitative research methods which test predetermined lists of values (Crumbie 2005). In other words, qualitative research methods give the participants greater scope to state what different things mean to them in their own words; unlike

quantitative research methods where they are asked to state the relative importance of a list of things that have been determined by the researcher.

There are relatively few value studies that have been undertaken in nursing compared to other fields like psychology. Nonetheless, the evidence from the studies that have been undertaken suggests that qualitative research methods may be the best way of exploring nurses’ values. This is because the delivery of nursing care to patients is often complex and

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is susceptible to a number of different contextual factors (Crumbie 2005). In addition, the value laden decisions that nurses are often compelled to make in clinical practice often have a direct impact on patient outcomes (Tschudin 1992; Koerner 1993). Thus, a qualitative research method was deemed to be the best way of ascertaining the value that nurses place on pressure ulcer prevention.

Qualitative research methods also seemed to be ideal for this study for other reasons. The researcher adopted a post-modernist stance on values in this study, which is most

consistent with a qualitative research approach. The qualitative research approach is the best way of eliciting values if one adopts a post-modernist stance on values because it reflects the dynamic and contextual complexity of values (Johnson 1983; Crumbie 2005). This is a point that is supported by the evidence from the small number of qualitative value studies that are available. The evidence from these studies suggested that the adoption of a post-modern view of values and the use of a qualitative approach was ideal for this study because nurses work in a dynamic and incessantly evolving environment.

Having discerned that qualitative research methods were the most consistent with the post- modernist stance on values that had been adopted, a concerted effort was made to

evaluate all the available qualitative research methods with an open mind. Qualitative research methods exist in the same paradigm but they differ in their objectives,

methodology and application (Cohen 2002; Creswell 2003). There are many qualitative research methods, but the three main qualitative research methods that are the most popular are ethnography, phenomenology and grounded theory (Higginbottom 2004; Richards and Morse 2007). Nonetheless, all the available qualitative research methods were closely examined for their suitability for use in this study.

Ethnography, phenomenology and grounded theory

Each of the three main qualitative research methods has its own unique intellectual underpinning and key objectives. Ethnography is a research method that entails the immersion of the researcher in the phenomenon under investigation resulting in a single interpretation of the phenomenon under investigation (Ausband 2006; Creswell 2007). Phenomenology is employed to ascertain meaning and focuses on establishing the lived experience of the participants, which is usually based on an in depth exploration of the topic

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(Cohen 2002; Priest 2002; Creswell 2007). Grounded theory formulates theory inductively from the systematic and replicable analysis of data (Glaser and Strauss 1967; Duffy, Ferguson et al. 2003).

The central objective of ethnography is to understand a phenomenon from the cultural perspective of the participant through immersion in that society by the researcher (Maggs- Rapport 2000; Cohen 2002; Richards and Morse 2007). The emphasis on lived experience in phenomenology makes it ideal for researching many nursing phenomena as it takes into account a wide range of contextual and personal factors (McNamara 2005; Richards and Morse 2007; Starks and Trinidad 2007). Grounded theory has an inherently inductive epistemic philosophy, but abductive and deductive principles may be used in the formulation of a theory as long any insights that arise from these two principles are supported by the data (Backman and Kyngas 1999; Cohen 2002). The use of different principles in the analysis of data in grounded theory facilitates the identification of the appropriate themes in the data, which ensures that the theory is generated is grounded in the data (Cohen 2002; Starks and Trinidad 2007). Therefore, each of these qualitative research methods has its own particular approach to data collection and analysis

Each of the three main qualitative research methods were evaluated for their suitability for use in this study, but only one research method was selected. Ethnography was not selected for use in this study because it relies on the researcher becoming immersed in the world of participants, which was incompatible with aim of this study to recruit as diverse a range of participants as possible. Phenomenology has many good qualities, but ultimately grounded theory was selected for use in this study because it provided the clearest framework for collecting and analysing data in order to generate a robust data based theory which answered the research question.

Each qualitative research method has its own way of generating a robust data based theory, but the framework for theory generation in grounded theory was deemed to be the best suited to this study because it is systematic and replicable. The fact that grounded theory has a systematic and replicable framework for data collection and analysis was of prime importance because this study was undertaken by a researcher who was learning the intricacies of the research process. A clear framework for the systematic and replicable

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generation of a theory was also important because this study examined a topic that had not been previously subjected to any scientific scrutiny.

Now that the rationale for the selection of grounded theory has been stated, the next section will set out the version of grounded theory that was used in this study and why it was selected.