Hermeneutic observational studies: describing a method

Abstract

There is a need to develop and use research observations in the clinical field, primarily to gain insight into and assess evidence of what comprises caring in a real‐life situation and confirm what is actually taking place. In addition, assessments lead to a new and different understanding of what caring constitutes, thereby enabling the identification of what kind of care is being provided and is required. Such observations also enable the observer to perceive and verbalise caring. There are ongoing discussions, specifically in Nordic countries, on how to use caring science‐based observations as a means of collecting and interpreting qualitative data through the application of a hermeneutic approach, which constitutes describing what has been seen and reporting on it by way of ethical obligation. This article contributes to the debate through the provision of additional content and by reflecting on the development and usability of hermeneutical research observations from a method and methodological perspective, thereby refining previous ideas and extending previous assumptions. The primary study objective was to report on the experience of utilising observations as a single data collection method for hermeneutic research with the aim of evaluating the interplay between intensive care unit (ICU) patients and their next of kin. A secondary objective was to highlight the impact of preknowledge and preunderstanding on the interpretation process. An intensive care context was assessed as the most appropriate, as the majority of patients are unable to engage in verbal narratives during ongoing treatment and care. The benefits of employing hermeneutic observation as well as interpretation and preunderstanding from a caring science perspective are considered.

Qualitative Observational Research in the Intensive Care Setting: A Personal Reflection on Navigating Ethical and Methodological Issues

“…The study aimed to examine if and how such a refurbished ICU patient room influenced nursing care, that is, if the nurses’ caring actions became more sensitive and directed to patients’ well-being and recovery. 1 We concur with Mulhall 3 and Author 4 that unstructured non-participation observation from an interpretative approach is fruitful when examining the physical environment and interaction. To gain access to an ICU is complex per se, and today’s outbreak of the COVID-19 pandemic increases this complexity.…”

“…The fact that the observer was an experienced ICU nurse meant that she had a preunderstanding of the routines, traditions but not personal relationships of staff which helped them in seeing with an attentive and receptive gaze. 4 , 41 In addition, this meant that actions and interactions were observed and interpreted through a caring science lens which underpinned the study. This approach is founded on the writings made by Katie Eriksson 42 as well as theory of professional growth as a nurse described by Patricia Benner.…”

“… 30 Unstructured observations are rarely used in nursing research, yet they provide a valuable means of gaining a holistic insight into interactions and illuminating the contextual influence of the physical environment. 4 However, at the same time, it is important to recognize that the reality perceived by the observer is conditional; it is multi-voiced and open to manipulation (whether deliberate or not) by the observed. 38 The analysis of the observational data from our previous study suggested that the nurses’ caring attitudes, that is, sensitivity to individual patient needs were not influenced by the ICU room in which they were working but were connected to the individual nurse themselves, that is, some displayed a more caring approach than others.…”

“…The interpreter, however, must be able to move from a subjective to a distanced position and to present arguments for the most probable interpretation, that is, to consider if it is reasonable and likely. 4 To maintain rigor in unstructured non-participating observations, as in all qualitative analyses, means to comprise a careful collection and critical analysis of data and a transparent reporting of findings.…”

“…While there are disadvantages to this role in terms of overfamiliarity with the setting blinding a researcher to the actions and interactions occurring within it, in this study being an insider appeared to facilitate access to the ICU setting and provided a degree of theoretical sensitivity that was important during the observations and data analysis. 4 However, to guard against making assumptions or taking for granted what was being observed, the researcher made detailed descriptive field notes and kept a reflective diary ( Box 1 ). In addition, prior experience as an ICU nurse provided the researcher with the knowledge and confidence to change her role from a non-participant to participant observer if the situation and the safety of the patient required her to act.…”