Nurse Researcher Culture

Ethnonursing and the ethnographic

approach in nursing
Cite this article as: Molloy L, Walker K, Lakeman R, Skinner I (2015) Ethnonursing and the ethnographic
approach in nursing. Nurse Researcher. 23, 2, 17-21.

Date of submission: July 7 2014. Date of acceptance: January 7 2015.

Correspondence
[email protected] Abstract
Luke Molloy RPN, Aim To present a critical methodological review of the of traditional ethnographic knowledge are being
MN lead, MN (Hons),
is programme co-ordinator at
ethnonursing research method. increasingly questioned today.
the School of Health Sciences,
University of Tasmania, Background Ethnonursing was developed to underpin Conclusion The authors argue that ethnonursing has
NSW, Australia
the study and practice of transcultural nursing and to failed to respond to contemporary issues relevant to
Kim Walker RN, PhD, is professor promote ‘culturally congruent’ care. Ethnonursing claims ethnographic knowledge and that there is a need to
of healthcare improvement at to produce accurate knowledge about cultural groups to refresh the method. This will allow nurse researchers
the University of Tasmania,
NSW, Australia
guide nursing care. The idea that the nurse researcher to move beyond hitherto unproblematic notions of
can objectively and transparently represent culture objectivity to recognise the intrinsic relationship between
Richard Lakeman RN, still permeates the ethnonursing method and shapes the nurse researcher and the researched.
DNursingSc, is clinical nurse
consultant at Queensland Heath
attempts to advance nursing knowledge and improve
QLD, Australia patient care through transcultural nursing. Implications for research/practice A revised
ethnonursing research method would enable nurse
Isabelle Skinner RN, PhD,
is professor of nursing at the
Data sources Relevant literature published between researchers to create reflexive interpretations of culture
University of Tasmania, NSW, the 19th and 21st centuries. that identify and embody their cultural assumptions
Australia and prejudices.
Peer review Review methods Literature review.
This article has been subject Keywords ethnography, ethnonursing, transcultural
to double-blind review and
Discussion Ethnography saw a ‘golden age’ in the nursing, culture, nursing research, anthropology,
has been checked using
antiplagiarism software first half of the 20th century, but the foundations Leininger

Author guidelines
journals.rcni.com/r/ Introduction disadvantaged in a society or anyone who stands
nr-author-guidelines Ethnonursing is a research method developed as some sort of ‘other’ to the well-educated and
by Madeleine Leininger that attempts to combine well-resourced Westerner (Madden 2010).
concepts from ethnography and nursing. The history of ethnography’s development is
Leininger’s anthropological experience with complex. By the 19th century, the term ‘ethnography’
ethnography in the 1960s was a core feature of had come to refer to an integration of first-hand
ethnonursing’s development (Leininger 2001). investigation and the theoretical interpretation of
As the bedrock of the discipline of anthropology, a culture (Hammersley and Atkinson 2007). It had
ethnography has been adopted by many disciplines in emerged from an anthropological tradition that had
their attempts to understand cultural phenomena. its focus on ‘native culture’, at a time of European
There is no standardised interpretation of (Pellatt imperialism and a dominance of ideas about the
2003). In its classic form, ethnography involves superiority of certain groups of people over others.
the researcher participating in people’s lives for an Many of the studies of this early period were shaped
extended period of time, observing what happens, by this ideology and the prevailing power structures
listening to what is being said and asking questions that were informed by it (Murchison 2010). They are
(Crowley-Henry 2009). Stereotypically, this involves the foundations on which ethnography in the modern
an exotic people, the ‘subaltern’, those who are age was built.

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 Nurse
Art Researcher
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Lewis Henry Morgan was one of the founders of to have on modern ethnographic practice.
American anthropology. Morgan’s use of ethnography Participant observation became the key approach
provided the foundations for the anthropological field to Malinowski’s fieldwork. This involved research
of ‘kinship studies’. In his work, Morgan fused racism over many months, living with the group of people
with the ideas of evolution, concluding that at ‘the on whom the research was focused and maintaining
Middle Period of barbarism… the Aryan and Semitic detailed field notes for analysis. For Malinowski,
families seem fairly to represent the central threads direct observation offered the ‘outsider’ a way of
of… progress, which in the period of civilisation has interpreting the significance of the group’s social
been gradually assumed by the Aryan family alone’ practices. The idea was that this enabled the
(Morgan 1877). researcher to view the world in the way the group
Similarly, Edward Tylor, the first professor of members viewed it.
anthropology at Oxford University and a founder of Rosaldo (1993) argued that this model foregrounds
the discipline of cultural anthropology, noted: ‘On ‘the lone ethnographer’ who describes the peoples
the definite basis of compared facts, ethnographers he or she encounters as harmonious, internally
are able to set up at least a rough scale of civilisation. homogenous and inhabiting a static culture,
Few would dispute that the following races are the supposed unchanging nature of which serves as
arranged rightly in order of culture: Australian, a ‘self-congratulatory reference point’ against which
Tahitian, Aztec, Chinese, Italian’ (Tylor 1871). the West can imagine its more culturally evolved
The work of these major figures shows that by ‘superiority’. The supposedly objective ethnographer
the latter half of the 19th century, ethnography translates ‘the utterances of the native informant’
was providing a scientific facade to work that into a coherent form (Cotera 2008), the results
manufactured cultural explanations to support projecting universal essentialisation of ‘us’ and ‘them’
imperialism and colonial expansion. Captured in the on the groups (Pels and Salemink 1994). This helped
categorisation of culture, Tylor, Morgan and many to perpetuate power imbalances by imagining and
others were providing the basis of an ideology that representing the indigenous populations as an
legitimised their nations’ sense of superiority (Lewis inferior ‘other’ (Asad 1973).
1973). This search for difference justified an imagined In this imagined otherness, the ethnographer
hierarchy of peoples and produced ‘scientific’ was ‘unable to envisage and argue for a radically
work that sustained this hegemony. different political future for the subordinate
people he studie[d]’ and acted as the subtle agent
Golden age of ethnography of colonial supremacy: ‘Anthropology does not
At the start of the 20th century, ethnography merely apprehend the world in which it is located,
underwent a period of transition, in tandem with but… the world also determines how anthology
a metamorphosis of anthropology into a legitimate will apprehend it’ (Asad 1973). The generation
social science. The golden age of anthropology was of ethnographers produced in this intellectual
beginning. Ethnography was embedded in the colonial environment, however, would generally ignore the
system (Asad 1973), as endeavours attempted ‘to way their Western preconceptions influenced their
bring light and civilisation in the dark places of the observations (Shadd 2006).
world, and to touch the minds of Asia and Africa with
the ethical ideas of Europe’ (Hyatt 1897). Rendered reality critiqued
Ethnography had become central to Tedlock (1991) noted that in the 1970s, there was yet
anthropology’s effort to establish a renewed another shift in ethnography, which saw a movement
discipline. In merging theory with fieldwork methods, from participant observation toward ‘the observation
a key figure was Bronislaw Malinowski, a founder of participation’. This was characterised by critical
of social anthropology. He believed the researcher reflection on the production of ethnographic
could produce objective, scientific descriptions knowledge. This period of transition was marked by
that represented ‘the native’s point of view, their a ‘loss of innocence’ (Elie 2006); the ethnographic
relation to life and to realise their vision of the world’ ideal of the neutral, objective observer producing data
(Malinowski 1922). We see clear remnants of the that reflected the other’s perspective was challenged.
imperialist perspective in this view of ethnography, The idea that these data were a rendered reality,
‘with the omnipotent Western visionary attempting to exact and unfiltered by the researcher’s values or
make sense of the unknown, dark hidden culture of interpretive schema, was questioned (Pratt 1986).
the native”’ (Goodley et al 2004). For many, it could no longer be presumed that the
Malinowski’s significance stems from his researcher was delivering an objective, uncontested
research methods and the impact these continue account of the other’s experience (Clifford 1986).

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 Culture

This represented a significant change from the person’s experiences (Denzin 1997). Any claims to
ideals of empiricism that had previously driven authority can be judged false.
ethnography’s development. It also raised the
question of whether ethnography could be viewed Ethnography and nursing
as scientific at all (Atkinson and Hammersley 1998). There were a number of nurses who had received
Elie (2006) sardonically identified the forces that doctoral preparation in anthropology in 1960s and
destabilised the ideals as ‘the postcolonial insurgency, who attempted to establish the use of ethnographic
the feminist revolt, and the poststructuralist methods in nursing. An important figure was
destabilisation’. That the forces driving these Madeleine Leininger, who had undertaken an
developments can be easily isolated to particular ethnographic study of the Gadsup people in
intellectual movements is an over-simplification, New Guinea. From this experience, Leininger
but what is undeniable is that ethnography has determined that care and beliefs about health were
recently undergone a period of radical critique. embedded in people’s ‘values, worldviews and life
Denzin and Lincoln (2005) identified a ‘profound patterns’ (Cohen 1991).
rupture’ occurring in the 1980s, with works such as Leininger envisioned the need for scientific and
Marcus and Fischer (1986) and Clifford and Marcus humanistic transcultural knowledge (Leininger
(1986) calling into question issues of gender, class and 1997), and blended ideas from anthropology and
ethnicity in ethnography and arguing for research and nursing to develop the concept of ‘transcultural
writing to be more reflexive during their production. nursing’ (Leininger 1970). She viewed nursing and
These works echoed a ‘crisis of representation’ anthropology as ‘unified in a single specific and
that raised questions about how the ‘totalising unitary whole’ (Leininger 1970). Underpinning this
frameworks’ and ‘encompassing paradigms’ approach to nursing is the ‘culture care theory’,
of the social science could represent social reality which asserts that nurses can only provide ‘culturally
unproblematically (Marcus and Fischer 1986). congruent’ care to patients when they know the
Postmodernism, in its more extreme versions, expressions, patterns and practices of their patients’
brought a growing emphasis on indeterminacy in the culture (Leininger 2001).
analysis of culture. Flaherty et al (2002) noted that The research method Leininger developed to
the postmodern perspective highlighted that it could underpin practice is ‘ethnonursing’ (Leininger 2001).
no longer be assumed that there was a single ‘correct’ This attempts to combine concepts from ethnography
interpretation of reality because one’s interpretation and nursing, and ‘focuses mainly on observing
of facts – including the ‘facts’ themselves – and documenting interactions with people of how
were products of one’s interpretive stance. Therefore, these daily conditions, and patterns are influencing
it is impossible to establish any form of unchallenged human care, health, and nursing care practices’
authority or truth (Lyotard 1984). (Leininger 1985). Research using this method has
From the postmodern perspective, authorship focused on groups including Syrian-American
becomes problematic in ethnography (Fontana 1994). Muslims (Wehbe-Alamah 2011), German-American
Authors can no longer assume an invisibility, as their Lutherans (McFarland and Zehnder, 2006)
work attests to the limits of their cultures and their and substance-dependent African-American women
cultures’ interpretative powers (Crapanzano 1986). (Ehrmin 2005).
Clifford (1986) described a postmodern construct The ethnonursing researcher does not focus
of ethnography as a process that produces a fiction, on whole populations, instead focusing on ‘key’
as it is ‘something made or fashioned’ by the writer and ‘general’ informants (Leininger 2001). These are
– anathema to any researcher who subscribes to the the people judged to be the most knowledgeable
positivist scientific perspective. about the culture of interest. Key informants
The ‘crisis of representation’ challenged the purportedly have a compelling understanding of the
intellectual authority of the ethnographer and norms, beliefs, values and general way of life of the
the moral authority of the approach. Validity, culture. In contrast, general informants usually have
reliability and objectivity had become problematic general ideas about the domain and can help verify
for ethnographers again (Denzin and Lincoln 2005). information given by the key informants (Leininger
Culture was now viewed as contested, temporal 2001). It is the researcher who defines these
and emergent, and representation and explanation two levels of informants, this decision seemingly
were implicated in this emergence (Clifford 1986). supported only by their own authority. For example,
The person undertaking an ethnographic study McFarland (1997) studied Anglo-American and
can now no longer presume to be able to present African-American elders in a long-term care setting.
an uncontested, objective account of another She selected 14 Anglo-American (five key and

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 Nurse
Art Researcher
& science | acute care

Box 1  Four phases of ethnonursing transcultural nursing care’. This knowledge, it is

■ Collecting, describing and recording data. claimed, enables nurses to understand ‘vague, largely
■ Identifying and categorising descriptors. complex, covert, and unknown’ cultural phenomena,
■ Data analysis to uncover repetitive patterns and provides a basis for ‘culturally congruent’ nursing
in the context. practice (McFarland and Wehbe-Alamah 2014).
■ Identifying major themes and reporting the findings.
(Leininger and McFarland 2006) New approach to ethnonursing
Ethnonursing tries to establish truths regarding
nine general informants) and 12 African-American culture, the outcome being a credible, unbiased
(four key and eight general informants) residents study producing substantive evidence. It has
‘carefully and purposefully’ on the basis of who failed to respond to contemporary issues relevant
‘might be most knowledgeable’. to ethnographic knowledge: despite claims of an
Ethnonursing involves four phases interconnection with anthropology, the method is
(Box 1). In keeping with its anthropological roots, nostalgic for another age and is not in keeping with
the researcher undertakes observation, interviews the critiques and discourse of the modern discipline
and reflection to generate knowledge. For example, of anthropology. It is unsuited to our postcolonial,
Wolf et al (2014) participated in Somali community multicultural world and the nursing care we provide.
activities, shopped at Somali shops and visited Transcultural nurses using the ethnonursing method
Somali community centres for a year before now find themselves ‘unified’ with structures and
conducting interviews. processes that have created oppressive assumptions
Leininger (2001) developed several conceptual about people and been linked to processes of
frameworks from the 1960s onwards, including the genocide in the colonial era (Bourgois 2002).
‘stranger-friend model’ for gaining the acceptance The reconfiguration of social thought that
of informants and the ‘observation-participation-r occurred in the later part of the 20th century must
eflection model’ for observing participants. These make us question the claims of our methodologies
frameworks purported to enable portrayals of (Geertz 1983). Ethnonursing needs to move beyond
indigenous people’s views with a high degree of the pursuit of generalisations and the presentation
accuracy, reliability and validity (Leininger 1978). of groups of people as internally homogenous with
Leininger (1978) asserted that nurses can use clearly defined borders with other groups.
the information they have gathered through this The idea that culture has a pattern and presents
process to make predictions about a particular a coherent and discoverable whole that a researcher
group’s attitudes and beliefs towards health. can reflect with detached impartiality ‘as it really
Leininger (2002) stated that ethnonursing has led to is’ is a nice idea, but a fanciful one (Moore 1986).
a body of knowledge about culture and care that can For example, Wehbe-Alamah (2011) claimed to have
‘assure culturally competent, safe, and congruent discovered ‘universal themes’ and ‘universal patterns’

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 Culture

related to Syrian-American Muslims from a study of basing their practice on knowledge that views
30 people. In light of the anthropological critique of individuals and communities as being: bounded
ethnographic knowledge, we believe that a study of by certain cultural rules, rights and ways of being;
such a group of people could provide the basis for homogenous; and unchanging over time, place and
a cultural analysis of social phenomena and their cultural space (Salazar 2013).
implications for healthcare, but such a study must
move beyond essentialism and the idea that it can Conclusion
create a supposedly holistic description (Gupta and The critique of anthropology’s involvement in
Ferguson 1997). colonialism and the emergence of new ethnographic
In a world where it is impossible to capture in concepts have brought into the question
any one place the complete workings of ‘a culture’, traditional forms of ethnography. In the context of
we must ask ourselves what kinds of methods ethnonursing, this has brought up challenges to its
are appropriate (Comaroff and Comaroff 2003). core principles.
A refreshed ethnonursing could involve multiple Ethnonursing continues to espouse the
methods that involve direct social contact with people methodological virtues of an ethnographic view
and ‘of richly writing up the encounter, respecting, that is a relic of 19th and 20th century imperialism.
recording, representing at least partly in its own It has failed to adequately evolve in response
terms the irreducibility of human experience’ (Willis to contemporary conceptualisations of culture
and Trondman 2002). and methods for ethnographic enquiry. Nurse
Our social analysis will move beyond the researchers using the approach can no longer
purported, yet ultimately false ideal of the detached assume that their research is delivering an objective
observer using ‘neutral language’ to explain ‘raw data’ account of the other’s experience.
(Rosaldo 1993) to creating reflexive interpretations For a discipline that identifies scholarship,
that identify the researchers’ cultural assumptions including rigorous enquiry, as being one of its
and prejudices and recognise the relationship values and that has a goal to advance scholarship
between them and the people with whom they have (Transcultural Nursing Society 2014), the challenges
contact. The methodology will further expose how posed to the ‘marquee methodology’ of transcultural
politics, gender, class, ideology and ethnicity shape nursing should no longer be ignored. Nurse
the lives of the people with whom we interact. It will researchers interested in ethnonursing need Online archive
view people’s worlds as being constructed through to find new ways of practising and producing
For related information, visit
and reflections of historical and political processes, ethnographic knowledge. Revising ethnonursing our online archive and search
for which it is impossible to create definitive will reinvigorate it, moving it beyond positivist using the keywords
interpretations (Denzin 1997). posturing to create reflexive interpretations based
The implication of a revised approach to on interpersonal contact that recognise the limits of Conflict of interest
ethnonursing is that nurses will move away from the concept of culture. None to declare

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