Ethnography as Method

Ethnography is considered to be the oldest of the qualitative research methodologies” (Roberts, 2009, p.
291). As nursing practice has broadened so too have the research methods used to study practice,
particularly the meanings of health and illness as lived by individuals, families, and groups. Nurses have
used ethnography to study a variety of topics important to nursing, including children’s quality of life
after heart transplant (Green et al., 2007); the culture of a Taiwanese nursing home (Chuang & Abbey,
2009); and decision-making by hospice professionals (Waldrop & Rinfrette, 2009). These are just a few
examples of how nurses are using ethnography to better serve those individuals who are entrusted to
their care. To fully understand why there is a demonstrated commitment to ethnographic research, it
is important to look at the foundations of ethnography as a research method.

Social scientists share an interest in and a commitment to discovery. Anthropologists, as a

particular group of social scientists, are committed to the discovery of cultural knowledge. Early in the
history of the social sciences, individuals interested in culture found that the ways of traditional science
were inadequate to discover the nuances of people who live together and share similar experiences.
This inadequacy led to the beginnings of ethnography , a means of studying groups of individuals’ life
ways or patterns. Sanday (1983) reports that ethnographic methods are not new. The ancient Greek
Herodotus was an ethnographer who recorded variations in the cultures to which he was exposed.
According to Sanday, Franz Boas’s (1948) ethnographic examination of the Eskimo culture signaled the
contemporary beginning of ethnographic study.

Anthropology is synonymous with the term ethnography. The product of anthropologists’ work
is ethnography (Muecke, 1994). As early as the 1960s, references can be found regarding the value of an
ethnographic approach as a means to study nursing culture (Boyle, 1994; Leininger, 1970; Ragucci,
1972). Early nurse ethnographers embraced the methods of anthropology to study phenomena they
perceived were irreducible, unquantifiable, or unable to be made objective. Leininger (1985) went
beyond the borrowing of ethnographic methods to develop what she called “ethnonursing research.”
This chapter explores ethnography and discusses common elements of ethnographic methodology and
its uses, interpretations, and applications.

ETHNOGRAPHY DEFINED

According to Spradley (1980), “Ethnography is the work of describing culture” (p. 3). The description of
culture or the cultural scene must be guided by an intense desire to understand other individuals’ lives
so much that the researcher becomes part of a specific cultural scene. To do this, Malinowski (1961)
believed that researchers must learn the “native’s point of view” (p. 25). Spradley, however, warned
that ethnography is more than the study of the people; rather, “ethnography means learning from
people” (p. 3). Spradley also pointed out that “the essential core of ethnography is this concern with the
meanings of actions and events to the people [ethnographers] seek to understand” (p. 5).

Beyond Spradley’s (1980) discussion of ethnography, there is a long-standing debate about what
constitutes ethnography. Muecke (1994) suggested, “there is not a single standard form of
ethnography” (p. 188). Boyle (1994) proposed that “the style and method of ethnography are a function
of the ethnographer, who brings her or his own scientific traditions, training, and socialization to the
research project” (p. 182). This debate has led to a certain amount of confusion about ethnography as a
method and has further fueled arguments about the relative value of ethnography as rigorous science
(Savage, 2000). More recently, Brink and Edgecombe (2003) suggested that there has been a
“bastardization of [qualitative] research de-signs” (p. 1028), in particular, ethnography. Despite the
disagreements and controversies surrounding the method, ethnography has and will continue to
provide important information about the meanings, organization, and interpretations of culture.

According to Muecke (1994), the four major ethnographic schools of thought are (1) classical; (2)
systematic; (3) interpretive or hermeneutic; and (4) critical. classical ethnography requires that the study
“include both a description of behavior and demonstrate why and under what circum-stances the
behavior took place” (Morse & Field, 1995, p. 154). Regardless of the school of thought or type of
ethnography, use of the method requires considerable time in the field, constantly observing and
making sense of behaviors.

The objective of systematic ethnography is “to define the structure of culture, rather than to
describe a people and their social interaction, emotions, and materials” (Muecke, 1994, p. 192). The
difference between classical and systematic ethnography lies in scope. Classical ethnography aims to de-
scribe everything about the culture. Systematic ethnography takes a focused look at the structure of the
culture—what organizes the study groups’ life-ways. Systematic ethnography is the framework used by
Spradley, whose method of ethnographic inquiry is explored fully in this chapter.

The aim of interpretive or hermeneutic ethnography is to “discover the meanings of observed

social interactions” (Muecke, 1994, p. 193). According to Wolcott (cited in Muecke, 1994), “Ethnography
is quintessentially analytic and interpretive, rather than methodological” (p. 193). Interpretive
ethnographers are interested in studying the culture through analysis of inferences and implications
found in behavior (Muecke, 1994).

Critical ethnography is another type of ethnography Muecke (1994) de-scribed. It “draws on

cultural studies, neo-Marxist and feminist theories and research on critical pedagogy” (Gordon, Holland,
& Lahelma, 2001, p. 193). Critical ethnographers do not believe there is a culture out there to be known
but, rather, that researchers and members of a culture together create a cultural schema.
Ethnographers subscribing to this tradition account for “historical, social and economic situations”
(Fontana & Frey, 1994, p. 369) when reporting. Germain (2001) adds that “critical ethnography . . . is
distinguished from conventional approaches by its focus on issues of injustice and social oppression” (p.
279). “Inherent in a critical approach is the under-standing that through communicative practices and
reflection, researchers and participants discern an absolute truth of the culture” (Manias & Street, 2001,
p. 235).

Carspecken (1996) has become a popular model for the conduct of critical ethnography. His
five-stage method has been utilized by nurses. The steps which he suggests are not necessarily
sequential include: compiling the primary record via observations and recordings; undertaking the
primary “reconstructive analysis”; using dialogical data generation—describing the insiders view through
the use of interviews and focus groups; subjecting the data to systems analysis; and, seeking explanation
through social–theoretical models. Researchers interested in learning more about Carspecken’s work
should read the primary source.

These four types of ethnographies represent four philosophic positions. “All research proceeds
from philosophy, articulated or not” (Germain, 2001, p. 279). Therefore , it is essential that researchers
define their position before embarking on an ethnographic study. A researcher’s philosophic stance
determines what he or she will study as well as the framework for data collection and analysis.

In addition to the four types of ethnographies described, it is important to add the work of
Leininger. Leininger (1985) identifies a specific approach to ethnography she calls ethnonursing that
allows nurses to “study explicit nursing phenomena from a cross-cultural perspective” (p. 38). The goal is
“to discover nursing knowledge as known, perceived and experienced by nurses and consumers of
nursing and health services” (p. 38). The most significant contribution of Leininger’s work is its focus on
nursing as the phenomenon of interest.

Grbich (1999) also offers auto-ethnography as a type of ethnography that is gaining in opularity.
Grbich states that this is the ethnography of personal experience. Using this approach, the “self is
overtly and centrally positioned; the subjective experience is located culturally and theoretically; thick
ethno-graphic description and other techniques of presentation capture its immediacy, combining its
emotional, physical, and cognitive aspects” (p. 167).

ETHNOGRAPHY ROOTS

There is much debate about the historical beginnings of ethnography. Sanday (1983) proposed that
ethnography began with Herodotus. Rowe (1965) suggests that the Renaissance marked the initiation of
ethnography as a research method. Still others have indicated that Malinowski’s (1922) study of the
Trobriand Islanders marked the beginning of ethnography. Atkinson and Hammersley (1994) offer that
the contemporary beginning of ethnography occurred late in the 19th century as individuals began to
acknowledge cultural differences or “deviations from norms” (p. 249) and became interested in studying
these deviations. “The application of ethnographic method by Western anthropologists and sociologists
to the investigation of their own societies has been a central feature of twentieth-century social
science” (Cole, cited in Atkinson & Hammersley, 1994, p. 250). Atkinson and Hammersley (1994)
identified two key phases in the development of ethnography in the 20th century: “the work of the
founders of modern anthropology and that of the Chicago school of sociology” (p. 250).

Boas, Malinowski, and Radcliffe-Brown, the founders of modern anthropology (Atkinson &
Hammersley, 1994), were committed to anthropology as a science. These ethnographers focused on
chronicling their descriptions of primitive cultures. “The prime motivation on the part of all three
founders was the rejection of speculation in favor of empirical investigation, a theme that has always
been a central characteristic of empiricism, but not exclusive to it” (Atkinson & Hammersley, 1994, p.
250).
 The Chicago School’s most striking feature was its limited “questioning of the relevance of
natural science as a methodological model for social re-search” (Atkinson & Hammersley, 1994, p. 250).
The University of Chicago was “the matrix in which there developed a rich tradition of urban sociology,
heavily dependent on the detailed investigation of local social settings and cultures” (Atkinson et al.,
2001, p. 9). One of the most important influences of the Chicago school was the attempt by many
scientists in the school to connect scientific and hermeneutic philosophies with pragmatic philosophies
such as the one espoused by Dewey (Atkinson & Hammersley, 1994). According to Woods (1992), the
University of Chicago scientists laid the foundation for field research. They saw the city as a “social
laboratory” (Woods, 1992, p. 338) that exemplified all forms of human behavior and activity. It was here
that the idea of “native” was expanded to include social groups of local importance. As Deegan (2001)
points out, the heirs to the Chicago tradition “continue to weave a tapestry in what is now a consider-
ably more complex and diverse discipline” (p. 22).

Beyond these early developments, ethnography has expanded and developed to meet the
needs of scientists using its varied forms. As Atkinson (1999) points out,

. . . ethnography has always contained within it a variety of perspectives. As a whole, it has

never been totally subsumed within a framework of orthodoxy and objectivism. There have
been varieties of aesthetic and interpretive standpoints throughout nearly a century of
development and change. (p. 465)

Today, it is the quest to discover cultures and behaviors different from the researcher’s that
drives the use of this method. It is an exciting, interactive, decidedly qualitative approach that appeals to
its followers. As Hughes (1992) pointed out, “What is quintessentially distinctive about anthropology
[and thus ethnography] is just [its] species-centeredness and holistic character” (p. 442).

FUNDAMENTAL CHARACTERISTICS OF ETHNOGRAPHY

Six characteristics are central to ethnographic research. Three can be claimed by other qualitative
methods: (1) researcher as instrument; (2) fieldwork; and (3) the cyclic nature of data collection and
analysis. The other three arguably are unique to ethnography: (4) the focus on culture; (5) cultural
immersion; and (6) the tension between researcher as researcher and researcher as cultural member,
also called reflexivity . These characteristics should be considered foundational to ethnographic
research.

Researcher as Instrument
The study of culture requires an intimacy with the participants who are part of a culture. Ethnography as
a method of inquiry provides the opportunity for researchers to conduct studies that focus on personal
and sometimes intimate experiences of members of the culture, which is why the ethnographer
becomes the conduit for information shared by the group. When anthropologists speak of researcher as
instrument, they are indicating the significant role ethnographers play in identifying, interpreting, and
analyzing the culture under study. The primary ways that researchers become the instruments are
through interviewing, observing, recording of cultural data, and examining cultural artifacts.
 More than just observing, researchers often become participants in the cultural scene. Atkinson
and Hammersley (1994) suggest that “participant observation is not a particular research technique but
a mode of being-in-the-world characteristic of researchers” (p. 249). Participant observation demands
complete commitment to the task of understanding. The ethnographer becomes part of the culture
being studied to feel what it is like for the people in the situation (Atkinson & Hammersley, 1994; Boyle,
1994; Sanday, 1983).

Ethnographic researchers, despite becoming part of the cultural scene, will never fully have the
insider’s (emic) view. The emic view is the native’s view, which reflects the cultural group’s language,
beliefs, and experiences. One of the ways ethnographers can begin to access the emic view is by inter-
viewing group members, observing their behavior, and collecting cultural artifacts. Another way is to
become an insider. This idea is much debated in the literature. Dwyer and Buckle (2009) state that the
benefit to being a member of the group is acceptance. “One’s membership automatically provides a
level of trust and openness in . . . participants that would likely not have been present otherwise” (p.
58). Further, these authors contend that qualitative research methodologies have advanced to the point
that the dichotomous role of insider or outsider is no longer necessary. However, as a new researcher,
the difficulty may seem more pronounced.

The strength of participant observation is the opportunity to access information from the
outsider’s (etic) view. The etic view is the view of the outsider with interpretation. The essence of
ethnography is determining what an ob-served behavior is or what a ritual means in the context of the
group studied. Ethnography is the description and interpretation of cultural patterns.

Fieldwork
All ethnographic research occurs in the field. Researchers go to the location of the culture of interest.
For example, Waters (2008) was interested in studying the experience of children suffering with long-
term illness. Specifically, she was interested in childrens’ lives at the time when they were experiencing
end-stage renal disease. The author perceived this topic to be important for nursing. Waters spent 12
months over a 16-month period in the hemodialysis unit of one health care facility. Being on the unit
helped the researcher better understand the culture of the people studied. Physically situating oneself
in the environs of the study culture is a fundamental characteristic in all ethnographic work.

Lee and Gregory (2008) have made the case for the Internet as a place to “do” ethnography.
These two authors contend that the participation of one researcher in the field and the other in a home
location provided the opportunity for analysis at a much different level. “The collaborative process,
facilitated through the Internet, lent psychological strength to the field researcher and added to the
research quality, timeliness, and trustworthiness of . . . [the] focused ethnography” (p. 30). The ideas
offered by these re-searchers are not necessarily new; however, the medium may well be.
Cyclic Nature of Data Collection and Analysis
In ethnographic research, a question about the differences in human experience found in a culture
usually different from one’s own leads researchers to investigate those differences. As Agar (1982, 1986)
has pointed out, one of the problems for ethnographers is that no clear boundaries exist between the
similarities and differences in human experience. Data collected by ethnographers in the field to
describe the differences and similarities lead to still other questions about the culture. Answering those
questions leads to more questions. Therefore, the researcher is engaged in a continuous process of
interviewing, observing, reviewing materials, analyzing those data, and returning to the field to do more
interviews, conduct more observations, and collect additional artifacts. As Spradley (1980) and Spradley
and McCurdy (1972) indicate, the study ends not because a researcher has answered all of the questions
or completely described the culture, but be-cause time and resources are exhausted.

Focus on the Culture

Unique to ethnography is the focus on the culture. Ethnography is the only research method whose sole
purpose is to understand the life ways of individuals connected through group membership. As Boyle
(1994) stated, “Ethnography focuses on a group of people who have something in common” (p. 161). It
is essential that ethnographic researchers strive to discover and interpret the cultural meanings found
within a connected group. Unfortunately, culture is hard to define (Roper & Shapira, 2000). From a
behavioral/materialistic perspective, culture is the way a group behaves, what it produces, or the way it
functions (Roper & Shapira, 2000). From a cognitive perspective, “it is the ideas, beliefs and knowledge
that are used by a group of people as they live their lives” (p. 3). According to Roper and Shapira (2000),
the application of the two perspectives will help to demonstrate “what people know and believe and
what they do” (p. 3).

Goodenough, as cited in Wolcott (2003), provides the following statement about culture:
The culture of any society is made up of the concepts, beliefs, and principles of action and
organization that an ethnographer has found could be attributed successfully to the members of
the society in context of his dealings with them. (p. 5)

Wolcott sees the appeal of this definition in the fact that Goodenough views ethnographers as the
individuals who attribute culture to a society. There are three reasons that Wolcott takes this position:
(1) the value of ethnography is found in the adequacy of the explanation rather than in the method; (2)
culture is not seen, it is inferred; and (3) the attention that ethnographers give culture is a job they have
given themselves (p. 156). In light of these interpretations by Goodenough, it is the search for the
meaning of culture that gives researchers the context in which to study and to offer their interpretations
of what is seen.

Cultural Immersion
Another characteristic of ethnography is the depth and length of participation ethnographers must have
with the culture under study. The researcher’s participation has been called cultural immersion , which
requires that re-searchers live among the people being studied. For example, if a nurse researcher is
interested in studying the culture of families coping with human immunodeficiency virus in a family
member, the researcher would need to immerse him or herself in the lives of the families studied. The
re-searcher would observe how each family functions inside and outside of the home, studying as many
facets of their lives as the participants will allow. Participant observation would take months, if not a
year or more, to complete. Based on interviews, observations, participation in the culture, and review of
cultural artifacts, the nurse researcher would interpret and draw conclusions about the culture based on
his or her discoveries while collecting data.

Reflexivity
Reflexivity describes the struggle between being the researcher and becoming a member of the culture.
It also has been described as the need to have an ongoing conversation about the experience while
simultaneously living the moment (Coffey, as cited in Pellat, 2003, p. 28). It “is a process of induction of
meaning that arises from . . . ethnographers’ analysis of data while simultaneously acknowledging their
own influences from their insider role on that data” (Barton, 2008, p. 12).

Although it is important for the researcher to remain objective and stay focused on the
research, on some level, the researcher becomes a member of the culture. Through this type of
participation, researchers come to realize that they alter the culture and have the potential to lose their
objectivity more than is typical in the conduct of research. Because of the prolonged involvement as a
researcher and participant in the group, it is extremely difficult to maintain a completely detached view.
Allen (2004) points to the tremendous difficulty in trying to maintain an outsider relationship when one
is both a re-searcher and a nurse. She further questions the value of such separation.

The tension between researcher as pure researcher and researcher as participant has been
discussed in many forums. How does one discover the emic perspective—the insider’s view—without
becoming a part of the culture? The struggle for objectivity in collecting and analyzing data while being
so intimately involved with the group is a characteristic unique to ethnography. More than just
objectivity is of concern, however. Also critical is the necessity for the researcher to be fully aware of the
fact that just by being present in the culture, it is changed.

Edvardsson and Street (2007) provide excellent examples of how their reflexive journals
informed their research. These authors specifically share how reflections on movement, sound, smell,
taste, touch, and sight in-formed their study of the ward environment. The tables included in this article
will be particularly useful to the nurse researcher interested in under-standing how reflexive journaling
informs the research process.

SELECTION OF ETHNOGRAPHY AS METHOD

One of the goals of ethnography is to make explicit what is implicit within a culture (Germain, 1986).
“Ethnography aims to get at the implicit or latent (backstage) culture in addition to the explicit, public,
or manifested (front-stage) aspects of culture” (Germain, 2001, p. 284). Cultural knowledge requires an
understanding of the people, what they do, what they say, how they relate to one another, what their
customs and be-liefs are, and how they derive meaning from their experiences (Goetz & LeCompte,
1984; Spradley, 1980; Spradley & McCurdy, 1972; van Maanen, 1983). With these goals in mind, nurses
interested in exploring cultures or subcultures in nursing or nurse-related cultures have the world
available to them for study. Within the profession of nursing, there are many undiscovered cultures. An
example of cultural practices within nursing that is implicit and has been made explicit through research
(Wolf, 1988) is nursing rituals. Wolf (1988) discovered the rituals that nurses use to enable and protect
them in their work with clients. Similarly, in Wright’s (2002) study of hospice nurses, the author
examines the qualities of the participants to better understand how those qualities enhance patient
care. In her research, she provides a look at how what is implicit is made explicit within a culture. The
use of the ethnographic approach provides nurses with the opportunity to explore the holistic nature of
society and to ask questions relevant to nursing practice. The naturalistic setting in which ethnographic
research is carried out supplies nurses with the view of the world as it is, not as they wish it to be.
Fundamentally, entrance into the naturalistic setting in which the research participants live with as little
interference as possible from outside sources provides a rich data source for exploring many nursing
practice issues.

Nurses conducting ethnographic research must accept reflexivity as part of the research design.
Reflexivity allows nurses to explore cultures within the paradigm of nursing, which values the affective
and subjective nature of humans. The duality of being both researcher and participant provides
opportunities to capitalize on insights derived from datum sources. “‘Meaning” is not merely
investigated, but is constructed by [the researcher] and inform-ant through active and reciprocal
relationships and the dialectical processes of interaction” (Anderson, 1991, p. 116). Anderson (1991)
added that “field work is inherently dialectical; the researcher affects and is affected by the phenomena
(s) he seeks to understand” (p. 117). Reflexivity therefore leads to a greater understanding of the
dynamics of particular phenomena and relationships found within cultures.

When choosing ethnography as the approach to study a particular culture or subculture, the
nurse should ask several important questions. Do I have the knowledge and skill necessary or the
research support available to conduct a credible study? Do I have the time to conduct this study? Do I
have the resources to carry it out? Will the data collected bring new insights to the profession? If the
nurse researcher answers yes to these questions, then his or her study has the potential to contribute
significantly to the nursing profession.

In addition to answering the preceding questions, nurses interested in ethnography should know
why the approach may be useful. Spradley (1980) identified four primary reasons for using ethnography
to study a particular culture. The first is to document “the existence of alternative realities and to
describe these realities in [the terms of the people studied]” (p. 14). Much of what individuals know
about other cultures they interpret based on their own culture. This way of thinking is limiting in that it
pro-motes the idea that one truth—and thus, one reality—exists. For ethnographers, a description of
alternative realities provides a rich and varied landscape of human interaction. Coming “to understand
personality, society, individuals, and environments from the perspective of other than professional
scientific cultures . . . will lead to a sense of epistemological humility” (Spradley, 1980, p. 15).

A second reason, according to Spradley (1980), for using the ethno-graphic approach is to
discover grounded theories. Through description of culture, researchers are able to discover theories
that are indigenous to the culture (Grant & Fine, 1992). Foundational to grounded theorists’ research is
a belief that the only useful theory is one that is grounded in the beliefs and practices of individuals
studied. The principle that research should be based on the beliefs and practices of individuals (cultural
groups) studied is also foundational to the work of ethnographers. The major difference between the
conduct of ethnographic and grounded theory research is that ethnographers wishing to develop
grounded theory will advance the description and interpretation of cultural observations to a level that
yields a description of basic social-psychological process. For a full discussion of grounded theory, see
Chapter 7.

Germain (2001) supports the development of theory as a natural out-come of ethnographic

study. She offers that “ethnography contributes descriptive and explanatory theories of culture and
cultural behaviors and meaning. Within the ethnography may be identified other middle-range theories
such as typologies and hypotheses for further study” (p. 281). A third reason for choosing ethnography
is to better understand complex societies. Early anthropologists believed that the ethnographic method
was ideally suited to the study of non-Western cultures. Today, anthropologists see the value of using
ethnography to study subgroups of larger cultures—both Western and non-Western. Examples can be
found in nursing in the works of Green et al. (2007) and Chuang and Abbey (2009).

The fourth reason Spradley (1980) offers for using the ethnographic approach is to understand
human behavior. Human behavior has meaning, and ethnography is one way to discover that meaning.
Such discovery be-comes particularly important when nurses look at the clients’ health and illness
behaviors. Understanding how and why cultural groups such as Hispanic immigrants, elderly citizens,
abused women, or the Amish behave in health and illness situations can assist nurses who care for these
groups to better provide interventions to enhance the health-related strategies already in use by the
groups.

When nurses decide they will use ethnography to study a culture of interest, a parallel
consideration will be whether they will conduct a micro- or macro-ethnographic study. Leininger (1985)
called these study types “mini” or “maxi,” respectively. Regardless of the terminology, the intent has to
do with the scale of the study. A micro-or mini-ethnography is generally of a smaller scale and is narrow
or specific in its focus. Schulte’s (2000) ethnographic study of the culture of public health nurses in a
large, Midwestern, urban health department is an example of a micro-ethnography. The study focused
on one organization, a particular group of employees, and occurred during a 6-month period. Therefore,
the study was considered a micro-ethnography because of its description of only one group, public
health nurses, within one health department, and with a limited time in the setting.

Increasingly, nurse researchers are using the term focused ethnography to identify their small-
scale ethnographies. Focused ethnographies have as their focal point a distinct problem that is studied
within a single context with a limited number of individuals.

Focused ethnographies share with classical ethnographies a commitment to conducting

intensive participant observation activities within a naturalistic setting, asking questions to learn
what is happening, and using other available sources of information to gain as complete an
understanding as possible of people, places and events of interest. (Roper & Shapira, 2000, p. 7)
 Green and coresearchers’ (2007) study of quality of life for school-aged children following a
heart transplant is an example of a focused ethnography. In this study, the researchers focused on a
small group of 11 children who had received heart transplants in a large children’s hospital in Arkansas.
The researchers reported that pediatric heart transplant patients and their families make up a
subculture of transplant patients. The individuals interviewed and the subject matter were very focused.
A macro- or maxi-ethnography is a study that examines the culture in a broader context,
extends over a longer period, and is most often reported in book form. Magilvy and Congdon’s (2000)
and Lipson’s (2001) ethnographies are examples of this type of study. These researchers observed a
significant number of individuals over a period of several years with a larger scope.

Spradley (1980) further delineated the scope of ethnographic studies by placing them on a
continuum. On one end are micro-ethnographic studies that examine a single social situation (nurses
receiving report on one unit); multiple social situations (critical care nurses participating in a report on
three intensive care units); or a single social institution (the American Cancer Society of Philadelphia).
Moving on the continuum closer to macro-ethnographic studies, Spradley included multiple social
institutions (American Cancer Societies of Florida); a single community study (Chinatown in San
Francisco); multiple communities (Hispanic communities in East Los Angeles); and a complex society
(tribal life in Africa).

ELEMENTS AND INTERPRETATIONS OF THE METHOD

A number of individuals have described ethnographic research methods. Early ethnographic reports
were written by individuals who documented their observations of the cultures they encountered.
Although many of these individuals were not trained anthropologists, they gave rich and vivid accounts
of the lives of the people they met. Sanday (1983) pointed out that these recorders were not
participants in paradigmatic ethnography. Paradigmatic ethnography consists of the range of activities
completed by a trained ethnographer, including observing, recording, participating, analyzing, reporting,
and publishing experiences with a particular cultural group. Sanday offered three traditions within
paradigmatic ethnography: (1) holistic; (2) semiotic; and (3) behavioristic.

The holistic ethnographic interpretation is the oldest tradition. The commitment of researchers
in this tradition is to “the study of culture as an integrated whole” (Sanday, 1983, p. 23). According to
Sanday, the ethnographers who ascribed to this approach included Benedict (1934), Mead (1949),
Malinowski (1922), and Radcliffe-Brown (1952). Although all four ethnographers varied in their focus,
their underlying commitment was to describe as fully as possible the particular culture of interest within
the con-text of the whole. For instance, “Mead and Benedict were interested in describing and
interpreting the whole, not in explaining its origin beyond the effect of the individual on it” (Sanday,
1983, p. 25). Radcliffe-Brown and Malinowski were not committed to the “characterization of the
cultural whole but to how each trait functions in the total cultural complex of which it is part” (Sanday,
1983, p. 25). Although the focus of both sets of ethnographers was different, the underlying
commitment to viewing the culture as a whole was preserved.
 The semiotic interpretation focuses on gaining access to the native’s viewpoint. Like the
researchers committed to holistic interpretation, the major anthropologists in this tradition did not
share epistemologies. The two major followers of this tradition are Geertz (1973) and Goodenough
(1970, 1971). According to Sanday ( 1983), Geertz views the study of culture not as a means to defining
laws but as an interpretative enterprise focused on searching for meaning. Furthermore, Geertz believes
that the only way to achieve cultural understanding is through thick descriptions , large amounts of data
(descriptions of the culture) collected over extended periods. According to Geertz, the analysis and
conclusions offered by ethnographers represent fictions developed to explain rather than to understand
a culture.

Goodenough (1970, 1971) is an ethnographer who embraces the semiotic tradition. He does so
through what has been described as ethnoscience , “a rigorous and systematic way of studying and
classifying emic (local or inside) data of a cultural group’s own perceptions, knowledge, and language in
terms of how people perceive and interpret their universe” (Leininger, 1970, pp. 168–169).
“Ethnoscience [is] viewed as a method of developing precise and operationalized descriptions of cultural
concept” (Morse & Field, 1995, p. 29). Ethnoscience is also called ethnosemantics or ethnolin-guistics to
emphasize the focus on language.

According to Sanday (1983), Geertz’s commitment is to the “notion that culture is located in the
minds and hearts of men” (p. 30). Culture is de-scribed by writing out systematic rules and formulating
ethnographic algorithms, which make it possible to produce acceptable actions such as the “writing out
of linguistic rules that makes it possible to produce acceptable utterances” (Sanday, 1983, p. 30).

“The differences between Geertz and Goodenough are not in aim but in the method, focus, and
mode of reporting” (Sanday, 1983, p. 30). Both ethnographers are committed to the careful description
of culture. Geertz’s method and reporting are viewed as more of an art form compared with
Goodenough’s method, in which the focus is on rigorous, systematic methods of collecting data and
reporting findings.

The third interpretation is the behaviorist approach. Ethnographers using this approach are
most interested in the behavior of members of a culture. The main goal “is to uncover covarying
patterns in observed behavior” (Sanday, 1983, pp. 33–34). This approach is deductive. Ethnographers
sub-scribing to this interpretation look specifically for cultural situations that substantiate preselected
categories of data. Use of this interpretation deviates radically from the intent of the other two
interpretations, which rely solely on induction.

Leininger (1978, 1985), a nurse anthropologist, developed her own interpretation of

ethnography: ethnonursing. Ethnonursing, according to Leininger, is “the study and analysis of the local
or indigenous people’s viewpoints, beliefs, and practices about nursing care behavior and processes of
designated cultures” (Leininger, 1978, p. 15). The goal of ethnonursing is to “discover nursing knowledge
as known, perceived and experienced by nurses and consumers of nursing and health services”
(Leininger, 1985, p. 38). The primary function of Leininger’s approach to ethnography is to focus on
nursing and related health phenomena. This approach has been an important contribution to the
nursing field. Many nurse ethnographers sub-scribe to Leininger’s philosophy and apply her method of
inquiry. A recent article by Prince (2008) on resilience in African American women formerly involved in
street prostitution is a good example of the use of Leininger’s method to analyze data.

SELECTING ETHNOGRAPHY

When nurses choose to conduct ethnographic research studies, usually they have decided there is some
shared cultural knowledge to which they would like access. The way individuals’ access cultural
knowledge is by making cultural inferences , which are the observer’s (researcher’s) conclusions based
on what the researcher has seen or heard while studying an-other culture. Making inferences is the way
individuals learn many of their own group’s cultural norms or values. For instance, if a child observes an-
other child being scolded for talking in class, the observer—without being told—concludes that talking
in class can lead to an unpleasant outcome. Therefore, the child learns through cultural inference that
talking in class is unacceptable. Ethnographers follow this same process in their observations of cultural
groups. According to Spradley (1980), ethnographers generally use three types of information to
generate cultural inferences: cultural behavior (what people do); cultural artifacts (the things people
make and use); and speech messages (what people say).

A significant part of culture is not readily available. This information, called tacit knowledge ,
consists of the information members of a culture know but do not talk about or express directly
(Hammersley & Atkinson, 1983; Spradley, 1980). In addition to accessing explicit or easily observed
cultural knowledge, ethnographers have the responsibility of describing tacit knowledge.

Understanding the Researcher’s Role

To access explicit and tacit knowledge, researchers must understand the role they will play in the
discovery of cultural knowledge. Because the researcher becomes the instrument, he or she must be
cognizant of what the role of instrument entails. The role requires ethnographers to participate in the
culture, observe the participants, document observations, collect artifacts, interview members of the
cultural group, analyze, and report the findings. This role requires a significant commitment to the
research that should not be taken lightly. In addition, it requires that researchers regularly reflect on the
impact their participation in the culture has on the data and analysis.

The step-by-step method of collecting, analyzing, and presenting ethno-graphic research,

according to Spradley (1980), is presented to educate read-ers. Although Spradley’s is not the only
ethnographic approach available, it is presented because of its explicitness, clarity, and utility for novice
ethno-graphic researchers.

Steps for Conducting Ethnographic Research

1. Do participant observation
2. Make an ethnographic record
3. Make descriptive observations
4. Make a domain analysis
5. Make a focused observation
6. Make a taxonomic analysis
7. Make selected observation
8. Make a componential analysis
9. Discover cultural themes
10. Take a cultural inventory
11. Write an ethnography

Spradley (1980) identifies 11 steps in the conduct of ethnographic re-search. Box 9-1
summarizes these steps. The processes for data generation, treatment, analysis, and interpretation are
discussed within the context of the steps identified.

Gaining Access
One of the first considerations when initiating an ethnographic study is to decide on the aim . Based on
the aim of the inquiry, researchers can decide the scope of the project. Will the aim be to focus on a
particular group or a particular problem of a group? Will you use a focused, micro- or mini-ethnography
approach? Will you examine a single social situation? Multiple social situations? A single social
institution? Multiple social institutions? A single community study? Multiple communities? Complex
societies?

Once researchers have decided on the scope of the project, their next step is to gain access to
the culture. Because ethnography requires the study of people, the activities in which they are involved,
and the places in which they live, to conduct the study, researchers will need to gain access to the
culture. This may be the most difficult part of the study. Because researchers are not usually members
of the group studied, individuals in the culture of interest may be unwilling or unable to provide the
access required. In other in-stances, researchers may be studying social situations that do not require a
group’s permission. For instance, if researchers are interested in the culture of individuals who come to
the local pharmacy to obtain their medications, permission may not be required. However, if they are
interested in studying the culture of health professionals in an outpatient clinic, permission is necessary.

Access is easiest when researchers have clearly stated the study purpose and have shared how
they will protect the participants’ confidentiality. In addition, offering to participate in the setting may
enhance researchers’ abilities to gain entry to social situations. If, for example, a researcher wishes to
study the culture of health professionals working in an outpatient clinic, his or her willingness to
participate by offering “volunteer” services while in the setting may improve the chances of obtaining
admission. As a “volunteer,” the researcher not only has the opportunity to make observations but will
also become part of the culture after remaining on the scene for an ex-tended period. Each organization
or institution will have its policies and procedures, some more clearly delineated than others. It is
strategically important that you ascertain early what those involved require both formally and informally
to gain access. Gaining access using the appropriate procedures will begin to build the trust needed to
be successful in the field.
Making Participant Observations
The role of rapport has not been talked about a great deal in the literature. However, the rapport the
researcher establishes with those being studied is critical. “Rapport is often cited as a central tenet of
research relationships, it has but, in a similar vein to that of insider status, it is perhaps something taken
for granted in the literature” (McGarry, 2007, p. 11). The relationships that are developed during the
early fieldwork period will provide the door-way to that which comes later.

Actual fieldwork begins when researchers start asking questions about the culture chosen.
Initially, the ethnographer will ask broad questions of the setting. Using the outpatient clinic as an
example, the researcher might ask: Who works in the clinic? Who comes to the clinic for care? What is
the physical set-up of the clinic? Who provides the care to clients who come to the clinic?

In addition to asking questions, the researcher will begin to make observations. There are three
types of observations: descriptive, focused, and selective (Spradley, 1980). Descriptive observations start
when the researcher enters the social situation. The ethnographer will begin by describing the social
situation, getting an overview of the situation, and determining what is going on. After completing this
type of observation, the researcher will con-duct more focused descriptive observations. These
observations are generated from questions the researcher asked during the initial descriptive phase. For
example, while in the clinic the researcher discovers that nurses are responsible for health teaching. A
focused observation is required to look specifically at the types of health teaching done by the nurses in
the setting. Based on this focused observation, the researcher conducts a more selective observation .
For example, the researcher observes that only two out of the seven nurses in the clinic conduct any
health teaching with clients with acquired immunodeficiency syndrome (AIDS). A selective interview or
observation involving the two nurses will address additional questions about why clinic staff members
behave as they do.

Neophyte ethnographers should not be led to believe that they conduct observations and
interviews in the linear manner just described. Rather, broad, focused, or selective questions may arise
out of any observation. Furthermore, the intent of an observation is not to merely “look at” some-thing.
More accurately, through observation while in the setting, researchers look, listen, ask questions, collect
artifacts, and analyze data collected in a cyclic manner.

At any given time, ethnographers may be more or less involved in the social situation. For
example, when the outpatient clinic is busy, the researcher as volunteer may be quite involved as a
participant in the culture. At times of lesser traffic, the researcher may spend more time observing or
interviewing. Explicit rules for when to participate and when to observe are not available. Researchers,
the actors (members of the culture studied), and the activity determine the degree of participation in
the social situation.

Roper and Shapira (2000) offer that “relying on personal observations alone can be misleading”
(p. 70). It will be essential that all interpretations of observations be validated through other collected
information. The re-searcher must be always aware of the fact that all individuals view social situations
through their own cultural lenses. Therefore, cross-comparison of data is fundamental. Brink and
Edgecombe (2003) observed the number of published ethnographic studies that use only one data
collection strategy. It is critical for the neophyte ethnographer to understand the necessity of using
varying data collection strategies to provide a rich cross-comparison of information collected.

More recently, there is a growing body of literature describing the practitioner ethnographer .
Barton (2008) describes the practitioner ethnographer as “a member of the investigated phenomena, a
practitioner in the field, a reactive part of the event with insider knowledge and an historical
perspective” (p. 12). “They are more than just participants; they live and have lived the experience that
they want to investigate” (p. 11). Practitioner ethnographers are focused on the dynamics between the
data, the self, and the practice environment (Barton). There are particular principles which should be
considered if one wishes to conduct a study as a practitioner ethnographer. The researcher interested in
this role should carefully consider the pros and cons of engaging in an ethnography using this approach.

Making the Ethnographic Record

On completion of each observation, ethnographers are responsible for documenting the experience.
Documents generated from the observations are called field notes. Field notes are generally made
during or immediately after an observation or interview. These are generally written “more or less
contemporaneously with the events, experiences and interactions they describe or recount” (Emerson,
Fretz, & Shaw, 2001, p. 353). Field notes may be man-aged by handwriting and storing them manually or
by using computer programs to store and categorize data. A number of data storage, retrieval, and
analysis software programs are available (see Chapter 3). Researchers who do not have a computer or
are more comfortable documenting their observations in writing may use handwritten notes they
organize in file boxes. These notes will chronicle what the researchers have seen and heard, answers
to questions they asked, and created or collected artifacts. In addition, the field notes can be used to
describe the researchers’ reflections on what is seen and heard and how their presence may be affecting
the data collection.

In the clinic, for example, the researcher may observe the physical layout. Based on the
observation, the researcher may ask questions related to what happens in each room. A floor plan
(artifact) may become part of the record. The researcher may also take photographs to document the
colors of the clinic or the decorations used. These artifacts may offer important insights as the study
continues.

It is important throughout the study—but especially in the beginning— not to focus too soon
and also not to assume that any comment, artifact, or interaction is incidental. Researchers should
document experiences to create a thick or rich description of the culture. In the outpatient example, the
re-searcher should document the colors of the clinic. This observation may seem incidental; however, if
a staff member later reports that it is important to maintain a calm atmosphere in the clinic because of
the types of clients seen, then the choice of the color may be an artifact that supports this belief system.

In addition to recording explicit details of a situation, ethnographers will also record personal
insights. A wide-angle view of the situation will provide the opportunity to detail what participants have
said and to share what may be implicit in the situation. Using a wide-angle lens to view a situation
provides ethnographers with a larger view of what is actually occur-ring in a social situation. For
example, if an ethnographer is interested in observing a change-of-shift report and attends the report
with the purpose of investigating the nurses’ interactions, the researcher may miss valuable information
regarding the report. With a wide-angle approach, the ethnographer would observe all individuals,
activities, and artifacts that are part of the social situation, rather than merely focus on the interactions
between the nurses in the report. Attention to all parts of the social situation will contribute to a richer
description of the cultural scene. Once the researcher has a good grasp of the wide-angle view, then
more focused and selective observations can take place.

Spradley (1980) offers three principles researchers should consider as they document their
observations: “the language identification principle, the verbatim principle, and the concrete principle”
(p. 65). The language identification principle requires that ethnographers identify in whose language the
text is written. Spradley has pointed out that the most frequently recorded language is the amalgamated
language (see Example 9-2), that is, the use of the ethnographer’s language as well as the informants’
language. For example, a nurse ethnographer recording his or her observations of a clinic day might
choose to mix the answers to questions with personal observations. Such mixing may create problems
when data analysis begins because the researcher can lose sight of the cultural meaning of the
observation. To minimize the potential of this happening, entries should identify the person making the
remarks. Example 9-1 illustrates the correct way to record field notes. In Example 9-2, the record does
not describe how the researcher obtained specific information. It is difficult to decipher whether the
notes are the researcher’s interpretations or whether the researcher obtained the information directly
from the informants.

Example 9-1

Field Note Entry No. 1 July 2, 2005

Ethnographer Today when I visited the clinic, I noticed that the walls were painted blue. I
asked the receptionist who had done the decorating.
Receptionist “We had several meetings with the decorator.”

Example 9-2
Field Note Entry No. 1 July 2, 2005

Today I observed the clinic waiting area. The area is painted in a pale blue. The chairs are wood and
fabric. The fabric is a white-and-blue print, which contrasts with the wallpaper. The waiting area is very
busy. The colors have an effect on the clients. They come in looking very harassed, then they fall asleep.
A decorator helped with the colors.

Although Example 9-1 is a limited notation, readers can get a sense of how researchers should
report field notes to facilitate analysis. In this example, the receptionist’s response gives the
ethnographer clear information about the decorating. The use of the word we in Example 9-1 gives the
researcher insight into the interactions occurring among staff members. Although Example 9-2 offers
significant information, the researcher will find it difficult, after long months of data collection, to return
to this note and distinguish his or her in-sights from factual information obtained from the informants.

The reporting of the receptionist’s comments in Example 9-1 reflects the verbatim principle,
which requires ethnographers to use the speaker’s exact words. To adhere to this principle, researchers
may use audiotaping, which not only offers ethnographers verbatim accounts of conversation but also
affords them an extensive accounting of an interaction that will provide the material for intensive
analysis. Documenting verbatim statements also pro-vides researchers with a view of native
expressions. In Example 9-1, the use of verbatim documentation allows the researcher to gain insight
into the language. The receptionist’s use of the word we to describe the activities with the decorator
may provide valuable insights into the culture of the clinic. The concrete principle requires that
ethnographers document without interpretation what they have seen and heard. Generalizations and
interpretations may limit access to valuable cultural insights. To reduce interpretation, researchers
should document observations with as much detail as possible. Example 9-3 offers an example of
concrete documentation without interpretation or generalization. In this example, documentation is
clear. The researcher has recorded facts and conversation verbatim.

Example 9-3

Field Note Entry No. 1 July 2, 2005

The clinic waiting area is painted ocean blue. The ladder-back chairs are light brown wood with
upholstered seats. The fabric on the seats is an ocean blue-and-white checkered pattern. There are two
small 2-ft by 3-ft by 2 1⁄2-ft brown wooden tables between the six chairs in the waiting room. There are
two chairs along one wall with a table in the corner. Then, two chairs along the second wall with another
table in the corner. The third wall has the two remaining chairs. The room is an 8-ft by 9-ft rectangle.
Each table has a ginger jar lamp. The lamp base and shade are white. The fourth wall has a door and
window in it. The draperies on the window are floor length and match the pattern on the chairs.

Individuals enter the clinic, approach the receptionist, state their names, sit in the chairs, and close their
eyes. Some patients snore.

Ethnographer “The colors in this room are great. Everything seems to go together so well. Who did the

decorating?”

Receptionist “We had several meetings with the decorator.”

Making Descriptive Observations

Every time ethnographers are in a social situation, they generally will make descriptive observations
without having specific questions in mind. General questions, which guide this type of observation, are
grand tour questions. For ex-ample, a grand tour question that might initiate a study of a particular clinic
is the following: How do people who live in this neighborhood receive health care? Remembering that
the primary foci of all observations include the actors, activities, and artifacts will assist in the
development of grand tour questions.
Spradley (1980) has identified nine major dimensions to any social situation:
1. Space refers to the physical place or places where the culture of interest carries out social
interactions. In the outpatient clinic example, space would include the physical layout of the care
delivery site.
2. Actors are people who are part of the culture under investigation. In the clinic example, the nurses,
physicians, clients, maintenance workers, secretarial and receptionist staff, and family members of
clients in the clinic would be the actors.
3. The activities are the actions by members of the culture. In the clinic example, activities would
include the treatments provided to clients and conversations between cultural group members.
4. Objects in the clinic example would include artifacts such as implements used for care, pamphlets
read by clients, staff records, and meeting minutes. Any inanimate object included in the space
under study may give insight into the culture.
5. Any single action carried out by group members is an act. An example of an act observed in the clinic
would be the locking of the medicine cabinet.
6. An event is a set of related activities carried out by members of the culture. In the clinic example,
the ethnographer one day may observe the staff giving a birthday party for a long-time client.
7. It is important that the researcher document the time he or she made observations and when
activities occurred during those times. In addition to recording time, the researcher must relate the
effect time has on all nine dimensions of social situations.
8. Goal relates specifically to what group members hope to achieve. The clinic example illustrates how
painting the clinic blue may be a way for the staff to relate their intention to create a calming effect
on clients, who often must wait long periods.
9. The researcher should also record feelings for each social situation, including the emotions
expressed or observed. For example, during the staff-given birthday party for a long-time client, the
ethnographer might observe tears from the client, cheers by the staff, and anger by a family
member. Recording feelings provides a rich framework from which to make cultural inferences.

The nine dimensions can be useful in guiding observations and questions related to social
situations. It is beneficial to plot the nine dimensions in a matrix (Spradley, 1980) to contrast each
dimension. For example, in addition to describing the space where the culture carries out its
interactions, researchers should relate space to object, act, activity, event, time, actor, goal, and
feelings. What does the space look like?

What are all the ways space is organized by objects? What are all the ways space is organized by
acts? What are all the ways space is organized by activities? What are all the ways space is
organized by events? What spatial changes occur over time? What are all the ways space is used
by actors? What are all the ways space is related to goals? What places are associated with
feelings? (Spradley, 1980, pp. 82–83)

Critical ethnographers would add the dimensions of social and political climate to Spradley’s
(1980) list. It is extremely important that researchers consider issues of power, social class, and politics
to get a full view of the culture. In the clinic example, the researcher might ask the following questions:
Why are women the providers of intimate care? Does the male doctor ultimately make all the decisions?
If so, why? Once researchers have collected data on all dimensions and have related each piece of data
to other information, they can begin to focus on further observations.

Making a Domain Analysis

Throughout data collection, ethnographers are required to analyze data. Analyzing data while in the
field helps to structure later encounters with the social group of interest. Ethnographic data “analysis is
a search for patterns” (Spradley, 1980, p. 85). These patterns make up the culture.

To begin to understand cultural meaning, ethnographers must analyze social situations they
observe. A social situation is not the same as the concept of culture but, rather, “refers to the stream of
behavior (activities) carried out by people (actors) in a particular location (place)” (Spradley, 1980, p.
86). Analysis of the social situation will lead to discovery of the cultural scene. Cultural scene , an
ethnographic term, refers to the culture under study (Spradley, 1980). The first step in analysis is to do a
domain analysis. Ethnographers doing a domain analysis focus on a particular situation.

In the outpatient clinic example, the category—people in the clinic—is the first domain the
researcher must analyze. The researcher should ask, Who are the people in the clinic? Reviewing the
field notes, the people in the clinic should be easy to identify (Figure 9-1). Spradley (1980) has suggested
it is important to identify the semantic relationships in the observations made. For example, x is a kind
of y: Nurses are kinds of people in the clinic. Furthermore, the researcher can do another analysis to
explore the types of nurses who work in the clinic. Hammersley and Atkinson (1983) have approached
analysis somewhat differently. They recommend researchers generate concept categories, refining them
further into subcategories. Regardless of the method used, it is essential that researchers work to
discover the cultural meaning for people, places, artifacts, and activities. Creating as extensive a list as
possible of categories will assist in discovery.

Figure 9-1.

Secretaries

Receptionist

Nurses

Doctors

Individuals with a problem

Family members of individuals with a problem

Maintenance staff
To maintain inclusiveness, return to the dimensions described earlier in this chapter. Generating domain
analyses leads ethnographers to ask additional questions and make further observations to explore the
roles and relation-ships of the cultural group members.

Making Focused Observations

Based on the completed domain analysis, ethnographers will need to make new observations and
collect additional material. The domain analysis should be the impetus for the next round of
observations. Researchers identify the domain categories that need development and then return to the
re-search site. In the clinic example, based on the identification of different types of nurses in the clinic,
the ethnographer would want to focus on the different types of nurses and discover their specific roles
and activities. This information can provide important insight into the culture. Making a Taxonomic
Analysis The taxonomic analysis is a more in-depth analysis of the domains re-searchers have previously
selected. Researchers are searching for larger categories to which the domain may belong. In the clinic
example, “nurses in the clinic” is a category identified in the domain analysis. Nurses are a type of
people in the clinic. In addition, there are other types of nurses. Nurses can be categorized based on
their educational backgrounds: licensed practical nurses (LPNs), registered nurses (RNs), nurse
practitioners (NPs), and clinical nurse specialists (CNSs). These categories may be broken down further
based on the focus of clients for whom the nurses care in the particular culture under study (Figure 92).
Figure 9-2.

Secretaries

Families LPNs All clients

Nurses NPs Pregnant women

Doctors Psychiatric clients

Receptionist RNs AIDS clients

Maintenance staff CNSs Cardiac clients

Clients with STDs

Diabetic clients

On completion of this analysis, ethnographers will look for relation-ships among the parts or
relationships to the whole. Based on these new categories, researchers will make additional
observations and ask more questions. In the clinic example, the researcher might ask, Why do the RNs
have the primary responsibility for care of the clients with AIDS and sexually transmitted diseases
(STDs)? Are there different types of AIDS clients, and are they cared for by specific RNs? Are AIDS clients
treated differently from the clients with STDs? Are other nurses consulted regarding the care of these
two groups of clients? Are the nurses able to select the types of clients for whom they care?
 Clearly, the researcher will generate a number of questions from this taxonomic analysis of the
concept nurse. In addition to using a reductive exercise, ethnographers should try to discover whether
there are larger categories for which they have not accounted. In the clinic example, are the people in
the clinic part of a larger system? If the clinic is affiliated with a hospital or a community-based
organization, then the answer is yes. The nurse ethnographer will then need to ask further questions
based on this association and conduct focused interviews to validate whether the previously derived
larger or smaller categorizations are accurate.

Making Selective Observations

Through selective observations, researchers will further refine the data they have collected. Selective
observations will help to identify the “dimensions of contrast” (Spradley, 1980, p. 128). Spradley offers
several types of questions that will help researchers discern the differences in the dimensions of
contrast. The dyadic question seeks to identify the differences between two domains. The question is,
In what way are these two things different? In the clinic example, one of the questions the researcher
should ask is, In what ways are NPs and CNSs different? Triadic contrast questions seek to identify how
three categories are related. The researcher in the clinic example might ask, Of the three—NPs, CNSs,
and RNs—which two are more alike than the third? Card-sorting contrast questions allow
ethnographers to place the do-mains on cards and sort them into piles based on their similarities. This
also can be managed by specific computer software applications (see Chapter 3). By identifying the
similarities, the contrasts become easily recognizable. Asking these questions of the available data will
lead ethnographers to the setting to ask still other questions.

Making a Componential Analysis

”Componential analysis is the systematic search for attributes associated with cultural categories”
(Spradley, 1980, p. 131). Boyle (1994) indicates that componential analysis has two objectives: to specify
the conditions under which participants name something and to understand under what conditions the
participants give something a specific name. Componential analysis is language driven.

During this stage of analysis, researchers are looking for units of meaning. Each unit of meaning
is considered an attribute of the culture. Again, re-searchers are searching for missing data. During
componential analysis, they examine each domain for its component parts and ask questions to identify
the dimensions of contrast. Based on the identification of missing data, the researchers will make
selected observations. Table 9-1 is an example of simple componential analysis that illustrates
dimensions of contrast based on the sorting of people who work in the outpatient clinic. In the clinic
example, the ethnographer is able to determine that unlicensed personnel do not provide health care.
This analysis helps the researcher to begin to identify a hierarchical structure. He or she must validate
conclusions through selective interviews and observations. The purpose of using this process is to search
for contrasts, sort them out, and then group them based on similarities and differences. This activity
provides ethnographers with important information regarding the culture under study.
To fully carry out a componential analysis, ethnographers should move through the process in a
sequential manner. The eight steps of the procedure are as follows: (1) select a domain for analysis
(people who work in the clinic); (2) inventory previously discovered contrasts (some members are
licensed, have supervisors to whom they report, and provide health care); (3) prepare the worksheet
(this is called a paradigm ); (4) classify dimensions of contrast that have binary values (licensed, yes or
no); (5) combine related dimensions of contrast into ones that have multiple values (doctors and nurses
are licensed personnel who provide health care); (6) prepare contrast questions for missing attributes
(Are doctors the owners of the clinic be-cause they appear not to have a reporting relationship?); (7)
conduct selective observations and interviews to discover missing data and confirm or discard
hypotheses; (8) prepare a complete paradigm (Spradley, 1980). “The final paradigm can be used as a
chart in [the] ethnography” (p. 139). Although every attribute will not be discussed on the chart,
important ones can be, allowing ethnographers to present a large amount of information in
a concise and clear manner (Spradley, 1980).

PERFORMING DATA ANALYSIS

Although data analysis occurs throughout data collection, the next two stages—discovering cultural
themes and taking a cultural inventory—focus solely on data analysis.

Discovering Cultural Themes

The discovery of cultural themes requires ethnographers to carefully examine the data collected and
identify recurrent patterns. Whether tacit or explicit, the patterns constitute the culture.

To complete the theme analysis, researchers must become immersed in the data, which
requires focused concentration over an extended period. The purpose of immersion is to identify
patterns that have not become ap-parent at the particular point in the study or to explore patterns that
may have been generated previously to ensure their soundness. Spradley (1980) identified six universal
themes that may be helpful during this stage of data analysis. These themes are not meant to explain all
patterns, but they do provide a place to begin. The universal themes are (1) social conflict; (2) cultural
contradiction (What types of conflicts are occurring between people in social situations?); (3) informal
techniques of social control (Is there information derived from the cultural group that appears contra-
dictory?); (4) management of interpersonal relationships (Are there infor-mal patterns of behavior that
result in social control?); (5) acquisition and maintenance of status (How do group members conduct
their interpersonal relationships?); and (6) problem solving. Researchers then write an overview
summary of the cultural scene to help identify themes they have not yet discovered.

Taking a Cultural Inventory

Completing a cultural inventory is the first stage in writing an ethnography. The inventory provides the
opportunity to organize collected data. A cultural inventory involves listing cultural domains; listing
analyzed domains; collecting sketch maps, which are drawings of places or activities; listing themes;
completing an inventory of examples; identifying organizing domains; completing an index or table of
contents; completing an inventory of miscellaneous data; and suggesting areas for future study
(Spradley, 1980).
Interpreting the Findings
The purpose of an ethnographic study is to describe the culture. It is important to remember that no
two researchers would likely describe a culture in the same way, because of the unique attributes and
values of researchers’ cultures, the period in which the study was conducted, and the information
gathered by the researchers. Perhaps, some researchers would argue, these are reasons why qualitative
methods and, in particular, ethnography can never be viewed as science. On the contrary, these are
precisely the reasons why ethnography and other qualitative methods are science. What most
qualitative methods of research seek to do is share a context-bound view of phenomena; in this case,
the phenomenon is the culture of a group. Because culture is ever-changing and dynamic, the
discoveries of today are applicable within context. These discoveries bring important insights; they do
not pretend to bring forward the truth but, rather, a truth. So, as ethnographers begin to write the
study findings, they must remember that, if they used appropriate rigorous methods to collect and
analyze data, then the product is one view of a truth.

“In the course of the final analysis, comparisons with existing ethnographies and other midrange
theories are made. Existing theories may be sup-ported or refuted and new midrange theories, in
addition to the descriptive and explanatory theory of culture (the ethnography) may be induced”
(Germain, 2001, p. 297). Once researchers have completed the inventory, interpreted the findings, and
compared their work to the literature, they are ready to write the ethnography.

Writing the Ethnography

The purpose of writing an ethnography is to share with people what the re-searcher has learned and to
attempt to make sense out of the cultural patterns that present themselves. To do so, an ethnographer
must ask, For whom am I writing? Based on the answer to this question, the document will look
different. If writing for a scholarly community, details will be important. If writing for the popular press,
insights with exemplars will be most useful. If writing for an organization in the form of a formal report,
the researcher must pay attention to those details that reflect the concerns that directed the inquiry.

One of the best ways to know what to write is to look for examples of what has been written.
Ethnographers may choose to report natural history organized chronologically or spatially, or they may
choose to organize information based on significant themes (Omery, 1988). A review of published texts
that chronicles macro-ethnographies or scholarly journals that have published focused or micro-
ethnographies will provide good examples of how to organize the final ethnographic report. Every detail
or idea may not be collapsible into one journal article or one book. Focusing on aspects of the research
for several books or articles may be the only feasible way to report the findings of an ethnographic
study.

Researchers may write several drafts until the document accurately reflects the culture. They
may recruit researcher colleagues to critique their work. Colleagues can help neophyte researchers
discover whether they have appropriately covered the topic.
ETHICAL CONSIDERATIONS

The protection of study participants is important regardless of the re-search paradigm, whether it is a
qualitative or quantitative approach, phenomenology, grounded theory, ethnography, action, or
historic. Because ethics is covered broadly in Chapter 4, this section shares unique ethical is-sues specific
to ethnography.

When conducting ethnographic research, researchers by virtue of their roles as participant-

observers are in a unique position to fit in. Researchers live among the people and therefore have the
ability to be invisible at times in the researcher capacity. The invisible nature of researchers has
significant value in data collection but can present potential dilemmas from an ethical standpoint. The
important elements in conducting any type of research study are to inform participants fully about the
matter to which they are consenting, inform participants that they can withdraw from the study at any
time for any reason, reduce all unnecessary risks, ensure that the benefits of the study outweigh the
risks, and ensure that the researchers who will be conducting the study have appropriate qualifications
(Lipson, 1994).

Informed consent is an ethical principle that requires researchers to obtain voluntary consent,
including description of the potential risks and benefits of participation. Munhall (1988) recommends
using “process consent” (p. 156) rather than the traditional consent signed in the beginning of most
studies and not revisited unless participants question their obligations related to the study. Process
consent or “consensual decision-making” (Ramos, 1989, p. 61) means that researchers renegotiate the
consent as unforeseen events or consequences arise (Munhall, 1988; Ramos, 1989). By providing the
opportunity to renegotiate the consent and be part of the decision making as the study develops,
ethnographers afford participants the chance to withdraw or modify that to which they initially agreed.

Lipson (1994) suggests that consent in the field becomes somewhat more difficult. For instance,
the researcher secures consent before formal fieldwork begins. Some time passes, and the researcher is
in the field at the time an unexpected event occurs, such as the birth of a child. Although it is important
that the researcher inform the group that he or she is chronicling this event for research purposes, it
would be intrusive to ad-dress consent at that point. One way to handle this situation would be for the
researcher to inform participants at a later time that the birth experience gave him or her insight into
cultural values. If objections are raised, the researcher would be unable to erase the memory of the
event; how-ever, to protect the informants, he or she would not include those data in the study. Covert
participation in all research is regarded as a violation of individuals’ rights. Therefore, ethnographers
should always be forthright with their intentions.

Risk is another major concern. Researchers should never put a participant group in danger for
data collection purposes. For example, the researcher in the field may discover that some young men
are staging a gang fight in which they plan to use weapons. Believing that it would be important to learn
more about conflict and how the group handles it, the researcher plans to go as an observer. In this
situation, the risk to the people involved far outweighs the goal to observe how the group handles
conflict. Intervention is necessary. How the researcher intervenes should be determined by a number of
factors. A research mentor is invaluable in helping the novice researcher sort out when and how to
intervene. Too many variables are involved to offer a simple answer. The important principle is that the
researcher should not engage in data collection to achieve his or her own goals when significant risk to
research participants is involved.

Another principle described by Lipson (1994) is the researcher’s qualifications. Usually,

institutional review boards will assess the researcher’s qualifications based on review of the submitted
research proposal. An un-qualified researcher can do substantial damage to a culture. It is essential that,
even as a neophyte ethnographer, one clearly understands what it is he or she is doing and the potential
risks in conducting a study without adequate sensitivity and knowledge.

Roper and Shapira (2000) also suggest that researchers adopt specific strategies to address
ethical dilemmas. The ones recommended are to

deliberately evaluate their own effects on the research process by consciously identifying biases
brought to the field and also emotional responses resulting from their experiences.
Next, . . . come up with an explicit description of their role during data collection. Finally, . . .
establish mechanisms that guarantee honest and trustworthy research relationships. (p. 114)

Goodwin et al. (2003) also address the inherent problems for re-searchers who conduct
research in a setting in which they have worked or have familiarity. In this case, the authors suggest that
the role of researcher is frequently overlooked. When this occurs, sensitive information may be shared
in the presence of the researcher when viewed as a practitioner rather than in the role of researcher. As
a practitioner, other professionals may consider sensitive information confidential. As a researcher,
however, the level of confidentiality may be compromised. There is no “right” way to handle this
situation. However, Goodwin and colleagues suggest that the researcher has the responsibility to be as
overt as possible in the research role.

It is important that all qualitative researchers—but, in particular, ethnographers—be aware of

and knowledgeable about their responsibilities to research participants. Specifically, because of the
intimate nature of the relationships that develop when ethnographers live among study participants,
these researchers have a duty to inform and protect informants.

SUMMARY

This chapter discussed the ethnographic approach to research and presented issues related to selection
of the method, interpretations of the approach, application of the approach, and interpretation of the
findings. A thorough explanation of how to conduct ethnographic research has been shared to provide a
framework from which to conduct the first ethnographic inquiry.

Ethnography offers a significant research approach to individuals interested in learning about

culture, willing and able to report data in narrative format, comfortable with ambiguity, able to build
trusting relationships, and comfortable working alone (Germain, 1986). The study of culture, whether in
a well-known nursing unit or in a country whose health practices are unknown, offers exciting discovery
opportunities. Nurse researchers who choose to use this approach will find that the focus of the study
will be-come an intimate part of their daily existence until they have fully explored, described, and
interpreted that focus. The nature of the study, the proximity to participants, and the opportunity to
bring forth a view of an undescribed or under-described culture provide a wonderful opportunity for
nurse re-searchers who have the tenacity to listen and observe. It is a great privilege to be allowed an
opportunity to view another’s culture, one that nurses in-terested in ethnography should value.

Chapter 10 provides a review of research that uses the ethnographic approach. It is hoped that
the review will further assist those individuals interested in the approach to understand the method and
will provide concrete criteria from which to judge the merits of published reports.
Ethnography in Practice, Education, and Administration
A s I reviewed the literature for this chapter, I was struck by the limited number of studies that are
classified as ethnography. Pondering the scarcity of studies, I found myself asking—have we become so
results oriented that the study of culture has been limited to mini studies of some aspect of nursing
because of the time it takes to conduct a good ethnography? I hope not because ethnography is an
important way of studying nursing and the cultural practices imbedded within it. The study of patterns
within a culture provides an excellent opportunity to describe the practices of the people for whom
nurses care, to understand the health-related phenomena of people within various cultures, and to
examine nursing’s own unique culture. Ethnography provides a chance to explore both the clinical
aspects of nursing and its administrative and educative patterns and life ways.

This chapter provides an overview of ethnographic studies that have explored cultures of
interest to nursing. In addition, it critiques ethnographic studies that reflect clinical nursing practice,
nursing education, and nursing administration to provide readers with examples of published works and
the contributions these works have made to the field. The ethnographic studies examined in this
chapter have been critiqued using the guidelines in Box 10-1. The critiquing guidelines offer specific
directives for determining the quality of the ethnographic works presented in this chapter and in the
literature.

Box 10-1

Criteria for Critiquing Ethnographic Research

Focus
1. What is the culture being studied?
2. What is the focus or scope of the study?
3. What is the purpose of the study?
Method
1. How does ethnography fulfill the purpose of the study?
2. Is the study conducted in the field?
3. What guidelines have been established for participant consent?
4. How has the researcher protected study participants’ rights?
Sampling
1. Why is the group selected to inform the study appropriate?
2. Does the researcher discuss how key informants are selected and why?
Data Collection
1. What strategies were used to collect data?
2. How do the strategies selected fully inform the study?
3. What was the researcher’s role in the study?
4. How has triangulation of data sources (observation, interview, collection of artifacts) enhanced
credibility of findings?
5. Is time in the field adequate to meet the purpose of the study?
Data Analyses
1. What strategies were used to analyze data? Were they consistent with the method?
2. How is the cyclic nature of data collection or data analyses reported?
3. Based on the report, can another researcher follow the logic of the researcher’s conclusions?
Rigor
1. How has the researcher maintained his or her “objectivity”?
2. How has the researcher documented the authenticity of the data?
3. What role do the informants play in validating the researcher’s findings?
Findings
1. Do the findings make clear a description of the culture studied?
2. In what context are the findings presented?
3. Are findings presented in a rich narrative format providing readers with a “feel” for the culture?
4. Do the findings go beyond the description to explain why particular aspects of the culture are as
they are?
5. Are the findings reported in a systematic way, such as by themes?
Conclusions
1. How do the conclusions relate to the findings of the study?
2. What is the relevance of the findings to nursing, and how can they be used in practice?
3. What future directions for research are offered?

The questions in Box 10-1 are specific to ethnographic research and reflect the most important
aspects researchers must evaluate in an ethnographic report. A reprint of Chuang and Abbey’s (2009)
article found at the end of this chapter assists readers in understanding the critiquing process. Table 10-
1 summarizes a recent series of ethnographic studies rep-resenting the areas of nursing education,
administration, and practice.

APPLICATION TO PRACTICE

“The purpose of classical ethnography is to describe a whole culture” (Grbich, 2007, p. 40). Although
often not addressed as such, the clinical setting by its very existence is a culture of its own. Clinical
practice takes place within a cultural context. Therefore, using ethnographic methods to study the
culture found in professional caring environments is appropriate. Whether the interest is in studying
humor in critical care (Dean & Major, 2008), postoperative pain assessment decisions (Harper, Ersser, &
Gobbi, 2007) or the culture of a Taiwanese nursing home (Chuang & Abbey, 2009), ethnographic
research provides the framework for exploring the richness of nursing and nursing-related phenomena.
Chuang and Abbey is the reference for critique in this section.

You can tell from the title of this study that Chuang and Abbey (2009) focused their research on
Taiwanese nursing homes. The authors state that this is an important study because admission to a
nursing home is very recent in Taiwan. Institutionalizing the elderly runs counter to cultural norms in
this country. The scope of the study is one nursing home located in southern Taiwan which is managed
by a government hospital. As stated by the authors, the purpose is to describe the culture of nursing
home life for older residents in Taiwan. The purpose, focus, and reason for the study are appropriate.
The authors have included enough detail so that the reader knows that there may be differences
between different types of nursing home management.

Although the researchers do not explicitly answer the question, why ethnography, it is clear
from the introduction to the method that they plan to study the culture of the nursing home and so by
inference the reader can be satisfied that the method is appropriate. The report indicates that the
research will be conducted onsite and the informants will be nursing personnel, orderlies, a clerk, and
residents of the facility.

Chuang and Abbey (2009) report that they obtained approval through a human subjects review
board. The authors do not state the method used to obtain informed consent from the residents.
However, in addition to obtaining approval from the university human subjects review board, the
researchers also gained permission from the governing body of the facility and the director of the
department of nursing. Gaining formal consent is important because in addition to fulfilling the
expectations of strong research, it also begins to build rapport with the organizational staff.

Initially, the informants for this study included 1 head nurse; 8 nurses; 18 nursing assistants, including 2
orderlies and a clerk. Chuang and Abbey (2009) do not fully explain why these individuals were included.
As the study progressed, a purposive sample was employed. This sample included 16 residents, 8 nurses,
6 nursing assistants (one private), 1 physician’s assistant, 1 orderly, and 4 family members (p. 1642). It is
unclear why these individuals were selected for the first or second group.

Chuang and Abbey (2009) used interview, participant observation, and examination of
important documents to inform the study. The use of multiple methods of data collection is important.
It adds to the credibility of the findings.

During the eight months of the study, the researchers offer that they con-ducted observations
on different days of the week, including weekends and during all three shifts. Both participant-as-
observer and observer-as-participant strategies were used. In addition, interviews and analyses of
documents were used to gain a richer understanding of the setting. The researchers also reported using
reflexive practices to maintain self awareness and to gain a better understanding of their actions
throughout the data collection phase. The use of multiple methods to collect data, time in the field, and
variability of time of observations are all important components of reaching a rich understanding of the
culture.

Transcripts and field notes were analyzed using NVivo7. NVivo7 is a data analysis program which
organizes data into manageable units of analysis to facilitate understanding of the raw data. The authors
do not offer documentation of the cyclic nature of data collection and data analyses which is so very
important in the implantation of ethnography. The statements referring to two different interview
groups provides some insight into the possibility that, in fact, the cycle of data collection and analyses
did exist since the researchers report that after the initial interviews, a purposive sample was used to
continue the interview.

The report of the findings includes a table which defines the process used to analyze the data. It
also includes a table illustrating the themes and the categories of data that support the themes. These
give the reader an eye into the analysis process. Further, the results section provides informant
statements which helps to support that the findings do emanate from the stories of the informants.
 As stated earlier, time in the field and use of multiple methods of data collection support the
rigor of the research. In addition, Chuang and Abbey (2009) report that the process used for data
analyses—a compare and contrast method, further verified their findings as did the use of a decision
trail and the thick descriptions by informants. Informants’ verification of the findings is not included in
this report.

Chuang and Abbey (2009) report three major themes: collective life, care rituals, and embedded
beliefs. The subcategories under each of these themes tell the story for the informants. Clearly,
statements reflecting living in a public space, mealtime as highlight, everyday is the same, and the
ceiling is my best mate (p. 1643), captures the culture of life in this nursing facility. The researchers offer
examples of similar data reported by other researchers.

The researchers’ conclusions are not overstated. They state clearly that this is the situation in
this Taiwanese nursing home. The contribution that the study makes is that it illustrates from the
informants’ perspectives what it is like to live in this space. The findings have the potential to in-form
nursing practice. Chuang and Abbey (2009) conclude their report by stating, “a change in nursing home
culture would be appropriate to pro-mote a more resident-centered form of care and to enhance the
provision of individualized care” (p. 1647). It is clear that these authors have added to the body of
nursing knowledge focused on care of the elderly, particularly those living in a nursing home. It also
provides valuable insights into changes Taiwanese health care providers are making as the number of
elderly in institutionalized settings grows. The authors’ work provides the groundwork for future studies
in this and related areas.

APPLICATION TO EDUCATION

Nursing education presents another context in which nurse researchers can conduct ethnographic
studies. The teaching and learning environment, including the way students, faculty, health care
providers, and clients relate to one another in clinical settings, creates its own culture. Few published
studies have specifically illustrated the life ways of students and faculty. Since the last publication of this
text, the trend continues. Few ethnographic studies of nursing education were found despite an
extensive electronic literature search. Clearly, ethnographic research has a role in the teaching and
learning process and offers the qualitative education researcher rich opportunities.

The article “Learning How We Learn: An Ethnographic Study in a Neonatal Intensive Care Unit”
(Hunter et al., 2008) serves as the reference for critique in this section. The study does not represent a
traditional academic research focus but does reflect how the concept of education can be studied using
and ethnographic approach.

In the article, Hunter et al. (2008) clearly identifies that the aim of the study is to “identify how
nurse clinicians learn with and from each other in the workplace” (p. 657). The culture being studied is
that of an Australian neonatal intensive care unit (NICU). Why this particular NICU is selected is unclear.
The researchers do make an excellent case for studying NICUs based on the complex subculture which
they believe exists. The focus of this particular study is a 20 bed NICU in Australia.
 The researchers do not explain why they selected ethnography to achieve their aim. However,
they do report spending 12 months onsite conducting interviews and observations on all three shifts.
Participation by informants was voluntary. Ethics committees at both the university and hospital
reviewed and approved of the study. In addition, Hunter et al. (2008) used two different consent forms,
one for participation and the other for recording. In situations when engagement in the site is for a long
period of time, researchers would be best served to use process consent. Process consent allows
individuals to reassess their willingness to continue in the study at some point after their initial
agreement.

The participants in this study were 32 nurse clinicians, 14 medical registrars, 5 allied health
workers, a nurse educator, a clinical nurse consultant, a nurse manager, 5 senior medical specialist, and
one administrative worker (Hunter et al., 2008, p. 659). Hunter et al. report that 57% of those working
on the unit participated. One could assume from this that appropriate individuals participated. The
report would be stronger if the researchers discussed who the key informants were and how they were
selected.

In-depth interviews and observations were the strategies used to conduct the study. The
researchers do not make reference to how the two methods supported the credibility of the findings.
Data analyses were conducted using ETHNOGRAPH 5. Qualitative data analysis packages such as this one
help to organize, retrieve, and identify key themes. There is no description in this report of how rigor
was assured. Generally, ethnographers use time spent within the culture and cross checking of data to
assure that the findings are credible.

The researchers offer four major “dimensions.” These include: Orientation of nurses or “learning
to do things the way we do things here,” orientation of medical registrars (The term medical registrar in
Australia refers to medical practice), through nurses’ eyes, preceptoring—moving up the ladder, and
decision-making. These four dimensions speak to what is required to be learned in order to be an
effective nursing clinician. The descriptions offered by Hunter et al. (2008) provide informant’s words to
illustrate the dimensions identified. The reader can easily see the relationship between the subjective
comments included and the dimensions identified.

“This study offers insight into bedside clinical teaching, which is advantageous because it is
reality-based” (Hunter et al.,2008, p. 663). According to the authors, using ethnography gives
researchers and clinicians the opportunity to look closely at the interactive context in which learning
occurs in the NICU. Looking carefully at learning within the context of the NICU provides a framework
for future planning of unit level education. The researchers do not overstate their findings. Significant
page space is taken up in this article to tell the story . This should not be viewed as a limitation of the
report, but rather as the focus of an ethnographic study. Researchers engaged in this approach focus
heavily on the story telling when the number of pages is controlled by the publication guidelines. Hunter
et al. (2008) provide the reader with the opportunity to view how ethnography can be used to guide the
learning process.
APPLICATION TO ADMINISTRATION

In previous editions of this text, it was challenging to find research articles which focused exclusively on
nursing administration. It is indeed true again. However, what has become apparent is many of the
articles you will find in Table 10-1 focus on practice issues but are not exclusively practice. For a
example, a report by Clabo (2008) focuses on pain assessment in two postoperative units. Although the
focus is on a particular practice issue, clearly the implications of the research are in the area of nursing
administration. For this reason, you will find that several of the articles in the table are identified as both
practice and administration.

It is important to point out that it is not unusual for researchers who publish ethnography in a
research journal to focus on only one facet of a larger study. Because of the significant amount of
information generated in a long-term cultural study, many ethnographies are published as books. When
researchers choose to publish their ethnographic work in a journal, the scope of the report must meet
the page guidelines of the selected journal. Sorensen, Iedema, and Severinsson (2008) research on
nursing leader-ship in contemporary health care is a report of one part of a larger 3-year study of an
intensive care unit. This study entitled “Beyond Profession: Nursing Leadership in Contemporary
Healthcare is critiqued to demonstrate the application of ethnography in nursing administration. Table
10-1 offers additional examples of ethnographic research studies.

Sorensen et al. (2008) share that the current report is part of a larger 3-year study which has
been conducted in an intensive care unit in Australia. This publication is one part of the study which
focuses on nursing leadership within the unit. It is reported that the 3-year study focused on this topic as
well as end of life care. There is no explanation as to why ethnography is the method of choice. The
researchers share that nursing leadership became symbolic of many of the concepts that emerged
during the study.

The research does take place in the field which is characteristic of ethnography. There is no
report on how human subjects were protected or how in-formed consent was obtained. Given that this
study is part of a larger study, the reader might find documentation of informed consent in the report of
the larger study. This is not meant to suggest that the reader is required to deter-mine whether this is
the case. Each sub-account of a larger investigation should be treated as though it is an independent
research report.

Focus groups and interviews were conducted over a period of three years with nurses in the
study. Based on the report, these were successful strategies for data collection. Also important is the
amount of time, the researchers spent in the field. Using more than one data collections strategy and
time in the field are two important ways to assure the credibility of the findings. The data generated
from the focus groups and interviews were analyzed using the constant comparative method. This is an
appropriate method of analysis for ethnographic studies.

There is no explicit description of rigor, however, as noted above, time in the field and
triangulation of data collection strategies are two ways to exploit the findings. Similar to the study
reported in the Education Section of this chapter, the authors utilize the pages of the report to tell the
story of nursing leadership in this ICU. The three major units of analysis emerged. These included:
nursing care at the end of life, barriers to enacting nursing’s professional role, and opportunities for
nursing leadership in the organization. These subunits were illustrated by informants’ descriptions of
what it is like to lead and manage in an intensive care unit, specifically as it relates to end of life care.
The final themes which emerged included: (1) nursing care at the end of life; (2) barriers to enacting
nursing’s professional role and (3) opportunities for nursing leadership in the organization.

Sorensen et al. (2008) place their findings in the context of what is already known about end-of-
life care—specifically nursing leadership. The conclusions offered in the research article are relevant and
do not overstate the findings. The implications are clear. Nurses have an important role to play in
organizational strategy and patient advocacy. Ultimately, Sorensen and colleagues believe that nurses
need to be equal partners in healthcare.

SUMMARY

This chapter reviewed samples of published ethnographic research in the areas of nursing practice,
education, and administration. Each critique presents the strengths and limitations of the ethnographic
research included. The reviewed authors have contributed to the literature and provided readers with
an opportunity to become part of the culture or subculture they studied.

Ethnographic research and the studies that use ethnography as a method add to the richness
and diversity of the human experience by allowing readers to share in the lives of the people studied. As
nurse researchers become more comfortable with multiple ways of knowing and multiple realities, they
will benefit by participating in the creation and dissemination of the knowledge imbedded in the cultural
realities that are a person’s life.