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approach was key to uncovering participants meanings of participants who had experienced body image disruptions
the complex and dynamic process of integrating hearing loss such as significant weight change; amputation or paralysis of
into their lives. body parts; and scars from burns, surgery, or trauma. Partici-
pants were interviewed at 3, 6, 12, and 18 months after the
Ethnography physical alteration. The constant comparative method of
The goal of ethnography is to learn about a culture from the concurrent data collection and analysis was used to develop
people who actually live in that culture.10 A culture can be a 3 phase theory of the process of reimaging: (a) body image
defined not only as an ethnic population but also as a society, disruption, (b) wishing for restoration, and (c) reimaging the
a community, an organisation, a spatial location, or a social self. Nurses can use this vital understanding of the phases of
world.11 Ethnography has its roots in cultural anthropology, reimaging to assist clients through the process by anticipat-
which aims to describe the values, beliefs, and practices of ing potential needs or problems, providing information and
cultural groups.10 The process of ethnography is character- support, and exploring alternative problem solving
ised by intensive, ongoing, face to face involvement with par- strategies. The grounded theory approach was ideally suited
ticipants of the culture being studied and by participating in to discovering the social-psychological process of reimaging.
their settings and social worlds during a period of fieldwork.
The essential data collection methods of participant observa-
tion and indepth interviewing permit the researcher to learn Conclusion
about the meanings that informants attach to their The examples of nursing research studies using 3 different
knowledge, behaviours, and activities.12 The context (social, approaches exemplify the value of qualitative research in
political, and economic) of the culture assumes an important answering important nursing questions. The studies also
part of an ethnographic study, unlike a phenomenological provide rich illustration of the differences and similarities
study. between the disparate approaches that are captured by the
An ethnographic approach was used to answer the term qualitative research. The approaches differed in the
research question what is it like to be a young urban type of research question asked, the philosophical underpin-
African-American who has at least one AIDS-afflicted family nings, the methods used, and to some extent, the final prod-
member?13 (See Evidence-Based Nursing, 1998 October, p130.) uct. All studies, however, resulted in important new
Stories of 6 young people are described in the article. There information about the phenomena studied. This new
was an extensive 4 year period of in depth fieldwork that information facilitates a deeper understanding of partici-
included telephone and in person interviews and participant pants experiences by nurse readers andas long as nurses
observation. The stories powerfully illustrated how the remain aware of the theoretical rather than empirical basis
culture in which the youths had to survive was so alienating for generalising from the qualitative findingshas the poten-
that they deliberately sought exposure to HIV. The findings tial for influencing nursing practice in similar situations.
provide an important understanding for nurses working with JENNY PLOEG, RN, MScN
adolescents in either preventive or acute care roles. The eth- School of Nursing, Faculty of Health Sciences,
nographic approach was uniquely suited to bring attention McMaster University,
to the important influence of the context of marginalisation, Hamilton, Ontario, Canada
insensitive social policies, and demanding caretaking respon-
sibilities, on the lives of these youths. 1 Marshall C, Rossman GB. Designing qualitative research. Second edition.
Thousand Oaks, California: Sage Publications, 1995.
2 Munhall PL, Boyd CO. Nursing research: a qualitative perspective. Second edi-
Grounded theory tion. New York: National League for Nursing Press, 1993.
3 Miles MB, Huberman AM. Qualitative data analysis. Second edition. Thou-
The purpose of a grounded theory approach to qualitative sand Oaks, California: Sage Publications, 1994.
research is to discover social-psychological processes.14 4 Morse JM. Designing funded qualitative research. In: Denzin NK, Lincoln
YS, editors. Qualitative research. Thousand Oaks, California: Sage Publica-
Grounded theory was developed by Glaser and Strauss in the tions, 1994:22035.
5 Morse JM, Field PA. Qualitative research methods for health professionals. Sec-
1960s and is founded philosophically on symbolic ond edition. Thousand Oaks, California: Sage Publications, 1995.
interactionism.15 Distinct features of grounded theory in- 6 Tesch R. Qualitative research: analysis types and software tools. New York:
Falmer, 1990.
clude theoretical sampling and the constant comparative 7 Streubert HJ, Carpenter DR. Qualitative research in nursing: advancing the
method. Theoretical sampling refers to sampling decisions humanistic imperative. Philadelphia: Lippincott, 1995.
8 Van Manen M. Researching lived experience: human science for an action sensi-
made throughout the entire research process in which tive pedagogy. London: Althouse Press, 1990.
participants are selected based on their knowledge of the 9 Herth K. Integrating hearing loss into ones life. Qual Health Res
1998;8:20723.
topic and based on emerging study findings. In data analysis, 10 Spradley JP. The ethnographic interview. New York: Harcourt Brace
Jovanovich College Publishers, 1979.
the researcher constantly compares incidents, categories, and 11 Hammersley M. Whats wrong with ethnography? Methodological explorations.
constructs to determine similarities and differences and to New York: Routledge, 1992.
12 Germain CP. Ethnography: the method. In: Munhall PL, Boyd CO, editors.
develop a theory that accounts for behavioural variation. Nursing research: a qualitative perspective. Second edition. New York:
Both observation and interviewing are commonly used for National League for Nurses Press, 1993:23768.
13 Tourigny SC. Some new dying trick: African American youths choosing
data collection. HIV/AIDS. Qual Health Res 1998;8:14967.
Grounded theory was used to answer the research 14 Strauss A, Corbin J. Basics of qualitative research: grounded theory procedures
and techniques. Newbury Park, California: Sage Publications, 1990.
question what is the process of reimaging after an alteration in 15 Chenitz WC, Swanson JM. From practice to grounded theory: qualitative
body appearance or function?16 (See Evidence-Based Nursing, research in nursing. Menlo Park, California: Addison-Wesley, 1986.
16 Norris J, Kunes-Connell M, Spelic SS. A grounded theory of reimaging.
1998 October, p133.) The theoretical sample consisted of 28 Adv Nurs Sci 1998;20:112.
These include:
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Notes