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ARTICLE 10.1177/1049732305283998
In this article, the authors provide an account of Carspeckens (1996) five-stage approach to doing critical ethnography, or what he has termed critical qualitative research (CQR). They provide the reader with an overview of the concepts presented in Carspeckens book Critical Ethnography in Educational Research and describe how they applied several of his ideas within a research project that explored renal nurses decision making using a critical ethnographic approach. They briefly describe the five stages of CQR and incorporate within the article an example of how they applied the stages. They propose this approach as a useful method for nursing and other health-related research. Keywords: critical ethnography; Carspeckens critical ethnography; critical qualitative research; methods; decision making ritical ethnography is fast becoming a recognized way of researching issues of importance to nursing. This approach, guided by the principles of critical theory, aims to link social phenomena to wider sociohistorical events to expose prevailing systems of domination, hidden assumptions, ideologies, and discourses, so that social situations such as nursing can be redefined. Lodh (1996) explained that critical theory was introduced as a philosophical position with the central tenet of freeing or emancipating people by actively addressing patterns of power and domination. The critically positioned researcher purposefully adopts an action agenda with the purpose of empowering people and transforming political and social realities (Creswell, 2003). Carspecken (1996) has considered critical ethnography to be a form of social activism and has called a researcher who uses the approach a criticalist (p. 3). He prefers the term critical qualitative research (CQR) over critical ethnography, as he believes that the ethnographic approach should not take precedence over other qualitative approaches (Georgiou & Carspecken, 2002). In this article, we introduce the reader to the five-stage CQR approach developed by
AUTHORS NOTE: This project was made possible by a Queensland Nursing Council Scholarship and School of Nursing Scholarship (James Cook University) and by the participation of the nurses and medical staff in the renal unit.
QUALITATIVE HEALTH RESEARCH, Vol. 16 No. 1, January 2006 151-161 DOI: 10.1177/1049732305283998 2006 Sage Publications
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Carspecken and demonstrate its usefulness to nursing by outlining its application to a study about renal nurses decision making (Hardcastle, 2004).
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TABLE 1: Stage 1
Carspeckens Five Stages of Critical Qualitative Research Description Data Collection Analysis Cultural reconstruction (etic)
2 3
Building a primary etic record: Fieldwork: nonparticipant What is going on? observer, monological, unobtrusive, reflection Researcher interpretation, etic Preliminary reconstructive perspective analysis Dialogical (emic) data genera- Fieldwork: participant tion, collaborative stage observer, interactive, interviews, reflection Describes systems relations to Conducting systems analysis broader context between locales/sites/cultures (discovery) Explains relational systems Links findings to existing macro-level theories (explanation)
and normative expectations of how things should be done (Georgiou, Carspecken, & Willems, 1996). Carspecken also adopted Herbert Meads idea of self-consciousness and its relationship to how we internalize cultural and social expectations during interaction. He explained that even if we observe something alone, we still make use of communicative structures as we symbolize the object in a way that can be communicated to others. For example, everyone perceives objects in different ways yet shares this perception through established language patterns, resulting in an assumed mutual understanding. As a result, Carspecken emphasized the importance of how body language is interpreted in research (Kincheloe & McLaren, 2003) and how truth claims are consistent for a group of people, thus leading to his call for shared understandings (pp. 19-20). It is the consent given by a group that validates shared understandings or truths, yet truth claims are always fallible, because future cultures might find reasons to discard the truths of today (p. 84). To construct a methodological approach that incorporates the basic tenets of critical theory, Carspecken (1996) developed a five-stage model for doing CQR. The first three stages of the framework use critical analytic models to reconstruct cultural structures and themes, whereas the last two stages are designed to discover how routine social actions form and reproduce system relations that coordinate activities across various reaches of space and time (Georgiou & Carspecken, 2002, p. 690). However, Carspecken (1996) warned that even though the method is presented as a five-stage approach, it should be interpreted as comprising loosely cyclical stages, or even portions of the stages, depending on the aim of the research. As a result, the researcher will often move from one stage to another and back again. The five stages are presented in Table 1.
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and maintained during social action (Giddens, 1984). The five-stage approach developed by Carspecken (1996) was considered an appropriate framework for the study of renal nurses decision making (Hardcastle, 2004), because it advocates for simultaneous data collection and analysis, identifies cultural structures and themes, and helps to reveal the culturally pragmatic material from which actors mutually construct their worlds (Georgiou & Carspecken, 2002). Critical qualitative research (CQR) involves the use of hermeneutic-reconstructive techniques of dialogue and reflexivity to reconstruct culture and provide meaning about social action with the intent of exposing personal, cultural, and political aspects of nurses decision making. The adopted ethnographic methods in this study were used to illuminate the decision-making culture that raised questions particularly about social organization, cultural rules and regulations (Fetterman, 1998, p. 1). We selected participants purposefully because of what we thought they knew, prompting reflexivity through interview techniques that made the researcher-participant dialogue rarely naturalistic (Carspecken, 1996, p. 154).
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TABLE 2:
Potential Issues for Preliminary Research Plan Information That Needs to Be Collected to Address These Interests Social routines and rituals in the unit Aims and goals of the unit Knowledge and surveillance of outcomes Rules, written and unwritten Relationships, communication, and power networks The culture of decision making Sociopolitical, economic, and historical aspects of nurses decision making in Australia Factors that enable and constrain decision processes Professional practice and scope of practice Personal and shared understanding Allocation and application of resources Subjective experiences of the nurses Individual versus group dynamics
Potential Interests to Be Investigated Who makes the decisions in the unit? What sort of decisions are made? How are decisions implemented and evaluated? What forces are behind decision-making procedures? What influence does interrelationships have in decision-making? What relationships exist between the unit and hospital locales? How do broader social structures and institutions influence decision making? What factors constrain and enable decision making? What decisions do nurses identify as nurse decisions? What role does trust play in decision making? How does economics influence decision making? How is autonomy perceived in nurses decision making? How do personal and group values, beliefs, and norms influence decision making?
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encourages participants to engage actively in the research project. The nurses automatically engaged in dialogue, asking questions of the researcher, and, as a result, became actively involved in the outcome of the project. The primary method of data collection applied in the research project involved field notes, journaling, and researcher reflections, in which focused and dense records of daily routines, rituals, and social interaction were constructed in keeping with Carspeckens (1996) approach. Several decision-making locales were included, as the nurses made decisions extending from the renal unit context to include the meeting rooms, intensive care unit, and wards. Carspecken defined locales as patterned activities taking place in areas surrounding a social site (p. 38) (e.g., the renal unit). We assumed that contrasting and comparing how decisions were made in various locales would provide a greater depth of understanding in relation to the nurses decision making. Mutual understanding of how to go about daily practice were observed in terms of how practice could enable and constrain decision making. The nurses drew from implicit, practical know-how structures during decision-making encounters, another reason why the participants in CQR must be studied from the third-person outsider position (Georgiou & Carspecken, 2002, p. 694), as people are rarely conscious of them during interaction. Routinized actions are not usually deliberately produced and maintained; rather, these are unacknowledged and unintended consequences of action (Carspecken, 1996; Giddens, 1984). Deviations from predictable actions and routines were also noted, as these might generate new meanings, albeit in subtle ways.
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We compared the initial etic data collected in Stage 1 to the nurse responses during discussions and interviews in Stage 3, illuminating practical understandings through discursive means where explanations could be provided. This takes conditions of action constructed by people at nondiscursive levels to one of awareness and reconstructs them linguistically (Carspecken, 1996, p. 42). Once spoken about, practice has the potential to be changed. Stage 3 was conducted over several months, ranging from 1 to 6 hours per day depending on daily routines, the nurses rostered shifts, time availability, and appropriateness. At the same time, we revisited Stages 1 and 2 in light of new understandings generated through discussions. The interviews were, at times, structured to facilitate cross-checking of findings, observations, and documentation review. At other times, they were open and flexible to encourage the nurses to describe their own experiences. Reviewing the medical records also helped with substantiating, negating, or providing information when cross-checking, although, at times, the documentation was incomplete, which limited the process. We critically examined the data in terms of the context and positioning of each nurse, including the researcher, to address credibility criteria. Carspecken (1996) adopted Guba and Lincolns (1985) validation criteria for assessing rigor and establishing trustworthiness in a qualitative inquirycredibility, transferability, dependability, and confirmabilitybut used them differently and gave them a slightly different rationale. Credibility, for example, can be achieved via triangulation. Triangulation is the expansion of research methods that are applied to study the same phenomenon (e.g., decision making) to provide diverse, rich data (Dootson, 1995; Kushner & Morrow, 2003; Lackey & Gates, 1997; Maggs-Rapport, 2000; Roberts & Taylor, 1998). Carspecken (1996), however, implemented triangulation via the use of multiple recording devices and bodily senses during data collection. The example he gave is I usually take notes with a tape recorder running and, when possible, have another observer take notes with me so that our two records may be compared (p. 88). In this study, we asked many nurses about decision making, at different times and in different contexts, checking what was said at one time with what was said at another, and what was said was checked against what was done (Maloney, 1996, p. 79, emphasis in original). This process required our reasoning to go back and forth, as we linked findings with participants responses, constantly checking and rechecking the information, and in this way creating a solid foundation on which to build rather than making cognitive leaps (Morse et al., 2002, para. 25). Other rigor techniques included variable data collection times, prolonged engagement in the field, peer debriefing by colleagues, and member checks, whereby the field notes were shared with participants. This researcher-participant relationship enabled engagement to be taken beyond a clinical partnership to one of great depth and meaning that facilitated researcher integrity and sincerity (Fontana & Frey, 1998).
Member Checking
Member checking is advocated as an important way to validate data (Carspecken & Apple, 1992). Carspecken (1996) referred to Stage 3 of his approach as an elaborate member check (p. 89), wherein researcher notes are returned to the corresponding participants for further discussion and feedback. Carspecken also recommended
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that participants be brought together for a group discussion from time to time as a method of further revealing dialogical data. In the decision-making study, Hardcastle (2004) casually presented ideas and findings that were emerging from the data at opportune times, for instance, at the nurses station or meeting room, with the purpose of encouraging nurses to make comment in less formal way. This stimulated spontaneous responses from whoever happened to be present and so provided a quick and effective way of evaluating field notes and promoted dialogue between the nurses. When disagreements arose, these were noted for further analysis. In contrast, we assumed agreement to give credibility to the interpretations and considered it to represent a shared understanding of reality. However, the researcher remained aware that this does not necessarily mean the view was correct, merely that is was the accepted view of the group.
Reflexivity
Burns and Grove (2001) stressed how qualitative researchers must be flexible not only in their research design but also in how they view the world. This implies that they must also be ready to change their perspectives as new aspects of the world are unveiled. Therefore, the researcher needs to be open to new ideas. As a result, critical research has an emancipatory intent not only for the researched but also for the researcher (Carspecken, 1996; Street, 1992). Carspecken thus recommended Giddenss (1984) notion of reflexivity as essential to the research process; that is, the chronic monitoring of ones actions and thoughts (internalized actions), which is an inherent feature of human life. Self-reflection assists in the maintenance of critical theory principles, as its purpose is to expose the researchers personal constructions of the world, their values, beliefs, strengths, and weaknesses that mold the research journey and the choices made (Mulhall, Le-May, & Alexander, 1999). Furthermore, a reflexive account increases the plausibility or rigor of ethnographic research (Pellatt, 2003, p. 29). Garson (2003) shared several critical ethnographic assumptions, and these were adopted as reflexive questions throughout the study to assist with conscious reflexivity:
Do I assume to understand the decision-making culture? Are these cultural understandings from a shared or individual perspective? Are group interests being overestimated at the cost of individual interests?
We believed that these questions helped us to maintain consistency throughout the research study.
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tem (patterned relations across time and space) is established, yet human action is separated in time and space, unlike social integration, in which interaction is faceto-face (Carspecken, 1996). Consequently, Stages 4 and 5 involve the adoption of a more objective analytical style and a level of theorizing: The last two stages of a research project are meant to focus entirely on objectively ascertainable behavioral routines locked into system relations (Georgiou, Carspecken, et al., 1996, p. 320). The economy and health organization are examples of system integration. The aim in Stage 4 was to discover system relations between renal nurses decision making and the institution of nursing within the Australian context, linking the social site of the renal unit and locales to other similar sites and locales within the health care system, including political and economic factors. In Stage 5, we attempt to explain the findings by linking them to sociological theory that critically addresses the reproductive circuits of society (Georgiou & Carspecken, 2002, p. 694). Why people act the same over and over again is of interest to CQR, as class structures, gender relations, and asymmetric relations (e.g., doctor-nurse) are all produced by people yet often escape peoples awareness. Consequently, what nurses say they do and what they do are habitually quite different. Carspecken (1996) recommended that key participants within the research project play a role in analysis during Stages 4 and 5. How achievable this is depends on the nature of the study, time availability to conduct participatory analysis, and the participants understanding of the phenomenon of study. In this study, group work was not a viable option because of time constraints and work structures. However, opportunities arose when the researcher was able to discuss issues and findings at a more abstract theoretical level with individual nurses.
CONCLUSION
We found Carspeckens (1996) five-stage approach to CQR to be a particularly useful way to study renal nurses decision making (Hardcastle, 2004). The approach was logical, and the examples provided in Carspeckens book assisted with data collection, organization, and analysis. It also helped the researcher to remain focused on the importance of seeking explanation for social behavior (e.g., nurses decision making) in a holistic way (Georgiou, Carspecken, et al., 1996) by comparing what was observed with what was said, and then comparing what was said with meanings generated during the researcher-participant encounter. This approach further facilitated validation and trustworthiness throughout the research process. The five-stage approach assisted the researcher by providing levels of inquiry and is particularly useful for novice researchers. The first three stages (cultural reconstruction) were used to construct a comprehensive understanding about the renal nurses decision-making practices. The aim in Stage 1 is collecting data from an etic, or outsider, perspective in relation to the social, cultural, and historical context, whereas Stage 2 involves the analysis of these relationships to expose the underlying assumptions that structure meaningful actions. In Stage 3, the dialogical stage, the researcher involves the participants during reconstructive analysis to gain an insiders, or emic, perspective and is guided by Habermass (1981) theory of communicative action. Stages 4 and 5 introduce the researcher to a more theoretical level. In Stage 4, the researcher links the findings from the local
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cultural site to other similar institutions and knowledge in an attempt to discover what these relations might be, whereas at Stage 5, he or she explains these discoveries in broader social theory terms. Carspeckens (1996) CQR five-stage approach is recommended for any interpretative research study, as the framework incorporates the initial stages of research design through to writing and disseminating of the findings. The five-stage CQR provides a comprehensive understanding of how to do research in the field that is easy to follow and flexible enough to be modified to reflect the needs and/or aims of a project. Although the title of the book, Critical Ethnography, is somewhat misleading, the five-stage approach proposed by Carspecken provides a comprehensive guide to CQR that can be used across a variety of disciplines.
NOTE
1. This and subsequent references refer to Hardcastle (2004).
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Mary-Ann Hardcastle, R.N., B.A., Dip.Ed., M.P.H.T.M., Ph.D., is a staff educator for Townsville Health District Services and also holds an adjunct lecturer appointment with the School of Nursing Sciences, James Cook University, Australia. Kim Usher, R.N., R.P.N., D.N.E., D.H.S., B.A., M.Nurs.S., Ph.D., is an associate professor and Head of the School of Nursing Sciences at James Cook University, Australia. Colin Holmes, R.M.H.N., B.A.(Hons.), T.Cert., M.Phil., Ph.D., is an adjunct professor in the School of Nursing Sciences at James Cook University, Australia.