The Underpinnings of Qualitative Research Exploring the Philosophical, Paradigmatic, Conceptual-Theoretical Underpinnings of Qualitative Research A Focus on a Phenomenological Study in Intensive Care Unit Brigitte S. Cypress, EdD, RN, CCRN Qualitative research has become more accepted as a legitimate mode of inquiry in the social and behavioral sciences for many years but not without controversy and confusion even now in the 21st century. The procedures for conducting a qualitative research study evolve from a philosophical, paradigmatic, and interpretive frameworks. These are the aspects of a naturalistic inquiry where inconsistency is evident related to its complexity. The purpose of this article is to describe qualitative methods focusing on these aspects that included phenomenology to set the stage for discussion and using a phenomenological study as an exemplar to further illustrate the process. Keywords: Paradigm, Phenomenology, Philosophical underpinnings, Qualitative research [DIMENS CRIT CARE NURS. 2017;36(3):208/216] Qualitative research has made a strong impression on meaning is socially constructed by individuals in inter- nursing science since the 1990s. This burgeoning interest action with their world. Qualitative research offers the in qualitative research methods from early times is not opportunity to focus on finding answers to questions without confusion, controversy, and experience of a centered on social experience, how it is created, and lack of or inconsistency of protocols or structure.1 From how it gives meaning to human life.2 The world or the 1990s and now, there is still some work to be con- reality is dynamic and not a fixed, single, or measurable ducted in the refinement and establishment of consis- phenomenon. There are multiple constructions, inter- tency of research methods and guidelines. The key to pretations, and contexts of reality that are active, and it understanding qualitative research lies with the idea that also changes in time.3 Recognizing this fact is the first 208 Dimensions of Critical Care Nursing Vol. 36 / No. 3 DOI: 10.1097/DCC.0000000000000240 Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved. The Underpinnings of Qualitative Research step in establishing a truly humanistic perspective of researcher’s pre-given understandings than by rules and qualitative research. guidelines detailing ‘proper’ methodological procedures There are issues that arise from the application of for epistemological development. Methods are not di- qualitative methods for examining nursing phenomena.1,4 rected to an end (an answer) but constantly self-renew as The first question is, ‘‘Should the research methods used questioning continues.’’ in other disciplines including assumptions, paradigms, In qualitative research, inquirers make assumptions. and goals be used in nursing without modification?’’ According to Creswell7(p16) (2007), these philosophical There are also questions that relate to the methods assumptions consist of a stance toward the nature of themselves. Are these methods simply techniques for data reality (ontology), how the researchers know and what collection and analysisVor if they must be used within they know (epistemology), the role of values in the re- the context of their discipline’s theoretical assumptions search (axiology), the language of research (rhetoric), and and perspectives?1(p15) Conceptual confusion is also the methods used in the process (methodology). Philosoph- almost always present extending beyond the methods ical assumptions and the questions to ask are presented in themselves. For example, phenomenology may be used to Table 1. Qualitative researchers take a philosophical stance refer to a philosophical stance or a research method or on each of these assumptions when they decide to undertake equivalent to qualitative research in general. Another a naturalistic inquiry. After the researcher makes the choice, area of concern is the use of qualitative methods to test the study is further shaped by paradigms or worldviews that theory. Morse1(pp16-17) (1991) stated, ‘‘The strength of qualitative researchers bring to the research study. A par- qualitative methods is in the process of induction; the adigm or worldview is a basic set of beliefs that guide data ‘emerge’ to provide a theory, not the reverse. Qual- action.7 Because a paradigm"s fundamental assumptions itative data cannot be categorized to fit into a frame- about the world determine what questions may (and may work.’’ From these methodological concerns arising from not) be asked, methodological choices only make sense in the 1990s, questions still arise now in the 21st century. the context of a paradigm.8 Paradigms used by qualitative The questions that Morse1(p17) (1991) asked are still researchers vary with the set of beliefs they bring to re- applicable to this day: (1) Should qualitative methods be search. It is important in a research design to make explicit rigorously prescriptive, as are quantitative methods, or what paradigm a researcher will work on. Using an es- loosely described to give investigators the freedom to de- tablished paradigm allows one to build on a coherent and velop their own style? (2) If the qualitative methods that well-developed approach to research.9(p36) Some examples originated from other disciplines must be adapted to nurs- of this worldviews are postpositivism, social constructiv- ing, who is responsible for this process of modification, ism, advocacy/participatory, and pragmatism and they are and is this a matter of trial and error? presented in Table 2.7 All are beyond the scope of this The purpose of this article is to describe qualitative article. The focus of this article is on social constructivism methods, specifically the philosophical assumptions and because it is evident in phenomenological studies. stance, paradigms, and the conceptual-theoretical aspect Social constructivism is often combined with inter- including the deductive-inductive perspectives of a natu- pretivism. The goal of the research is to describe and ralistic inquiry with the focus on phenomenology using a understand the subjective meanings that individuals attach phenomenological study as an exemplar. to the world in which they live and work and are nego- A qualitative study begins with posing a broad re- tiated socially and historically. This worldview manifests search question focusing on a phenomenon of which little in phenomenological studies, in which individuals describe is known.5 The process of designing a qualitative study their lived experiences of a phenomenon. A description of begins not with the methodsVwhich is actually the eas- iest part of the researchVbut rather the broad assump- tion central to the inquiry. After a research question to be TABLE 1 Philosophical Assumptions and answered has been identified, researchers need a thor- Questions to Ask ough understanding of the philosophic assumptions that Assumptions Questions are the foundation of the method. Almost always, novice Ontological What is the nature of reality? researchers develop and conduct research studies begin- ning with the methods without having a solid under- Epistemological What is the relationship between the researcher standing of the philosophic underpinnings or the broad and that being searched? assumptions central to the qualitative inquiry. This lack Axiological What is the role of values? of understanding has the potential to sloppy science, Rhetorical What is the language of research? resulting in misunderstood findings. Ironside6(pxvi) (2005) Methodological What is the process of research? stated, ‘‘The nature of inquiry is determined more by May/June 2017 209 Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved. The Underpinnings of Qualitative Research TABLE 2 Paradigms or Worldviews Assumptions Postpositivism Social Constructivism Advocacy/Participatory Pragmatism Ontology Critical realism: real ‘‘reality’’ Relativism (constructed realities); ‘‘Voice’’ of participants heard Not committed to any 1 system or but only imperfectly and interpretivism throughout the research philosophy; external world probabilistically apprehendable process independent of the mind; belief of not asking questions about reality and laws of nature; world is not an absolute unity Epistemology Modified dualist objectivist; Transactional/subjectivist; Alternative view; contain an Truth is what works at the time; not reductionistic; critical subjective meanings are action agenda for reform based on dualism between reality tradition/community negotiated socially and that may change the lives independent of the mind or findings probably true historically; focus is on specific of participants, researchers, within the mind contexts of people; addresses and institutions the processes of interaction among individuals; understanding of the world; created findings; researchers inductively develop a theory or pattern of meaning Methodology Modified experimental/manipulative; Hermeneutic/dialectical Participatory action is Researchers are ‘‘free’’ and have the critical multiplism; chiefly recursive/dialectical; freedom of choice on methods quantitative methods; falsification emancipatory; practical; and procedures of research; the of hypothesis; emphasis on collaborative ‘‘what’’ and ‘‘how’’ to research empirical data collection; are based on its intended cause-and-effect oriented; consequencesVwhere they want deterministic based on previous to go with it, rather than the theories; may include antecedent