Nurse Researcher
Nurses’ experiences of ethnographic fieldwork Cite this article as: Pereira de Melo L, Sevilha Stofel N, Gualda D, Antunes de Campos E (2014) Nurses’ experiences of ethnographic fieldwork. Nurse Researcher. 22, 1, 14-19. Date of submission: April 10 2013. Date of acceptance: July 29 2013. Correspondence [email protected] Lucas Pereira de Melo RN, MN, PhD is a professor of public health at the Multicampi School of Medical Sciences, Federal University of Rio Grande do Norte, Brazil Natália Sevilha Stofel RN, MPH is a researcher at the Federal University of Pelotas, Brazil
Abstract Aim To reflect on the experiences of nurses performing ethnographic fieldwork in three studies. Background The application of ethnography to nursing research requires discussion about nurses’ experiences of ethnographic fieldwork. This article examines some of the dilemmas that arise during the research process.
Dulce Maria Rosa Gualda LM, MN, PhD is a professor of maternal and children’s health at the School of Nursing
Data sources Three ethnographic studies conducted by the authors in the south and southeast of Brazil. Excerpts from field diaries created during each research are presented at the end of each topic discussed.
Edemilson Antunes de Campos BA, MA, PhD is a professor of medical anthropology at the School of Arts, Sciences and Humanities
Review methods This is a reflexive paper that explores the nurses’ experience in ethnographic fieldwork.
Both at the University of São Paulo, Brazil Peer review This article has been subject to double-blind review and has been checked using antiplagiarism software Author guidelines rcnpublishing.com/r/ nr-author-guidelines
Discussion This article discusses the main tasks involved in ethnographic research, including defining the study aim, reading and understanding anthropological theoretical bases, and setting a timeframe for the study. The article also discusses THE STUDY of phenomena associated with care services demands an interdisciplinary approach to ensure that their social and cultural contexts are understood (Dougherty and Tripp-Reimer 1985, Mulhall 1996, Leininger 2001). Ethnography, which is the descriptive study of the culture of a community or social group, is often the methodological framework chosen for these studies. In nursing research, ethnography is regarded primarily as a methodological framework for participant observation and interviews, rather than as a theoretical framework as it is in anthropology. Ethnographic studies of nursing usually cover technique instead of theories (Gualda and Hoga 1997, Roper and Shapira 2000, Elsen and Monticelli 2003, Henderson 2005).
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the idiosyncrasies of the cultural contexts studied, the bureaucracy that may be confronted when gaining access to the field, the difficulty of transforming the familiar into the strange, why ethnocentric perspectives should be avoided, and the anthropological doubt that places the ethnographer in the position of apprentice. It also discusses the importance of listening to others, reflexivity and strategies to stay in the field. Conclusions For researchers, ethnographic fieldwork can be a rite of passage, but one that provides invaluable experiences that emphasise the value of relationships based on dialogue, reflexivity and negotiation. Implications for practice/research The main tasks undertaken in ethnographic research discussed in this article could contribute to the nurse’ experience of conducting ethnographic fieldwork. Keywords Ethnography, nursing research, research personnel, nursing, methodological issues Nurse researchers’ experiences of fieldwork and the adoption of participant-observation techniques are discussed in other articles (Marcon and Elsen 2000, Schwartz and Elsen 2003, Allan 2006), while nurses’ experiences of performing ethnographic fieldwork are covered by Pellatt (2003) and Simmons (2007). This paper focuses on the practical and existential dilemmas that arise during the preparation of a research project, gaining access or staying in the field, dealing with theoretical queries, and researchers’ moods and emotions. These dilemmas tend to be especially acute for researchers in professions such as nursing (Heras González 2004). The article refers to three ethnographic studies conducted by the authors in the south and south east of Brazil. Excerpts from field diaries made during these © RCN PUBLISHING / NURSE RESEARCHER
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Ethnography studies are presented at the end of each topic to illustrate how the authors reflected on theory. The three studies are described briefly below. Study one: structural and symbolic dimensions of a hospital space The aim of this study was to interpret the structural and symbolic dimensions of a dining room used by staff working in a surgical ward in the University Hospital of Campinas, in São Paulo. The fieldwork was conducted in the surgical ward from March to September 2008. Forty-five members of the patient care team took part in the research, which involved combinations of participant observations, interviews, completion of questionnaires and photography of the site. Study two: ethnography and the management of type 2 diabetes in health education This was an examination of strategies to manage type 2 diabetes in five health-education groups in a primary healthcare service in south east Brazil. Fieldwork was conducted between August 2011 and September 2012. Research techniques included participant observation, individual interviews, and a group discussion with patients and professionals. Study three: child care among the Guarani Mbya The aim of this study was to interpret the cultural beliefs that guide care practices for Guarani Mbya’s children. The fieldwork was conducted between January 2012 and January 2013 in the indigenous village Tekoá Porã in south Brazil. Research techniques included participant observation, interviewing and photography.
Ethnography As a field of research in the anthropological tradition, ethnography is not only a methodology, but also a theoretical framework and philosophical paradigm (Hammersley 1998, Tedlock 2000). The characteristics of ethnography are that it: ■■ Is guided by the notion of culture. ■■ Takes place in local settings, such as institutions, communities and groups. ■■ Is conducted over long periods of time. ■■ Involves a variety of research techniques. ■■ Involves observations of participants and often requires intense face-to-face contact. ■■ Produces holistic descriptions and interpretations of phenomena that can be contextualised at individual, or micro-social, and communal, or macro-social, levels. From an operational viewpoint, ethnography involves a continuous attempt to participate in encounters and events, and to understand contexts and © RCN PUBLISHING / NURSE RESEARCHER
phenomena that are significant to the community being studied. It combines fieldwork, and a variety of designs and methods of research, to produce stories, descriptions, interpretations and representations of life in historical, political and biographical contexts. Ethnographers openly or discreetly participate in people’s everyday lives over periods of time. They observe what happens, listen to what is said, ask questions and collect data to illustrate the topic being studied (Hammersley and Atkinson 2009). Ethnographers try initially to discover the insider, or ‘emic’, perspective on contexts and phenomena that are significant to a community so that they can learn about its emic categories of health and care practice. In becoming part of the communities they study, researchers are influenced by their experiences and relationships in the field, and so ethnography can be described as reflexive (Roper and Shapira 2000). Thus, explanations in ethnographic studies are based on the researchers’ insights informed by a theoretical framework (2002). Since the 1980s, the application of ethnography has been extended to other human sciences and areas for research, such as nursing (Tedlock 2000, O’Reilly 2005). In Brazil, this move is due to a growing politicisation of the topics studied by anthropologists and a growing respect for anthropology among social science professionals (Durham 2004). As a result, nursing research literature has grown considerably. The broader application of ethnography is also driven by researchers’ demand for theoretical and methodological material about health care as they seek to describe people’s experiences of illness (Lenardt et al 2011). In nursing, such studies can explain aspects of health, illness and care in different situations, and of cultural contexts and processes in health services (Henderson 2005). In ethnographic nursing research, it is important to value participants’ points of view and take into account the social conditions in which care is given. Ethnographic nursing studies can generate data about holistic approaches to care and so can help to improve the quality of nursing practice and services (Dougherty and Tripp-Reimer 1985, Holden and Littlewood 1991, Leininger 2001). Most ethnographic studies in Brazil involve participant observations and interviews, but are not informed by a theoretical framework (Diniz 1997, Knauth 2010). Such studies are often regarded as examples mini-or even micro-ethnography because they tend to focus on small communities (Roper and Shapira 2000). The use of these terms does not imply that the studies, including the authors’ case studies, are of lower quality than those of larger communities, nor that they were predefined or controlled. September 2014 | Volume 22 | Number 1 15
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Nurse Researcher According to LeCompte and Schensul (1999), decisions about what to investigate depend on: ■■ Specific problems, populations, processes, projects or topics the researchers want to explore. ■■ The interests and commitments of anyone involved in formulating research questions. ■■ The tasks in which researchers engage at their workplaces. ■■ Funding initiatives. ■■ Scholarly or personal commitments.
Fieldwork Ethnography takes place in social situations, each of which has three elements: place, actors and activities (Spradley 1980). Each, any or all of these elements can be the ethnographer’s field of study (Schensul et al 1999). Historically, anthropological studies concerned societies remote from the researchers’, but today anthropologists study phenomena and topics in familiar, often urban societies. The field can be a hospital, school playground or street corner, as well as a peasant or rural community (O’Reilly 2005). Decisions about research questions and the fields to be investigated require an understanding of the anthropological theoretical framework, which functions as a prism through which observed reality is understood. This process is crucial in the development of the ‘ethnographic gaze’, which is a gaze sensitised by theory (Cardoso de Oliveira 2006). From this perspective, ethnography is not merely a data-collection technique but a way of seeing, learning and interpreting reality (Knauth 2010). It is not defined by the activities, techniques or processes conducted in the field, but by the type of intellectual effort that they represent. Ethnography involves making ‘thick descriptions’, which are descriptions of the fields being studied that take into consideration their symbolic meanings, and so allow researchers to perceive, interpret and make sense of everyday events, actions and behaviours (Geertz 1973). The cultural contexts in which nurses conduct ethnographic studies, such as healthcare centres, can present difficulties and opportunities, depending on their bureaucratic structure. For example, the researcher in study two said: ‘On August 2 of 2011, I made my first contact with the field. I arrived at the healthcare centre at around 10 am, as previously agreed with the co-ordinator by telephone. The receptionist informed me that she was in a meeting so I sat on a bench in front of the reception for about 20 minutes. The personnel at the reception were looking at me with an air of suspicion. Suddenly, the co-ordinator arrived. The beginning of the conversation took place right there: standing 16 September 2014 | Volume 22 | Number 1
in the hallway in front of the reception desk. After introducing myself and explaining details about the project, she finally invited me to go to her office. Later, I was shown around the health centre and scheduled my return for the following week, when the blue team would accompany me.’ Ethnography can also be challenging because of the length of time it takes. Depending on the phenomena being investigated, a single ethnographic study should be performed over at least six months (O’Reilly 2005). However, ethnography is generally conducted in graduate programmes with tight deadlines, which limits the time available for fieldwork and prevents researchers from developing the theoretical maturity they need to analyse data. The questions that guide ethnographic studies are crucial. The euphoria felt by researchers who make discoveries or have insights in the field is not explored in academic publications, yet it recurs in fieldwork like notes in a blues song (Pellatt 2003, Heras González 2004). Researchers’ joys, sorrows and fears should be communicated and documented, along with the affection they feel towards natives, the difficulties they experience in the field and their struggles to leave it after their research is completed. Fieldwork involves countless dilemmas and problems, but its human side – the ‘anthropological blues’ – must be confronted (Da Matta 1987). Nurse ethnographers studying healthcare services should be careful not to judge them by the standards of their own, or assume that the protocols and guidelines that have informed their practice are applicable to the objects of their studies. By avoiding such ethnocentric assumptions, ethnographers can deepen their relationships with, and learn more about, the objects of their studies. Some nurses may find ethnography challenging because it involves the study of individuals, each with a variety of unique experiences, in an interconnected social context, not simply the study of patients in a healthcare system. Ethnographic studies conducted in familiar contexts, such as studies by nurses of hospitals, are different from those in which researchers are ‘strangers’ with no knowledge of local routines and codes. In both cases, emotional detachment is necessary and nurses conducting research into healthcare systems must not allow their own experiences affect their analyses of data. When researchers conduct ethnographic studies in their own fields, several important questions are raised (Moss 1996), including: ■■ Does the ethnographer’s role in the field compromise the study and, if it does, how? ■■ How does the role of the ethnographer affect established relationships in the field? © RCN PUBLISHING / NURSE RESEARCHER
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Ethnography ■■ How does the ethnographer’s role affect the way actors perceive the researcher and how the researcher perceives them? ■■ Are the ethnographer’s conclusions about what specific behaviours mean and how these meanings are established in the community based on the ethnographer’s previous knowledge or on the data collected? ■■ Would an outsider attach more significance to observed patterns of behaviour than the insider? ■■ What issues can an insider face when writing an ethnograph? Ethnography involves full immersion in a society to understand, not only its external manifestations, but also the meanings that individuals in the society attribute to them (Laplantine 1993). Ethnographers in the field interact with people, and participate in their daily practices, and should act and feel like them even though they are not members of their groups. This immersion in the lives of others is followed by a period of detachment (Peacock 2001). In this context, Magnani (2002) proposes that ethnographers should regard themselves as ‘near and inside’, or primarily as nurses working with colleagues inside their communities, rather than ‘out and away’, or primarily as observers. Ethnographers who adopt the near and inside approach in studies of cities would regard the inhabitants as a network of actors dependent on each other and on the local infrastructure. They would reject the notion that people in a city are simply individuals ‘alone in a crowd’ (Magnani 2002). Fieldwork implies a double task: transforming the exotic into the familiar, and transforming the familiar into the exotic (Da Matta 1987). For ethnographers, the first of these transformations involves becoming familiar with what was once considered foreign and bizarre, while the second involves distancing themselves from the beliefs and values of their own societies. However, familiarity is often misunderstood. A situation may have occurred during birth, in an operating room, in a primary health care centre or a nursing home, but although it might have been studied in school or ‘seen’ during work, the nurse needs to be acquainted with the social situation. Thus, nurses performing ethnographic fieldwork cannot claim to be truly familiar with a given healthcare situation because each is dependant on context and the individuals concerned, and so is unique. In anthropology, familiarity is something that can be transformed and transcended until the fieldwork’s perspective emerges (Da Matta 1987). Empirical studies of nursing have little theoretical depth (Melo et al 2013). Ethnographers tend to © RCN PUBLISHING / NURSE RESEARCHER
regard them as superficial because they present researchers’ observations and interpretations, but not those of the people being studied (Moss 1996, Heras González 2004). Usually the data collected do not present anything new and can even help to reinforce stereotypes (Melo et al 2013). For example, in study two the authors said: ‘It took me a few weeks to finally detach myself from the group in order to put forward social and health education. At the beginning of the fieldwork, I felt this intense desire to intervene, to change the way things were being done, and to teach other professionals what I understood of health education. And I would covertly estimate and judge their practices.’ Before classifying phenomena, doubt must be cast on the data and ethnographers must relearn what they think they know. According to Spradley (1980), understanding social phenomena from other people’s points of view involves regression into a ‘childlike state’ so that researchers become ‘apprentices’ to the people’s experiences and perspectives. In study one, for example, the authors said: ‘Although I had introduced myself as a nurse, I would frequently be treated as a last-year undergraduate intern. So, I received from other nurses extensive explanations about nursing procedures, routines and ethics. In these situations I would always behave like an apprentice, and in fact I was one.’
Dialogue One of most important tasks for ethnographers is forming a dialogue, or shared semantic space, with natives to better understand their customs, beliefs and actions (Moss 1996, Spradley 1980, O’Reilly 2005). This should be an exchange of ideas between equals, without either discourse being ‘contaminated’ by the other. Such dialogue is methodologically superior to the researcher‑informant relationship, in which the latter gives the former information but is not expected to interpret it (Cardoso de Oliveira 2006). Partners in dialogue should experience empathy for each other. Pellatt (2003) said that listening to patients during her fieldwork gave her feelings of joy and frustration that she had not had in 18 years as a nurse in a spinal trauma unit. Nurse-ethnographers may also become involved emotionally involvement with patients, families and other members of a healthcare team. When researchers acknowledge that they are part of the social world they are studying they are being reflexive (Ersser 1996). Reflexivity is important because the tasks that ethnographers must carry September 2014 | Volume 22 | Number 1 17
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Nurse Researcher out, such as observation, enquiry, listening and recording, require them to be immersed in the subjects’ social world (Peacock 2001, Hammersley and Atkinson 2009, Nawrath 2010). Thus, ethnographers must be able to practise reflexivity and be aware of their roles as researchers, especially when dealing with experiences that seem commonplace. They must participate and commit themselves to the social world being studied. Ethnographers should be reflective observers who record and rationalise evidence, and redirect research and design strategies, while always being aware of their subjectivity, the situations they are experiencing and what is going on around them. They are subjects who investigate (Nawrath 2010). For Pellatt (2003), reflexivity in ethnographic fieldwork drives nurses to question their practice, values and identity as nurses. In this form of research, meanings are understood through a constant process of negotiation between researcher and informant, and adapted to different research opportunities. This process can lead to a shared viewpoint or consensus known as intersubjectivity. Ethnography is a radical methodology because it involves the researchers experiencing the lives of others. Fieldwork is self-transforming for the researcher and can be a rite of passage (Peacock 2001). For example, in study one the authors said: ‘As time went by, and relations got deeper, it was impossible not to get involved in the research field and its social actors. Entering and staying in the kitchen [were] no longer strange and unfamiliar [activities]. This transformation led me to some important discoveries. Though conducting research, [one informant became] a friend, sometimes a counsellor, a child, a nurse, someone who stimulates people’s potential. [Another] informant once said that, because I was around so often, I should be entitled to vacation and salary.’
In study two, the authors said: ‘In addition to the academic debates, my experience as a nursing professional who acts in public health was the basis for my informal and lonely reflections about the relational character of rituals in Brazil.’ In study three, they said: ‘A few months after the phone call to the cacique, I was the only Juruá, or non-indigenous person, present in the village. [I stayed] in a comfortable tent thinking: “What am I doing here?” The first two days are for adaptation, both from my part and the villagers, who were initially puzzled by my desire to live in the village.’ Ethnographic research can also be full of errors. Sometimes, attempts to understand behaviours or contexts are unsuccessful because crucial information is not taken into account or unexpected adverse events occur (Laplantine 1993). According to Cardoso (2004), researchers’ education prepares them to plan every phase of their work, but does not explain the mechanisms through which discoveries are made, nor prepare researchers to examine their own moods and misfortunes. Moreover, ethnographic fieldwork cannot be taught in the same way other disciplines are taught (Peacock 2001). Its results depend on the researchers’ biographies, the aims of their studies, the theoretical approach they adopt and the relationships they establish in the field. In study two the authors said: ‘In the meetings the therapeutic and cultural logics within the groups of diabetics [became clear]. It was satisfying and reassuring to perceive them while I was working, although there was some resistance and struggle. This meant that my theoretical object existed. Now, the complex task of unravelling its contours was up to me. The challenge and curiosity that structure the anthropological question was set: I needed to interact, participate, listen to and learn about my object of study.’
References Allan HT (2006) Using participant observation to immerse oneself in the field: the relevance and importance of ethnography for illuminating the role of emotions in nursing practice. Journal of Research in Nursing. 11, 5, 397-407. Cardoso RC (2004) Aventuras de antropólogos em campo ou como escapar das armadilhas do método. In Cardoso R (Ed) A Aventura Antropológica: Teoria e Pesquisa. Paz e Terra, Rio de Janeiro. Cardoso de Oliveira R (2006) O Trabalho do Antropólogo. Third edition. Editora da Unesp, São Paulo. Da Matta R (1987) Relativizando: Uma Introdução à Antropologia Social. Rocco, Rio de Janeiro.
Diniz D (1997) O que é isso que chamamos antropologia da saúde no Brasil? Revista Brasiliense de Pós-graduação em Ciências Sociais. 1, 1, 213-234.
Ersser SJ (1996) Ethnography in clinical situations: an ethical appraisal. In de Raeve L (Ed) Nursing Research: An Ethical and Legal Appraisal. Baillière Tindall, London.
Henderson A (2005) The value of integrating interpretive research approaches in the exposition of health care context. Journal of Advanced Nursing. 52, 5, 554-560.
Dougherty M, Tripp-Reimer T (1985) The interface of nursing and anthropology. Annual Review of Anthropology. 14, 219-41.
Geertz C (1973) The Interpretation of Cultures. Basic Books, New York NY.
Heras González P (2004) De enfermera a antropóloga: la experiencia de una transformación. In Téllez Infantes A (Ed) Experiencias Etnográficas. Editorial Club Universitario, San Vicente.
Durham ER (2004) A pesquisa antropológica com populações urbanas: problemas e perspectivas. In Cardoso R (Ed) A Aventura Antropológica: Teoria e Pesquisa. Paz e Terra, Rio de Janeiro. Elsen I, Monticelli M (2003) On the track of ethnography: reflections on nursing knowledge. Revista Brasileira de Enfermagem. 56, 2, 193-197.
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Gualda DM, Hoga LA (1997) Ethnographic research into the nursing. Revista da Escola de Enfermagem da USP. 31, 3, 410-422. Hammersley M (1998) Reading Ethnographic Research. Second edition. Addison Wesley Longman, New York NY. Hammersley M, Atkinson P (2009) Etnografía: Métodos de Investigación. Second edition. Paidós, Barcelona.
Holden P, Littlewood J (1991) Anthropology and Nursing. Routledge, London. Knauth D (2010) A etnografia na saúde coletiva: desafios e perspectivas. In Schuch P, Vieira MS, Peters R et al (Eds) Experiências, Dilemas e Desafios do Fazer Etnográfico Contemporâneo. Editora da UFRGS, Porto Alegre.
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Ethnography In study three: ‘When I arrived at the village, I was homesick. During my first visit I got sick and, because of that, I went back home. After I got better, I went back to the village. This time the adults started to get closer and trust me due to my everyday relationship with the children. After that, I started to share the meals in one of the villager’s houses.’ A strategy is needed to guarantee permanence in the field. Nurse-ethnographers may find that their participation in specific social situations is hindered by protocols, routines or professional hierarchies. In these circumstances, they can form friendships with people who can facilitate negotiations, and secure access and permission for activities (Spradley 1980, LeCompte and Schensul 1999). Nurse-ethnographers may find that, due to their nursing education, they are more easily accepted into health teams (Marcon and Elsen 2000, Pellatt 2003, Heras González 2004, Simmons 2007), but they may need to rethink the limits of their participation and their status as researchers. They may find that one moment they are nurses, the next researchers, and sometimes both at once. Ethnographers who are nurses but who enter the field exclusively as researchers may be perceived as investigators into irregularities (Marcon and Elsen 2000, Pellatt 2003, Heras González 2004, Simmons 2007). This may help or hinder their access to social situations and information. In study one the authors said: ‘Today, I was saved by computerised tomography (CT). One of the patients had a complex clinical condition and needed CT. The doctor and the nurse had to accompany him to the nuclear medicine service and I volunteered to go with them. When we were by the elevator the nurse changed one of the infusion pumps and asked me to hold the empty container. Seizing the moment I said playfully: “I cannot do any procedure, but I can hold an empty purse?” I loved the
Laplantine F (1993) Clefs Pour L’Anthropologie. Seghers, Paris. LeCompte MD, Schensul JJ (1999) Designing and Conducting Ethnographic Research. Rowman and Littlefield, New York NY. Leininger M (2001) Current issues in using anthropology in nursing education and services. Western Journal of Nursing Research. 23, 8, 795-806. Lenardt M, Michel T, Melo L (2011) The nursing ethnographic research into complex societies. Colombia Médica. 42, 2, Supplement 1, 70-77. Magnani JG (2002) Insider and a close-up view: notes on urban ethnography. Revista Brasileira de Ciências Sociais. 17, 49, 11-29.
situation and it was clear that I wanted to help her. We proceeded to the examination and our good relationship was restored.’ In study two the authors said: ‘In my first contact I offered to measure users’ blood pressure. Thereafter, my role in the meetings was to measure blood pressure. This was a strategy for insertion [of researchers] in the field, since it helped professionals in carrying out the activities and therefore optimised the time and the speed at which the activities were conducted. Additionally, my new task allowed me to have direct contact with everyone.’ Study three: ‘Being communicative and bold has helped me considerably. I gradually approached my neighbours in the village, and we would often prepare and have breakfast together every morning. They also taught me how to make baskets. In the course of time I understood the village pace and managed to adapt to it. I became more confident to walk around freely. I would sit with the women, and weave baskets and bracelets with them. I would also babysit for them. In the evening, we would drink tea on the balcony and play with the kids.’
Conclusion Ethnographic fieldwork is a complex and demanding task, and nurse researchers who intend to conduct ethnographic studies should be fully prepared. As well as ensuring their studies have clear aims and timeframes, and are based on sound anthropological theory, they must be prepared to join the communities they intend to study. This involves putting themselves in the position of apprentice to the experiences and perspectives of individuals in these communities so that they can form relationships based on dialogue, reflexivity and negotiation. By doing so, nurse researchers will find ethnographic fieldwork a highly rewarding and transformative experience.
Online archive For related information, visit our online archive and search using the keywords Conflict of interest None declared
Marcon S, Elsen I (2000) Estudo qualitativo utilizando observação participante: análise de uma experiência. Acta Scientiarum. 22, 2, 637-647.
Nawrath M (2010) The Ethnographic Method: The Origin and Basis of a Multitechnical Approach. tinyurl.com/qdp74bk (Last accessed: July 22 2014.)
Schensul SL, Schensul JJ, LeCompte MD (1999) Essential Ethnographic Methods: Observations, Interviews, and Questionnaires. Rowman and Littlefield, New York NY.
Melo L, Gualda D, Campos E (2013) As pesquisas antropológicas nos programas de pós‑graduação em enfermagem do Brasil. In Melo LP, Gualda DM, Campos EA (Eds) Enfermagem: Antropologia e Saúde. Manole, Barueri.
O’Reilly K (2005) Ethnographic Methods. First edition. Routledge, Abingdon.
Schwartz E, Elsen I (2003) Observação participante: uma metodologia para conhecer o viver, o adoecer e o cuidar das famílias rurais. Família: Saúde e Desenvolvimento. 5, 1, 19-27.
Moss BJ (1996) Ethnography and composition: studying language at home. In Wiley M, Gleason B, Wetherbee Phelps L (Eds) Composition in Four Keys: Inquiring into the Field. Mayfield, Mountain View CA. Mulhall A (1996) Anthropology, nursing and midwifery: a natural alliance? International Journal of Nursing Studies. 33, 6, 629-637.
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Peacock JL (2001) The Anthropological Lens: Harsh Light, Soft Focus. Second edition. Cambridge University Press, Cambridge. Pellatt G (2003) Ethnography and reflexivity: emotions and feelings in fieldwork. Nurse Researcher. 10, 3, 28-37. Roper J, Shapira J (2000) Ethnography in Nursing Research. Sage, Thousand Oaks CA.
Simmons M (2007) Insider ethnography: tinker, tailor, researcher or spy? Nurse Researcher. 14, 4, 7-17. Spradley JP (1980) Participant Observation. Wadsworth, Orlando FL. Tedlock B (2000) Ethnography and ethnographic representation. In Denzin NK, Lincoln YS (Eds) Handbook of Qualitative Research. Second edition. Sage, Thousand Oaks CA.
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Nurses’ experiences of ethnographic fieldwork Cite this article as: Pereira de Melo L, Sevilha Stofel N, Gualda D, Antunes de Campos E (2014) Nurses’ experiences of ethnographic fieldwork. Nurse Researcher. 22, 1, 14-19. Date of submission: April 10 2013. Date of acceptance: July 29 2013. Correspondence [email protected] Lucas Pereira de Melo RN, MN, PhD is a professor of public health at the Multicampi School of Medical Sciences, Federal University of Rio Grande do Norte, Brazil Natália Sevilha Stofel RN, MPH is a researcher at the Federal University of Pelotas, Brazil
Abstract Aim To reflect on the experiences of nurses performing ethnographic fieldwork in three studies. Background The application of ethnography to nursing research requires discussion about nurses’ experiences of ethnographic fieldwork. This article examines some of the dilemmas that arise during the research process.
Dulce Maria Rosa Gualda LM, MN, PhD is a professor of maternal and children’s health at the School of Nursing
Data sources Three ethnographic studies conducted by the authors in the south and southeast of Brazil. Excerpts from field diaries created during each research are presented at the end of each topic discussed.
Edemilson Antunes de Campos BA, MA, PhD is a professor of medical anthropology at the School of Arts, Sciences and Humanities
Review methods This is a reflexive paper that explores the nurses’ experience in ethnographic fieldwork.
Both at the University of São Paulo, Brazil Peer review This article has been subject to double-blind review and has been checked using antiplagiarism software Author guidelines rcnpublishing.com/r/ nr-author-guidelines
Discussion This article discusses the main tasks involved in ethnographic research, including defining the study aim, reading and understanding anthropological theoretical bases, and setting a timeframe for the study. The article also discusses THE STUDY of phenomena associated with care services demands an interdisciplinary approach to ensure that their social and cultural contexts are understood (Dougherty and Tripp-Reimer 1985, Mulhall 1996, Leininger 2001). Ethnography, which is the descriptive study of the culture of a community or social group, is often the methodological framework chosen for these studies. In nursing research, ethnography is regarded primarily as a methodological framework for participant observation and interviews, rather than as a theoretical framework as it is in anthropology. Ethnographic studies of nursing usually cover technique instead of theories (Gualda and Hoga 1997, Roper and Shapira 2000, Elsen and Monticelli 2003, Henderson 2005).
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the idiosyncrasies of the cultural contexts studied, the bureaucracy that may be confronted when gaining access to the field, the difficulty of transforming the familiar into the strange, why ethnocentric perspectives should be avoided, and the anthropological doubt that places the ethnographer in the position of apprentice. It also discusses the importance of listening to others, reflexivity and strategies to stay in the field. Conclusions For researchers, ethnographic fieldwork can be a rite of passage, but one that provides invaluable experiences that emphasise the value of relationships based on dialogue, reflexivity and negotiation. Implications for practice/research The main tasks undertaken in ethnographic research discussed in this article could contribute to the nurse’ experience of conducting ethnographic fieldwork. Keywords Ethnography, nursing research, research personnel, nursing, methodological issues Nurse researchers’ experiences of fieldwork and the adoption of participant-observation techniques are discussed in other articles (Marcon and Elsen 2000, Schwartz and Elsen 2003, Allan 2006), while nurses’ experiences of performing ethnographic fieldwork are covered by Pellatt (2003) and Simmons (2007). This paper focuses on the practical and existential dilemmas that arise during the preparation of a research project, gaining access or staying in the field, dealing with theoretical queries, and researchers’ moods and emotions. These dilemmas tend to be especially acute for researchers in professions such as nursing (Heras González 2004). The article refers to three ethnographic studies conducted by the authors in the south and south east of Brazil. Excerpts from field diaries made during these © RCN PUBLISHING / NURSE RESEARCHER
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Ethnography studies are presented at the end of each topic to illustrate how the authors reflected on theory. The three studies are described briefly below. Study one: structural and symbolic dimensions of a hospital space The aim of this study was to interpret the structural and symbolic dimensions of a dining room used by staff working in a surgical ward in the University Hospital of Campinas, in São Paulo. The fieldwork was conducted in the surgical ward from March to September 2008. Forty-five members of the patient care team took part in the research, which involved combinations of participant observations, interviews, completion of questionnaires and photography of the site. Study two: ethnography and the management of type 2 diabetes in health education This was an examination of strategies to manage type 2 diabetes in five health-education groups in a primary healthcare service in south east Brazil. Fieldwork was conducted between August 2011 and September 2012. Research techniques included participant observation, individual interviews, and a group discussion with patients and professionals. Study three: child care among the Guarani Mbya The aim of this study was to interpret the cultural beliefs that guide care practices for Guarani Mbya’s children. The fieldwork was conducted between January 2012 and January 2013 in the indigenous village Tekoá Porã in south Brazil. Research techniques included participant observation, interviewing and photography.
Ethnography As a field of research in the anthropological tradition, ethnography is not only a methodology, but also a theoretical framework and philosophical paradigm (Hammersley 1998, Tedlock 2000). The characteristics of ethnography are that it: ■■ Is guided by the notion of culture. ■■ Takes place in local settings, such as institutions, communities and groups. ■■ Is conducted over long periods of time. ■■ Involves a variety of research techniques. ■■ Involves observations of participants and often requires intense face-to-face contact. ■■ Produces holistic descriptions and interpretations of phenomena that can be contextualised at individual, or micro-social, and communal, or macro-social, levels. From an operational viewpoint, ethnography involves a continuous attempt to participate in encounters and events, and to understand contexts and © RCN PUBLISHING / NURSE RESEARCHER
phenomena that are significant to the community being studied. It combines fieldwork, and a variety of designs and methods of research, to produce stories, descriptions, interpretations and representations of life in historical, political and biographical contexts. Ethnographers openly or discreetly participate in people’s everyday lives over periods of time. They observe what happens, listen to what is said, ask questions and collect data to illustrate the topic being studied (Hammersley and Atkinson 2009). Ethnographers try initially to discover the insider, or ‘emic’, perspective on contexts and phenomena that are significant to a community so that they can learn about its emic categories of health and care practice. In becoming part of the communities they study, researchers are influenced by their experiences and relationships in the field, and so ethnography can be described as reflexive (Roper and Shapira 2000). Thus, explanations in ethnographic studies are based on the researchers’ insights informed by a theoretical framework (2002). Since the 1980s, the application of ethnography has been extended to other human sciences and areas for research, such as nursing (Tedlock 2000, O’Reilly 2005). In Brazil, this move is due to a growing politicisation of the topics studied by anthropologists and a growing respect for anthropology among social science professionals (Durham 2004). As a result, nursing research literature has grown considerably. The broader application of ethnography is also driven by researchers’ demand for theoretical and methodological material about health care as they seek to describe people’s experiences of illness (Lenardt et al 2011). In nursing, such studies can explain aspects of health, illness and care in different situations, and of cultural contexts and processes in health services (Henderson 2005). In ethnographic nursing research, it is important to value participants’ points of view and take into account the social conditions in which care is given. Ethnographic nursing studies can generate data about holistic approaches to care and so can help to improve the quality of nursing practice and services (Dougherty and Tripp-Reimer 1985, Holden and Littlewood 1991, Leininger 2001). Most ethnographic studies in Brazil involve participant observations and interviews, but are not informed by a theoretical framework (Diniz 1997, Knauth 2010). Such studies are often regarded as examples mini-or even micro-ethnography because they tend to focus on small communities (Roper and Shapira 2000). The use of these terms does not imply that the studies, including the authors’ case studies, are of lower quality than those of larger communities, nor that they were predefined or controlled. September 2014 | Volume 22 | Number 1 15
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Nurse Researcher According to LeCompte and Schensul (1999), decisions about what to investigate depend on: ■■ Specific problems, populations, processes, projects or topics the researchers want to explore. ■■ The interests and commitments of anyone involved in formulating research questions. ■■ The tasks in which researchers engage at their workplaces. ■■ Funding initiatives. ■■ Scholarly or personal commitments.
Fieldwork Ethnography takes place in social situations, each of which has three elements: place, actors and activities (Spradley 1980). Each, any or all of these elements can be the ethnographer’s field of study (Schensul et al 1999). Historically, anthropological studies concerned societies remote from the researchers’, but today anthropologists study phenomena and topics in familiar, often urban societies. The field can be a hospital, school playground or street corner, as well as a peasant or rural community (O’Reilly 2005). Decisions about research questions and the fields to be investigated require an understanding of the anthropological theoretical framework, which functions as a prism through which observed reality is understood. This process is crucial in the development of the ‘ethnographic gaze’, which is a gaze sensitised by theory (Cardoso de Oliveira 2006). From this perspective, ethnography is not merely a data-collection technique but a way of seeing, learning and interpreting reality (Knauth 2010). It is not defined by the activities, techniques or processes conducted in the field, but by the type of intellectual effort that they represent. Ethnography involves making ‘thick descriptions’, which are descriptions of the fields being studied that take into consideration their symbolic meanings, and so allow researchers to perceive, interpret and make sense of everyday events, actions and behaviours (Geertz 1973). The cultural contexts in which nurses conduct ethnographic studies, such as healthcare centres, can present difficulties and opportunities, depending on their bureaucratic structure. For example, the researcher in study two said: ‘On August 2 of 2011, I made my first contact with the field. I arrived at the healthcare centre at around 10 am, as previously agreed with the co-ordinator by telephone. The receptionist informed me that she was in a meeting so I sat on a bench in front of the reception for about 20 minutes. The personnel at the reception were looking at me with an air of suspicion. Suddenly, the co-ordinator arrived. The beginning of the conversation took place right there: standing 16 September 2014 | Volume 22 | Number 1
in the hallway in front of the reception desk. After introducing myself and explaining details about the project, she finally invited me to go to her office. Later, I was shown around the health centre and scheduled my return for the following week, when the blue team would accompany me.’ Ethnography can also be challenging because of the length of time it takes. Depending on the phenomena being investigated, a single ethnographic study should be performed over at least six months (O’Reilly 2005). However, ethnography is generally conducted in graduate programmes with tight deadlines, which limits the time available for fieldwork and prevents researchers from developing the theoretical maturity they need to analyse data. The questions that guide ethnographic studies are crucial. The euphoria felt by researchers who make discoveries or have insights in the field is not explored in academic publications, yet it recurs in fieldwork like notes in a blues song (Pellatt 2003, Heras González 2004). Researchers’ joys, sorrows and fears should be communicated and documented, along with the affection they feel towards natives, the difficulties they experience in the field and their struggles to leave it after their research is completed. Fieldwork involves countless dilemmas and problems, but its human side – the ‘anthropological blues’ – must be confronted (Da Matta 1987). Nurse ethnographers studying healthcare services should be careful not to judge them by the standards of their own, or assume that the protocols and guidelines that have informed their practice are applicable to the objects of their studies. By avoiding such ethnocentric assumptions, ethnographers can deepen their relationships with, and learn more about, the objects of their studies. Some nurses may find ethnography challenging because it involves the study of individuals, each with a variety of unique experiences, in an interconnected social context, not simply the study of patients in a healthcare system. Ethnographic studies conducted in familiar contexts, such as studies by nurses of hospitals, are different from those in which researchers are ‘strangers’ with no knowledge of local routines and codes. In both cases, emotional detachment is necessary and nurses conducting research into healthcare systems must not allow their own experiences affect their analyses of data. When researchers conduct ethnographic studies in their own fields, several important questions are raised (Moss 1996), including: ■■ Does the ethnographer’s role in the field compromise the study and, if it does, how? ■■ How does the role of the ethnographer affect established relationships in the field? © RCN PUBLISHING / NURSE RESEARCHER
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Ethnography ■■ How does the ethnographer’s role affect the way actors perceive the researcher and how the researcher perceives them? ■■ Are the ethnographer’s conclusions about what specific behaviours mean and how these meanings are established in the community based on the ethnographer’s previous knowledge or on the data collected? ■■ Would an outsider attach more significance to observed patterns of behaviour than the insider? ■■ What issues can an insider face when writing an ethnograph? Ethnography involves full immersion in a society to understand, not only its external manifestations, but also the meanings that individuals in the society attribute to them (Laplantine 1993). Ethnographers in the field interact with people, and participate in their daily practices, and should act and feel like them even though they are not members of their groups. This immersion in the lives of others is followed by a period of detachment (Peacock 2001). In this context, Magnani (2002) proposes that ethnographers should regard themselves as ‘near and inside’, or primarily as nurses working with colleagues inside their communities, rather than ‘out and away’, or primarily as observers. Ethnographers who adopt the near and inside approach in studies of cities would regard the inhabitants as a network of actors dependent on each other and on the local infrastructure. They would reject the notion that people in a city are simply individuals ‘alone in a crowd’ (Magnani 2002). Fieldwork implies a double task: transforming the exotic into the familiar, and transforming the familiar into the exotic (Da Matta 1987). For ethnographers, the first of these transformations involves becoming familiar with what was once considered foreign and bizarre, while the second involves distancing themselves from the beliefs and values of their own societies. However, familiarity is often misunderstood. A situation may have occurred during birth, in an operating room, in a primary health care centre or a nursing home, but although it might have been studied in school or ‘seen’ during work, the nurse needs to be acquainted with the social situation. Thus, nurses performing ethnographic fieldwork cannot claim to be truly familiar with a given healthcare situation because each is dependant on context and the individuals concerned, and so is unique. In anthropology, familiarity is something that can be transformed and transcended until the fieldwork’s perspective emerges (Da Matta 1987). Empirical studies of nursing have little theoretical depth (Melo et al 2013). Ethnographers tend to © RCN PUBLISHING / NURSE RESEARCHER
regard them as superficial because they present researchers’ observations and interpretations, but not those of the people being studied (Moss 1996, Heras González 2004). Usually the data collected do not present anything new and can even help to reinforce stereotypes (Melo et al 2013). For example, in study two the authors said: ‘It took me a few weeks to finally detach myself from the group in order to put forward social and health education. At the beginning of the fieldwork, I felt this intense desire to intervene, to change the way things were being done, and to teach other professionals what I understood of health education. And I would covertly estimate and judge their practices.’ Before classifying phenomena, doubt must be cast on the data and ethnographers must relearn what they think they know. According to Spradley (1980), understanding social phenomena from other people’s points of view involves regression into a ‘childlike state’ so that researchers become ‘apprentices’ to the people’s experiences and perspectives. In study one, for example, the authors said: ‘Although I had introduced myself as a nurse, I would frequently be treated as a last-year undergraduate intern. So, I received from other nurses extensive explanations about nursing procedures, routines and ethics. In these situations I would always behave like an apprentice, and in fact I was one.’
Dialogue One of most important tasks for ethnographers is forming a dialogue, or shared semantic space, with natives to better understand their customs, beliefs and actions (Moss 1996, Spradley 1980, O’Reilly 2005). This should be an exchange of ideas between equals, without either discourse being ‘contaminated’ by the other. Such dialogue is methodologically superior to the researcher‑informant relationship, in which the latter gives the former information but is not expected to interpret it (Cardoso de Oliveira 2006). Partners in dialogue should experience empathy for each other. Pellatt (2003) said that listening to patients during her fieldwork gave her feelings of joy and frustration that she had not had in 18 years as a nurse in a spinal trauma unit. Nurse-ethnographers may also become involved emotionally involvement with patients, families and other members of a healthcare team. When researchers acknowledge that they are part of the social world they are studying they are being reflexive (Ersser 1996). Reflexivity is important because the tasks that ethnographers must carry September 2014 | Volume 22 | Number 1 17
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Nurse Researcher out, such as observation, enquiry, listening and recording, require them to be immersed in the subjects’ social world (Peacock 2001, Hammersley and Atkinson 2009, Nawrath 2010). Thus, ethnographers must be able to practise reflexivity and be aware of their roles as researchers, especially when dealing with experiences that seem commonplace. They must participate and commit themselves to the social world being studied. Ethnographers should be reflective observers who record and rationalise evidence, and redirect research and design strategies, while always being aware of their subjectivity, the situations they are experiencing and what is going on around them. They are subjects who investigate (Nawrath 2010). For Pellatt (2003), reflexivity in ethnographic fieldwork drives nurses to question their practice, values and identity as nurses. In this form of research, meanings are understood through a constant process of negotiation between researcher and informant, and adapted to different research opportunities. This process can lead to a shared viewpoint or consensus known as intersubjectivity. Ethnography is a radical methodology because it involves the researchers experiencing the lives of others. Fieldwork is self-transforming for the researcher and can be a rite of passage (Peacock 2001). For example, in study one the authors said: ‘As time went by, and relations got deeper, it was impossible not to get involved in the research field and its social actors. Entering and staying in the kitchen [were] no longer strange and unfamiliar [activities]. This transformation led me to some important discoveries. Though conducting research, [one informant became] a friend, sometimes a counsellor, a child, a nurse, someone who stimulates people’s potential. [Another] informant once said that, because I was around so often, I should be entitled to vacation and salary.’
In study two, the authors said: ‘In addition to the academic debates, my experience as a nursing professional who acts in public health was the basis for my informal and lonely reflections about the relational character of rituals in Brazil.’ In study three, they said: ‘A few months after the phone call to the cacique, I was the only Juruá, or non-indigenous person, present in the village. [I stayed] in a comfortable tent thinking: “What am I doing here?” The first two days are for adaptation, both from my part and the villagers, who were initially puzzled by my desire to live in the village.’ Ethnographic research can also be full of errors. Sometimes, attempts to understand behaviours or contexts are unsuccessful because crucial information is not taken into account or unexpected adverse events occur (Laplantine 1993). According to Cardoso (2004), researchers’ education prepares them to plan every phase of their work, but does not explain the mechanisms through which discoveries are made, nor prepare researchers to examine their own moods and misfortunes. Moreover, ethnographic fieldwork cannot be taught in the same way other disciplines are taught (Peacock 2001). Its results depend on the researchers’ biographies, the aims of their studies, the theoretical approach they adopt and the relationships they establish in the field. In study two the authors said: ‘In the meetings the therapeutic and cultural logics within the groups of diabetics [became clear]. It was satisfying and reassuring to perceive them while I was working, although there was some resistance and struggle. This meant that my theoretical object existed. Now, the complex task of unravelling its contours was up to me. The challenge and curiosity that structure the anthropological question was set: I needed to interact, participate, listen to and learn about my object of study.’
References Allan HT (2006) Using participant observation to immerse oneself in the field: the relevance and importance of ethnography for illuminating the role of emotions in nursing practice. Journal of Research in Nursing. 11, 5, 397-407. Cardoso RC (2004) Aventuras de antropólogos em campo ou como escapar das armadilhas do método. In Cardoso R (Ed) A Aventura Antropológica: Teoria e Pesquisa. Paz e Terra, Rio de Janeiro. Cardoso de Oliveira R (2006) O Trabalho do Antropólogo. Third edition. Editora da Unesp, São Paulo. Da Matta R (1987) Relativizando: Uma Introdução à Antropologia Social. Rocco, Rio de Janeiro.
Diniz D (1997) O que é isso que chamamos antropologia da saúde no Brasil? Revista Brasiliense de Pós-graduação em Ciências Sociais. 1, 1, 213-234.
Ersser SJ (1996) Ethnography in clinical situations: an ethical appraisal. In de Raeve L (Ed) Nursing Research: An Ethical and Legal Appraisal. Baillière Tindall, London.
Henderson A (2005) The value of integrating interpretive research approaches in the exposition of health care context. Journal of Advanced Nursing. 52, 5, 554-560.
Dougherty M, Tripp-Reimer T (1985) The interface of nursing and anthropology. Annual Review of Anthropology. 14, 219-41.
Geertz C (1973) The Interpretation of Cultures. Basic Books, New York NY.
Heras González P (2004) De enfermera a antropóloga: la experiencia de una transformación. In Téllez Infantes A (Ed) Experiencias Etnográficas. Editorial Club Universitario, San Vicente.
Durham ER (2004) A pesquisa antropológica com populações urbanas: problemas e perspectivas. In Cardoso R (Ed) A Aventura Antropológica: Teoria e Pesquisa. Paz e Terra, Rio de Janeiro. Elsen I, Monticelli M (2003) On the track of ethnography: reflections on nursing knowledge. Revista Brasileira de Enfermagem. 56, 2, 193-197.
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Gualda DM, Hoga LA (1997) Ethnographic research into the nursing. Revista da Escola de Enfermagem da USP. 31, 3, 410-422. Hammersley M (1998) Reading Ethnographic Research. Second edition. Addison Wesley Longman, New York NY. Hammersley M, Atkinson P (2009) Etnografía: Métodos de Investigación. Second edition. Paidós, Barcelona.
Holden P, Littlewood J (1991) Anthropology and Nursing. Routledge, London. Knauth D (2010) A etnografia na saúde coletiva: desafios e perspectivas. In Schuch P, Vieira MS, Peters R et al (Eds) Experiências, Dilemas e Desafios do Fazer Etnográfico Contemporâneo. Editora da UFRGS, Porto Alegre.
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Ethnography In study three: ‘When I arrived at the village, I was homesick. During my first visit I got sick and, because of that, I went back home. After I got better, I went back to the village. This time the adults started to get closer and trust me due to my everyday relationship with the children. After that, I started to share the meals in one of the villager’s houses.’ A strategy is needed to guarantee permanence in the field. Nurse-ethnographers may find that their participation in specific social situations is hindered by protocols, routines or professional hierarchies. In these circumstances, they can form friendships with people who can facilitate negotiations, and secure access and permission for activities (Spradley 1980, LeCompte and Schensul 1999). Nurse-ethnographers may find that, due to their nursing education, they are more easily accepted into health teams (Marcon and Elsen 2000, Pellatt 2003, Heras González 2004, Simmons 2007), but they may need to rethink the limits of their participation and their status as researchers. They may find that one moment they are nurses, the next researchers, and sometimes both at once. Ethnographers who are nurses but who enter the field exclusively as researchers may be perceived as investigators into irregularities (Marcon and Elsen 2000, Pellatt 2003, Heras González 2004, Simmons 2007). This may help or hinder their access to social situations and information. In study one the authors said: ‘Today, I was saved by computerised tomography (CT). One of the patients had a complex clinical condition and needed CT. The doctor and the nurse had to accompany him to the nuclear medicine service and I volunteered to go with them. When we were by the elevator the nurse changed one of the infusion pumps and asked me to hold the empty container. Seizing the moment I said playfully: “I cannot do any procedure, but I can hold an empty purse?” I loved the
Laplantine F (1993) Clefs Pour L’Anthropologie. Seghers, Paris. LeCompte MD, Schensul JJ (1999) Designing and Conducting Ethnographic Research. Rowman and Littlefield, New York NY. Leininger M (2001) Current issues in using anthropology in nursing education and services. Western Journal of Nursing Research. 23, 8, 795-806. Lenardt M, Michel T, Melo L (2011) The nursing ethnographic research into complex societies. Colombia Médica. 42, 2, Supplement 1, 70-77. Magnani JG (2002) Insider and a close-up view: notes on urban ethnography. Revista Brasileira de Ciências Sociais. 17, 49, 11-29.
situation and it was clear that I wanted to help her. We proceeded to the examination and our good relationship was restored.’ In study two the authors said: ‘In my first contact I offered to measure users’ blood pressure. Thereafter, my role in the meetings was to measure blood pressure. This was a strategy for insertion [of researchers] in the field, since it helped professionals in carrying out the activities and therefore optimised the time and the speed at which the activities were conducted. Additionally, my new task allowed me to have direct contact with everyone.’ Study three: ‘Being communicative and bold has helped me considerably. I gradually approached my neighbours in the village, and we would often prepare and have breakfast together every morning. They also taught me how to make baskets. In the course of time I understood the village pace and managed to adapt to it. I became more confident to walk around freely. I would sit with the women, and weave baskets and bracelets with them. I would also babysit for them. In the evening, we would drink tea on the balcony and play with the kids.’
Conclusion Ethnographic fieldwork is a complex and demanding task, and nurse researchers who intend to conduct ethnographic studies should be fully prepared. As well as ensuring their studies have clear aims and timeframes, and are based on sound anthropological theory, they must be prepared to join the communities they intend to study. This involves putting themselves in the position of apprentice to the experiences and perspectives of individuals in these communities so that they can form relationships based on dialogue, reflexivity and negotiation. By doing so, nurse researchers will find ethnographic fieldwork a highly rewarding and transformative experience.
Online archive For related information, visit our online archive and search using the keywords Conflict of interest None declared
Marcon S, Elsen I (2000) Estudo qualitativo utilizando observação participante: análise de uma experiência. Acta Scientiarum. 22, 2, 637-647.
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Schensul SL, Schensul JJ, LeCompte MD (1999) Essential Ethnographic Methods: Observations, Interviews, and Questionnaires. Rowman and Littlefield, New York NY.
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Schwartz E, Elsen I (2003) Observação participante: uma metodologia para conhecer o viver, o adoecer e o cuidar das famílias rurais. Família: Saúde e Desenvolvimento. 5, 1, 19-27.
Moss BJ (1996) Ethnography and composition: studying language at home. In Wiley M, Gleason B, Wetherbee Phelps L (Eds) Composition in Four Keys: Inquiring into the Field. Mayfield, Mountain View CA. Mulhall A (1996) Anthropology, nursing and midwifery: a natural alliance? International Journal of Nursing Studies. 33, 6, 629-637.
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Peacock JL (2001) The Anthropological Lens: Harsh Light, Soft Focus. Second edition. Cambridge University Press, Cambridge. Pellatt G (2003) Ethnography and reflexivity: emotions and feelings in fieldwork. Nurse Researcher. 10, 3, 28-37. Roper J, Shapira J (2000) Ethnography in Nursing Research. Sage, Thousand Oaks CA.
Simmons M (2007) Insider ethnography: tinker, tailor, researcher or spy? Nurse Researcher. 14, 4, 7-17. Spradley JP (1980) Participant Observation. Wadsworth, Orlando FL. Tedlock B (2000) Ethnography and ethnographic representation. In Denzin NK, Lincoln YS (Eds) Handbook of Qualitative Research. Second edition. Sage, Thousand Oaks CA.
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