Exploring painful experiences: impact of emotional narratives on members of a qualitative research team

A Tale of Two Stories: A Narrative of Bulimia in a Research Study of Anorexia, and the Dilemmas of a Novice Researcher

The purpose of this paper is two-fold: Firstly, it reports on one man's experience of bulimia. After being interviewed it became evident that he did not meet the inclusion criteria for the study, which was focussed on anorexia in men. Secondly, the paper explores the implications for a novice researcher of including someone in a study who does not meet the inclusion criteria. The researcher's story reflects upon the implications of self-doubt when embarking upon sensitive research, and the morality of holding onto a rogue participant's story. It offers others an opportunity to consider and learn from this experience.

ADVANCE: Methodology of a qualitative study

BACKGROUND/OBJECTIVES

Quantitative studies have documented persistent regional, facility, and racial differences in the intensity of care provided to nursing home (NH) residents with advanced dementia including, greater intensity in the Southeastern United States, among black residents, and wide variation among NHs in the same hospital referral region (HRR). The reasons for these differences are poorly understood, and the appropriate way to study them is poorly described.

DESIGN

Assessment of Disparities and Variation for Alzheimer's disease Nursing home Care at End of life (ADVANCE) is a large qualitative study to elucidate factors related to NH organizational culture and proxy perspectives contributing to differences in the intensity of advanced dementia care. Using nationwide 2016-2017 Minimum DataSet information, four HRRs were identified in which the relative intensity of advanced dementia care was high (N = 2 HRRs) and low (N = 2 HRRs) based on hospital transfer and tube-feeding rates among residents with this condition. Within those HRRs, we identified facilities providing high (N = 2 NHs) and low (N = 2 NHs) intensity care relative to all NHs in that HRR (N = 16 total facilities; 4 facilities/HRR).

RESULTS/CONCLUSIONS

To date, the research team conducted 275 h of observation in 13 NHs and interviewed 158 NH providers from varied disciplines to assess physical environment, care processes, decision-making processes, and values. We interviewed 44 proxies (black, N = 19; white, N = 25) about their perceptions of advance care planning, decision-making, values, communication, support, trust, literacy, beliefs about death, and spirituality. This report describes ADVANCE study design and the facilitators and challenges of its implementation, providing a template for the successful application of large qualitative studies focused on quality care in NHs.

A path forward for qualitative research on sustainability in the COVID-19 pandemic

The unique strengths of qualitative research, through in-depth inquiry and identification of unexpected themes and linkages, is essential to our growing understanding of COVID-19's impacts on the social world and its intersection with sustainability science. However, many challenges-physical, psychological, and ethical in nature-face qualitative researchers during the pandemic, as social distancing and travel restrictions prevent in-person field work. In this paper, we outline the essential contributions of qualitative study to sustainability science, discuss current challenges, and in turn, provide recommendations for researchers.

Self-care while undertaking qualitative nursing research

BACKGROUND

Nursing research is usually carried out by registered nurses with some experience of practice. However, nurses may find that the role of the nurse researcher is very different from that of the practising clinical nurse and has its own challenges.

AIM

To explore the differences between the two roles and offer some guidance to nurses carrying out qualitative research, particularly research into sensitive topics.

DISCUSSION

Nurses need to be aware of various issues that could affect their ability to carry out nursing research and be emotionally traumatic.

CONCLUSION

There is a general need for greater awareness about the potential risks of carrying out qualitative research into sensitive topics.

IMPLICATIONS FOR PRACTICE

Nurse researchers must consider self-care when planning a research project, assessing their role, personality, background, personal experiences and stress triggers, and ensuring peer and supervisory support, reflection and a healthy lifestyle.

Who else Needs Protection? Reflecting on Researcher Vulnerability in Sensitive Research

Ethnographic research characterised by immersion, reflexivity, and rapport can be unpredictable and uncontrollable, producing a wide range of emotional responses. Much of the literature on sensitive research focuses on ethical requirements and strategies for protecting participants while less attention has been given to the need for researcher protection. In this paper, we share some of the concealed and/or overlooked aspects of researcher vulnerability that are commonly disregarded or under-explored. Based on our fieldwork experiences with a vulnerable population, it considers some of the different ways doing sensitive research with people experiencing homelessness has had an impact on our research team and wider. Specifically, we analyze the emotional impact of distressing and painful research experiences on those directly and not directly involved with the collection of research data (i.e., transcribers and coders). The themes that are discussed include: i) blurring of roles in the field; ii) dealing with heart-rending life stories; and iii) handling emotionally charged experiences. By reflecting on our fieldwork experiences and emotions, we also explore the ways in which emotional impacts can be managed in practice. Strategies for emotion management that have helped us deal with the unique challenges of this research are outlined.

Situating our selves: using mixed media to convey experiences of psychosocial cancer research

BACKGROUND

In contrast to the field of art therapy, the use of art-making as a form of reflective or creative practice by social scientists by themselves or for themselves has been limited. In this article, we describe the impetus and outcomes for collective art-making within our group of seven health researchers.

METHODS

As a group, we represent sociology, psychology, nursing, occupational therapy, and kinesiology, as well as interdisciplinary studies. Guided by a professional artist, we engaged with mixed media to explore our experiences as psychosocial cancer researchers.

RESULTS

Findings are brought to light through a process and outcome narrative that highlights the meaningfulness of cancer to researchers.

CONCLUSIONS

Key learnings could inform initiatives that other health researchers might undertake if choosing to expand beyond prevalent models of art as intervention for those who are ill to more fully engage those who explore such lines of inquiry.

'When you are a data collector you must expect anything'. Barriers, boundaries and breakthroughs: insights from the South African data-collection experience

The impact of the research process on the researcher is an emerging topic of interest. Data collection in most low- and middle-income countries (LMICs) is often the responsibility of community members who are identified and trained specifically for data collection. When research involves data on mental health and social well-being, data collectors may have specific competency needs and the task of data gathering may impact data collectors. This study aims to explore the experiences and needs of data collectors within South Africa using qualitative methods to examine the impact of data collection on data collectors. Nineteen data collectors, involved in face-to-face data collection, completed semi-structured interviews exploring their insights, attitudes and experiences. Thematic analysis revealed barriers and challenges associated with research, complexities regarding boundaries within the participant-data collector relationship and the benefits of being involved with research for the individual and the community. Numerous challenges and opportunities are outlined. Findings expose the beneficial and often overlooked contribution of data collectors and warrants key considerations in the planning and implementation of future research to ensure adequate support and standardization of practice.

Service user involvement enhanced the research quality in a study using interpretative phenomenological analysis - the power of multiple perspectives

AIM

The aim of this study was to examine how service user involvement can contribute to the development of interpretative phenomenological analysis methodology and enhance research quality.

BACKGROUND

Interpretative phenomenological analysis is a qualitative methodology used in nursing research internationally to understand human experiences that are essential to the participants. Service user involvement is requested in nursing research.

DESIGN

We share experiences from 4 years of collaboration (2012-2015) on a mental health promotion project, which involved an advisory team.

METHODS

Five research advisors either with a diagnosis or related to a person with severe mental illness constituted the team. They collaborated with the research fellow throughout the entire research process and have co-authored this article. We examined the joint process of analysing the empirical data from interviews. Our analytical discussions were audiotaped, transcribed and subsequently interpreted following the guidelines for good qualitative analysis in interpretative phenomenological analysis studies.

RESULTS

The advisory team became 'the researcher's helping hand'. Multiple perspectives influenced the qualitative analysis, which gave more insightful interpretations of nuances, complexity, richness or ambiguity in the interviewed participants' accounts. The outcome of the service user involvement was increased breadth and depth in findings.

CONCLUSION

Service user involvement improved the research quality in a nursing research project on mental health promotion. The interpretative element of interpretative phenomenological analysis was enhanced by the emergence of multiple perspectives in the qualitative analysis of the empirical data. We argue that service user involvement and interpretative phenomenological analysis methodology can mutually reinforce each other and strengthen qualitative methodology.

The psychosocial needs of students conducting research with patients and their families in advanced cancer and palliative care: A scoping review

OBJECTIVE

The objective of this article was to explore the extent of the scientific literature and evidence base about the psychosocial needs of students conducting research in the fields of advanced cancer and palliative care.

METHOD

A scoping review was conducted in major scientific databases. English-language articles on the topic of interest were retained if they were published in peer-reviewed journals between 1995 and 2013.

RESULTS

A total of 3,161 references were screened, and 7 were retained for analysis. Only two articles were empirical studies involving the collection of primary empirical data. The remaining ones were commentaries and personal reflections. While there is a near absence of empirical research about the psychosocial needs of students, several commentaries suggest that students in this field have a high need for support. Three themes were identified in the limited literature retrieved: (1) the importance of proper training and supervision; (2) the availability of emotional support structures; and (3) the use of effective and deliberate self-care strategies.

SIGNIFICANCE OF RESULTS

This scoping review demonstrates that little is known about the psychosocial needs of students conducting research in advanced cancer and palliative care. However, what is clear is that there is a large emotional impact on student researchers engaged in this type of work. Adequate training and support is needed to promote students' health and well-being, encourage retention of students, and foster high-quality studies. More empirical data are needed to better understand the experiences of students conducting this type of research and to ensure the sustainability of training and research in this field.

Researcher-researched relationship in qualitative research: Shifts in positions and researcher vulnerability

Background

The researcher role is highly debated in qualitative research. This article concerns the researcher-researched relationship.

Methods

A group of health science researchers anchored in various qualitative research traditions gathered in reflective group discussions over a period of two years.

Results

Efforts to establish an anti-authoritarian relationship between researcher and researched, negotiation of who actually “rules” the research agenda, and experiences of shifts in “inferior” and “superior” knowledge positions emerged as central and intertwined themes throughout the discussions. The dual role as both insider and outsider, characteristic of qualitative approaches, seemed to lead to power relations and researcher vulnerability which manifested in tangible ways.

Conclusion

Shifting positions and vulnerability surfaced in various ways in the projects. They nonetheless indicated a number of similar experiences which can shed light on the researcher-researched relationship. These issues could benefit from further discussion in the qualitative health research literature.

Ethical considerations in sensitive suicide research reliant on non-clinical researchers

The impact on researchers of working with sensitive data is often not considered by ethics committees when approving research proposals. We conducted interviews with eight research assistants processing clinical notes on emergency department presentations for deliberate self-harm and suicide attempts during a suicide prevention trial. Common experiences of working with the data included feeling unprepared for the level of detail in the records, being drawn deeply into individual stories, emotional exhaustion from the cumulative exposure to the data over long periods of time while working alone, and experiencing a heightened awareness of the fragility of life and the need for safety. The research assistants also reported on some of the strategies they had developed to cope with the sensitive nature of the data and the demands of the work. The ethical implications for suicide research reliant on non-clinically trained researchers exploring sensitive data are considered. These include the need for research leaders and ethics committees to be aware of the potential adverse mental health impacts for these researchers examining sensitive data and to make appropriate arrangements to minimize the mental health impacts of such work.

Strategy for Mental Health Improvement of Iranian Stillborn Mothers From Their Perspective: A Qualitative Study

BACKGROUND

Mothers got stressed when they are informed about the occurrence of stillbirth. Many researchers believe that the failure to provide the required care by health teams during this hard time is the main determinant of maternal mental health in the future. In other words, psychosocial support by medical care providers can significantly improve mental outcomes of mother after stillbirth.

OBJECTIVES

This study aimed to explore stillborn mothers' suggested strategies to provide maternal mental health in the experience of stillbirth.

PATIENTS AND METHODS

Twenty women who had experienced stillbirths participated in this qualitative content analysis study. They were selected through purposeful sampling method. Data were gathered by individual interviews recorded on audiotapes, transcripted and then analyzed. Then, transcriptions were coded and classified. Finally, 3 main categories and 9 subcategories were emerged.

RESULTS

Analysis of participants' viewpoints and their opinions about strategies to provide maternal mental health in the experience of stillbirth lead to development of 3 main categories: "before delivery strategies" with 3 subcategories, "during labor strategies" with 3 subcategories, and "postpartum strategies" with 3 subcategories. Analyses of findings showed that, health care providers can mitigate some of the long-term negative mental outcomes of stillborn mothers by spending extra time with grieving mothers, facilitating bonding, and validating their emotional expressions.

CONCLUSIONS

According to the results, revision and modification of the care plan in the experience of stillbirth seems necessary to improve mental health in these mothers. According to suggested strategies, midwives and health care providers are health professionals who can effectively and properly care for stillborn mothers.

Work stress and cancer researchers: an exploration of the challenges, experiences and training needs of UK cancer researchers

Work stress is a significant issue for many UK healthcare professionals, in particular those working in the field of oncology. However, there have been very few attempts to explore the challenges, experiences or training needs of researchers working in cancer research. In doing so, we will be better positioned to support and develop these researchers. Eighteen UK oncology researchers from a variety of backgrounds took part in a semi-structured interview. Interviews were transcribed and analysed using thematic analysis. The analysis identified two overarching themes: logistical research issues (workload, accessing/recruiting participants, finances) and sensitive research issues (emotional demands, professional boundaries, sensitivity around recruitment). One cross-cutting theme, supportive strategies (support and training, coping mechanisms), was seen to influence both logistical and sensitive research issues. While further research is needed to fully understand the causes and impact of work stress on cancer researchers, three specific issues were highlighted: emotional demands are relevant to quantitative and mixed methods researchers as well as those engaged in qualitative research; the researchers' background (experience; clinical/non-clinical) was influential and an exploration of effective coping strategies is required; and there is a clear need for adequate support systems and training to be available, particularly for early career researchers.

Being a quantitative interviewer: qualitatively exploring interviewers' experiences in a longitudinal cohort study

Background

Many studies of health outcomes rely on data collected by interviewers administering highly-structured (quantitative) questionnaires to participants. Little appears to be known about the experiences of such interviewers. This paper explores interviewer experiences of working on a longitudinal study in New Zealand (the Prospective Outcomes of injury Study - POIS). Interviewers administer highly-structured questionnaires to participants, usually by telephone, and enter data into a secure computer program. The research team had expectations of interviewers including: consistent questionnaire administration, timeliness, proportions of potential participants recruited and an empathetic communication style. This paper presents results of a focus group to qualitatively explore with the team of interviewers their experiences, problems encountered, strategies, support systems used and training.

Methods

A focus group with interviewers involved in the POIS interviews was held; it was audio-recorded and transcribed. The analytical method was thematic, with output intended to be descriptive and interpretive.

Results

Nine interviewers participated in the focus group (average time in interviewer role was 31 months). Key themes were: 1) the positive aspects of the quantitative interviewer role (i.e. relationships and resilience, insights gained, and participants' feedback), 2) difficulties interviewers encountered and solutions identified (i.e. stories lost or incomplete, forgotten appointments, telling the stories, acknowledging distress, stories reflected and debriefing and support), and 3) meeting POIS researcher expectations (i.e. performance standards, time-keeping, dealing exclusively with the participant and maintaining privacy).

Conclusions

Interviewers demonstrated great skill in the way they negotiated research team expectations whilst managing the relationships with participants. Interviewers found it helpful to have a research protocol in place in the event of sensitive situations - this appeared to alleviate the pressure on interviewers to carry the burden of responsibility. Interviewers are employed to scientifically gather quantitative data, yet their effectiveness relies largely on their humanity. We propose that the personal connection generated between the interviewers and participants was important, and enabled successful follow-up rates for the study. The enjoyment of these relationships was crucial to interviewers and helped balance the negative aspects of their role. Our results suggest that experienced quantitative interviewers endeavour, as do many qualitative researchers, to carefully and respectfully negotiate the requirements of the interview within a relationship they form with participants: being sensitive to the needs of participants and respectful of their wishes - and establishing an ethical relationship.

Data collectors' field journals as tools for research

With rising numbers of families giving care to elderly loved ones, novel methods and sources of data need to be used to obtain comprehensive information about family caregiving patterns. The purpose of this paper is to present the interviewers' reflective journals as a source of rich data. Data collectors interviewed Hispanic family caregivers as part of a quantitative study of caregiving patterns. The stories derived from the personal journals brought to life three themes: caregiving as responsibility; creativity in giving care; and resistance to delegating tasks. Well-written journals have the potential of enhancing the interpretation of data collected by other means and of raising the quality of interviews and data through introspection and cultural understanding of the caregiving reality.

Utilizing participants' strengths to reduce risk of harm in a study of family estrangement

In this article I examine some issues involved in researching vulnerable populations and sensitive issues, and the challenges and risks of researching issues of a deeply personal nature. Participants might have complex needs and vulnerabilities, but they also have many resources to ensure their own well-being. I ask researchers to move beyond the minimum standards espoused by human ethics committees, and utilize participant strengths to further reduce the risk of harm. My reflections on a study of older people who were experiencing family estrangement highlight some of the actions that participants used to increase their personal safety. I discuss the usefulness of "strengths" questions in assessing risk and facilitating participant strengths to minimize harm. Finally, I propose a three-way model for reducing risk that involves the "lessons learned" from ethics committees, researchers, and the participants themselves.

Community researchers conducting health disparities research: Ethical and other insights from fieldwork journaling

Lay persons who are trained to conduct research in their own communities form an essential part of many research projects. However, the effects of conducting research in their own communities have not been adequately explored. This paper examines the experiences, perceptions, and challenges faced by a group of community researchers during their involvement in a research project that examined if, and how, the relationships between mothers and their adolescent daughters could be harnessed to develop a daughter-initiated cervical cancer intervention. Seven community researchers interviewed 157 mother-daughter pairs in Cape Town, South Africa. We examine the use of journaling as a tool to document the experiences of community researchers, and we consider how journaling may help the community-based researcher grapple with the research process, and, more broadly, what such journal content illustrates with respect to the nature and challenges of community-engaged health research. An analysis of the content of the journals provides a strong indication of how personal and intimate the research process can be for community researchers by virtue of the background that they bring into the process as well as the additional weight of the research process itself. The complexities of navigating dual and somewhat oppositional roles - the role of impartial scientist or researcher and the role of invested community person - has been both underestimated and insufficiently researched.