Volume 73, October 2023, 151713Author links open overlay panel, Abstract

While case studies can offer an in-depth investigation of a particular issue in healthcare, cultural context may be overlooked. Researchers may want to consider adding a cultural component to the design aimed at identifying and/or explaining values, beliefs, or traditions influencing the case. The addition of focused ethnography as a supplemental component to the research design is one strategy to examine cultural content. In this article, we provide insights gained from using case study research and focused ethnography in a qualitatively-driven mixed method design. Despite a detailed research plan, there were challenges that hindered the implementation of the design. To help prevent others from experiencing similar methodological challenges, we provide the following lessons learned and recommended strategies: discussion of structured procedures for intentional observations, reflexivity to guide decision-making, and refinement of processes using a pilot study.

Section snippetsCase study research

Case study research has its origins in anthropology and sociology (Platt, 1992). Although there are multiple approaches to case study research, key contributors include Yin, 1989, Yin, 2018 and (Stake, 1995). Yin (2018) transformed scholarly inquiry by educating others on case study as a research method and continues to contribute to the development of case study research. The use of case study research is recommended when answering how or why questions about contemporary events outside the

Focused ethnography

Focused ethnography is a specific ethnographic approach that allows focused inquiry on an existing phenomenon occurring in a culture or subculture of contemporary society (Higginbottom et al., 2013; Knoblauch, 2005). The specificity of focused ethnography allows short, intermittent field visits and intense data collection from multiple sources (i.e., observations, interviews, documents, and field notes), unlike the lengthy field visits associated with conventional ethnography (Higginbottom et

Mixing qualitative methods

Once a baseline understanding of each qualitative method was achieved, the lead author sought to learn about mixing qualitative methods. Upon initial review of the literature, it became evident conceptual differences existed among concepts of “blending” (Fusch et al., 2017), “merging” (Cote-Boileau et al., 2020), or mixing a “method” (Morse, 2017) or “methods” (Fetters & Freshwater, 2015). Insights occurred supporting the use of two qualitative methods to fully answer the research question(s)

Lessons learned and recommended strategies

Through this research journey, lessons were learned. In particular, reflexivity was challenging for the lead author, and more structure was needed as a novice researcher. In addition, challenges related to the collection of observation data were a barrier to fully understanding the cultural component. Observational data is critical to the trustworthiness of cultural findings because it provides data for triangulation (Denzin, 1989). However, observations were disregarded during data collection

Conclusion

Healthcare is dynamic and complex, often requiring an understanding of the cultural context of the topic being studied. Our goal in writing this article was to provide guidance to other researchers interested in exploring the use of case study research with focused ethnography to study cultural contexts within healthcare settings. Despite the methodological challenges, this experience presented an opportunity to reflect on lessons learned and share strategies that may prevent similar

CRediT authorship contribution statement

Jones-Hooker: Conceptualization, Methodology, Investigation, Writing- Original draft preparation, Writing- Reviewing and Editing, Funding Acquisition. Tyndall: Conceptualization, Methodology, Supervision, Writing- Reviewing and Editing.

Funding

This work was supported by a Doctoral Student Research Grant from the College of Nursing at East Carolina University in Greenville, N.C.

Declaration of competing interest

None to declare.

References (30)D.E. Tyndall et al.Troublesome knowledge for entry-level PhD nursing students: Threshold concepts essential for the research-focused doctorate

Journal of Professional Nursing

(2021)

S. Anthony et al.Qualitative case study methodology in nursing research: an integrative review

J. Adv. Nurs.

(2009)

R. BergerNow I see it, now I don’t: Researcher’s position and reflexivity in qualitative research

Qualitative Research

(2015)

G. Bunkenborg et al.Handing over patients from the ICU to the general ward: A focused ethnographical study of nurses' communication practice

Journal of Advanced Nursing

(2017)

M. Cicellin et al.Understanding the low cost business model in healthcare service provision: A comparative case study in Italy

Social Science & Medicine

(2019)

E. Cote-Boileau et al.Organizational ethnographic case studies: Toward a new generative in-depth qualitative methodology for health care research?

International Journal of Qualitative Methods

(2020)

E.V. Cruz et al.The use of focused ethnography in nursing research

Nurse Researcher

(2013)

N.K. DenzinThe research act: A theoretical introduction to sociological methods

(1989)

K.A. EggelingEmbracing the ‘inverted commas’, or How COVID-19 can show us new directions for ethnographic ‘fieldwork’

Qualitative Research

(2022)

E.W. Ferrell et al.Changing the doctoral student-dissertation chair relationship through the article dissertation format

Mid-Western Educational Researcher

(2020)

M.D. Fetters et al.Publishing a methodological mixed methods research article

Journal of Mixed Methods Research

(2015)

L. Finlay“Outing” the researcher: The provenance, process, and practice of reflexivity

Qualitative Health Research

(2002)

P.I. Fusch et al.How to conduct a mini-ethnographic case study: A guide for novice researchers

The Qualitative Report

(2017)

G.M.A. Higginbottom et al.Guidance on performing focused ethnographies with an emphasis on healthcare research

The Qualitative Report

(2013)

M.R. Kalogirou et al.How the hospital context influences nurses’ environmentally responsible practice: A focused ethnography

Journal of Advanced Nursing

(2021)

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