Abstract
The obser-view is a method to generate data and create a learning space for both researcher and participants in qualitative research. It includes reflection between the two after the researcher has observed the participant. This article aims to reveal the benefits and challenges encountered when using the obser-view in two different research projects. In a Dutch project whose aim was to empower residents with dementia, in nursing homes the obser-view was used to generate data and create space for reflection which included residents and the family members. It showed that the obser-view cannot be finished when reflection does not happen. A Danish project with the aim to map the practice for inmates’ opportunities for education and job guidance highlighted that it made participants—educational prison leaders and teachers—aware they were doing their jobs by rote and showed the difficulties the researcher had trying to reflect with some participants. In both projects the obser-view created a learning space for participants. A benefit of the obser-view is that it can be used in dissimilar settings with different research purposes and with vulnerable and stigmatized people often excluded from the research. A challenge is for the researcher to reflect with participants, which is more likely to be successful if they have had time to develop a trusting relationship. Although the obser-view is a novel method in qualitative research, it has proved useful in different settings. It is a valuable method and we recommend developing it further in additional different settings with different populations.
The obser-view is both a method to generate data in qualitative research and create a learning space for both researcher and participant. It was developed in a project about student nurses’ learning processes in interaction with psychiatric patients (Kragelund, 2006; Box 1).
Development of the Obser-View
When Kragelund undertook a research project with the purpose of describing and explaining student nurses’ learning processes when interacting with psychiatric patients data were generated from qualitative semistructured interviews with and direct observations of participants. The aim of the interviews was to gain students’ inside perspectives of their learning processes, while the aim of the observations was to get Kragelund’s outside perspective as researcher. Through observation, Kragelund expected to describe students’ potential learning opportunities and the context of their learning, and uncover learning opportunities they might not be aware of themselves. The study was greatly successful in generating that type of data.
Nevertheless, students wanted more: They wanted an opportunity to discuss situations both they and Kragelund had been part of and to learn from their experiences through common reflection. Kragelund realized such follow-up discussions would allow her to uncover the students’ reflections before, during and after their interactions with patients, thereby gaining information that could not be obtained through observation alone.
Because of this and because such discussions could provide an inside and an intersubjective perspective, Kragelund integrated follow-up talks in the research design, and the obser-view became a reality. The aim was not to reach a common understanding of the situations, but to find out what was behind students’ actions and thereby obtain deep and detailed data (Kragelund, 2006, Kragelund, 2013).
Obser-view is defined as a researcher’s observation of a participant, immediately followed by common reflection between two of them, during which the researcher questions the participant. They both reflect on the situation in which they have participated. Because the obser-view contains observation, questioning the participant and reflection, it gives three perspectives on data. Observation gives an outside perspective that of the researcher. The researcher questions the participant’s inside perspective. An intersubjective perspective is obtained, composed of both the participant’s and the researcher’s perspectives (Kragelund, 2013). Garnering these perspectives enhances the research’s transparency (Kragelund, 2006).
As long as researchers undertaking qualitative research struggle with the lack of generally accepted terminology to verify how they have undertaken research, and face challenges to demonstrate methodological transparency in their research, there are reasons to develop new methods to improve the arsenal researchers undertaking qualitative research can use to get rich data. The obser-view is such a method.
Probably because the obser-view is a novel method in qualitative research, a review of the literature in PubMed, CINAHL, Psykinfo, and ERIC using the search term “obser-view” gave only one result. That result was a reflection in Nurse Researcher about the value of observation and how to overcome some of the complexities linked to this approach, written by Baillie. Part of it was also a comment on Kragelund’s article in the same volume of Nurse Researcher where Baillie pointed out that by Kragelund making the participants contribute directly to the analysis of data, they become “coconstructors” of data using the “learning space” in the obser-view (Baillie, 2013, pp. 4–5).
Dutch researchers Moser and van Zadelhoff asked Kragelund if she would advise them in using obser-view in relation to a research project involving residents with dementia and their families. Moser and van Zadelhoff wanted to use the obser-view as one of the methods to generate data. At the same time, Kragelund was undertaking a research project about the educational and job guidance opportunities inmates in Danish prisons have. In that project, she used obser-view as one of the methods to generate data. The three researchers decided to bundle their experiences and write this article in order to present the strengths and challenges in using the obser-view.
How the Obser-View Was Used in the Dutch and the Danish Project
In the Dutch project, the process of the obser-view was taken over as described by Kragelund (2013, and described above). First we (Moser and van Zadelhoff) undertook a photovoice interview with the participants. The photovoice interview was here the observation part of the obser-view. The observation was followed by common reflection between the researcher and the residents with dementia and their family members. The researcher also asked the participants question about what they have experienced during the observation (the photovoice interview). All data were tape-recorded and transcribed and analyzed through qualitative content analysis.
In the Danish project, obser-view was the way Kragelund preferred to generate data about inmates’ opportunities for education and job guidance to get three perspectives on data: Observing a counseling session between a teacher or educational leader and an inmate would give an outside perspective on their practice, and the reflection part of the obser-view would give their perspective while asking them questions and common reflection would give an intersubjective perspective. Because the prison leaders decided with whom Kragelund could speak, generating of data was influenced, and group interviews and qualitative semistructured interviews were also undertaken. All data were recorded, transcribed, and analyzed through qualitative content analysis.
First, we will describe the Dutch and Danish research projects to provide contextual information. Then, we will use examples to support the benefits and challenges we want to highlight when using the obser-view. We have chosen examples where obser-view worked out well, where it did not work, methodological concern arose and surprising situations occurred, which highlight the “undiscovered” potential of the obser-view. In order to present an honest picture of the use of the obser-view, we do not want to promote only the positive aspects but also look critically at the approach. Finally, we discuss benefits and challenges in the light of advancing the method of the obser-view.
A Dutch and a Danish Research Project and Findings
Empowering Residents With Dementia: A Dutch Project
Purpose
The goal of the project was to empower residents with dementia in small home-like units and their families. Empowerment in a Dutch context means that residents and family members have “a say” and can exercise control. The essential aspect is participation in performing activities and tasks (Raad voor de Volksgezondheid en Zorg, 2013), working with them in a meaningful way, and not doing research about them. Empowerment should not be a forced ideal but should be meaningful to the residents and family members based on their emotional, physical, and social resources. A flexible approach, depending on the daily well-being and capabilities of the individual resident, was used. Moser and van Zadelhoff chose to treat residents and their family members as a unit (Noruma et al., 2009). The majority of family members remain closely involved in the care of their loved ones, and chiefly they mainly undertake activities to preserve their loved one’s identity (Gaugler, 2005).
Setting
The setting was a nursing home organization in the Netherlands which has 17 locations where 1,500 residents live. The majority were residents with advanced stage dementia who were unable to live independently any more. The locations where the project was carried out were small home-like living units that center on the social model of care, emphasizing residents’ well-being and social context, and residents were stimulated to participate in meaningful domestic activities (van Zadelhoff, Verbeek, Widdershoven, van Rossum & Abma, 2011).
Nursing aids had integrated tasks as they were not only responsible for personal and medical care but also did household chores such as cooking and organizing leisure time activities (Verbeek, van Rossum, Zwakhalen, Kempen & Hamers, 2009). In these units, family members (mainly spouses and/or children), welcomed all day long, were encouraged to participate in care activities of their loved one and all other activities like preparing coffee, having a barbecue, going for a walk, participating in music evenings, and so on.
Sample and data gathering
Three living units were included with 17 residents and their family members participating. The age of residents ranged from 67 to 97 years. Data were generated through a participatory action research using the appreciate inquiry approach consisting of four phases (Reed, 2007), however, we mainly focus on the obser-view in this article, used in the first phase. Obser-views were undertaken with all participating residents and their family members. The focus of the obser-views was to deepen our understanding of moments and situations residents enjoyed. To uncover these moments and situations, we used photographs, better known as photovoice (Wang & Burris, 1997). Photovoice is an approach in which residents use cameras to photograph their everyday realities, thereby focusing on issues of greatest concern and communicating these issues to those who have the power to initiate changes (Wang, Burris & Ping, 1996). The family received a disposable camera with instructions. Prints were made for the photovoice interviews between the resident, the family member, and the researcher, which in turn were the input for the obser-view which followed. The reflection part of the obser-view started after the photovoice interview. In some cases, another photovoice interview was planned for another point in time due to time constraints of family members, loss of concentration, or tiredness of the residents. In some cases, we had to undertake several obser-views based on the availability of the resident. In most cases, obser-view was carried out immediately after the photovoice interview. The approach was adapted to the situation at hand. Photovoice was used to uncover moments and situations residents enjoyed, whereas the reflection part of the obser-view allowed family members and researchers to uncover reflections before, during, and after the photovoice interview. We perceived that these two methods complement each other to get rich data. The interview questions for obser-view were not prepared in advance and developed as the reflection unfolded in a dialogic manner (Kragelund, 2011, 2013).
Ethical issues
The study was reviewed by the ethics commission of Atrium-Orbis-Zuyd (12-N-19). Ethical approval was also obtained by the ethics commission of the participating nursing home. All residents and family members who were identified as legal representatives received an information letter and a reminder if they did not respond. A representative refers to either a legal authorized representative or, if not available, the informal caregiver of the resident who has the power to consent, according to Dutch guidelines and regulations. Residents were asked to assent. Assent is defined as willingness to participate even without full understanding of the complexity and the whole aims of the study. During the project, a sense of comfort of the participants, willingness to participate, and signs of verbal or nonverbal dissent or distress (Slaughter, Cole, Jennings & Reimer, 2007) were monitored. If residents felt uneasy, they could leave any time.
Findings
The main condition of the obser-view was that it was based on the content of the photovoice interview and observations during this interview. We present three different obser-views.
Example 1 NL
This example shows how space for reflection was created for Mrs. Bard, her daughter-in-law, her son, and the researcher. When I (vam Zadelhoff) entered the living unit, Mrs. Bard’s daughter-in-law explained that her mother-in-law was in bed, having and was suffering from a pubic fracture. A nursing aid transferred Mrs. Bard to a wheelchair and placed her in the living room. On the way there I met her son. During the obser-view, we sat in the living room since it was a quiet place. Mrs. Bard started to sing a local folk song. The daughter-in-law explained that Mrs. Bard did not speak anymore except to say something when she liked the way she was dressed. Mrs. Bard did not react to any attempts at communication. She liked singing said the daughter-in-law and continued: “My mother [in-law] was a long-standing member of the church choir and she went to the local conservatorium to listen to music.” I turned on the “Wiegenlied” by Brahms on my iPhone. Mrs. Bard listened, looked, and started singing. I also started singing. She rocked her arms softly and rhythmically, bending toward me, singing the song, and started smiling. After we finished, the son and daughter-in-law were silent. Then both started talking. They told me a lot about Mrs. Bard’s earlier life where music had a central role. While we were talking Mrs. Bard sang the folk song again and parts of the lyrics she filled in with her “own” lyrics. “Listen” said the son. She was singing about the camera on the table and about us being there: “You for me, you here, there camera.” She spoke to us while singing and she enjoyed the attention she got. Her facial expression was open and she turned herself toward us. We sang the Wiegenlied a second time. Mrs. Bard rocked her arms and her body. The son got tears in his eyes. He said that Mrs. Bard only reacted to music and today she was communicating in a way that he could follow. He explained that his father also sang that song and others when he put him and his brother to bed. He said that he would make a CD with these songs for his mother. Later the daughter-in-law and the son told me that it was special today. They were astonished that. Mrs. Bard still knew the lyrics and even more amazed that she communicated with me so easily through singing. They said that this was real contact.
Example 2 NL
This example, an obser-view with Mrs. Ramer’s nephew and his wife illustrates an unfinished obser-view regarding Mrs. Ramer. A nursing aid was to do the photovoice interview with Mrs. Ramer and I (van Zadelhoff) would do the observation and the reflection part of the obser-view afterward. We decided to stay in Mrs. Ramer’s room, since she does not like too much noise around her. She had been very restless the past few days and was given some medication. She laid in her bed a lot, and was agitated, but when her family visited her, she became more comfortable and was delighted. When we entered the room, Mrs. Ramer sat at the table with her nephew and his wife. They ate some local cake Mrs. Ramer liked a lot. We got to know each other. The family had already placed the photographs on the table. Mrs. Ramer had a hearing problem. She could hardly understand when people talked. She had already had several hearing aids, but she cut off the cables of all the hearing aids she had had with a pair of scissors. The nephew said that it made no sense to buy new ones even though the cost was reimbursed by insurance. After the photovoice interview, I started the reflection part of the obser-view and asked Mrs. Ramer how she liked the interview. She could not understand me. I repeated the question several times to no avail. The nephew’s wife said: “It was okay, yes, nice to sit around photographs and talk about the past. For me it is important that something happens because of the stories we tell.” At the same time, the nephew was already busy with the ticket for the parking lot. He barely reacted to my questions and wanted to leave.
Example 3 NL
The third example illustrates an unexpected obser-view between Bep, a nursing aid, and van Zadelhoff which turned into learning space for Bep to improve patient care. During the photovoice interview with Mrs. Jansen, her son and daughter-in-law, which was done by Bep, I observed that Mrs. Jansen talked about her sisters and brothers. Her sister was in a German jail during the Second World War as were her parents. When they came home they were completely underweight. Mrs. Jansen told us how they distributed food and how one had to behave to get any food at all. She said that she thought about the scarcity of food that morning. The son asked his mother: “Weren’t you also hiding a person from the Nazis in Rotterdam for some time? What was his name?” Mrs. Jansen remembered the person’s full name. “And when you stood with some people, chatting together, yes, this was very dangerous in those days,” she explained. Bep reacted instantly by saying that Mrs. Jansen behaved quite strangely when a room was overcrowded with people. Most of the time she walked away from it. Bep added that when Mrs. Jansen saw nurses sitting together, she angrily accused them of talking about her. “Now I understand where this behavior comes from; during the War, this was dangerous,” said Bep. The reflection started out with me questioning Bep about how she felt about the aversion Mrs. Jansen had for overcrowding. During the reflection, Bep said that it was clear to her why she behaved in a certain way when a room was full of people. She continued saying that she could do something in the care planning about it informing the primary nurse responsible, writing it in the patient file, and discussing it in the team meeting. “Then we will all be informed about the background to that behavior,” she concluded. I asked her how she felt about the use of photographs to learn about the impact of these life events on the behavior of Mrs. Jansen. She told me that the nonverbal reactions said a lot and reinforced the feelings and past experiences behind the photographs. “One can see her strong feelings in her body language and facial expression” Bep said, “but Mrs. Jansen cannot verbally express her emotions anymore.”
Inmate Opportunities for Education and Job Guidance in Danish Prisons
Purpose
The main purpose of the project in Danish prisons was to map the practice for inmate guidance in relation to education and work opportunities. The project took place in 2012 in nine different prisons (Kragelund, 2012).
Sample and data gathering
A total of 46 people participated in the project: 28 staff, mainly prison teachers and educational leaders, and 18 inmates chosen by the prison leaders. Data were generated through different methods. Eleven obser-views focused on the prison teachers’ and educational leaders’ practice in relation to counseling inmates about education and work while in prison and afterward. Reflecting together after an observation offered the opportunity to gain a deeper understanding of what had happened during the counseling session.
Ethical issues
Permission was obtained from prison managers and staff. Informed written consent was sought from the inmates who volunteered to participate in the project. All participants were guaranteed confidentiality and anonymity, therefore numbers and letters have been used instead of names of prisons. The staff members are named by their professional title and the inmates are called inmates.
The Danish Data Inspection Institution reviewed and approved the project. As the issues investigated by the project are not within the remit of the Danish Ethics Committee, its approval was not sought (Kragelund, 2012).
Findings
One of the conditions for undertaking the project was that the staff in the prisons decided which teaching and guidance situations Kragelund would get permission to be part of and with whom she could speak.
Example 1 DK
This example demonstrates how the reflection part of the obser-view can make the participant aware that they are doing their job by rote, without consideration for what they are doing. We were in closed prison 2b. I (Kragelund) had the opportunity to watch a male prison teacher counsel four inmates in relation to education and work. We were sitting in a classroom, the inmates came in one by one. The teacher and I were sitting on one side of a table, and the inmates were seated on the opposite side of it. When an inmate entered the room, we shook hands, introduced ourselves, and I told them why I was there. What surprized me was that each session took about 5 min. The inmates were all foreigners, male and in their twenties. The inmate from Eastern Europe was going to be in prison for 3 months. Afterward, he was to be expelled from Denmark. The session was conducted in English. One inmate said that he would like to learn some Danish, so he would be able to talk with other inmates. He also wanted to improve his English. The teacher told him that he could get 2 hr of Danish and 2 hr of English lessons a week. Then the teacher asked the inmate where he came from in Eastern Europe. The inmate answered and the teacher told him that he had lived in a town not far from the inmate’s hometown. Then the session finished. The teacher and I reflected together after the four guidance sessions. In relation to the inmate in the example, the teacher told me that he had asked the inmate where he came from to starting to build a relationship with him. I said to the teacher that I found it interesting that all four inmates were male foreigners in their twenties. The teacher said that he had not been aware of that, and that it might be because it was routine for him to teach and counsel inmates who were foreigners. I wondered if the counselling sessions I had observed could be called education and work counselling because no vocational training was mentioned and the teacher asked mostly yes or no questions of the inmates, and decided at which level they were going to be taught. I thought that was strange, but also that it might be because the teacher is an expert at what he is doing and has the competence to judge what level is best for each inmate. The teacher told me that he called what I had just observed “screening talks” and that the real guidance came when he had learned to know the inmates and established a relationship with them.
I also realized how much the relationship with the inmates meant to the teacher similar to what I experienced in other prisons. To establish a relationship between inmates and teachers takes time and can make the first counseling session challenging for both.
Example 2 DK
This example has been chosen to shown how an expert educational leader counselled an inmate and the difficulties I (Kragelund) had getting us to reflect together after the observational part of the obser-view. We were in open prison 6f where I was met by the prison’s female educational leader. One of the things she had planned for me was an obser-view with a Danish inmate in his thirties, for whom she was going to create an education and work plan during a guidance session. The observational part took about half an hour and the following reflection took about 10 min. We were sitting in the educational leader’s office. She was on one side of her desk while the inmate and I sat next to each other on the other side. The educational leader talked the most and both she and the inmate tried to get me involved in the dialogue, although I had explained that I was just going to watch and listen to what they said. It was difficult not to participate in their talk. It seemed important to the inmate that I knew that he was in prison because of economic criminality and that he was not violent or addicted to any drugs, and that he had committed the crime because he needed money. It also seemed important to him that I knew that he had two children, and he had not been able to see them for some time, which made him sad. The educational leader started the session by summing up what she and the inmate had talked about previously. It was the third session the inmate had had since arriving at the prison around 14 days earlier. So far they had talked about the inmate’s desire to join preparatory adult education in Danish, mathematics, and computer skills. Furthermore, he would like to start a vocational education as a mechanic. Finally he would like to join what is called a “cognitive skill course”, where the aim is for the participants to learn how to behave and think before they act. The educational leader said that she was pleased that they already had such a good education and work plan for the inmate, but she had been informed that the inmate had changed his mind and now wanted to be educated as a blacksmith. The inmate confirmed he had changed his mind because what he would learn would be useful in outside society. The two of them decided that the inmate would start his vocational education immediately. The educational leader, inmate, and other staff were going to formulate the education and work plan for the inmate together.
Example 3 DK
This example has been chosen to show how the reflection part of an obser-view might lead to learning for both participant and researcher. In open prison 4d, I (Kragelund) observed the female educational leader counsel a 21-year-old male Danish first-time inmate who had arrived at the prison three days before to serve a two year sentence. She and I were sitting in the prison’s employment office eating bread and drinking coffee. Among other things was a breadknife on the table. The educational leader told me that within half an hour an inmate would come for counselling. Suddenly there was knocking at the door and the inmate entered the room. He was tall with broad muscles and tattoos all over his arms and neck. He and I shook hands and introduced ourselves. The educational leader invited him to come and sit on the opposite side of her desk, where she was going to use her computer during the session. I stayed at the table and told them that I was just going to listen to their talk and take some notes. The educational leader started to talk with the inmate about undertaking some work while he was in prison. He told her that he had started a vocational blacksmith course and had 1 year left before finishing. At the same time, he said that he could not continue his education because of problems with his back, neck, eyes, and headaches; all problems which had started after he was attacked on the street. Nevertheless there were many other things he would like to do: study economy and business, work outside doing gardening, obtain a driving licence as it would be easier for him to get a job after leaving prison. After some time, the inmate said that he had only gone to primary school for 6 years because he was not able to concentrate and control himself (that surprized me as 9 years is the official minimum number of years pupils have to attend school in Denmark). After leaving school, he had had some private tutoring and said he was able to read, write, and do mathematics. He did not want to go to school while he was in prison because he could not concentrate. The educational leader told him that even though he felt that way she thought that it would be good for him to study and finish the ninth grade. The inmate changed the subject saying that he had around 50 cases pending and that he might be charged with homicide. Suddenly it looked like the inmate had had enough. He stood up. He said that he would go to see a nurse and then he would come back to continue the talk. It looked like he just had to get OUT. He almost ran out of the office saying “Have a nice day.”
Then, the reflection turned to the fact that the inmate had only gone to school for 6 years. The educational leader told me that was normal for many inmates, and she thought that this inmate was resistant to going to school because she knew that he had problems writing his own name.
I told the educational leader that I almost fainted when the inmate told her that he had about 50 cases pending and that he might be charged with homicide. She said that she was not surprised and knew from experience that the inmates could have committed many different types of crime. It was routine for her to hear such things.
I asked her what she had thought about the breadknife on the table. She said she had not thought about it. I asked her what the safety rules for the staff were. She realized that it was not wise to have a loose knife in a room where she was alone with an inmate.
Because of the reflection part of the obser-view, I got a much better understanding of what I had been observing than I would have had if we had not reflected together. My data became deeper and more detailed. The educational leader relearned to be aware of her own safety in the prison and also became aware of how challenging her work seems to others even though it was everyday work for her to talk with young men such as the one in this example.
Benefits and Challenges
The Reflection Part of the Obser-View
In the Dutch project, the observations during the photovoice interview helped to guide the obser-view. In fact, Moser and van Zadelhoff perceived it as substantial input for reflection with residents and their family members. Photovoice helps to visually formulate perceptions and experiences about particular interests that may be difficult to express in words alone (Wang & Burris, 1997). People with advanced dementia perform verbally better with pictures than with words (Lambon, Graham, & Patterson, 1999; Murphy, Gray, van Achterberg, Wyke & Cox, 2010), and photographs encourage residents to share information by triggering memories (Robinson, 2000). Besides recall problems, interviews with residents having dementia are difficult to perform because of empty speech, dwindling vocabulary, changes in word association patterns, and varying day-to-day communication skills (Hubbard, Downs & Tester, 2003). Observations alone of the photovoice interviews are perceived as not being able to capture depth, since observations are the researcher’s interpretation of what is going on around them (Kragelund, 2013; Robson, 2008). The advantage of observations is that verbal and nonverbal cues of residents and family members can be followed up on (Hubbard et al., 2003). We also used the strategy to plan the obser-view at a later point in time when we interpreted signs of nonparticipation as being unwilling to participate at that moment.
All obser-views were undertaken with the residents present. In some cases, residents joined the obser-view and added information. Obser-view provides space for communicatively challenged vulnerable people as Example 1 NL with Mrs. Bard demonstrates. The obser-view which had an open, engaging, and highly intersubjective character triggered family members to add in-depth information to situations. By reflecting together with family members, creating space where residents were able to have input, we found that we were able to ensure inclusive reflection and gained a deeper understanding of the moments residents enjoyed. This example confirms that photovoice and obser-view complement each other in generating rich amounts of data.
In the Danish project, Kragelund got a greater understanding of what educational and working counseling in prisons involve and how complex giving guidance is because the inmates were very different and had different problems and needs. The staff and guides need many different competencies to be able to counsel inmates. It would not have been possible to gain such detailed knowledge about counseling doing only staff interviews, as they would only have yielded the inside perspective of their jobs. Using obser-view permitted outside and intersubjective perspectives on guidance to be obtained. In Example 3 DK, the educational leader’s reflections before, during, and after the guidance session provided a much deeper knowledge about her educational and working guidance practice than an interview would have.
Unfinished Obser-Views
In both the projects, the observational part of the obser-view was not a problem. In the Dutch project, several residents and the vast majority of family members engaged in the obser-view. In the Dutch setting, Moser and van Zadelhoff did not experience many cases where the obser-views did not work out, but Example 2 NL with Mrs. Ramer and her family demonstrates that the obser-view was not always successfully carried out. In this example, it appears, first, that sensory handicaps impacted severely on the conversation and, second, that family members saw their role as giving in-depth information about the life history of the resident and took a lot of time to explain life events behind the photographs. The family members seemed to have their own agenda and wanted Moser and van Zadelhoff to see the “person before suffering from dementia.” However, they were not willing to engage in the reflection part of the obser-view. The question remains how to deal with such situations. On the one hand, when using the obser-view method participants and researchers should immediately engage in the reflection after the event that has been observed (Kragelund, 2011, 2013). On the other hand, researchers need to comply with research ethics and have to respect that participants may not want to engage in all parts of an obser-view.
The difficult part of the obser-views in the Danish project was as in the Dutch project: getting to do the reflection with the teachers and educational leaders. That was the case in Examples 1 DK and 2 DK. In Example 1 DK, the teacher counseled four inmates in relation to what kind of teaching he thought would be good for them, and in Example 2 DK, the educational leader counseled an inmate who wanted to be a blacksmith. Both the teacher and the educational leader seemed to be experts in what they were doing and maybe that is why it was difficult for Kragelund to reflect with them afterward. The difficulties could also be due to not having made it clear to them that Kragelund wanted to reflect with them about their counseling right after it finished. The teacher in Example 1 DK thought it was a good idea that Kragelund saw how he worked when he met the inmates the first time, and the educational leader in Example 2 DK thought that it was nice that Kragelund had the opportunity to observe how an inmate’s learning and work plan was constructed during guidance. Both the teacher and the educational leader seemed to be very effective counselors, and in the obser-views, they looked like professionals who did not mull over things much before they acted because of their experience. It can be a challenge to reflect with experts as according to Dreyfus and Dreyfus (1986) they do their work without having to think or articulate what they are doing. However, Example 3 DK shows an educational leader who is also an expert in what she is doing, and she was more than ready to reflect and wanted to learn about her practice from the obser-view, which she and Kragelund both did.
The Learning Space in the Obser-View
The third Dutch example shows that obser-view can provide unexpected and valuable learning opportunities. In the obser-view, the researcher functioned as a catalyst for reflection and it primarily became a space for learning about the impact of a resident’s life events on their present behavior for nursing aids. What is interesting is that the reflection, the intersubjective perspective, goes further than data generation. The impact of intersubjective reflection on nursing practice has also been reported when using videos of real-world caring situations (Idema, 2011). It seems that the learning from the obser-view might have an impact on the provision of care and that the scope of obser-view might be extended from data generation to practice improvement.
In the Danish project, how much or what the teachers and educational leaders learned from the obser-view differed. As mentioned in Example 3 DK, the educational leader learned something about her counseling practice and her own safety, and Kragelund got deep and detailed data. According to Jarvis, practitioners might fail to appreciate the significance of their jobs, if they are unaware that what they are doing is routine for them (Jarvis, 1987, 1999). If they reflect on their work, then they might see learning potential for themselves and their work will not deteriorate into mere ritual or isolation, therefore, reflection is a way to develop practice.
Further Considerations
A strength of the obser-view is that it can be used in totally different settings for qualitative research projects with different purposes as shown in this article using examples from the Dutch and the Danish settings. Another strength is that it can be used with vulnerable and stigmatized people who are often excluded from research.
A weakness of the obser-view could be ensuring that the researcher gets the best opportunity to reflect with the participants, which is dependent upon two of them having had time to develop a trusting relationship (Kragelund, 2006). Often that takes longer than a few hours. The question remains if a longer relationship between the participants and the researcher makes it easier to do the reflection part of the obser-view.
Some anthropologists might say that the obser-view is similar to what they do in their fieldwork when they undertake unstructured interviews. We would argue that it is not the same because the reflection part of the obser-view is in a way highly structured: The reflection has to take place immediately after the researcher’s observation of the participant and the aim is to get an intersubjective perspective on the situation they participated in. The result is that the participants may possibly learn something in relation to their social life or working life, and the researcher may get a deeper understanding and richer data through the participants’ reflections.
Conclusion and Recommendation
Although the obser-view is a novel method in qualitative research, it has been used in several different settings: education (Kragelund, 2006), prisons (Kragelund, 2012), nursing homes (Author 2, 2011), hospitals (Galster, 2013), and the construction industry (Umeokafor, 2015) with highly diverse participants. The difference between the Dutch and the Danish projects’ research purposes was while the former project used the obser-view in a participative approach, the latter used it to gain understanding. However, in both the projects, the obser-view fulfilled the potential to generate data that provide new insights relevant for research. This shows that it is a valuable method for qualitative researchers’ purposes. We recommend developing the obser-view further in several ways. First, by describing a methodological quality standard in general, it would guide researchers to perform trustworthy research since observation, reflection, and dialogue standards need to be considered. Second, obser-view should be developed further by studying conversational patterns between the researcher and participant to get more insights into the dialogical nature of reflection and what might endanger or fully exploit its potential. Third, research in what kind of competencies the researcher need to have to undertake an obser-view has to be developed further, since obser-view requires sophisticated observation and communication skills and presupposes an experienced researcher initiating reflection without preparing research questions. Finally, we recommend preparing a step-by-step manual so that researchers are sufficiently equipped to generate high-quality data.
Footnotes
Authors’ note
Thank you to the Danish inmates, educational leaders and teachers for participating in the Danish project. We would like to thank Cheryl la Montagne for her editing assistance throughout the writing process. Although we have had some assistance in writing this article, any errors and omissions that may remain are ours alone.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The Dutch project was supported by the Netherlands Organisation for Health Research and Development, The Hague, The Netherlands.