This is a philosophical movement concerned with the study of conscious experience, from the point of view of the first person (Moran, 2000). There is emphasis on the intentionality of experience – that is, the idea that conscious experience is directed towards some phenomena, rather than being merely aimless. Such purposefulness is usually contained in the meaning that the first person ascribes to his or her experience. Human experience is said to be conscious, meaning that we are somehow usually aware of an experience as it is happening, as opposed to for example Sigmund Freud’s psychoanalytic view in which experience isn’t always conscious. Conscious experience is defined in broad terms, incorporating a wide range of factors including sensation, perception, objects, events, time, self, others, space, sequence, emotion, logic, and so on, with particular emphasis on the meanings of these experiences (two individuals may have exactly the same experience, yet attach completely different meanings). Historically, phenomenology has been a fragmented philosophy, with numerous variations emerging and becoming established especially since the early part of the 20th century, deriving from works of philosophers like Martin Heidegger, Jean-Paul Satre, Edmund Husserl, G.W.F Hegel, Max Scheler, and others. The basic tradition of Anglo-Saxon European philosophy as we know it has been dominated by phenomenology throughout the last century, and currently provides the philosophical basis for a major part of clinical studies, usually subsumed under the heading of qualitative research.
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EXPERIMENTAL (SCIENTIFIC) APPROACH
Scientific experimentation forms part of the wider traditional positivist doctrine, developed by Auguste Comte during the early part of the nineteenth century (Coolican, 1994). Positivism dictates that only phenomena that can be quantified and measured, are worthy of scientific experimentation. Emerging from this philosophy is the hypothetico-deductive doctrine, which entails making observations, developing theories, formulating and testing predictions from those theories, and modifying or supporting the theory accordingly. This procedure is what many researchers refer to as the ‘scientific method’. Experimentation is often regarded as the ‘gold standard’ in scientific (clinical) research. It entails the deliberate manipulation of variables under controlled conditions, in order to establish causality, and important factor in clinical settings. Control is achieved primarily by random allocation of participants to conditions, effectively distributing any differences between people evenly across the conditions, and hence ‘balancing things out’. Many experiments are also conducted in a controlled environment, such as laboratory. Experimentation is underpinned by a number of assumptions, including the idea that people can be isolated from their social environment and treated as a group rather than as individuals. Furthermore, it is possible for the researcher to remain objective, remaining distant from the subject and hence having no influence on their behaviour.
Aims and Objectives
Phenomenological research is exploratory, seeking to understand people’s conscious experiences through that persons’ own viewpoint, what ever it may be.
By contrast experimentation focuses on testing specific hypotheses, which have usually been selected by the researcher, hence reflecting the researchers own perspectives, rather than those of the participant. For example, take the case of a patient who has recently being diagnosed as anorexic. She is receiving treatment but there is a need for research to establish whether the treatment is having the desired effect. Phenomenology will focus on the patient’s own conscious experience of anorexia and recovery, and the meaning she attaches to these experiences. For example, the individual may view anorexia as a devastating experience with feel that she is not recovering despite her treatment. The whole experience may have created a sense of revulsion about her condition and pessimism about the recovery. The phenomenologist will try to explore – to use Husserl’s Greek terms – her “noesis” or intentional act of consciousness (e.g. her beliefs and feelings) and “noematic”, meaning the object or phenomena (anorexia, recovery). By contrast, the experimenter will aim to test hypotheses that the treatment is or isn’t effective in eliciting recovery, which will be appraised in quantifiable terms, such as changes in body-mass index, blood sugar levels, and blood pressure. Given the different aims/objectives (i.e. exploration, hypothesis testing), the experimenter and phenomenologist could arrive at completely different conclusions. For example, the patient may feel and believe they are not getting better albeit experimental (medical) parameters suggest otherwise.
Research Questions & Hypotheses
Phenomenological questions typically exploratory, asking how an individual has consciously experienced a phenomenon, such as illness or disease. There are no hypotheses. The question can take any one of several forms, depending on the area of phenomenology. For example, existential phenomenology will inquire about the persons’ experience of free choice (e.g. in selecting their treatment), generative phenomenology will explore the meaning of the phenomena to the individual with reference to historical factors (e.g. the way a disease has historically been interpreted in their society), while a transcendental phenomenology will ask about the person’s conscious experiences completely excluding questions about the external environment (e.g. how the disease is experienced, regardless the hospital environment, treatments, and other external factors). Experimental questions are often more precise, asking whether there is a relationship between two or more variables. The question is usually accompanied by testable hypotheses, which specify whether or not a relationship exists and the direction (i.e. positive or negative) of the relationship. So, for example the experimenter will ask whether a particular intervention will cure the illness, accompanied by a hypothesis (e.g. the intervention significantly improves health outcomes). Unlikely phenomenology, the experimental approach rarely involves exploratory or open-ended questions as it is a requirement that all variables (independent and dependent) are specified a priori. However, statements of hypotheses can be “two-tailed” whereby the precise relationship expected between two variables is left “open” (i.e. not specified).
Phenomenological research is typically unstructured, with no specific ‘design’ or ‘format’. The researcher is at liberty to proceed as they see fit, merely ensuring that they conform to the basic tenets of philosophy, notably emphasising the first-person and targeting their conscious experience. The setting is usually realistic or naturalistic, so for example, no attempt is made to ‘remove’ the patient from their natural environment. Experimental research is traditionally highly structured. There are specific designs available to the researcher, each with set parameters or protocols. Randomisation of subjects to conditions is critical, to minimise the counfounding effects of nuisance variables. Therefore it is essential to recruit a sample of individuals who serve as participants. They can either be exposed to all conditions of the experiment, leading to a within-groups design, or assigned to just one of the conditions, creating a between-groups design. Independent and dependent variables must be specified clearly, so that there is no uncertainty about the conditions being manipulated, the direction of causality, and outcome measures. The setting is typically artificial – for example a laboratory – with a low degree of realism. It is important to point out that some phenonemonological research assumes that conscious experience is a function of neurological activity in the brain, known as neurophenomenology. This overlap with physiological sciences means that an experimental design may be used to establish the authenticity of certain aspects of conscious experience (e.g. determining whether an experience of motor activity is accompanied by electrical activity in the appropriate regions of the brain).
Data is typically collected using one-to-one interviews between the researcher and the participant, rather similar to private sessions between a patient and their psychiatrist or psychotherapist. The interviews are typically open-ended, thereby “letting things show themselves”, to use Heidegger’s terms. Data collection in experimentation may involve one or more techniques including observational methods (participant and non-participant observation, role playing and simulation, the diary method, and naturalistic observation), interviews and surveys (psychometric tests, structured/semi-structured interviews, clinical method). Whatever technique is used, the goal is to generate quantitative data which would allow mathematical assessments of reliability and validity, and also statistical analysis. Reliability relates to the consistency of a participants responses, while validity indicates whether the appropriate phenomenon of interest is being measured in the first place. Questions in interviews and surveys are typically close-ended, so that the participant can only respond using a pre-determined range of options provided by the experimenter.
The phenomenological method assumes first-person familiarity with the particular experience of interest to the researcher. Data analysis essentially entails description of a conscious experience exactly as it is lived by the participant and presented to the researcher, who does not interfere. The researcher may then attempt to interpret the experience from their particular phenomenological perspective. For example, hermeneutical phenomenologists, such as Heidegger, will try to make sense of the experience by placing it in a social and linguistic context (e.g. who else is involved, and how do the parties communicate). By contrast a naturalistic constitutive phenomenologist will relate the experience to nature, seeking out links with natural environment (e.g. climate, culture, ecology). Regardless of their area of phenomenology, it is essential for the researcher to analyse the type of experience presented, identifying any unique features for further investigation. More recently, data analysis may entail a logico-semantic approach that aims to identify the truth of an experience (e.g. “this disease can be cured”) and the conditions necessary to satisfy an intention (e.g. “I will feel better if I take my medicine”). Phenomenologists also use modern techniques for analysing qualitative data, such as thematic analysis, typologies, quotations, and so on. Data analysis in experimentation requires the use of statistical tests in order to establish the “significance” of any observed changes in the dependent variable, following manipulation of the independent variable. Usually, a ‘level of significance’ is set, depicting a specific probability (e.g. .05) that observed differences between groups or conditions occurred by chance. Typically, the probability of chance must be equal to or less than the chosen significance level in order for the test results to be regarded as significant. There is no attempt by the experimenter to “impose” any interpretation or subjective analysis on the data without the use of statistical tools, which introduce some mathematical objectivity. However, the likelihood of obtaining significant results is often affected by analytic and methodological considerations, such as the sample size and the sensitivity of the chosen statistical test. Furthermore, results that are statistically significant may nevertheless have little or no clinical significance, for example in terms of Quality Life Years, and morbidity and mortality rates.
Table 1 Differences between phenomenological and experimental approaches (selected issues)
CLINICAL PRACTICE Phenomenological and experimental approaches both have an important role to play in clinical practice. Nevertheless, each method may offer very different perspectives on the same medical quandary, or may be more suited to certain problems rather than others. Consider the effectiveness of nurse-led thrombolysis on patients present at an Accidence & Emergency unit with cardiac symptoms. A phenomenological approach would be suitable for obtaining detailed insights into nurses feelings about their effectiveness in administering the procedure, their confidence, doubts, anxieties, suspicions, resentments, and other feelings and beliefs that may explain their clinical competence or otherwise. This may provide managers and consultants with valued ideas about how to support nurses, hence improving service delivery. By contrast the experimental approach will be more amenable to establishing the clinical effectiveness of nurse-initiated thrombolysis, for example in terms of the percentage of fatalities and door-to-needle times. A & E units could be randomly assigned to a condition in which nurses implement thrombolytic procedures, or a control condition in which the intervention is performed by busy consultants. Patient satisfaction rates and hospital delays could then be compared across both conditions using statistical procedures. Although phenomenology and experimentation approach the problem differently, findings from both paradigms will have some clinical benefit if service delivery is ultimately improved.
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