NUR 608 Module 2 Observation and Reflection Paper Example

Cuffs, Coffee and a Clipboard: Observing a Library Blood Pressure Screening and Reflecting on What a Nurse's Eye Brings to Fieldwork

Student Name

Edson College of Nursing and Health Innovation, Arizona State University

NUR 608: Qualitative Research Design and Methods

Instructor Name

Month Day, Year

Cuffs, Coffee and a Clipboard: Observing a Library Blood Pressure Screening and Reflecting on What a Nurse's Eye Brings to Fieldwork

Part 1: Description of the Observation

Setting: the community room of a branch public library in a mid-sized Arizona city, on a Saturday from 9:30 to 11:00 a.m. A volunteer group from a local congregation runs a monthly free blood pressure screening there. I observed as a member of the public, with the coordinator's permission, sitting at a table near the entrance and taking handwritten notes. I spoke to no one beyond greetings and recorded no names.

The room is rectangular, carpeted in gray, with fluorescent ceiling lights and windows along the east wall facing the parking lot. Two folding tables stand at the far end, each with two chairs, an automated blood pressure monitor, a box of disposable cuff covers, a bottle of hand sanitizer and a stack of half-page paper cards. A third table near the door holds a coffee urn, a plate of wrapped granola bars and a sign-in clipboard. Twelve stacking chairs line the north wall as a waiting area. A rolling whiteboard reads "FREE BP CHECKS 9:30-11 TODAY" in blue marker, with a hand-drawn heart.

Four volunteers are present: two women seated at the screening tables, a man at the sign-in table and a woman who moves between the tables and the waiting chairs. Three wear name tags. One of the women at a screening table wears a lanyard with a badge I cannot read.

At 9:31 the first visitor, an older man in a baseball cap, signs the clipboard, takes a granola bar and sits at the first screening table. The volunteer wraps the cuff around his upper left arm over his shirt sleeve, presses the button and waits, looking at the screen. When the machine beeps, she writes on a card, hands it to him and says, "A little high. Do you have a doctor?" He says, "At the VA," folds the card into his shirt pocket and leaves at 9:35.

Between 9:35 and 10:15, fourteen people arrive, singly and in pairs. Two women speak Spanish to each other while waiting. The volunteer who moves around the room walks over and speaks with them in Spanish; they laugh, and one points to her own wrist. A man in a reflective work vest arrives at 9:52, checks his phone repeatedly while waiting and leaves at 9:58 before being seen. A woman with a stroller is waved ahead to the second table by the sign-in volunteer. One visitor is measured three times; after the third reading the volunteer says, "Let's sit for a minute," and the two talk quietly with their heads close for about four minutes.

From 10:15 to 11:00 the room is quieter. Volunteers refill the coffee and talk among themselves about a church supper. Four more visitors are seen. At 10:58 the volunteers begin packing the monitors into a plastic bin. In total I counted nineteen people screened and one who left unseen.

Part 2: Map of the Setting

Part 3: Reflection

What a Casual Visitor Might Not See

A casual visitor would see a friendly volunteer event. Because I have taken thousands of blood pressures, I noticed technique: cuffs placed over shirt sleeves, readings taken within a minute of sitting down after walking in, a single measurement for most people and no record of which arm was used. I noticed the half-page card, which had space for a number and a box to check "see your doctor," but no explanation of what the numbers meant. I noticed who was missing: no one younger than about 35, apart from the woman with the stroller, and the man in the work vest who left before being seen. These observations are not neutral facts; they are the product of a trained eye looking for what clinical guidelines say should happen.

How My History and Identity Shaped the Observation

Green and Thorogood (2018) describe the observer as part of the setting and the observation as shaped by what the observer brings. I brought eight years of emergency nursing, in which I saw people arrive with strokes who had "known their pressure was a little high." That history made me watch the moment of handing over the card more closely than the coffee table or the conversations about the church supper. A classmate without clinical training might have focused on the social life of the room and seen what I missed: that the screening seemed to function as much as a gathering as a health check. My theoretical presuppositions also shaped what I saw. I am drawn to explanations about access to care, so the man who left unseen became, in my notes, a symbol of people with too little time for prevention. I do not know why he left.

How I Felt

I felt uncomfortable sitting with a notebook while others waited for a health check, as though I were judging volunteers who were giving their Saturday. I felt an urge to step in when I saw a cuff over a sleeve, and I noticed relief when the volunteer took a visitor aside after three readings, as if she had "done the right thing" by my standard. That relief is worth noting: it shows that I was evaluating, not only observing. Ethnographic writers caution that the urge to judge is part of the data about the observer (Emerson et al., 2011). Reporting standards for qualitative research likewise ask researchers to state their own background and relationship to the setting (Tong et al., 2007).

Issues in Writing the Description

Writing the description was harder than observing. My first draft said that the volunteer "seemed worried" about the visitor with three readings. I removed it because I could not observe worry, only that they talked quietly for four minutes with their heads close. I also had to decide how much clinical language to use. Writing "cuff over the sleeve" is description; writing "improper technique" is interpretation, so I kept the first in the description and moved the second to this reflection. The counts and times helped me stay concrete. The hardest part was the Spanish conversation: I understood some words but chose to record only what I could see, since partial translation would have put my interpretation into the record.

Comparing My Experience With a Peer's

In our small group, a classmate observed a food bank distribution line. She described the setting through its rhythm, waiting, moving, waiting, and she wrote little about any one person. My account was organized around individual encounters, almost like patient visits. We realized that each of us had organized our notes in the way our professional training organizes experience: hers as a public health worker who thinks in flows and populations, mine as a nurse who thinks in encounters. Another member, a former teacher, noticed how the children in her setting were managed. These differences confirm the point from our readings that observation is never a neutral recording.

Questions Generated

The observation left me with questions I could study. How do visitors understand the number on the card, and what do they do with it? What does the screening mean to the volunteers who run it? Who does not come, and why? Each question would need a different design, and the last would require going beyond the room.

What I Will Carry Forward

For my own research on escalation in rural hospitals, the exercise showed me that my clinical eye will be both my main tool and my main risk. I will keep a reflexive journal alongside field notes, separate description from interpretation in my notes by using two columns and ask a non-clinician colleague to read early notes to point out what my training has made invisible to me.

Part 4: Oral Report Outline

The 15-minute report will cover the setting and my position (2 minutes), three moments from the description (4 minutes), how my nursing lens shaped what I recorded (4 minutes), what I learned about writing description (3 minutes) and the questions the observation raised (2 minutes).

References

Emerson, R. M., Fretz, R. I., & Shaw, L. L. (2011). Writing ethnographic fieldnotes (2nd ed.). University of Chicago Press.

Green, J., & Thorogood, N. (2018). Qualitative methods for health research (4th ed.). SAGE.

Tong, A., Sainsbury, P., & Craig, J. (2007). Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care, 19(6), 349-357. https://doi.org/10.1093/intqhc/mzm042