In my early doctoral research, I studied family caregivers for older people in the community; the goal was to gain understanding of their everyday experience of care giving. One of the themes of meaning that I drew from the ethnographic interviews was a theme of “managing.” The caregivers approached their everyday care giving in a way that helped them achieve “a sense of managing,” — or not.
At first, the descriptions in the interviews of organizing, scheduling, and adapting the everyday tasks of care giving in their daily lives seemed to be testimony to the core meanings of managing. I found that having a “sense of managing” was an at-risk part of their daily lives that caregivers worked hard to protect. Two examples: One caregiver described the exercise routines that the physical therapist had asked her to do several times a day with her husband, but, she said, “I didn’t know how I would ever get my work done. So I figured out a way to do his leg exercises just once before he gets out of bed in the morning, and that seems to work.” Another caregiver made a chart of daily and weekly routines — specific helpers coming in and specific tasks being done at specific times. When the scheduled routines didn’t happen as planned, she referred to the incidents as “emergencies.”
Then, somewhere in the middle of the months of doing the interviews, I came up against an entirely different narrative. In my first of four interviews with Caregiver #9, I started with my usual ethnographic opener: “Can you start by describing for me what your day is like?” As part of his response that day, this husband-caregiver told me that, for him, he had to “take things as they come.” He said it made him nervous to try to plan things out; he preferred to just take the days one by one and handle whatever was needed “as things come up.”
Aha! This was an instance of dis-confirming data for me — his approach to his care giving took a form that was different from the domain of “managing” I had been developing before seeing him. I remember feeling unsettled and puzzled by this lack of planned routines in his daily life. But soon after that first reaction, I began to see how “taking things as they come” was also part of the meanings of “managing.” Managing is not merely getting organized and scheduled for each day. The caregiver who had to “take things as they come” was sharing with me his way of managing.
Caregiver #9 led me to expand my thinking and go deeper. What else was I missing?
Well, as it turns out, I was missing a lot. Rather quickly, I realized how much more there was to the meaning of a “sense of managing.” Being able to meet the caregivers’ standards for ordinary daily living — cleanliness, preventing falls, keeping the bed dry, preventing bed sores, finding things for the care-receiver to do during the day, etc. — were all important contributors to having a sense of managing. We could view this single example of “taking things as they come” as an outlier, but, if we do, we are dismissing the richness of understandings that this caregiver gave me. How family caregivers organized their days and weeks was a good start to understanding a sense of managing, but it was only the tip of the iceberg.
When I was editor of The American Journal of Occupational Therapy, I always looked for the author’s description of dis-confirming data and how it contributed to her or his analysis of the data. I came to believe that dis-confirming data need to be addressed in qualitative research and in the published manuscript. If the author makes no mention of it, it seems likely that the data have not been studied deeply enough.