The treachery of 'participant observations'

Since Feb 23rd, I've spent 8 days in the emergency department (ED) at [Teaching hospital] conducting 'participant observations'. The broad research question guiding my efforts so far is -

How can information and communication technologies (ICTs) be leveraged to alleviate emergency department overcrowding?

My research proposal reads "ICTs have the potential to aid three kinds of flows in the ED - information, communication, and resource flows. I intend to use ethnographic methods such as observations, interviews, and focus groups with healthcare providers to examine these flows and how ICTs affect these flows. "

And so I've started with 'ethnographic methods' and am currently conducting participant observations. But having spent 8 days and almost 17 hours in the ED, I am feeling a little lost about what it really means to do an ethonography. And what is the difference between ethnography and participant observation. Coming from an engineering (and hence a very quantitative) background, I am still unsure about how to apply qualitative methods, even though I think they are best suited to examine the problem I have picked for my research.

So I've been reading up on ethnography and I'm finding it hard to wade through the philosophical explanations and extract meaning and practical tips from the dense writing of the sociological and anthropological traditions. However, I found an interesting paper which says that "ethnography and participant observation should not be used interchangeably since ethonography is a methodology that deals with "the desciption and explanation of regularities and variation within a culture" while participant observations is a way of gathering data [1]. Then there are various kinds of participant observation, ranging from 'participant as a fly on the wall' to 'participant actively participating in the research domain'. I am certainly in the former category right now and don't expect for my role to be anything other than a passive observer. And then there is the role of rhetoric in capturing and describing the observations. Much of the meaning and analysis of the data collected depends on how the ethnographic notes are written as well as how the data is presented to an audience.

Right now, I am focussing on 'blending into' the work environment of the Medical Center. This is hard because it requires me to become less self-conscious and more comfortable in a strange environment as well as requires the participants (those working in that environment) to trust and accept my presence in their world. Its a give-and-take process and as I gain their trust, they accept my presence, and this in turn makes me more comfortable. I did not realise how physically, mentally, and emotionally strenuous ethnographic research can be. But I'm enjoying the challenge and learning a lot about the medical domain.

[1] Savage, J. (2000). Participative observations: Standing in the shoes of others? Qual Health Res;10, p. 324 - 339. Available at http://qhr.sagepub.com/cgi/content/abstract/10/3/324