Showing papers by "Karen Francis published in 2007"

Grounded theory: a methodological spiral from positivism to postmodernism

Abstract: Aim. Our aim in this paper is to explain a methodological/methods package devised to incorporate situational and social world mapping with frame analysis, based on a grounded theory study of Australian rural nurses' experiences of mentoring. Background. Situational analysis, as conceived by Adele Clarke, shifts the research methodology of grounded theory from being located within a postpositivist paradigm to a postmodern paradigm. Clarke uses three types of maps during this process: situational, social world and positional, in combination with discourse analysis. Method. During our grounded theory study, the process of concurrent interview data generation and analysis incorporated situational and social world mapping techniques. An outcome of this was our increased awareness of how outside actors influenced participants in their constructions of mentoring. In our attempts to use Clarke's methodological package, however, it became apparent that our constructivist beliefs about human agency could not be reconciled with the postmodern project of discourse analysis. We then turned to the literature on symbolic interactionism and adopted frame analysis as a method to examine the literature on rural nursing and mentoring as secondary form of data. Findings. While we found situational and social world mapping very useful, we were less successful in using positional maps. In retrospect, we would argue that collective action framing provides an alternative to analysing such positions in the literature. This is particularly so for researchers who locate themselves within a constructivist paradigm, and who are therefore unwilling to reject the notion of human agency and the ability of individuals to shape their world in some way. Conclusion. Our example of using this package of situational and social worlds mapping with frame analysis is intended to assist other researchers to locate participants more transparently in the social worlds that they negotiate in their everyday practice.

Feminist‐informed participatory action research: A methodology of choice for examining critical nursing issues

Abstract: Identifying a methodology to guide a study that aims to enhance service delivery can be challenging. Participatory action research offers a solution to this challenge as it both informs and is informed by critical social theory. In addition, using a feminist lens helps acquiesce this approach as a suitable methodology for changing practice. This methodology embraces empowerment self-determination and the facilitation of agreed change as central tenets that guide the research process. Encouraged by the work of Foucault, Friere, Habermas, and Maguire, this paper explicates the philosophical assumptions underpinning critical social theory and outlines how feminist influences are complimentary in exploring the processes and applications of nursing research that seeks to embrace change.

Live my work: rural nurses and their multiple perspectives of self

Abstract: Aim. This paper is a report of a study to explore rural nurses' experiences of mentoring. Background. Mentoring has recently been proposed by governments, advocates and academics as a solution to the problem for retaining rural nurses in the Australian workforce. Action in the form of mentor development workshops has changed the way that some rural nurses now construct supportive relationships as mentoring. Method. A grounded theory design was used with nine rural nurses. Eleven semi-structured interviews were conducted in various states of Australia during 2004–2005. Situational analysis mapping techniques and frame analysis were used in combination with concurrent data generation and analysis and theoretical sampling. Findings. Experienced rural nurses cultivate novices through supportive mentoring relationships. The impetus for such relationships comes from their own histories of living and working in the same community, and this was termed 'live my work'. Rural nurses use multiple perspectives of self in order to manage their interactions with others in their roles as community members, consumers of healthcare services and nurses. Personal strategies adapted to local context constitute the skills that experienced rural nurses pass-on to neophyte rural nurses through mentoring, while at the same time protecting them through troubleshooting and translating local cultural norms. Conclusion. Living and working in the same community creates a set of complex challenges for novice rural nurses that are better faced with a mentor in place. Thus, mentoring has become an integral part of experienced rural nurses' practice to promote staff retention.

Breaching the wall: interviewing people from other cultures.

Abstract: The interview as a data collection tool is an essential component of qualitative research. Many nurses are familiar with the process of interviewing through its use in the practice environment; however, in-depth interviewing for the purpose of research is a unique process. The ability to conduct an effective in-depth interview requires skill in the use of specific techniques, in particular when interviewing people from other cultures. A number of factors specific to the researcher, the participant, and the research context can affect the interview procedure. As global margins diminish, nurse researchers will increasingly find themselves working with people from ethnic groups that are different from the dominant culture. This article discusses strategies to improve the interview process in such circumstances. Techniques to enhance the process, along with avoidable potential pitfalls, will be illustrated using an example of conducting research with participants from the culturally diverse environment of Malaysian Borneo.

Taming the rescuer: The therapeutic nature of qualitative research interviews

Abstract: Interviewing in qualitative research allows, indeed encourages, participants to tell their story. Although the researcher might want to hear a certain part of the story, it is not unusual for participants from vulnerable populations to tell the researcher their entire story. This paper explores the dilemmas faced by a researcher when interviewing in a non-sensitive area and explicates the ethical decision-making that occurred during the interviews to prevent blurring of boundaries.

The problem of workforce for the social world of Australian rural nurses: a collective action frame analysis.

Abstract: Aim and background: Globally, nursing workforce shortages are a hot topic for discussion among politicians, academics and clinicians. This paper uses collective action framing to analyse the literature about the problem of workforce for Australian rural nurses. Evaluation: As part of a larger constructivist grounded theory study, we utilize collective action framing to bridge social world mapping and the literature. Data sources included journal databases, newspapers, newsletters and websites. We limited the years searched from 2000 to 2005. This analytical heuristic categorizes text into three main categories: diagnoses of a problem, postulations of solutions and actions to motivate change. Key issues: Having mapped the social world of Australian rural nurses as comprising four groups of collective actors – community, advocates, academics and government – we trace the texts that they have produced with a focus on mentoring as a potential solution to the problem of workforce. Conclusions: Mentoring entered the literature about the problem of workforce for Australian rural nurses because of a combination of political and academic will. These collective groups are now changing how they are framing the problem of workforce to focus instead on the globalization of nursing workforce shortages, which is resulting in diminished support for mentoring activities in clinical practice.

The importance of language for nursing: does it convey commonality of meaning and is it important to do so.

Abstract: Objective: Language is the medium by which communication is both conveyed and received. To understand and communicate meaning it is necessary to examine the theoretical basis of word conceptualisation. The determinants of understanding language however are somewhat elusive and idiosyncratic by nature. This paper will examine briefly the development of language and how language is used in the health care setting, while recognising that nursing is an internationally recognised profession. Setting: In nursing, language is used to facilitate quality care and inform and educate recipients of that care. In today's somewhat litigious society, it is essential that what is transmitted is commonly interpreted by nurses and patients alike. Questions are posed relating to an elitist language for nurses and its placement for communicating with other health care professionals. Primary argument: Through exploring language with a small group of nurses, this paper alludes to consumer expectations; how nurses use a common language; and where and when they move toward a more elitist communication. The paper examines consumer expectations of health care communication and how it facilitates consumer choice and the quality care agenda. Conclusion: Communication for the nursing profession poses a challenge as there are differing requirements for specific situations. Nurses acknowledge that language facilitates commonality of understanding and hence meaning. An elitist language when communicating with other health professionals does exist within specialist units, though where commonality of language ends and an elite language begins is difficult to determine. Language does elicit power and authority when educating and communicating with patients while proving difficult in the context of international global nursing requirements. (author abstract)

Contributing to a culture of learning: a mentor development and support project for Australian rural nurses.

Abstract: Mentoring in rural and remote nursing receives little attention in the literature, even though it is emerging in Australia as a popular strategy to improve the retention of staff. The Association for Australian Rural Nurses established a 2-year Mentor Development and Support Project in 2003 with the aim of promoting mentoring among rural and remote nurses. During the life of the project, 101 such nurses attended Mentor Development Workshops. This project demonstrated that training is an important prerequisite for rural and remote nurses who are planning to enter a mentoring relationship. Participant evaluation showed an increase in mentoring knowledge and skills and a subsequent rise in confidence about undertaking the role. Participants also believed that their increased capacity to mentor was reflected in their workplaces, contributing to a positive culture of learning.

The accidental mentor: Australian rural nurses developing supportive relationships in the workplace

Abstract: Introduction: Like the fictional ‘Accidental Tourist’, an author who does not plan to write about travel, the accidental mentor is an experienced rural nurse who does not plan to be a mentor, and yet assumes that role with new or novice rural nurses as a result of them encountering a critical incident. Accidental mentoring is a short-term relationship that provides support for the new or novice nurse in managing the incident, while maintaining their level of confidence. This article describes the findings from a constructivist grounded theory study that examined Australian rural nurses’ experiences of mentoring, including evidence for a new concept of mentoring – accidental mentoring. Methods: Constructivist grounded theory is a research methodology that focuses on issues of importance for participants around an area of common interest – in this case Australian rural nurse mentoring. In this study, seven participants were interviewed, generating nine transcripts. These were analysed using a process of concurrent data generation and analysis. In addition, the literature regarding rural nurse workforce and mentoring was incorporated as a source of data, using collective frame analysis. Results: Rural nurses live their work, which predisposes them to developing supportive relationships with new or novice rural nurses. Supportive relationships range from preceptoring, to accidental mentoring, mentoring and deep friendship, depending on the level of trust and engagement that is established between the partners and the amount of time they spend together. Accidental mentoring is a short-term relationship that is prompted by experienced rural nurses observing a new or novice rural nurse experiencing a critical incident. Conclusions: Findings are presented that illustrate a new concept of accidental mentoring not present in the current literature around nurse mentoring. A series of recommendations are included that suggest strategies for improved rural nurse retention as an outcome of recognising and developing such supportive relationships in the workplace. Strategies include: performance review and development processes that account for all forms of supportive relationships conducted in the workplace; recognising the importance of developing supportive relationships and allocating time for these; and continuing professional development designed to meet local needs for developing a culture of support in the workplace.

Live my work : rural nurses and their multiple perspectives of self

Abstract: Aim This paper is a report of a study to explore rural nurses' experiences of mentoring Background Mentoring has recently been proposed by governments, advocates and academics as a solution to the problem for retaining rural nurses in the Australian workforce Action in the form of mentor development workshops has changed the way that some rural nurses now construct supportive relationships as mentoring Method A grounded theory design was used with nine rural nurses Eleven semi-structured interviews were conducted in various states of Australia during 2004-2005 Situational analysis mapping techniques and frame analysis were used in combination with concurrent data generation and analysis and theoretical sampling Findings Experienced rural nurses cultivate novices through supportive mentoring relationships The impetus for such relationships comes from their own histories of living and working in the same community, and this was termed 'live my work' Rural nurses use multiple perspectives of self in order to manage their interactions with others in their roles as community members, consumers of healthcare services and nurses Personal strategies adapted to local context constitute the skills that experienced rural nurses pass-on to neophyte rural nurses through mentoring, while at the same time protecting them through troubleshooting and translating local cultural norms Conclusion Living and working in the same community creates a set of complex challenges for novice rural nurses that are better faced with a mentor in place Thus, mentoring has become an integral part of experienced rural nurses' practice to promote staff retention © 2007 The Authors

Does Interpersonal Psychotherapy improve clinical care for adolescents with depression attending a rural child and adolescent mental health service? Study protocol for a cluster randomised feasibility trial

Abstract: Depression amongst adolescents is a costly societal problem. Little research documents the effectiveness of public mental health services in mapping this problem. Further, it is not clear whether usual care in such services can be improved via clinician training in a relevant evidence based intervention. One such intervention, found to be effective and easily learned amongst novice clinicians, is Interpersonal Psychotherapy (IPT). The study described in the current paper has two main objectives. First, it aims to investigate the impact on clinical care of implementing Interpersonal Psychotherapy for Adolescents for the treatment of adolescent depression within a rural mental health service compared with Treatment as Usual (TAU). The second objective is to record the process and challenges (i.e. feasibility, acceptability, sustainability) associated with implementing and evaluating an evidence-based intervention within a community service. This paper outlines the study rationale and design for this community based research trial. The study involves a cluster randomisation trial to be conducted within a Child and Adolescent Mental Health Service in rural Australia. All clinicians in the service will be invited to participate. Participating clinicians will be randomised via block design at each of four sites to (a) training and delivery of IPT, or (b) TAU. The primary measure of impact on care will be a clinically significant change in depressive symptomatology, with secondary outcomes involving treatment satisfaction and changes in other symptomatology. Participating adolescents with significant depressive symptomatology, aged 12 to 18 years, will complete assessment measures at Weeks 0, 12 and 24 of treatment. They will also complete a depression inventory once a month during that period. This study aims to recruit 60 adolescent participants and their parent/guardian/s. A power analysis is not indicated as an intra-class correlation coefficient will be calculated and used to inform sample size calculations for subsequent large-scale trials. Qualitative data regarding process implementation will be collected quarterly from focus groups with participating clinicians over 18 months, plus phone interviews with participating adolescents and parent/guardians at 12 weeks and 24 weeks of treatment. The focus group qualitative data will be analysed using a Fourth Generation Evaluation methodology that includes a constant comparative cyclic analysis method. This study protocol will be informative for researchers and clinicians interested in considering, designing and/or conducting cluster randomised trials within community practice such as mental health services. Australian Clinical Trials Registry ACTRNO12607000324415

A safety net: use of pseudonyms in oral nursing history.

Abstract: This paper explores the use of pseudonyms in a historical study that weaves oral testimony throughout the narrative. The research was undertaken to unveil the experiences of Australian Army nurses in Malaya's Communist insurgency (1948-1960). Thirty-three women from the Royal Australian Army Nursing Corps served in this conflict termed the Malayan Emergency, but only four nurses could be located for this study. After almost fifty years of silence the female nursing voice emerged as the informants spoke at interview of their unique personal and military experiences in Malaya. It is acknowledged that assigning the nurse informants pseudonyms, as opposed to using their names, constitutes a significant deviation from the established traditions of oral history. However, it is argued that the use of pseudonyms provided an opportunity for candid disclosure by the nurses on a range of topics whilst keeping the informants safe from adverse public or military scrutiny.

Multipurpose Services and Palliative Care: Emerging Funding Challenges and Possible Solutions

Abstract: The changing demographics of rural communities in Australia had rendered some health services inappropriate for small acute hospitals to deliver. Many of these small rural acute hospitals, which the government believed were not sustainable, accepted a new concept in healthcare servicing in the mid 1990s; the Multipurpose Service (MPS). MPS combined and consolidated allocated funding from both the state and Australian governments to service the identified needs of the local community and outlying areas through a service plan. Residential aged care is an integral part of an MPS service plan. The provision of funding for residential aged care in MPS is in contrast to the funding of specific purpose Residential Aged Care Facilities (RACF), (Aged Care Act, 1997). The Aged Care Act 1997 being synonymous with the funding of RACF reformed and revolutionised institutional residential aged care. The Aged Care Act 1997 provided a funding system which increased payment for a resident's increasing frailty through the Resident Classification Scale, in order to provide extended nursing care to the ill/dying. Caring for the ill/dying has always been a part of institutionalised aged care nursing, though deemed by government to be fragmented in the context of the Guidelines for a Palliative Approach in Residential Aged Care. There is an expectation that residents who are ill/dying who reside in MPS receive nursing care in accordance with the Guidelines for a Palliative Approach, despite the difference in the funding arrangements. This paper will examine the variance of funding relationships associated with the provision of palliative care, between RACFs and MPSs to ascertain whether the funding variation has implications for the delivery of palliative care to residents and offers some options for addressing these perceived problems.

Invisible partners: the Royal Australian Army Nursing Corps pathway to the Malayan Emergency.

Abstract: This paper highlights the role of women from the Royal Australian Army Nursing Corps who served in the Malayan Emergency. The British administrators of Malaya declared an Emergency in 1948 in response to threats posed by Chinese Communist Terrorists. Australia was slow to support Britain, but in 1955 Australian ground troops, accompanied by six Army nurses were deployed to Malaya. The nurses worked in British Military Hospitals, continuing the traditions of their antecedents; yet their contributions remain hidden from view. The exact number of Australian nurses who served in the Emergency is unknown, because of the poor record-keeping of the Southeast Asian conflicts. However, it is estimated that 33 Australian Army nurses served in Malaya from 1955, with some continuing their service into the early 1960s. The experiences of four of these nurses are revealed in this paper: they are no longer invisible partners.