DEVELOPMENT OF THE DRAFT STRATEGIES TO PRESERVE THE PROFESSIONAL DIGNITY OF NURSES IN PRIVATE HEALTHCARE FACILITIES

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Selection of participants for the refinement of the strategies

The target population for the current study comprised managers, professional nurses and members of the health team working in private healthcare facilities in South Africa. The accessible target population comprised health professionals who were associated with the selected private healthcare facilities, including 447 professional nurses, 20 hospital management members (general managers, doctors and nurse managers) and 395 health team members (members other than nurses). Health team members comprised of 273 medical practitioners, 106 practitioners (physio therapists, dietitians and occupational therapists) and 16 pharmacists. Purposive sampling was applied in selecting participants to be included in the focus group interviews for refinement of the strategies to preserve the professional dignity of nurses. Purposive sampling is a method used to deliberately choose a sample of participants for their unique characteristics to contribute to the research topic (Ritchie, et al. 2003:78). Researchers ask the following question in considering participants for a purposive research study sample: “What types of people have the greatest amount of insight on this topic?” (Krueger & Casey, 2015:57).

Preparing for the focus group interview

The researcher prepared a draft set of strategies to preserve the professional dignity of nurses from the findings in phase 1 of the experiences of nurses of the factors impacting on their professional dignity. The draft set of strategies is included in Chapter 5 of this thesis. The nurse managers of the two healthcare facilities were approached for assistance with the identification and selection of participants, suitable dates for interviewing, an appropriate interviewing facility and for the provision of contact details of the selected participants. Eight focus group interview participants and a co-facilitator were identified in private healthcare facility 1. Participants included the hospital general manager, clinical manager, nurse manager, medical practitioner, pharmacy manager, unit manager, senior professional nurse and professional nurse. Eight focus group interview participants and a co-facilitator were identified in private healthcare facility 2. Participants included the hospital general manager, financial administrative manager, nurse manager, pharmacy manager, unit manager, clinical facilitator, senior professional nurse and deputy nurse manager. The boardroom was found to be an appropriate facility for privacy, minimum disturbance and comfort in both private healthcare facilities. The researcher confirmed the availability and booking of the board room at both facilities.

Focus group interview 1

Permission to conduct focus group interviews was obtained from the 1st participating private healthcare facility prior to commencement of phase 1 of the study (Refer to Annexure B). This 377 bedded healthcare facility is one of the largest private healthcare facilities in South Africa and is well known as a super speciality city hospital with state of the art equipment and facilities. Multi-disciplinary intensive care and general units provide medical and nursing care serving all major specialities such as cardiac and cardiothoracic disciplines. The researcher received a warm and friendly welcome from the managers on the day of the focus group interview. The researcher met the medical practitioner prior to the focus group interview for a face-to-face discussion. Relevant strategies and actions were discussed.
The discussion took 30 minutes. Although no suggestions or changes were made during the discussion, appreciation for the discussion was expressed and the relevance of the topic was confirmed. The board room was available one hour prior to the commencement of the focus group interview to prepare the facility. After confirmation of all participants’ attendance the researcher introduced herself and welcomed all participants. The focus group participants were familiar with each other, rendering the introduction of participants unnecessary. A brief introduction of the study and the purpose of the focus group discussion were presented. Informed consent was discussed and the documents were signed and handed to the researcher. Opportunity for questions was given and group ground rules discussed and agreed upon. The role of the co-facilitator was clarified and the process of refinement of the strategies was explained. A power point presentation was used to facilitate the discussion and revise and refine strategies with actions one by one. Participants were provided with a hard copy of the power point presentation and were encouraged to make notes on the document during the discussion. Each strategy with actions were brainstormed and debated comprehensively. Changes were agreed upon by all group members before moving on to the next strategy. Group members’ conduct was professional. They remained focussed and provided inputs and suggestions for changes.

Focus group interview 2

Permission to conduct focus group interviews was obtained from the healthcare facility prior to commencement of phase 1 of the study (Refer to Annexure B). This 238 bed healthcare facility is a medium sized city hospital with state of the art equipment and facilities and provides intensive care and general units serving all major specialties in accordance to the unique disease patterns of the area. The researcher drafted a new refined set of strategies for preserving nurses’ professional dignity for focus group interview 2, guided by the responses from focus group 1’s participants. She considered inputs from the focus group interview and the notes made by participants during focus group interview 1. Changes were made as suggested by the group, grammar errors were corrected and some words were rephrased. Field notes, compiled by the cofacilitator, were considered. The nurse manager and participants were approached in the same manner as during the preparation phase of focus group 1.
The refined strategies were discussed and debated one by one and changes were made from the participants’ inputs. The researcher enjoyed a very active participating focus group interview comprising divergent participants. This focus group discussion lasted two hours. The group composition was similar to that of focus group 1 but had more diverse participants. The clinical manager was replaced by the financial administrative 69 manager representing hospital management. The researcher was unable to secure the participation of a medical practitioner and a pharmacy manager participated as a member of the health team during the focus group discussion. A final set of strategies to preserve the professional dignity of nurses was formulated by implementing the recommendations of the focus group’s participants.

ETHICAL CONSIDERATIONS

Conducting research in an ethical manner requires researchers to portray honesty and integrity in their methodological approaches towards their participants. Careful consideration should be given to informed consent, confidentiality, anonymity and courtesy while engaging with research participants (Walliman, 2011:43). The researcher considered the ethical principles of beneficence, respect for human dignity and justice, as stipulated in the Belmont Report, in conducting both phases of the current study (Polit & Beck, 2017:139)

TABLE OF CONTENTS PAGE :

• Declaration
• Dedication
• Acknowledgements
• Abstract
• List of abbreviations
• CHAPTER 1: INTRODUCTION TO THE STUDY
  • 1.1 INTRODUCTION
  • 1.2 BACKGROUND
    • 1.2.1 Historical development of the concept of dignity
    • 1.2.2 Nursing practice and dignity
    • 1.2.3 Nursing practice and the professional dignity of nurses
    • 1.2.4 Healthcare and the professional dignity of nurses
  • 1.3 PROBLEM STATEMENT
  • 1.4 RESEARCH QUESTION
  • 1.5 AIM OF THE STUDY
  • 1.6 RESEARCH OBJECTIVES
  • 1.7 SIGNIFICANCE OF THE STUDY
  • 1.8 CLARIFICATION OF THE KEY CONCEPTS
  • 1.9 OUTLINE OF THE CHAPTERS
  • 1.10 SUMMARY
• CHAPTER 2: PARADIGMATIC PERSPECTIVE, PHILOSOPHICAL FRAMEWORK AND RESEARCH METHODOLOGY
  • 2.1 INTRODUCTION
  • 2.2 PARADIGMATIC PERSPECTIVE (PHASE 1)
    • 2.2.1 Research paradigm
    • Meta-theoretical assumptions: constructivist paradigm
  • 2.3 PHILOSOPHICAL FRAMEWORK (PHASE 1)
    • 2.3.1 Epistemological and ontological assumptions
    • 2.3.2 Methodological assumptions
  • 2.4 RESEARCH METHODOLOGY (PHASE 1)
    • 2.4.1 Research design
    • 2.4.2 Research method
      • 2.4.2.1 Assuming the phenomenological attitude
      • 2.4.2.2 Researcher’s role
      • 2.4.2.3 Research setting
      • 2.4.2.4 Selection of participants
      • 2.4.2.5 Data collection
      • 2.4.2.6 Data analysis
      • 2.4.2.7 Description of findings
      • 2.4.2.8 Literature review
    • 2.4.3 Measures to ensure trustworthiness
      • 2.4.3.1 Credibility
      • 2.4.3.2 Authenticity
      • 2.4.3.3 Transferability
      • 2.4.3.4 Dependability and confirmability
• 2.5 PHASE 2: DEVELOPMENT OF STRATEGIES TO PRESERVE THE PROFESSIONAL DIGNITY OF NURSES IN THE DEMANDING HEALTHCARE ENVIRONMENT OF PRIVATE HEALTHCARE FACILITIES
• 2.5.1 Philosophical assumptions
• 2.5.2 Ontological assumptions
• 2.5.3 Epistemological assumptions
• 2.5.4 Methodological assumptions
• 2.5.5 Research design
• 2.5.6 Research method
• 2.5.6.1 Focus group interviews as a research method
  • 2.5.6.2 Researcher’s role
  • 2.5.5.3 Research setting
  • 2.5.6.4 Selection of participants for the refinement of the strategies
  • 2.5.6.5 Inclusion criteria
  • 2.5.6.6 Data collection
  • 2.5.6.7 Data organisation and analysis
• 2.5.7 Trustworthiness
• 2.6 ETHICAL CONSIDERATIONS
• 2.6.1 Beneficence
• 2.6.2 Respect for human dignity
• 2.6.3 Justice
• 2.7 SUMMARY

• CHAPTER 3: PRESENTATION OF FINDINGS OF THE STUDY (PHASE 1)
  • 3.1 INTRODUCTION
  • 3.2 DESCRIPTION OF THE ESSENCE OF THE PHENOMENON AND CONSTITUENTS
  • 3.2.1 Perceiving one’s own professional dignity
  • 3.2.2 Having contradictory experiences
  • 3.2.3 Being proud to be a professional nurse
  • 3.2.4 Receiving support, appreciation and respect
  • 3.2.5 Providing care in complex situations
  • 3.2.6 Performing as a professional nurse
  • 3.2.7 Valuing patient well-being
  • 3.2.8 Being humiliated by others
  • 3.3 SUMMARY
• CHAPTER 4: PHASE 2: DISCUSSION OF THE FINDINGS, WITH A LITERATURE CONTEXTUALISATION, FOR THE DEVELOPMENT OF STRATEGIES TO PRESERVE THE PROFESSIONAL DIGNITY OF NURSES IN PRIVATE HEALTHCARE FACILITIES
  • 4.1 INTRODUCTION
  • 4.2 PROFESSIONAL STANDING DUE TO OWN AND OTHERS’ PERCIPIENCE
  • 4.3 DISCUSSION OF CONSTITUENTS
    • 4.3.1 Perceiving one’s own professional dignity
    • 4.3.2 Having contradictory experiences
    • 4.3.3 Being proud to be a professional nurse
    • 4.3.4 Receiving support, appreciation and respect
    • 4.3.5 Providing care in complex situations
    • 4.3.6 Performing as a professional nurse
    • 4.3.7 Valuing patient well-being
    • 4.3.8 Being humiliated by others
  • 4.4 SUMMARY
• CHAPTER 5: PHASE 2: DEVELOPMENT AND REFINEMENT OF STRATEGIES TO PRESERVE THE PROFESSIONAL DIGNITY OF NURSES IN A DEMANDING HEALTHCARE ENVIRONMENT OF PRIVATE HEALTHCARE FACILITIES
  • 5.1 INTRODUCTION
  • 5.2 DEVELOPMENT OF THE DRAFT STRATEGIES TO PRESERVE THE PROFESSIONAL DIGNITY OF NURSES IN PRIVATE HEALTHCARE FACILITIES
  • 5.2.1 Sensing
  • 5.2.2 Making sense
  • 5.2.3 Designing
  • 5.2.4 Enacting
  • 5.3 DRAFT STRATEGIES TO PRESERVE THE PROFESSIONAL DIGNITY OF NURSES
  • 5.4 PROCESS OF REFINEMENT OF THE DRAFT STRATEGIES TO PRESERVE THE PROFESSIONAL DIGNITY OF NURSES
  • 5.5 INTRODUCTION TO THE DRAFT STRATEGIES
  • 5.6 DESCRIPTION OF THE DRAFT STRATEGIES AND THE RECOMMENDED IMPROVEMENTS AS OUTCOMES OF THE FOCUS GROUP INTERVIEWS
  • 5.7 SUMMARY
• CHAPTER 6: THE GUIDELINES, RECOMMENDATIONS, IMPLICATIONS AND CONCLUSIONS
  • 6.1 INTRODUCTION
  • 6.2 SUMMARY OF THE STUDY
  • 6.3 DESCRIPTION OF THE STRATEGIES
  • 6.4 RECOMMENDATIONS FOR PRACTICE AND RESEARCH
  • 6.5 IMPLICATIONS FOR NURSING
  • 6.6 LIMITATIONS OF THE STUDY
  • 6.7 CONCLUSION
  • REFERENCES

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STRATEGIES TO PRESERVE THE PROFESSIONAL DIGNITY OF NURSES IN A DEMANDING HEALTHCARE ENVIRONMENT