Journey of the clinical facilitator

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VALIDITY AND TRUSTWORTHINESS OF THE RESEARCH

The term ‘trustworthiness’ was used to indicate how the researcher enhanced the validity of the findings, using the criteria described by Herr and Anderson (2005:55) as guidelines. The mixed-method approach used during data collection included both qualitative and quantitative data collection techniques. This allowed the researcher to capture different kinds of data and indicated discrepancies between how things are and how the nurse practitioners wanted or expected them to be. It not only increased the understanding of the issues under investigation, but also increased the validity and decreased the level of known bias of the research (Somekh & Lewin 2005:275). The possible subjectivity of the researcher when using a qualitative approach in a situation in which she is closely involved and even, as in this study, formed part of the PDG had its challenges. It was therefore important to enhance the trustworthiness of the findings during the qualitative data collection and analysis. The principles followed, specifically pertaining to the qualitative approach used, are discussed in Section 1.9.2.

Freedom from harm

Since discomfort and harm may be physical, emotional, spiritual, economic, social or legal (Brink et al. 2006:32) and qualitative approaches are regarded as invasive (Brink et al. 2006:33), the researcher regarded this principle as important as she entered the nurse practitioners’ workplace as well as their lives in the workplace. The researcher recognised that qualitative enquiry risks exploring unresolved issues (Brink et al. 2006:33) and therefore remained vigilant throughout the process. The risks to the participants were minimised as far as possible by conducting the data gathering techniques in a safe environment and with sensitivity. Careful consideration was given to the framing of questions so that no harm would be caused to the participants.

The right to self-determination

The right to self-determination was guaranteed by ensuring the right of the participants to voluntarily participate in the research or to refuse to disclose information of any kind at any stage of the research. Participants could at any stage ask for clarifications about the purpose of the research or any matter concerning the research. Had any person refused to participate, no means of coercion would be applied. An ‘anonymous box’ was set up in the A&E unit into which all participants could submit opinions (positive or negative) about the research at any time.

SIGNIFICANCE AND CONTRIBUTION OF THE RESEARCH

Undoubtedly, recruitment and, more significantly, retention of practice leaders and nurse practitioners in the nursing profession are two high-priority issues (Walker 2005:185). The nurse practitioners in the A&E unit were leaving at a rapid rate, causing severe distress for those staying behind. Staff shortages and high nurse turnover and the effect thereof on the clinical practice and an organisation’s capacity to meet patients’ needs and provide quality patient care have been researched extensively (Aiken, Clarke & Sloane 2002a; Aiken, Clarke, Sloane, Sochalski & Silber 2002b:1987; Freed 2005:97; Hayes et al. 2006:248; Shields & Ward 2001:677). It is time that practice leaders focus on actions that could be taken to retain nurse practitioners and decrease their turnover.

THE SETTING

The setting in which the AR for practitioners project took place was an A&E unit of a tertiary public hospital (teaching hospital), which found itself in an emergency situation due to a perceived toxic environment. Two practice leaders worked in the A&E unit. The unit manager, a first-line manager, had been appointed on 1 June 2005 and was mainly responsible for organising the daily activities in the A&E unit as well as short-term planning, and implementing the plans of middle management (Smit & Cronjé 2002:14). The clinical facilitator had been in the post for a period of three years, but was only formally appointed in April 2005. The clinical facilitator was mainly responsible for the professional development of the nurse practitioners and clinical accompaniment of the A&E learners. The unit manager worked office hours (08:00-16:00, weekdays only), whilst the clinical facilitator worked 12-hour shifts (weekdays and day duty only).

Credibility

Credibility addresses the question of whether the research has established confidence in the truth of the results, and deals with the question of how the results of the research match the reality of the context of the study (De Vos et al. 2002:351). Credibility was addressed by doing an extensive literature review through all three phases of the research (O’Leary 2004:66). Prolonged engagement was ensured as the researcher was actively involved at the research site for a period of two years. Persistent observation was enhanced throughout the study. Data were consistently collected by means of observation and interpreted in different ways by following a process of constant and tentative analysis.

Table of content :

• Declaration
• Dedication
• Acknowledgements
• Abstract
• Table of content
• List of tables
• List of figures
• List of annexures
• List of abbreviations
• Chapter 1: Orientation to the study
  • 1.1 INTRODUCTION
  • 1.2 BACKGROUND AND RATIONALE FOR THE STUDY
    • 1.2.1 The emergency meeting
    • 1.2.2 Shortage of nurse practitioners
    • 1.2.3 Morale of the A&E unit personnel
    • 1.2.4 Change in patient population
  • 1.3 PROBLEM STATEMENT
  • 1.4 RESEARCH QUESTIONS
  • 1.5 AIM AND OBJECTIVES OF THE STUDY
  • 1.6 FRAME OF REFERENCE
  • 1.6.1 Paradigm
    • 1.6.2 Assumptions of the researcher
    • 1.6.2.1 Epistemological assumptions
  • a. The object of the enquiry of the “I”
  • b. Knowledge creation is a collaborative process
    • 1.6.3 Clarifications of the key concepts
      • 1.6.3.1 Accident and emergency (A&E) unit
      • 1.6.3.2 Action learning
      • 1.6.3.3 Benchmarking
      • 1.6.3.4 Coaching
      • 1.6.3.5 Creativity
      • 1.6.3.6 Culture
      • 1.6.3.7 Emancipatory process
• a. Enlightenment
• b. Empowerment
• c. Emancipation
• Chapter 2: The research methodology and process
  • 2.1 INTRODUCTION
  • 2.2 THE SETTING
  • 2.3 AIM AND OBJECTIVES OF THE RESEARCH
  • 2.4 THE RESEARCH DESIGN
    • 2.4.1 Contextual nature of the research
    • 2.4.2 Descriptive nature of the research
    • 2.4.3 Exploratory nature of the research
  • 2.5 THE RESEARCH METHOD
    • 2.5.1 Action research purposes
    • 2.5.2 Action research modes
    • 2.5.3 Validity of action research
      • 2.5.3.1 Outcome validity
      • 2.5.3.2 Process validity
      • 2.5.3.3 Democratic validity
      • 2.5.3.4 Catalytic validity
      • 2.5.3.5 Dialogic validity
• 2.6 RESEARCH APPROACHES
• 2.7 POPULATION/RESEARCH PARTICIPANTS
• 2.8 THE RESEARCH PROCESS
• Phase 1: Independent phase
• 2.8.1 Step 1: Diagnose the emergency situation
• 2.8.1.1 Sampling
• 2.8.1.2 Data collection
• a. Fieldwork
• b. Reflective diary
• Phase 2: Collaborative phase
• 2.8.3 Step 1: Action: Initiating the journey
• 2.8.3.1 Step 1: Cycle 1: Establish the practice development
• group
• a. Sampling
• b. Data collection
• c. Data analysis
• d. Trustworthiness
• 2.8.3.2 Step 1: Cycle 2: Address the barrier
• a. Sampling
• b. Data collection
• c. Data analysis
• d. Trustworthiness
• 2.8.3.3 Step 1: Cycle 3: Explore the challenges
• a. Sampling
• b. Data collection
• c. Data analysis
• d. Trustworthiness
• 2.8.4 Step 2: Address the challenges
• Chapter 3: Action: Initiating and planning the journey
  • 3.1 INTRODUCTION
  • 3.2 INITIATING THE JOURNEY (STEP 1)
  • 3.2.1 Reflection
  • A journey towards emancipatory practice development
  • 3.3 ESTABLISH THE PRACTICE DEVELOPMENT GROUP (STEP 1: CYCLE 1)
    • 3.3.1 Actions planned and implemented
    • 3.3.2 Observations
    • 3.3.3 Reflection
  • 3.4 ADDRESS THE BARRIER (STEP 1: CYCLE 2)
    • 3.4.1 Actions planned and implemented
    • 3.4.2 Observations
    • 3.4.3 Reflection
  • 3.5 EXPLORE THE CHALLENGES (STEP 1: CYCLE 3)
    • 3.5.1 Actions planned and implemented
    • 3.5.2 Observations
• Chapter 4: Journey of the clinical facilitator
  • 4.1 INTRODUCTION
  • 4.2 OVERVIEW OF THE CLINICAL FACILITATOR’S JOURNEY
    • 4.2.1 Timeframe
    • 4.2.2 Coded data
    • 4.3 INITIATING THE CLINICAL FACILITATOR’S JOURNEY
    • 4.3.1 Reflection
  • 4.4 DEVELOP A ROLE (STEP 2: CYCLE 4)
    • 4.4.1 Actions planned
    • 4.4.2 Act and observe
    • 4.4.3 Reflection
  • 4.5 ROFESSIONAL DEVELOPMENT (STEP 2: CYCLE 5)
    • 4.5.1 Action planned
    • 4.5.2 Act and observe
• Chapter 5: Journey of the unit manager
• Chapter 6: Evaluating the worth of the journey
• Chapter 7: Conclusions, lessons learnt and recommendations

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A JOURNEY TOWARDS EMANCIPATORY PRACTICE DEVELOPMENT