2008 QHR: Qualitative Health Research Conference Abstracts

2009 International Journal of Qualitative Methods  
The principles of ethnography were used to map the development of decision-making skills in student midwives during training and after qualification in the United Kingdom. The 49 participants were a combination of students, midwives who had been qualified for less than a year, and midwifery mentors. The data collection methods consisted of focus groups, observations of practice, and individual semistructured interviews. Data analysis followed the principles of coding data, category, theme, and
more » ... etatheme formation described by Garner (1991) and Ely et al. (1997). The classification of the nature of professional knowledge and typology of nonformal learning created by Eraut (2000) was used to identify where explicit and implicit learning occurred. Very little knowledge related to decision-making was gained from formal teaching sessions in the classroom. The personal knowledge or "know-how" surrounding decision-making was acquired by the student working alongside the mentor in practice. Consequently, the relationship between learner and mentor and the quality of mentoring itself became strong influences. Findings suggest that study participants use a number of strategies to learn the skill of decisionmaking. These strategies include seeing the outcome of care, predicting and anticipating events, pattern recognition, self and group reflection and the use of heuristics. Other factors that helped or hindered decision-making were evident, such as confidence and emotion management, getting to know the woman, and contextual and environmental influences. Vignettes were created to represent composites of the findings; these were presented to study participants in a focus group as a means to achieve respondent validation. In recent years U.K. ambulance services have been involved in widening health care provision within outof-hospital unscheduled urgent care settings. As a result, paramedics have seen a significant expansion to their scope of clinical practice. To support these developments, it is essential to provide a solid academic foundation to underpin paramedic practice and clinical decision-making, and to foster understanding of evidence-based practice and research. In an attempt to increase paramedic students' motivation to "get to grips" with research methods and critical appraisal skills, an observational research elective was introduced into a preregistration paramedic science degree program allowing students to explore areas of health care that specifically interested them, either in the United Kingdom or overseas. In a study informed by an interpretative methodology, 20 final year students participated in focus groups designed to explore their experiences of these electives and to evaluate this learning activity's relevance to their professional development. Rigorous thematic analysis facilitated identification of emergent themes, including Research awakening, Transition from topic "novice" to topic "expert," and Development of a unique professional identity with interprofessional recognition. Preliminary findings indicate overwhelming support for this initiative with participants describing success of the elective on several different levels. Students demonstrated renewed interest in finding out more about research processes as they wanted to learn how to effectively contribute to the construction of an evidence base to underpin professional practice. Overall, participants recognized that an increased knowledge level about research methods, in conjunction with development of critical appraisal skills, is necessary to sustain continued clinical progression within the paramedic profession. It is well established that economic and racial inequalities are significant factors for health disparities. What is less well understood are the acts of resistance and resilience within families and communities that are protective against the ill-health effects of poverty and racism across the lifespan. In this paper the author presents an analysis of extensive research on gendered racism and its link to adverse birth outcome and disparate chronic diseases among African American women living in Atlanta, Georgia. Her objective is to present analysis of qualitative data from interviews and focus groups describing and comparing the lives of research collaborators (participants) with their mothers to demonstrate generational exposure and resistance to the multiplicative stressors of race, gender, and class impacting health outcomes. Quantitative findings from the results of a unique measure derived from the qualitative data of the study, the Jackson, Hogue, Phillips Contextualized Stress Measure, will also be integrated into the presentation to advance an assets model steeped in the lived experiences of African American women as the foundation for health interventions expressly designed for African American women. Creating a life vision for oneself can have a significant and profound impact in one's life. It can influence and direct choices, environments and occupations. Very little has been written in occupational therapy literature about this important aspect of life. In this study the author explores the experience of creating a life vision. Heuristic (Clarke Moustakas) and organic transpersonal (Clements, Ettling, Jenett and Shields) approaches were used. These emphasize the researcher's own in-depth exploration and experience of the topic as the primary data source, the telling of stories and a creative synthesis. This study also used indepth interviews and life vision narratives from the researcher and 7 participants aged 30 to 70 years and a focus group to uncover experiences of visioning. The findings indicate that there are two journeys that participants go on-an outer journey that is more worldly and linear, and an inner journey that comes from an intuitive place within and speaks to existential, spiritual and transpersonal domains of concerns-but that both of these experiences of learning are needed to create an integrated and deep sense of purpose and life vision. Implications. Person-centeredness involves more than assessments, interventions, and treatments. Professionals might need to stand beside the person on their journey of discovery (after a spinal cord injury, after cancer). Therapists must also be willing to experience their own journey of discovery, to create their life visions, and to live their own dreams if they are to be a guide for others. Both the "art" and "science" of occupational therapy practice are essential to maintaining excellence in the provision of service. Although the current evidence-based climate favors the science of practice, artistry is intrinsic in daily practice, essential to high quality of care, and part of the clinical decision making process. A phenomenological approach was used to explore the meaning of artistry in occupational therapy practice. Data were collected from three occupational therapists using in-depth interviews. Approximately 14.5 hours of interview data were collected. Data management was facilitated through the use of NVivo software and Moustakas's method of analysis was employed to interpret the data. Both individual and composite portraits of participants were completed for analysis, providing an overall understanding of the experience. Rigor in this study was addressed through clarification of researcher bias, triangulation of data collection methods, debriefing, rich thick description, and member checking. Results illuminated the meaning of professional artistry to occupational therapists in their daily practice, indicating that professional artistry is at the very heart of occupational therapy practice, is central to the establishment of therapeutic relationships, and provides therapists with the greatest meaning in their practice. An alignment of personal and professional values provides the groundwork for the development of professional artistry and through this development of artistry there is a further valuing of occupational therapy practice. Findings from this study have implications for professional practice and recruitment to the profession. Explicating the art of practice fosters its development and expands occupational therapy's body of research knowledge. This grounded theory study examined the perceptions of children living with a parent with a mental illness. The aim of the study was to construct a substantive theory to explain how children perceived and managed the experience of living with a parent with a mental illness. Data were collected through interview, participant observation, and field notes. Twenty two children between the ages of 6 and 16 who were living full-or part-time with a parent with a mental illness were interviewed. Theoretical sampling was used to identify incidents and participants; 10 children were interviewed twice. Data collection and analysis were undertaken concurrently. The core variables suggest that children focus their energy and time on finding the rhythm with their parents while maintaining the frame by establishing connections within a safe and comfortable distance between themselves and their parents. The findings suggest most children were comfortable in their homes and wished to be there, children and their parents coexisted in reciprocal relationships, and children were often managing their circumstances with little information about the mental illnesses. All of the children navigated emotional currents that affected how they were able to find the rhythm and to maintain the frame. Although these children valued their parents and were able to see their parents beyond the mental illnesses, they experienced painful emotions in managing their circumstances. The findings have important implications for nursing practice, education and research; as well as policies that address the larger issues that affect these children and their families. Cooperative inquiry is a form of action research concerned with facilitating practice change through the self-critical examination of experience. Co-researchers get engage in cycles of action and reflection that can take many forms. A balance between reflection and action should be found to help participants look at their beliefs and theories critically and improve the quality of their practice (Reason, 1999). The aim of this paper is to describe the cycles of action and reflection of a cooperative inquiry used to facilitate the integration of work rehabilitation scientific evidence into occupational therapy practice. Eight occupational therapists who attended a 4-day workshop on evidence-based work rehabilitation were recruited to participate to a reflective practice group. The group met once a month during one year. Different learning strategies were used to progressively achieve balance between reflection and action. Data were analyzed using the grounded theory method. Co-researchers engaged in five cycles of action and reflection. The first cycle was concerned with describing the client's work disability problem in a new way. The second cycle aimed at recognizing the gap between the new understanding and practice. The third cycle was related to exploring new evidence-based approaches. The fourth cycle allowed participants to explore their client centered-practice skills. Finally, the fifth cycle helped participants review their report writing and discuss their use of theoretical models. Not all participants achieved the same level of reflection and practice change but co-operative inquiry was a good strategy to facilitate the integration of evidence into practice.
doi:10.1177/160940690900800303 fatcat:unc7rauwyrgghjkpib2i7mdrdm