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Balcom S, Doucet S, Dubé A. Registered Nurses and Practical Nurses Working Together: An Institutional Ethnography. Glob Qual Nurs Res 2024; 11:23333936231225201. [PMID: 38288369 PMCID: PMC10823840 DOI: 10.1177/23333936231225201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 01/31/2024] Open
Abstract
In Canada, different categories of nursing professionals, including registered nurses and practical nurses, often "collaborate" to provide care to patients. How their collaboration is currently conceptualized in the literature varies; and these conceptualizations are not always contextualized by the complex sociopolitical environment in which nursing professionals work. The purpose of this study was to explicate how different categories of nursing professionals (registered nurses and practical nurses) worked together to provide patient care after a provincial health authority implemented a new nursing care delivery model to "optimize" patient care. The authors used Smith's institutional ethnography to guide the study, and data collection methods included observing, conducting interviews, and identifying the texts activated through the nursing professionals' work. Data analysis focused on the social organization of the nursing professionals collaboration, while keeping the complex contexts within they completed their daily work in view. The article concludes with recommendations for future research.
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Affiliation(s)
- Sarah Balcom
- University of New Brunswick, Fredericton, Canada
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Balcom S, Doucet S, Dubé A. Observation and Institutional Ethnography: Helping Us to See Better. QUALITATIVE HEALTH RESEARCH 2021; 31:1534-1541. [PMID: 34092144 PMCID: PMC8278555 DOI: 10.1177/10497323211015966] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Observation is a staple data collection method, which is used in many qualitative approaches, including both traditional and institutional ethnographies. While observation is one of the most used data collection methods in traditional ethnography, less is written about its use by institutional ethnographers. Institutional ethnography is an approach to social research where the aim is to explicate how peoples' every activities are coordinated or ruled by different institutions. In this article we explore uses of observation as a data collection method, focusing on its use in institutional ethnography. We use examples from the health care literature to show how observation can be beneficial and help institutional ethnographers see better.
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Affiliation(s)
- Sarah Balcom
- University of New Brunswick, Fredericton, New Brunswick, Canada
| | - Shelley Doucet
- University of New Brunswick, Saint John, New Brunswick, Canada
| | - Anik Dubé
- Université de Moncton, Moncton, New Brunswick, Canada
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Nieto-Eugenio I, Ventura-Puertos PE, Rich-Ruiz M. S.O.S! My Child is at School: A Hermeneutic of the Experience of Living a Chronic Disease in the School Environment. J Pediatr Nurs 2020; 53:e171-e178. [PMID: 32334897 DOI: 10.1016/j.pedn.2020.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 03/23/2020] [Accepted: 03/25/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE The purpose of the present study is to understand the experience of living a chronic disease in the school, from the perspective of the parents. DESIGN AND METHODS A Grounded Theory study was proposed with a sample of 14 affected families with children between three and eleven years old, all of them from the west and south of Spain. Information was collected using semi-structured surveys and the constant comparative method was used for the analysis. RESULTS Results are divided into three main themes: SOS! My child is at school, The Systems (don't) Answer and Families Answer. Parents live school enrolment in a state of constant alertness, characterized by distrust, worry, fear, anguish, and indignation. The responses to the problem given by the education and health systems are insufficient, uncoordinated and inefficient. Therefore, parents end up not expecting anything, they transmit the information, organize training sessions, and solve any occurring incident by themselves, often at the expense of quitting their jobs. CONCLUSION The presence of a school nurse would mean for these parents the integration between the education and health systems. PRACTICE IMPLICATIONS As findings highlight, more collaboration and sensitivity between the healthcare and educational system is needed, and the school nurse has been indicated as a crucial figure in this matter.
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Affiliation(s)
- Irene Nieto-Eugenio
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba (UCO), Hospital Universitario Reina Sofía (HURS). Avda. Menéndez Pidal s/n, Córdoba, Spain
| | - Pedro E Ventura-Puertos
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba (UCO), Hospital Universitario Reina Sofía (HURS). Avda. Menéndez Pidal s/n, Córdoba, Spain..
| | - Manuel Rich-Ruiz
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba (UCO), Hospital Universitario Reina Sofía (HURS). Avda. Menéndez Pidal s/n, Córdoba, Spain
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Ng SL, Mylopoulos M, Kangasjarvi E, Boyd VA, Teles S, Orsino A, Lingard L, Phelan S. Critically reflective practice and its sources: A qualitative exploration. MEDICAL EDUCATION 2020; 54:312-319. [PMID: 31914210 DOI: 10.1111/medu.14032] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 09/11/2019] [Accepted: 10/31/2019] [Indexed: 05/17/2023]
Abstract
CONTEXT Critical reflection may improve health professionals' performance of the social roles of care (eg collaboration) in indeterminate zones of practice that are ambiguous, unique, unstable or value-conflicted. Research must explore critical reflection in practice and how it is developed. In this study, we explored what critical reflection consisted of in a context known for indeterminacy, and to what sources participants attributed their critically reflective insights and approaches. METHODS The study context was the interface between health care and education for children with chronic conditions or disabilities necessitating health-related recommendations and supports (eg accommodations or equipment) at school. We conducted a secondary analysis of 42 interview transcripts from an institutional ethnographic study involving health professionals, school-based educators and parents of children with chronic conditions or disabilities. We coded all transcripts for instances of critical reflection, moments that seemed to lack but could benefit from critical reflection, and participant-attributed sources of critically reflective insights. RESULTS Critically reflective practice involved getting to know the other, valuing and leveraging different forms and sources of knowledge, identifying and communicating workarounds (ie strategies to circumvent imperfect systems), seeing inequities, and advocating as collaborators, not adversaries. Participants invariably attributed critically reflective insights to personal experiences such as former careers or close personal relationships. CONCLUSIONS This study shows that personal experiences and connections inspire critically reflective views, and that being critically reflective is not a binary trait possessed (or not) by individuals. It is learnable through personally meaningful experiences. Health professions education could aim to preserve philosophical space for personal experience as a source of learning and integrate evidence-informed approaches to foster critically reflective practice.
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Affiliation(s)
- Stella L Ng
- Centre for Faculty Development, St Michael's Hospital, Toronto, Ontario, Canada
- Wilson Centre for Research in Education, University of Toronto, Toronto, Ontario, Canada
| | - Maria Mylopoulos
- Wilson Centre for Research in Education, University of Toronto, Toronto, Ontario, Canada
| | - Emilia Kangasjarvi
- Centre for Faculty Development, St Michael's Hospital, Toronto, Ontario, Canada
| | - Victoria A Boyd
- Wilson Centre for Research in Education, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Sabrina Teles
- The Department of Recreation and Leisure Studies, University of Waterloo, Waterloo, Ontario, Canada
| | - Angela Orsino
- Developmental Paediatrics, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Lorelei Lingard
- Department of Medicine and Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Shanon Phelan
- Faculty of Rehabilitation Medicine, Occupational Therapy, University of Alberta, Edmonton, Alberta, Canada
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Duitsman ME. Group Assessment of Resident Performance: Valuable for Program Director Judgment? J Grad Med Educ 2019; 11:118-124. [PMID: 31428268 PMCID: PMC6697275 DOI: 10.4300/jgme-d-18-01069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 04/17/2019] [Accepted: 04/23/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Group discussion of resident performance is an emerging assessment approach in postgraduate medical education. However, groups do not necessarily make better decisions than individuals. OBJECTIVE This study examined how group meetings concerning the assessment of residents take place, what information is shared during the meetings, and how this influences program directors' judgment of resident performance. METHODS In 2017, the researchers observed 10 faculty group meetings where resident performance was discussed and interviewed the program directors within a month after the meetings. We used a thematic framework analysis to identify themes from the transcribed meetings and interviews. RESULTS The information shared by group members during the meetings had 2 aims: (1) forming a judgment about the residents, and (2) faculty development. Most group members shared information without written notes, most discussions were not structured by the program director, the major focus of discussions was on residents with performance concerns, and there was a lack of a shared mental model of resident performance. The program directors who benefited most from the meetings were those who thought group members were engaged and summarized the information after every discussion. CONCLUSIONS Unstructured discussions and a lack of a shared mental model among group members impede effective information sharing about resident performance with a developmental approach. Structured discussions with an equal amount of discussion time for every resident and creating a shared mental model about the purpose of the discussions and the assessment approach could enhance use of a developmental approach to assessing resident performance.
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Ng SL, Bisaillon L, Webster F. Blurring the boundaries: using institutional ethnography to inquire into health professions education and practice. MEDICAL EDUCATION 2017; 51:51-60. [PMID: 27582407 DOI: 10.1111/medu.13050] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 11/19/2015] [Accepted: 02/05/2016] [Indexed: 05/23/2023]
Abstract
CONTEXT Qualitative, social science approaches to research have surged in popularity within health professions education (HPE) over the past decade. Institutional ethnography (IE) offers the field another sociological approach to inquiry. Although widely used in nursing and health care research, IE remains relatively uncommon in the HPE research community. This article provides a brief introduction to IE and suggests why HPE researchers may wish to consider it for future studies. METHODS Part 1 of this paper presents IE's conceptual grounding in: (i) the entry point to inquiry ('materiality'), (ii) a generous definition of 'work' and (iii) a focus on how 'texts' such as policies, forms and written protocols influence activity. Part 2 of this paper outlines the method's key features through exemplars from our own research. Part 3 discusses the ways in which research that blurs the lines between educational and clinical practice can be both generative for HPE and accomplished using IE. RESULTS The authors demonstrate the usefulness of IE for studying complex social issues in HPE. It is posited that a key added value of IE is that it goes beyond individual-level explanations of problems and phenomena, yet also closely studies individuals' activities, rather than remaining at an abstract or distant level of analysis. Thereby, IE can result in feasible and meaningful social change at the nexus of health professions education and other social systems such as clinical practice. CONCLUSIONS IE adds to the growing qualitative research toolkit for HPE researchers. It is worth considering because it may enable change through the study of HPE in relation to other social processes, structures and systems, including the clinical practice world. A particular benefit may be found in blending HPE research with research on clinical practice, toward changing practice and policy through IE, given the interrelated nature of these fields.
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Affiliation(s)
- Stella L Ng
- Centre for Faculty Development, St Michael's Hospital, Toronto, Ontario, Canada
- Centre for Ambulatory Care Education, Women's College Hospital, Toronto, Ontario, Canada
- Department of Speech-Language Pathology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Wilson Centre for Research in Education, University of Toronto, Toronto, Ontario, Canada
| | - Laura Bisaillon
- Health Studies, University of Toronto Scarborough, Toronto, Ontario, Canada
- Centre for Criminology and Sociolegal Studies, University of Toronto, Toronto, Ontario, Canada
- Centre for Critical Qualitative Health Research, University of Toronto, Toronto, Ontario, Canada
| | - Fiona Webster
- Wilson Centre for Research in Education, University of Toronto, Toronto, Ontario, Canada
- Centre for Critical Qualitative Health Research, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Ng SL, Lingard L, Hibbert K, Regan S, Phelan S, Stooke R, Meston C, Schryer C, Manamperi M, Friesen F. Supporting children with disabilities at school: implications for the advocate role in professional practice and education. Disabil Rehabil 2015; 37:2282-90. [PMID: 25738906 PMCID: PMC4673542 DOI: 10.3109/09638288.2015.1021021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 02/10/2015] [Accepted: 02/16/2015] [Indexed: 11/13/2022]
Abstract
PURPOSE School settings are a common practice context for rehabilitation professionals; health advocacy is a common and challenging practice role for professionals in this context. This study explored how pediatric practitioners advocate for children with disabilities at school. Specifically, we examined everyday advocacy in the context of school-based support for children with disabilities. METHOD Our theoretical framework and methodological approach were informed by institutional ethnography, which maps and makes visible hidden social coordinators of work processes with a view to improving processes and outcomes. We included families, educators, and health/rehabilitation practitioners from Ontario. Of the 37 consented informants, 27 were interviewed and 15 observed. Documents and texts were collected from the micro-level (e.g. clinician reports) and the macro-level (e.g. policies). RESULTS Pediatric practitioners' advocacy work included two main work processes: spotlighting invisible disabilities and orienteering the special education terrain. Practitioners advocated indirectly, by proxy, with common proxies being documents and parents. Unintended consequences of advocacy by proxy included conflict and inefficiency, which were often unknown to the practitioner. CONCLUSIONS The findings of this study provide practice-based knowledge about advocacy for children with disabilities, which may be used to inform further development of competency frameworks and continuing education for pediatric practitioners. The findings also show how everyday practices are influenced by policies and social discourses and how rehabilitation professionals may enact change. Implications for Rehabilitation Rehabilitation professionals frequently perform advocacy work. They may find it beneficial to perform advocacy work that is informed by overarching professional and ethical guidelines, and a nuanced understanding of local processes and structures. Competency frameworks and education for pediatric rehabilitation professionals may be improved by: encouraging professionals to consider how their practices, including their written documents, may affect parental burden, (mis)interpretation by document recipients, and potential unintended consequences. Policies and texts, e.g. privacy legislation and the Diagnostic and Statistical Manual (DSM), influence rehabilitation professionals' actions and interactions when supporting children with disabilities at school. An awareness of the influence of policies and texts may enable practitioners to work more effectively within current systems when supporting individuals with disabilities.
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Affiliation(s)
- Stella L. Ng
- Centre for Faculty Development, St. Michael's Hospital,
Toronto,
Canada
- Centre for Ambulatory Care Education, Women's College Hospital,
Toronto,
Canada
- Department of Speech-Language Pathology, University of Toronto,
Toronto,
Canada
| | - Lorelei Lingard
- Centre for Education Research & Innovation, Schulich School of Medicine & Dentistry, Western University,
London,
Canada
- Department of Medicine, Schulich School of Medicine & Dentistry, Western University,
London,
Canada
| | - Kathryn Hibbert
- Centre for Education Research & Innovation, Schulich School of Medicine & Dentistry, Western University,
London,
Canada
- Faculty of Education, Western University,
London,
Canada
| | - Sandra Regan
- Arthur Labatt Family School of Nursing, Faculty of Health Sciences, Western University,
London,
Canada
| | - Shanon Phelan
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta,
Edmonton,
Canada
| | | | - Christine Meston
- Centre for Education Research & Innovation, Schulich School of Medicine & Dentistry, Western University,
London,
Canada
- Health & Rehabilitation Sciences, Faculty of Health Sciences, Western University,
London,
Canada
| | - Catherine Schryer
- Department of Professional Communication, Ryerson University,
Toronto,
Canada
| | | | - Farah Friesen
- Centre for Faculty Development, St. Michael's Hospital,
Toronto,
Canada
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Abstract
It is well established in the literature that school-based practice is fraught with challenges such as acquisition of appropriate and sufficient resources, communication barriers among professionals, parental burden, and redundancies and gaps in services. The purpose of this perspective paper is to reframe potentially problematic school-based practices using a critical social science perspective, suggesting a vision and strategies for therapists working in the context of school-based practice. We illustrate our approach with a case example. To reframe school-based practices, we begin with Jill's case, exploring it through a critical lens to identify potential issues and opportunities for change. We then trace these findings to our larger dataset from an ongoing program of research to ensure relevance to the broader context of school-based practice. Reframing of three school-based practice issues is discussed from: (a) advocacy by proxy to collaborative dialogue, (b) governing texts to guiding texts, and (c) playing the "right" part to having a voice. Although this is a perspective paper based on a case exemplar, we posit how we may reframe and rethink school-based practices in pediatric rehabilitation. We suggest that only with a genuine shift in our professional values will we see the enactment of collaborative practice in school-based settings.
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Affiliation(s)
- Shanon K Phelan
- a 1 Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta , Edmonton, Alberta, Canada
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