Coproducing knowledge through practitioner research an example from research into nursing expertise

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Co-producing knowledge through practitionerresear
ch an example from research into nursing
expertise

• Brendan McCormack,
• Professor of Nursing Research/Postgraduate Tutor,
  University of Ulster
• Adjunct Professor of Nursing, Monash University,
  Melbourne, Australia
• Visiting Professor, University of Northumbria,
  Newcastle, England

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The Yes and of Transformational Research
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The Intent of Emancipation

• To redress a situation in which a group is
  experiencing dissatisfaction as a result of the
  way their lives are arranged. The aim is to
  overturn these arrangements and to put into place
  another set in which people can relate and act in
  fuller, more satisfying ways (after Fay, 1987)
• Emancipatory research and development is focused
  on facilitating and understanding human potential
  and growth of the whole person (McCormack
  Titchen in press)
• and develop new knowledge about effective
  processes and outcomes

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• We may be entering an age of greater
  spirituality within research efforts. The
  emphasis on inquiry that reflects ecological
  values, on inquiry that respects communal forms
  of living that are not Western, on inquiry
  involving intense reflexivity regarding how our
  inquiries are shaped by our own historical and
  gendered locations, and on inquiry into human
  flourishing as Heron and Reason (1997) call it,
  may yet reintegrate the sacred with the secular
  in ways that promote freedom and
  self-determination ... We may be in a period of
  exploring the ways in which we can both be and
  promote others being, as whole human beings
  (Lincoln Denzin, 2000, p. 185).

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What is Practitioner Research?

• practitioner research is a formal and systematic
  attempt made by practitioners either alone, or in
  collaboration with others, to understand their
  work, with the intended purpose of making public
  new knowledge about the transformation of self,
  colleagues and work contexts McCormack 2009,
  adapted from McCormack 2003

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Common Principles

•  is planned for the future of practice.
• utilises research processes that are negotiated
  and that are an integral component of practice
  development.
• adopts processes that are based in practice and
  supported by a variety of potential supervisory
  frameworks (e.g. academic supervision clinical
  supervision mentorship external facilitation
  appraisal action learning).
• focuses on personal and professional
  effectiveness.
•  enables the systematic development of practice
  and an integrated approach to the evaluation of
  the effectiveness of structures, processes and
  outcomes.
• Considers knowledge to be contextually bound and
  therefore new knowledge is derived from and
  engagement with the realities of practice.

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3 Modes of Practitioner Research

• Mode 1 Practitioner Led
• Mode 2 Practitioner Collaborative
• Mode 3 Practitioner focused
• (McCormack 2009)

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• A proper critical social theory is one which
  possesses a stereoscopic vision which recognises
  every situation as one both of gain and loss, of
  change and stasis, of possibility and limit
  (Fay, 1987)
• The same man sic might be capable of writing
  both comedy and tragedy the tragic poet might
  be a comedian as well (Socrates)

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The Intent of Emancipation
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Be Wary of False-Logic!

• "Well ya see, Norm, it's like this... A herd of
  buffalo can only move as fast as the slowest
  buffalo. And when the herd is hunted, it is the
  slowest and weakest ones at the back that are
  killed first. This natural selection is good for
  the herd as a whole, because the general speed
  and health of the whole group keeps improving by
  the regular killing of the weakest members. In
  much the same way, the human brain can only
  operate as fast as the slowest brain cells.
  Excessive intake of alcohol, as we know, kills
  brain cells. But naturally, it attacks the
  slowest and weakest brain cells first. In this
  way, regular consumption of beer eliminates the
  weaker brain cells, making the brain a faster and
  more efficient machine. That's why you always
  feel smarter after a few beers."

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Limits to Emancipation

• Epistemological limits the capacity of
  individuals to achieve self-actualisation
• Therapeutic limits the extent by which systems
  of domination can be overcome by action arising
  from rational reflection
• Ethical limits the emancipation of one group can
  oppress another
• Power limits constraints on human power that
  restrict the ability of humans to be
  self-determining and therefore autonomous
• (McCormack Titchen, 2006 after Fay 1987)

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Epistemological Limits

• The reification of consensus in the making of
  rational judgements (Gore 1992)
• Reflection as a means of learning about self in
  the context of theory (Fay 1997)
• Reflection and the pre-conscious (Dunne 1993
  vanManen 2002)
• The limits of inherited dispositions on our
  freedom (Fay 1987)
• The evidence that critical reflection makes a
  difference (Manias Street 2000)

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Therapeutic Limits

• The space for emancipatory research (Meyer, 2005)
• Cultures of managerialism
• the transformation of practice understands
  that changing practices is not just a matter of
  changing the ideas of individual practitioners
  alone, but also discovering, analysing and
  transforming the social, cultural, discursive and
  material conditions under which their practice
  occurs (Kemmis, 2005)
• The reality of telling unwelcome truths
  (Kemmis, 2005)
• Over reliance on rational processes of
  verification

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Ethical Limits

• An ethics of care versus the ethics of risk
  reduction (PRAR Committee of Inquiry, 2005)
• Research Ownership and the desire for
  emancipation
• Knowledge hierarchies, blind-spots and EBP
  (McCormack, 2007)

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Power Limits

• Empowerment and disempowerment
• Disempowered, empowered, powerful PIP project
  example (Dewar McCormack, in progress)
• The challenge of achieving collective autonomy
  (Fay, 1987) An autonomous group is one in which
  its members are what they wish to be, in the
  sense that they are not subject to forces which
  can cause them to be other than they desire
• Organisational structures and hierarchies
• Accountability and responsibility
• Lack of vision creativity
• False-consciousness

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Co-constructing knowledge about Expertise in
Nursing through Practitioner Research the
Expertise in Practice Project
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Expertise in Practice Project Purpose

• Recognise and value expertise in nursing practice
• Develop a recognition process for expertise in
  practice
• Develop further understanding of the concept of
  expertise in UK nursing
• Explore links between expertise and outcomes for
  service users and healthcare providers

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Research approach

• Practitioner Research with emancipatory and
  transformational intent
• Stakeholder evaluation (Guba Lincoln, 1989)

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Even expert nurses need help to understand
develop evidence of their expertise!

• Action learning (McGill Beaty, 1992)
• Critical companionship (Titchen, 2000)
• Portfolio development

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Methods used by nurse participants/critical
companions to collect evidence of expertise

• 360 degree feedback
• Based on principle of systematic data collection
  from stakeholders on performance of individual
• Qualitative feedback tool and protocol developed
  with co-researchers to gain feedback from
  nurse-participants role set (including user
  narratives and staff interviews)

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Methods used by nurse participants/critical
companions to articulate knowledge of expertise

• Observing, listening and questioning
• Reflection in and on practice (Schon 1983)
• Formal and structured reflection to explore tacit
  knowledge
• case vignettes (nurses accounts of patients
  experiences)
• Reflective responses to evidence
• Critical dialogues

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Methods used by nurse participants/critical
companions to analyse evidence of expertise

• Inductive thematic analyses
• Deductive analyses using research-based models or
  frameworks of nursing expertise
• Member checking with evidence providers for
  trustworthiness, faithfulness
• Checking analytic/interpretative methods with
  critical companion

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Project Outcomes

• Awareness of different kinds of knowledge (ways
  of knowing) used in practice
• Pre-cognitive
• Cognitive
• Metacognitive
• Development of reflexive knowing.
• Deliberate and intentional use of different types
  of knowledge.
• Differentiation between expert and non-expert
  practice and impacts on patients, teams and
  organisations.
• Explication of the professional artistry of
  expert practice.
• Working with different intelligences

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Issues for the Co-construction of Knowledge

• The intent of different forms of research, need
  for clarity of purpose.
• Co-construction can have emancipatory and
  transformational impact but need to be aware of
  limits
• The dominance of powerful paradigms limiting
  the potential of emancipatory and
  transformational research
• What counts as impact?
• Outcomes from these research approaches have
  immediate impact, so should be acceptable to
  strategists and policy makers so why the
  resistance?
• Need to broaden our view of what counts as
  knowledge and valid knowledge whose
  validity?
• Research training, atheoretical and
  anti-philosophical foundations