Professional Caregiver Risk and Despair: A Unitary Appreciative Inquiry

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Unitary Appreciative Inquiry Praxiological
Investigation of Risk Induced Professional
Caregiver Despair -- Reflections and Implications

• Thomas Cox RN, PhD
• School of Nursing
• Virginia Commonwealth University
• April 30, 2004
• www.afn.org/mathstat

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Risk Induced Professional Caregiver Despair?

• Great changes have occurred in healthcare finance
  
• i access to quality healthcare.
• Disrupted bonds between RNs and clients
• i Character, quality, rapport of relationships
• Need new understandings to reshape HC
• Some RNs despair over i environmental quality
• RNs had rich stories of negative effects of
  working under fiscal constraints risk transfers

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Professional Caregiver Insurance Risk

• Financial contracts and intra-organizational
  budgets that transfer insurance risks to
  caregivers
• Risk transfers cause financial, professional,
  spiritual, and affective disharmonies i service
  quality
• Recognizing, addressing and healing the spiritual
  and affective wounds is critical to the
  well-being of RNs, clients, and the healthcare
  system

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How I Developed RIPCD

• Social work
• Insurance/Actuarial
• Social researcher
• Biostatistician
• Nursing
• Peers at conferences, classes, Christmas
  parties.

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Correlates and Corollaries of Professional
Caregiver Despair

• Burnout Depression
• Unhappiness Anomie
• Angst Dissatisfaction
• Alienation Suffering
• Stress Poor Attitude
• Ethical Conflict Moral Distress

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Risk Induced Professional Caregiver Despair

• 8 RNs experiences, perceptions and expressions of
  RIPCD about their careers working environments
• Reasons for despair - not biological/chemical/Rx
  deficiency
• Unmet expectations, unfulfilled hopes,
  opportunities lost, challenges too hard to meet,
  and uninviting futures
• RNs created new meaning in their experiences -
  blending art, science, perception, feeling, and
  intuition into new wholes

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Unitary Appreciative Inquiry
Theory generating, practice-enhancing, and
research method Appreciation of humans and
phenomena as wholes Participants shared their
experiences, perceptions UAI Goal
Appreciation of participants' RIPCD
experiences Researcher sought a healing
appreciation of the participants, not just data
collection Praxis not just research
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Practicing Unitary Appreciative Inquiry
Accept and validate participants in an empathic
and appreciative manner, empathizing with, seeing
through the eyes of, and gaining a deeper
understanding of their wholeness, and with the
healing intention of assisting them toward freer
expression, greater insight, and greater
integration Researcher dwells in preconceptions
and assumptions favorable to the co-researchers,
fostering rapport and promoting harmony and
mutuality. Participants are wholes but may see
themselves as not-whole. Researcher assists
participants in the healing appreciation of their
own wholeness, facilitating growth, and
transformation
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RIPCD A Unitary Inquiry

• Experiences, intuitions, reflections of RNs RIPCD
  experiences
• Collaborative, theorogenic, research, and healing
  journey
• Opportunity to reveal, explore, and represent
  effects of HC financing experiments
• 8 RNs shared experiences highlighting the breadth
  and depth of the impact of insurance risk
  transfers on nursing care
• OPERATING ROOM, TRANSPLANT, ONCOLOGY
• MATERNITY AND PEDIATRICS
• PSYCHIATRY and MEDICAL-SURGICAL

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Why UAI is Important

• Wholeness and healing occur when sufficient time
  and energy are devoted to free, unstructured
  expression
• Most participants thankful for opportunity to
  discuss their experiences until THEY were
  finished
• Some felt peers superiors prematurely reacted,
  designing interventions or viewing their concerns
  as staffing problems to fix or them as
  problem employees
• Appreciative profiles are helpful in addressing
  features of modern life mismatches between
  expectations and capacities
• Synopsis C. D. Broad hold seemingly
  incompatible ideas

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Recruitment and Opening Dialogue

• Participants solicited through key informants,
  professional colleagues, flyers, and
  presentations
• The opening questions
• What does risk induced professional caregiver
  despair mean to you?
• What make your life as a nurse difficult?
• Most participants discussed workplace events that
  affected them and their clients - revealing
  serious deficiencies in staffing, supply, and
  coordination

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Thoughts on the Research Process

• IRB Difficult to explain praxis to panels
  focused on risk reduction in designed biomedical
  experiments
• How do we distinguish between healing intent
  and intervention to accomplish a specific,
  planned outcome?

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During and After Inquiry

• Allowed to freely consider, explore, and express
  the essence of their experiences, most of the RNs
  developed new ideas and attitudes about
  themselves and their experiences
• New insights into how RNs respond to
  environmental impediments to caregivers
• New theories and strategies for preparing RNs in
  their roles Greater understanding of how to
  deal with insurers
• Read understand budgets and management
  reports,
• Ethical reasoning regarding quality of care
  issues
• New ideas about healing for individuals, groups,
  and systems

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Some Guiding Principles of Healing Synoptic
Narrative Construction

• Allegorical Metaphors encompass past, present,
  and future
• Collaborations, incorporating multiple methods of
  cognitive, affective, aesthetic interpretation,
  and representation
• A reaching forward, grounded in the past,
  present, and alternative possible futures
• Researcher as guide, reference point, healer, and
  co-inquirer, journeying with co-researchers
• Embrace contradiction, dissimilarity, and
  incoherence as birthing the future

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Some Guiding Principles of Risk Induced
Professional Caregiver Despair

• RIPCD is rhythm, flowing in out of despair,
  hope, joy, and pessimism
• RIPCD may never be resolved, emerging,
  shifting, changing, forming coherence over time
  as different patterns form in an ever-changing
  environment
• Most participants loved their jobs, peers and
  nursing
• Some RNs said flooding their experiences out,
  dramatically altered their lives and taking action

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What Have Been the End Products?

• Completed dissertation
• Presentations on PCIR related topics influenced
  by the dissertation research (NNN, ISPN)
• Future articles/presentations about research
  findings, method, PCIR, MISs, financial
  management
• Development of tools for monitoring and
  forecasting nursing capacity under changing
  supply and demand
• New venues for collaboration with other nurses,
  researchers, practitioners, educators,
  administrators

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