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Title: Job description of nurse managers


1
Using Qualitative Research Methods in Nursing
Research
  • Simon K. Macharia, MSN, BScN, CCN, KRN.

2
Exploratory Research
  • Systematic, subjective research approach used to
    describe life experiences and attribute meaning
    to them

3
Exploratory Designs Purpose
  • Describe phenomena
  • Identify concepts
  • Generate Theory starting with grounded theory

4
Exploratory Designs
  • Driven by the state of the science
  • Limited previous information(eg what did the
    minority mean when they said NO?)
  • Lack of theoretical development
  • Concepts and variables not yet identified
  • New context or new culture

5
Qualitative Methods
  • Goal To document and interpret the totality of
    what is being studied from peoples own frame of
    reference
  • Subjective and objective data
  • Feelings
  • Beliefs
  • Patterns of action
  • Interactions in social networks
  • Interpretations and explanations

6
Characteristics of Quantitative and Qualitative
Methods
  • QUANTITATIVE Vs
  • Hard Science
  • Narrow focus
  • Reductionistic
  • Deductive reasoning
  • Basis of knowledge Cause and effect
  • Test theory
  • QUALITATIVE
  • Soft science
  • Broad focus
  • Holistic
  • Inductive reasoning
  • Basis of knowledge Discovery
  • Generate theory

7
Characteristics of Quantitative and Qualitative
Methods
  • QUANTITATIVE Vs
  • Control
  • Instruments
  • Analysis of numbers
  • Statistical Analysis
  • Generalization
  • QUALITATIVE
  • Shared interpretation
  • Researcher as instrument
  • Analysis of words
  • Individual interpretation
  • Uniqueness

8
Trustworthiness of quantitative and qualitative
findings
  • QUANTITATIVE Vs
  • Internal Validity
  • Generalizability
  • Statistical conclusion validity
  • Reliability, consistency
  • QUALITATIVE
  • Credibility
  • Transferability
  • Dependability
  • Confirmability

9
Assumptions underlying qualitative methods
(Leininger, 1985)
  • The natural environment provides rich and
    meaningful data about people.

10
Assumptions underlying qualitative methods
(Leininger, 1985)
  • Both subjective and objective life experiences
    help reveal the totality of reality

11
Assumptions underlying qualitative methods
(Leininger, 1985)
  • The nature of human beings is reflected in
    patterns and themes

12
Assumptions underlying qualitative methods
(Leininger, 1985)
  • Entering the individuals world to grasp intimate
    personalized information is essential to
    discovering and valuing humanistic expression

13
Assumptions underlying qualitative methods
(Leininger, 1985)
  • Understanding how informants know their world is
    essential to understanding working conditions,
    roles they play and demands placed on their job
    description as nurse managers

14
Qualitative Methods
  • Phenomenology
  • Grounded theory
  • Ethnography
  • Historical
  • Critical Social Theory

15
Phenomenology
  • Origin Philosophy, Psychology
  • Purpose Discover the lived experience of an
    identified phenomenon
  • Living with HIV/AIDS
  • Exploring the experience of labor and delivery in
    the village vs. at the hospital
  • Method explore the meaning of the experience by
    in-depth contact with participants

16
Grounded Theory
  • Origin Sociology (Glaser Strauss, 1967)
  • Purpose discover the underlying social process
  • Method Observe social interaction
  • Participant observation
  • Interviews
  • Written documentation of social interaction
  • Fiction, non-fiction, poetry
  • Minutes or meetings
  • Uses a certain nomenclature in analysis

17
Ethnography
  • Origin Anthropology
  • Purpose Discover cultural meaning
  • Method Observe culture
  • Become immersed e.g going native
  • Obtain detailed descriptions of culture
  • Key informant interviews
  • Observe
  • Sociocultural norms
  • Language
  • Religion
  • Work
  • Communication
  • Traditions
  • Going native

18
Historical
  • Origin Myth, Chronicling of events
  • Purpose Interpret past, inform future
  • Method Developmental Schemes
  • Progression
  • Regression
  • Repetition

19
Critical Social Theory
  • Origin Social research, Marx
  • Purpose Empowerment of oppressed groups, social
    justice
  • Method Participatory research participants are
    represented on the research team

20
Mixing Methods
  • Loss of philosophical foundation
  • Violation of assumptions of data collection
    techniques
  • Sloppy science

21
Managing mixed methods
  • Let research question be the guide
  • Use separate research questions and separate
    methods for each research question
  • Select data collection techniques that are
    consistent with research questions
  • Analyze data separately before triangulating
    results.

22
Data collection methods
  • Interviews
  • Focus groups
  • Observations (participant and non-participant)
  • Story telling
  • Life stories
  • Case studies

23
Common data collection methods
  • Participant observation appropriate for
    collecting data on naturally occurring behaviors
    in their usual contexts.
  • In-depth interviews for collecting data on
    individuals personal histories, perspectives,
    and experiences, and when sensitive topics are
    being explored.
  • Focus groups effective in eliciting data on the
    cultural norms of a group and in generating broad
    overviews of issues of concern to the groups
    represented.

24
Inductive data analysis
  • Audio taping
  • Transcribing
  • Listening and Reading
  • Computer software eg ATLAS,ti 5.0
  • Coding individual transcripts
  • Clustering codes across transcripts
  • Defining categories (concepts)
  • Elevating concepts to themes
  • Generating theory

25
Using qualitative methods in health sciences
research
  • Begin with the research question
  • Determine the underlying philosophical
    foundation (cultural, social process, lived
    experience)
  • Select appropriate, consistent data collection
    technique
  • Immerse yourself in inductive process of data
    analysis
  • Verify that conclusions are grounded in the data

26
  • An example of a qualitative study
  • Citation Kamau S, (2014)

27
Title Nurse Managers Perceptions Towards The
Roles They Played in a Resource - Limited
Hospital Setting in Western Kenya
By KAMAU, Simon Macharia
(MSN, BSN, CCN)
University of Kabianga
28
Objectives
29
Background
30
Background
31
Background
  • The Nurse Manager is responsible for development
    and supervising nursing services of a
    division/department/unit managed by senior
    nursing officers. The nurse manager is key in
    both facilitating patient care and in ensuring
    the quality of work life of the nursing
    fraternity.

32
purpose
  • To take stock of the various factors that
    affect the job description and roles played by
    the Nurse Managers in a teaching and referral
    hospital.

33
Literature search
34
Methodology
35
Data collection tools
  • qualitative data from a Focus group Discussion
    and interviews with the same group and subjected
    to content analysis into themes.
  • Study done in February 2013.
  • This section of the qualitative aspect is part
    of a larger study.

36
Grounded Theory Method
  • Sample (N 6) targeting out of all the 16 Nurse
    Managers working in the institution at the time.
  • later interviewed 2 key informants( more
    experienced N/M)
  • The mean age of respondents was 40.9 years, with
    4 being female 2 men. Majority were married (only
    1 was single),
  • 4 had a Bachelors degree , one had higher
    diploma and one was a Diploma holder.
  • Duration of practice in MTRH mean was 6.3 years
    and 9.3 yrs as nurses since qualifying from
    college.

37
This was a qualitative phenomenological
Phenomenological researcher asks what is the
essence of this phenomenon as experienced by
these people and what does it mean? (Polit Beck
2012, p.494). For rigor in the methodology
memory recorded (subjects validates findings) for
fit, trustworthiness, credibility.
38
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39
The study made use of purposive sampling all the
nurse managers working in the hospital. Nine
subjects were purposively selected through
convenience sampling for the focus group
discussion and interview out of whom seven took
part. Data gathering done in February 2011
employed the use of unstructured moderator
interview, nonverbal observations, field notes
and voice recording through a 3 hour focus groups
discussion is that they capitalize on the fact
that members react to what is being said by
others, thereby potentially leading to deeper
expressions of opinion (Polit Beck 2012 p.
532). The venue of choice was a familiar
meeting point within the working environment.
Probing was done up to exhaustive exploration and
completion of data (saturation).


40
Significance
  • The study gathered some perceptions of the Nurse
    Managers who participated towards their profile,
    progression and what they do.
  • If the Nurse Managers role is to be maintained
    and more importantly, if the role is to develop
    as a significant one in the hospital
    infrastructure, more understanding, more study,
    and clear directions for the future are required.

41
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42
Coding Scheme
  • Code
  • Definition
  • perception
  • Challenges
  • Benefits
  • Role of nurse manager
  • Feelings about the job as a nurse manager
  • Nurse managers suspicion that something was
    wrong , not interesting or beyond their ability
    to cope about their position as nurse managers
  • How much the job as nurse manager offers that is
    perceived as positive
  • Responsibilities of the nurse manager, Job
    description of the nurse manager

43
C o n c e p t u a l - f r a me w o r k The
conceptual framework (See fig. 2 below) evolved
as an emergent design reflecting on what was
already learned (Polit Beck 2012 p.487) and not
out of a prior theory.
44
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45
Emergent Themes
  • We have a problem here
  • Commitment and Duty
  • Overwhelmed and worn out
  • High expectations with low appreciation
  • Willingness to relinquish extra workload
  • Nursing care role needs to reemerge

46
Representative quotes
47
Is the position interesting or just
plain challenging? The Position is interesting-
  • Representative quotes
  • I think given an opportunity to make some
    alterations, being a nurse manager is challenging
    rather than interesting, challenging in the sense
    that there are a lot of responsibilities that are
    bestowed in a nurse manager especially now that
    we are moving in a direction where you cant
    recognise the roles of a nurse manager. I think
    in a functional system, I could say it is
    interesting to certain extents. It appears that
    those responsibilities that others are shunning
    end up being handled to the nurse manager. So you
    spend most of your time addressing non-nursing
    duties.

48
  What the nurse managers really feel about
the benefit of this position
  • I dont think the nurse manager is given any
    benefits, considering that they report to work
    before 7.30am, work past 5pm. Many of us you
    will agree do between 2 and a half to 4 extra
    hours every week, overtime which nobody pays us,
    no responsibility allowance , no extraneous
    allowance, nothing!

49
Emergent Themes
  • Themes are presented from the employee context,
    and the context of the relationship between nurse
    and their role as nurse manager.

50
Emergent themes
  • General attitudes of the nurse managers on the
    roles and position the jobs call for some sort of
    overhaul.
  • From the study findings the nurse managers seemed
    to hold varied opinions as to what the roles for
    this position are.
  • MOST of them felt that there is a greater need to
    re- outline the roles and ensure that the nurse
    managers work according to their outlined roles
    in the Job description.
  •  
  • SOME of the nurse managers held somewhat general
    positive attitudes towards the job and position.
  • It should be noted that the study clearly
    indicated that possible relationships between
    benefits of this position and the general
    attitudes towards carrying out the roles assigned
    to the nurse manager indeed existed.
  • MOST of the nurse managers recognized the
    potential benefits in being a nurse manager.
  •  

51
Findings
52
Abraham Maslows theory of motivation
53
Discussions
54
Insightful view analogy
55
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56
conclusion
  • Perceptions of the Nurse Managers towards their
    profile, progression and what they do.
  • Some apprehension was obvious
  • lack of recognition coming out strongly as a
    limiting factor in the performance of the complex
    roles the nurse manager plays.

57
Recommendation
  • There is great need to clearly outline the roles
    that should be played by nurse managers in the
    hospital as the job description of the Nurse
    Manager as it came out in this study is either
    complex or multidimensional or both.

58
Further reading Mauthner and Doucet Reflections
on a Voice Centred Relational Method
Blaxter, Hughes and Tight How to Research
Chapter 7. Analysing Data
Lyn Richards Handling Qualitative Data A
Practical Guide Blaxter, Hughes and Tight How
to Research Chapter 8. Writing Up
Bryman and Burgess Analyzing Qualitative Data
Introduction
59
Acknowledgements
  • Nurse managers of Moi Teaching Referral
    Hospital
  • Moderators,
  • Adroit consultants

60
Selected References
  • Kamau, Simon.(2013).Nurse managers perceptions
    towards the roles they play in a limited hospital
    setting in western Kenya. Journal of Biology,
    Agriculture and Healthcare. Vol.3,No.4, p84-87.
  • Kamau S. Macharia(2014). Peer to peers nurse
    managers on supporting structures
  • and systems they support in a resource-
    constrained setting in Kenya. American Journal
    of Nursing Science. 3(6) 126-132doi
    10.11648/j.ajns.20140306.16
  • Kamau S, (2012). Inventory on job description of
    nurse managers in developing countries, rising
    above the challenges and demands placed on the
    nurse manager in a changing work environment, LAP
    Lambert AcademicPublishing, Saarbrücken, Germany
  • Polit D, Beck C, (2012). Nursing research,
    generating and assessing evidence for nursing
    practice, WoltersKluwer/Lippincott ,Williams
    Wilkins, Philadelphia.
  • .

61
Other references
62
References
63
Thank You
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