Qualitative Research Discussion

Qualitative Research Discussion ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Qualitative Research Discussion Discussion Forum 4: Qualitative Researcha. Read the posted article attached. b. Refer to Chapter 6 pages 120 to121 of your assigned textbook for more guidance. Stratford University NSG 410 Qualitative Research Discussion c. To be more clear, respond to the following aspects of the article and support your findings with literature. Qualitative Research Discussion Your critique responses should reflect the following: 1. What type of qualitative method did the researcher use? 2. what type of sampling method did the researcher use? Is it appropriate for the study? 3. Was the data collection focused on human experiences? 4. Were issues of protection of human subjects addressed? 5. Did the researcher describe data saturation? 6. What procedure for collecting data did the researcher use? 7. What strategies did the researcher use to analyze the data? 8. Does the researcher address credibility (can you appreciate the truth of the patient’s experience), auditability (can you follow the researcher’s thinking, does the research document the research process) and fittingness are the results meaningful, is analysis strategy compatible with the purpose of the study) of the data? 9. What is your cosmic question? example_qualitative_study.pdf N E O NATA L , PAE D IAT RI C AN D CH I L D H EALT H N U R S I N G Nurses’ contribution to child protection Marie Land BN Master Mid Current PhD Student Charles Darwin University, NT Professor Lesley Barclay AO RN RM PhD Graduate School of Health Practice, Charles Darwin University, NT Abstract This qualitative study used interviews to explore nurses’ perceptions of their role in protecting children and to identify any barriers to implementing the role. Participants in this study were recruited through purposive sampling. Ten nurses whose work brings them into regular contact with children and their families were interviewed; the sample included nurses from acute care and community-based nursing services in the Northern Territory (NT). Results from semi-structured, open-ended questions were analysed using a process of coding and thematic analysis. Three major themes, derived from aggregating related sub-themes, were identified and names as Drawing a line in the sand; Mushrooms in the dark and Fear factor. Three broad areas that influence nurses’ effectiveness in the protection of children were identified – organisational structures, institutional practices and legislative frameworks. Recommendations from this study include a need for collaborative interdisciplinary practices, development of departmental protocols to support such practice, and nurse-led models of care that aim for early identification of risk factors for child abuse and early intervention to support families and improve family functioning. This exploratory research has provided baseline data for an action research study in progress on the role of nurses in protecting children. Key words: nurses; child protection; interdisciplinary collaboration; family support. What is already known on the topic What this paper adds Rates of reported child abuse and neglect are escalating in the Northern Territory as they are across Australia and globally. There are legal, institutional and professional impediments that limit the ability of nurses to protect children through recognising signs of family vulnerability and assisting parents in child rearing. Statutory child protection agencies focus their attention on investigation of child abuse and neglect and do not have the necessary resources to provide support to vulnerable families. Introduction The Australian Institute of Health and Welfare (AIHW) 1 reports that the incidence of child abuse reports, and substantiation of reports, is rising.Stratford University NSG 410 Qualitative Research Discussion Legislation in the Northern Territory (NT) mandates reporting of child abuse. Concern that nurses have insufficient understanding of the requirements of the NT Community Welfare Act 1983 and how to report child abuse was a motivator for this investigation. The inconsistency of legislation throughout Australia may also limit the ability of a mobile nursing workforce to keep abreast of the legislative frameworks that govern their practice. It is also unclear whether nurses perceive that they have a role in protecting children and, if so, what barriers they perceive may limit their ability to perform this role. 18 Data suggest that some nurses may become desensitised to the problems of marginalised groups of Aboriginal children through constant exposure to their poor health and circumstances. Most children in the NT come into contact with nurses throughout their early years and at school; however, it is unclear whether these contacts provide a mechanism for protection, advocacy and general family support. Assessment of the psychosocial and emotional wellbeing of clients occurs in nursing interactions with children and their families 2. In urban areas of the NT, child and family health nurses (CFHN) provide regular services for developmental assessments and immunisations in the first 2 years of life. Once at school, children may seek consultation and be involved in education sessions with health promoting school nurses (HPSN). Nurses in the emergency department and paediatric/neonatal wards of hospitals are also well positioned to assess the safety of children in these areas. VOL.11 NO.1 march 2008 N E O NATAL, PA EDI AT R IC AND CHILD HEA LTH NU RSING Literature review There is abundant international literature pertaining to nurses’ involvement in child protection. Much is from the United Kingdom following the Lord Laming inquiry in 2003 into the death of Victoria Climbié, an 8 year old who was the victim of continual abuse leading to her death 3. Although seen by many health professionals, including nurses, in the months prior to her death, action to prevent abuse was not taken 4-6. Nurses were criticised for failing to make adequate documentation about her physical condition when she presented to two hospitals 7. The inquiry found that lack of communication, as well as assumptions about what colleagues were doing for Victoria, led to her death 8. Statistics published by the AIHW show an increase in both reports and substantiation of child abuse 9. Stratford University NSG 410 Qualitative Research Discussion There is limited literature that explores Australian nurses’ perceptions of their role in protecting children, and none addressing the NT context. This gap in research is significant considering the large Aboriginal population in the NT and the overrepresentation of these children in child abuse reports 1. A study by Nayda 10 about the decision making of South Australian community health nurses in reporting of child abuse concluded that nurses are constrained by a number of factors including negative perceptions of the services that may be offered to a family following a report of child abuse. They were also concerned about the potential damage to their therapeutic relationship with the family and preferred to offer support to the family as a first step. Nayda 11 suggests that, while nurses are in an ideal position to recognise child abuse, they may not have a sufficient understanding of their role to do so adequately. She listed constraints mitigating nurses’ ability to report suspected child abuse as lack of educational preparation, organisational structures, fear of the legal process, perception of potential damage to the nurse-patient relationship, and their relationships with other professionals 12. This study therefore set out to investigate if dilemmas arise for nurses in their mandated requirement to report cases of suspected child abuse in the NT and in their effectiveness in their role protecting children. Aims The aims of this study were to: • Explore, with a small sample of child health, paediatric and school nurses, their understanding and knowledge of child abuse and neglect. • Identify these nurses’ perceptions of their role and involvement in protecting children. • Identify any perceived barriers to nurses having a role in protecting children. Study and method Exploratory qualitative research was undertaken as a means of capturing the perceptions and experiences of nurses V O L . 1 1 NO.1 march 2008 about their professional role, and involvement in, protecting children. This approach was chosen so the words and stories of the participants could guide the exploration of their professional and personal experiences in dealing with potential, suspected or confirmed child abuse. According to Roberts & Taylor “qualitative research is interested in questions that involve human consciousness and subjectivity, and value humans and their experiences…” 13. Sample and setting A purposive sample of eight participants who had more than 2 years’ experience in nursing which involved children and their families was planned. Flyers seeking participation were placed in urban workplaces where nurses were involved with children. The sample increased to ten over the course of the study. Although the sample size was small, saturation of the data became obvious early in the analysis therefore no further participants were recruited. Volunteers were recruited from acute, community and school practice settings and interviewed in their location of choice. Stratford University NSG 410 Qualitative Research Discussion Data collection A series of core questions were used for interviews to ensure that each participant had an opportunity to address all areas of interest. Semi-structured and open-ended questions facilitated a full exploration of experiences (Figure 1). Further questions, prompted by cues from participants, were asked to explore perceptions and clarify meanings. Interviews lasted from a minimum of 30 minutes up to 1 hour. The interviews were audiotaped and then transcribed verbatim by the researcher. Data analysis Interview transcripts were analysed through manual thematic coding of concepts. Line-by-line coding of words and phrases allowed concepts to emerge within the context of the Figure 1. Guideline questions. Guideline questions • Tell me about your role as a nurse in ED/paediatrics/child health/ school nursing. • What have been your experiences in relation to child protection or child abuse? • Can you tell me about how you felt about those experiences? • Tell me about the processes, if any, that you understand are required to be followed if you suspect child abuse in any of your clients. • What do you think is the best way of handling this situation? • What gets in the way of you acting in this way? • What is your understanding of risk factors that may lead to child abuse? • Can you tell me about your relationship with Family and Children’s Services (FACS) workers? 19 N E O NATA L , PAE D IAT RI C AN D CH I L D H EALT H N U R S I N G language used and the experiences described. Perceptions of nurses’ role and involvement in protecting children, and any barriers to their involvement, were elucidated and these were synthesised into sub-themes. Three major overarching themes, grouped by aggregating sub-themes, were identified. These themes provide some explanation through critical analysis as to how those perceptions may have developed. have a role in protecting children, most of the participants perceived that they were capable of keeping children safe by supporting families. The practice setting, level of seniority and previous professional experiences (identified in participant data) influenced to some degree participants’ priorities concerning perceived barriers to protecting children. However, all participants made some reference to concepts in the sub-themes that emerged. All participants recognised they had a role in keeping children safe and that there were barriers to this role being performed well. Ethics Ethical approval was gained from the Joint Human Research Ethics Committee, Menzies School of Health Research, and the Department of Health and Community Services (DHCS). Participants were advised that they could withdraw at any time. All participants signed a consent form agreeing to be interviewed and for that interview to be tape-recorded. The population of the NT is small, areas where health services are provided are well known, and it is possible that nurses are recognisable to a wide professional audience, therefore there was potential for identification of participants; considerable care was therefore taken in de-identifying data. Participant identifiers, including their place of work, are not attached to direct quotes included in the body of this paper. Sub-themes were grouped to form three major themes and named as Drawing a line in the sand, Mushrooms in the dark and Fear factor.Stratford University NSG 410 Qualitative Research Discussion A diagrammatic representation of these themes demonstrating the sub-themes that they represented is shown in Figure 2.Stratford University NSG 410 Qualitative Research Discussion Theme 1: Drawing a line in the sand This theme arose from data suggesting contextual conditions influenced the decision making of nurses regarding reporting of suspected child abuse. The theme grouped sub-themes of the caring profession, subjective decision making, scarce resources, cultural perspectives, and protecting professional roles. Results Data confirmed nurses as a ‘caring’ profession with this approach demonstrated by all participants. As one child and family health nurse said, All of the participants identified their legal responsibility to report suspected child abuse to the child protection agency and they related experiences of professional involvement with abused children. While not overtly stating that nurses ? ? Figure 2. A graphical representation of themes and sub-themes ? ? that emerged from the data. ? ? This was equally so for school nurses in the study, … we are ideally placed to build up that trusting relationship with families so, and provide that early intervention sort of stuff. ?????????? ?????????? ????????????????? ?????????????????? ??????????? ??????????? ??????????? ????????? ????????? ??????? ??????? This concept was less evident in the responses of the acute care nurses with their focus of care appearing to be more task driven and medically orientated. These nurses also, however, demonstrated concern for their patients and families. As one nurse put it, ??????? ????????? ??????????? ??????????? ????????????? ??????????? ????????? ???????? ???????? ? ? ? ?????????? ? ???????????? ???????????? ? ? ? ? ? ? ? ???????? ?????????????????? ???????? ?????????????????? ? ?????????? ?????????? ?????????????????? ???????????? ????????????? ?????????? ? ????????????? ? ?????????????? ?????????????? ?????????? ?????????? ? ? ? ? ? ???????????? ???????????? ? ? ? ? ? ? ? ????????????????? ????????????? ?????????????????? ?????????????????? ????????????? ??????????????????? ? ???????????? ????????????? ????????????? ???????????? ????????????? ????????????? ? ??????????? ??????????? ? ? ? ? ??????????????????????????????????????????????????????????????????????????????????????????Stratford University NSG 410 Qualitative Research Discussion 20 ? … it did take patience and it did take chasing, that’s the thing, I just didn’t give up on it. … you… try to provide the safest and most comfortable environment, and there are more people involved than just one patient – it’s the mother, it’s the father and maybe other children. Many of the participants stated they made a report when obvious signs of physical abuse were noted. However, they expressed concern about reporting suspicion of abuse and neglect, How emotionally tied up in a knot we get about some of the fine line ones. It’s that grey stuff that’s hard, yeah. They believed a lack of clear, prescriptive definitions of child abuse in the NT Community Welfare Act 1983 left nurses in the position of making subjective judgments about their clients’ wellbeing. ??? VOL.11 NO.1 march 2008 N E O NATA L , PAE D IAT RI C AN D CH I L D H EALT H N U R S I N G Targeted service delivery to vulnerable families by CFHNs, and reporting of suspected abuse, were determined in part on available resources. While many participants were clear about the needs of vulnerable families, they felt constrained in their ability to ameliorate problems because of a lack of resources. As one participant said, to effective practices through communication and knowledge deficits. The sub-theme of anonymous FACS workers arose from responses that indicated many of the participants did not know the child protection workers, … we can’t do all the extended visiting that we could, probably should do. I think I would like to meet them, who they are, face to face, it would be good. Several participants also raised concern that Family and Children’s Services (FACS) is poorly resourced. They believed this limited its ability to respond to reports made. This was indicated by comments such as, There was also a perception that FACS workers had limited knowledge of the professional roles and expertise of nurses, … half the time they are not investigated… People aged 15 are… often put to the bottom of the pile. Another participant described FACS as, … a little area that just runs on stress and crisis all the time… sometimes, you know, they are out of their depth with the workload. Cultural perspectives appeared to influence participants’ views about the standards of care that were acceptable for Aboriginal children which were seen by them to be variable. Several participants made comments concerning the difficulties faced by remote Aboriginal families in securing resources required for wellbeing. Evidence, though, of repeated skin infections, failure to thrive, or exposure to a violent or substance abusing community constitute a threat to the future wellbeing of the child. But for some nurses, the constancy and alarmingly high rates of these situations in Aboriginal families has had a desensitising effect,Stratford University NSG 410 Qualitative Research Discussion It’s a normal type thing for people to have scabies or for parents to come in intoxicated, or for, you know, parents to yell and swear and scream at their children… and I think what we do now is we say, that is culturally acceptable. The sub-theme of protecting professional roles formed part of this major theme because participants, particularly the CFHNs and HPSNs, believed they had the ability to support families and therefore protect children. However, they expressed reservations about the skills of child protection workers in this area. The majority of participants stated they were able to deal effectively with issues of parenting support and education. As one participant said, I believe if you support people in the right way that the abuse won’t be there… I’m not saying their life mightn’t be perfect, but it’s not going to be abuse at a harmful level. Theme 2: Mushrooms in the dark This theme was named to describe the communication barriers that appear to prevent interdisciplinary practice and the lack of awareness by each individual professional group about the roles and skills of other health professionals. The sub-themes of anonymous FACS workers, one-way communication, lack of multidisciplinary collaboration, absence of clear protocols, and lack of appropriate education were grouped within this theme. Each sub-theme contained elements of impediments 22 … they have no idea what our roles, as in registered nurse, registered midwife, maternal and child health, they have no idea the skills that are involved in all that. Participants perceived FACS as the ‘black box’ of the DHCS in that little is known about the services it provides. Comments such as the following indicated a level of frustration at the lack of interdisciplinary communication and collaborative practice, it’s this lack of, they don’t gi … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10