RESEARCH METHODOLOGY
3.5 RESEARCH SETTING AND SETTING DESCRIPTION
60 research studies, albeit not in the context of nursing education constructs of critical reflection, but among nurse practitioners, some of which explored the psychosocial aspects of nurses working in the context of HIV/Aids. This experience has created a worldview for the researcher and Strauss and Corbin’s (1990) acknowledgement of a researcher’s past experience and discipline specific knowledge in inspiring the research through theoretical sensitivity fitted more appropriately than Glaser’s (1992) complete “blankness” and objectivity to a phenomenon aligned to emergence.
61 study will be obtained from the research setting (Allen, 2010; Strauss and Corbin, 1990). In light of this study, the nature of HIV nurse practitioners, in terms of their work place and experience of HIV related challenges, was a theoretically relevant category/concept that needed to be sampled. Based on the empirical dialogue presented in the background of this study (see Chapter One), the changing nature of HIV/Aids clinical care policies and practice guidelines compounded with the increased workload and lack of adequate and appropriate HIV/Aids training were a few challenges presented in reported findings. It is within this background that the research aimed to explore the process of critical reflection within CoPs among HIV nurse practitioners, thus making the nature of the HIV nurse practitioner theoretically relevant.
Bearing this in mind, the province of KwaZulu-Natal (KZN) was purposively sampled. KZN is the third smallest province in SA comprising of 34,361 SQM2 , but it, is one of the most populated provinces, with an estimated 10 million people living in the province (DoH, 2010b), which is about 22% of the country’s total population. Health estimates of HIV/Aids in this province indicate that it is at the epicenter of HIV, with antenatal HIV prevalence rates of 38.7%
(DoH, 2010b). The province of KZN is divided into eleven health districts (see Figure 1.) each managed by its own district health authority (HST, 2007).
According to the national HIV/Aids Plan (DoH, 2007), each district will have at least one ARV delivery site provided by the government health service. Armed with this knowledge, the researcher purposively selected KZN as in light of its high incidence of HIV/Aids, the possibility of finding “challenged” HIV nurse practitioners was greater.
Figure 1: Map of KZN Health Districts
Source: Health Systems Trust, (2007
3.5.1 Theoretical sensitivity
The principle of theoretical sensitivity, discussed by the originators of grounded theory Glaser and Strauss (1967), and later Strauss
setting. Theoretical sensitivity, critical in grounded theory, refers to the insight” (Strauss and Corbin, 1990: 42
has already been noted that the researche : Map of KZN Health Districts
2007)
The principle of theoretical sensitivity, discussed by the originators of grounded theory Glaser , and later Strauss and Corbin (1990), guided the selection of the research setting. Theoretical sensitivity, critical in grounded theory, refers to the “attribute of having Strauss and Corbin, 1990: 42), and refers to the personal quality of the researcher. It has already been noted that the researcher is coming to the study with “insight”
62 The principle of theoretical sensitivity, discussed by the originators of grounded theory Glaser , guided the selection of the research
“attribute of having , and refers to the personal quality of the researcher. It
“insight” and a degree of
63 sensitivity from previous reading. The nature of theoretical sensitivity facilitated the researcher’s ability to give meaning to the data collection process and data; and the capacity to discern what is important in the data.
3.5.2 Rationale for choice of setting and theoretical sensitivity.
The researcher has had the familiarity of previously working as a research assistant on a HIV/Aids related research study in the province of KZN, albeit not at the same health care facility. This research study was in connection with the Preventing Mother-to-child Transmission (PMTCT) programme and was conducted at both an urban and rural sites.It became apparent that unique context specific issues such as the lack of resources provided unique challenges in terms of how the PMTCT programme functioned. Drawing from this previous experience, the researcher felt that this aspect could be explored in terms of the phenomenon she wished to investigate. Guided by the provincial directorate, it became evident that there are a total of 41 district level hospitals in the province of KZN, each of which provide PMTCT care (DoH, 2009;
HST, 2009). Through consultation with other researchers in the field of HIV research (a NGO and research organization) who maintain, support, monitor and evaluate the health care facilities in terms of attainment of the PMTCT programme goals, the researcher established that the hospital settings should be at district level because in these institutions, nurses are not only involved in general maternal and child health care, but are also involved with the PMTCT programme, which means they are providing HIV/Aids care on a daily basis. Two district level hospitals were conveniently sampled from the 41 district hospitals in the population. The researcher chose a rural and an urban health care facility from two health districts in the province of KZN to explore the process of establishing CoPs of critically reflective nurse practitioners, and whether urban and rural context conditions will influence this process.
64 The increased HIV prevalence reflected in the antenatal indicators (i.e. 38.7%), was one of the reasons why the researcher chose to use nurse practitioners working in the maternal and child health departments as the sample. Further to this, the nature of care in the maternal and child health department is very layered and comprehensive (Zelnick and O’Donnell, 2005). In light of this, nurse practitioners working in such areas of care have to be up to date in their knowledge of the clinical management of pregnant women and their infants through all the stages of antenatal care, labour and delivery, and postnatal care, the latter of which involves immunization and monitoring of the infant until 18 months post delivery (DoH, 2009). Moreover, HIV/Aids nurse practitioners need to completely au fait with the current HIV/Aids treatment and care guidelines so as to function optimally within the boundaries of the PMTCT programme, which all nurses working in maternal and child health departments are exposed to (Matjila et al., 2008). Because of the prevalence of antenatal HIV in KZN, the PMTCT programme has been prioritized in an endeavor to reduce the disease (DoH, 2010a).
Hospital A: This district level hospital is a 300 bedded hospital situated in the Umdoni Local Municipality in the Ugu Health District of KwaZulu-Natal. This health district covers an area of 2 470 square km. It has 31 service points and has approximately 33 715 antenatal visits and 63 733 family planning visits per annum.(HST, 2000).
Hospital B: This district level hospital is a 1200 bedded general hospital situated in the eThekwini Health District. Together with its associated 22 clinics it serves about 500 000 people who live in Umlazi, an urban community situated in the south east of Durban.
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