OF PRACTICE AMONG HIV/AIDS NURSES USING CRITICAL REFLECTION AT SEXED HOSPITALS IN KWAZULU-NATAL. I declare that the thesis submitted entitled A Grounded Theory Inquiry: Establishing Communities of Practice among HIV/Aids nurse practitioners through the use of Critical reflection at selected hospitals in KwaZulu-Natal, carried out under the guidance of Professor N.G.
ACRONYMS
CHAPTER ONE
THE PURPOSE AND MOTIVATION OF THE STUDY
INTRODUCTION
2 in the context of HIV/AIDS, due to the incidence and complexity of HIV/AIDS-related comorbidities. In support of this assumption, Lave and Wenger (1991b) propose the notion of situated learning, fostered in Communities of Physicians (CoPs) to achieve ongoing organizational learning that can support nurses in meeting the challenges associated with the dynamic nature of HIV/AIDS. .
BACKGROUND TO THE STUDY
- The socio-political context of health and HIV/Aids in South Africa
- The Impact of HIV/Aids on Human Resources (HR) in Southern Africa
- The role of critical reflection in practice development
- The mechanism of CoP in transforming practice
Various global initiatives have been implemented in response to the complex nature of HIV/AIDS care and treatment. At the workshop, DENOSA indicated that the main challenge in the clinical management of HIV/AIDS is the inadequate number of qualified health workers.
THE PROBLEM STATEMENT
In a review of 87 empirical studies between 1999-2005, Taylor (2008) suggested three circumstances in which Transformative Learning Theory can be used effectively in creating change, which included: (i) a disorienting dilemma of sudden or gradual that requires a process change to begin; (ii) the circumstance when a new way of looking at life's experiences and situations is required to provoke renewed action or to prompt a change of perspective; and (iii) circumstances where through critical reflection and discourse among trusted others, change is part of a larger organizational or societal mandate to bring about a transformed way of learning. 15 rapidly changing health care context and to meet the demand for their accountability in practice, nurses must execute a set of higher order thinking and functioning skills, which are fostered through critical reflection.
THE PURPOSE OF THE STUDY
OBJECTIVES OF THE STUDY
RESESEARCH QUESTIONS
SIGNIFICANCE OF THE STUDY
17 nurse practitioner can be supported and transformed through critical reflective practice within communities of practice. The development of a middle range theory will explain the constructs, relationships and the process of how critical reflective nursing practice is developed and shared between like-minded professions within the structure of a CoP.
OPERATIONAL DEFINITIONS
In the context of CoPs, the term process describes the activities and stages of group formation and cohesion. In the context of this study, middle range theory provides an explanation of the relationship between concepts, constructs, and variables that describe the process of planning and establishing a CoP among critically reflective HIV nurse practitioners.
CONCLUSION
Middle range theory: As per the guidelines of Strauss and Corbin (1990), a middle range theory refers to a set of constructs, themes or set of relationships that provide an explanation range theory refers to a set of constructs, themes or set of relationships that provide an explanation of the phenomenon presents. Furthermore, HIV/AIDS nursing practice refers to providing comprehensive pre- and post-test counseling, initiating antiretroviral therapy, monitoring and evaluating for side effects and adherence, and ensuring continuity of care.
STUDY OVERVIEW
CHAPTER TWO
LITERATURE REVIEW
- INTRODUCTION
- UNDERSTANDING CRITICAL REFLECTION
- The philosophical thread of critical reflection: Critical Social Theory
- Defining reflective practice, critical reflection and their application
- Contribution of critical reflective practice to nursing
- UNDERSTANDING COMMUNITIES OF PRACTICE
- CoPs and situated learning as knowledge
- Social Learning Theory and CoPs
- CoPs and group knowledge creation in nursing
- CONCLUSION
Therefore, Kolb's experiential learning theory plays an important role in the learning process of reflective practice (Kinsella, 2009; Budgen and Gamroth, 2008). This chapter also included a brief presentation of the use of critical reflection in the nursing context.
CHAPTER THREE
RESEARCH METHODOLOGY
INTRODUCTION
QUALITATIVE RESEARCH PARADIGM
- Rationale for the use of Constructivism
This paradigm also assumes that individuals seek insight into the world they live in (Crotty, 1998). In the context of this study, the researcher recognizes that the interactive relationship between the researcher and the participants in terms of establishing the CoPs and the process of capacity development in critical reflective practice among the HIV nurses will assist in the constructed meaning that will are made about this phenomenon.
QUALITATIVE RESEARCH INQUIRY
Summarizing the fundamental and general reasons why qualitative research investigation is used, Botma, Greeff, Mulaudzi and Wright (2010) write that this method of investigation is often used when: (i) little is known about a subject or phenomenon, (ii) ) the context within which the research is poorly understood; (iii) the boundaries of the phenomenon are not well defined; (iv) the phenomenon is not quantifiable; (v) the nature of the research problem is not clear; and (vi) the researcher intends to re-examine a research phenomenon. Furthermore, Ploeg (1999) stated that qualitative research is designed to explore and describe a phenomenon in terms of the question "what is happening here?". Thus, in light of this study's purpose, which is to explore the process of establishing a CoP of critically reflective HIV nurses, it further fits the purpose of qualitative research.
THE GROUNDED THEORY DESIGN
- Overview of Grounded Theory
56 identifies the phenomenon to be studied, thereby asserting that the research question should be formulated in the early stages of the research process. 57 is flexible, while Glaser (1992) states that the process of data analysis will lead to the discovery of the research question. According to Schreiber (2001), Glaserian and Straussian modes differ in terms of the coding process.
RESEARCH SETTING AND SETTING DESCRIPTION
- Theoretical sensitivity
- Rationale for choice of setting and theoretical sensitivity
The researcher has had knowledge of previously working as a research assistant on an HIV/AIDS-related research study in the province of KZN, albeit not at the same health centre. 64 The increased HIV prevalence reflected in the prenatal indicators (i.e. 38.7%) was one of the reasons why the researcher chose to use nurses working in the maternal and child health units as the sample. Hospital B: This district-level hospital is a 1200-bed general hospital located in the eThekwini Health District.
STUDY POPULATION
SAMPLING PROCEDURE AND SAMPLE DESCRIPTION
- Theoretical sampling of group sessions
Since the conceptual category of interest was the development process in terms of the participants' abilities for critical reflection and establishment of CoPs, the researcher chose to purposefully sample a group of 8-10 HIV nurses from each of the two district hospitals. . This criterion was used to gain a wider range of experiences in relation to the participants' challenges in working with HIV care. Given the process-oriented nature of the study, the willingness of participants to be part of the study over a longer period of time was important to the success of establishing a CoP and exploring the development process, if any, in terms of critical reflection.
DATA COLLECTION TECHNIQUES AND PROCESS
- Focus group discussions
- Observations
Saturation of the theoretical concepts regarding the participants' experiences was achieved after six interviews of the total of eighteen participants in the study. A presentation and demonstration on the use of the reflective journal was initially provided by the researcher who served as a facilitator in the developing CoP. Probing questions were also used in the reflective discourse process to verify or strengthen the meaning the researcher makes in terms of the observations.
DATA ANALYSIS
- Open Coding
- Axial Coding and the Paradigm Model
- Selective Coding
This second step in the data analysis process described by Strauss and Corbin (1990) refers to the process of the researcher reassembling the data in a new innovative way. Axial coding focuses the researcher in describing the phenomenon of the study (which in this case was the establishment of CoPs) in terms of the antecedents, which described categories that led to or gave rise to the need for the CoP; the context, which describes a set of conditions within which the need for a CoP was embedded; the action and interaction strategies, which describe the process that took place in the development of the phenomenon; the intervening variables, which presented the facilitating and impeding conditions that had an impact on the development of the CoP; and the outcomes, both intended and unintended or consequences of the phenomenon, which in this case were the functioning CoPs of critically reflective HIV practitioners (Strauss and Corbin, 1990). Various diagrams are presented during selected phases of the data analysis write-up in Chapter 4.
QUALITATIVE RIGOR
- Credibility
- Transferability
- Dependability
- Confirmability
The generalizability of the emerging theory and the research investigation is addressed by transferability (Guba and Lincoln, 1994). A complete and dense description of the data collection sessions in terms of duration and period of each phase is also described. This author suggests that a thick description of the study design, the data collection plan and the procedure for data collection should be specified.
DATA MANAGEMENT
Monitoring the data collection process served as peer review and examining the emerging findings contributed to the trustworthiness of the research process. The research participants' reflection reports were kept in a locked cabinet to which only the researcher and research supervisor had access. All data will be destroyed five (5) years after completion of the study by destroying reflective journals and paper copies of transcribed data.
RESEARCH ETHICS
Following initiation of the study and data collection and analysis, a re-application for a change of study title was made to the Humanities and Social Science Ethics Committee of the University of KwaZulu-Natal. The informed consent also had a contract that contained the above threat and that the participants' consent to the study was an expression of their acknowledgment of the above. Benefit and anonymity: Participant well-being was maintained through the use of a private room for the FGDs and CoP meetings.
CONCLUSION
CHAPTER FOUR
PRESENTATION AND ANALYSIS OF THE MAIN FINDINGS
INTRODUCTION
97 engagement of professional literature, which encompassed the professional and disciplinary literature that was used, acquaints the reader and the researcher with the critical phenomena of interest in this study. During data collection, the researcher observed and recorded nuances (such as the isiZulu phrase Nazo to indicate agreement), body language (such as folded arms indicating distance from group dynamics or frowning, etc.) and gestures (such as long sighs, laughter, crying and … or err indicating a pause in the conversation) of the participants and were placed in brackets ( ) in the transcript.
SAMPLE DESCRIPTION AND REALISATION
The average number of years as a nurse was 22 years, varying from 12 to 36 years. Similar to the country hospital, the rank or job positions of the participants ranged from professional nurses to zone matrons. Average number of years working as a nurse Number of years working as a nurse HIGHEST LEVEL OF EDUCATION.
THE RESULTS OF THE STUDY
- Conceptualization of the process of establishing Communities of Practice
- A practice and learning community “Better than being back at school”
- A support network“Feels like home…I’m with family here”
- Collaborative and purpose driven working “Sisonke…together we can!”
- Antecedents for establishing a CoP
- The Internal Domain: The Emotive Challenges
- The National Health Imperatives
- The dynamic nature of national policy guidelines
- The Action and Interactional Strategies
- Planning and preparing the CoPs
- Implementing (launching) the CoP
It emerged from the findings that the supportive feature of the CoP is also extended to the co-creation of practical knowledge related to HIV/AIDS. If we can come together like this to share and talk about what we're going through...like some challenges. As shown in the data, participants described their preferences for how they wanted the CoP to work in terms of structure and logistics.
Some participants expressed concern about working with each other for extended periods of time. It was clear from the data sources that none of the participants had experience or knowledge about reflection.
COALESCING, LEARNING AND
Reflecting on the phase of learning, interaction strategies and activities became clear, which collectively described a transitional phase. During this transition phase, the participants progressed from a point of dependence on the facilitator to guide the nature and content of the sharing sessions (i.e.
DEVELOPING
I can say that now that we are discussing what happens to us as nurses..it also helps me to cope..because sometimes you are very afraid of this HIV..I can see that it is..I feel sorry for these women. .but I..I was distancing myself from working well with them..because you start to feel like this disease is a monster..and yet some of these women have no choice..they are just taking their husbands.. so it makes me also think about my role as a nurse to support him..and not to keep them away because I'm afraid of them..”. 175 are not using amaCondom..so I am learning to be better..and understand women better so that they too can trust us to maybe accept HIV sooner…” ( FGD Urban, participant 5). I have gained so much from the group.. we share so much information.. so when I meet others who are not in this group. HIV/Aids.." (Urban FGD, participant 5).
