taking action for action

313 Pages·2014·3.04 MB·English

TAKING ACTION FOR ACTION
A study of the interplay between contextual
and facilitator characteristics in developing an
effective workplace culture in a Dutch hospital
setting, through action research.
Famke van Lieshout
The research of this thesis was conducted at the faculty of Life and Health Science of the Univer-
sity of Ulster in Belfast (UK), in cooperation with the Knowledge Centre for implementation and
evaluation of Evidence Based Practice, Fontys University of Applied Sciences, Eindhoven (NL).
The printing of this thesis was financially supported by Fontys School of Nursing.
ISBN: 978-90-5335-865-8
Printing and lay-out: Ridderprint BV, Ridderkerk, the Netherlands.
The cover is a painting by Caroline Williams.
© F. van Lieshout, Veldhoven, the Netherlands 2013
All rights reserved. No part of this thesis may be reproduced or transmitted in any form or by
any means, electronic, mechanical, photocopying, recording or otherwise, without the prior
written permission of the author or, when appropriate from the publishers of the publications,
illustrations and brief quotations may be used for scientific and educational purpose provided
that the source is acknowledged clearly.
TAKING ACTION FOR ACTION
A study of the interplay between contextual and facilitator characteristics in developing an
effective workplace culture in a Dutch hospital setting, through action research
Famke van Lieshout (MSc, RN)
Faculty of Life and Health Science of the University of Ulster
A thesis submitted in fulfilment of the requirements of the degree of Doctor in Philosophy
July, 2013
Promotores:
Prof. B. McCormack
Prof. T. McCance
Copromotores:
Prof. A. Titchen
Dr. K. Cox
Viva committee:
Prof. D. Freshwater (External examiner)
Prof. K. Parahoo (Internal examiner)
Dr. D. Fitzsimons (Chair)
LIST OF CONTeNTS
List of Contents E
List of figures, tables and images K
Thesis’ paintings H
1 – INTROduCTION: POSITIONING The STudy 1
Introduction 3
Development of nursing practice through research 3
Developing an effective workplace culture in a Dutch health care context 5
Process of the study 7
The Dutch health care context 10
Who I am 11
Outlining the chapters 14
Summary 15
2 – MeThOdOLOGy: wORKING wITh dIFFeReNT PhILOSOPhICAL
PeRSPeCTIVeS 17
Introduction 19
A praxis methodology 19
Phase one: Reconnaissance 21
Intermezzo: repositioning the study 32
Phase two: Reflexivity 34
Phase three: Contemplation 52
A research journey into a praxis spiral 54
Ethical approval for the study 55
Summary 56
3 – The STORIed dATA OF The ReSeARCh IN ACTION 59
Introduction 61
Story A - A story of exploring workplace culture I 62
Story B - A Story of building relationships 73
Story C – A story of embedding the research in the hospital 90
Story D – A story of exploring workplace culture II 104
Story E – My story 123
Summary 139
4 – eMbARKING uPON A ‘heRMeNeuTIC SeASCAPe’:
SAILING ThROuGh STORMy wATeRS 141
Introduction 143
Metanarrative: ’Sailing through stormy waters’ 144
Spelling out the crises 148
Finding navigational buoys 149
Positioning the boat, plotting the course, and directing the crew 152
Building trust and morale on board 157
Catching the wind 161
Preserving energy to face the storm 163
Lying at anchor 167
Summary 170
5 – wIdeNING My hORIzON 173
Introduction 175
A synthesis of critical moments 175
A dialogue with the literature 177
A conceptual context 177
Conceptual balance 182
The conceptual area of support 190
A conceptual area of synchronicity 199
New insights leading to a mid-range theory 209
Ideologies revised 209
The compass model 211
Use of a mid-range theory 213
Summary 214
6 – TAKING The heLM AGAIN 217
Introduction 219
Rigour of the study 219
The implications for practice 226
Implications for policy and further research 229
Conclusion and contribution to knowledge 230
Closure 237
APPeNdICeS 239
Appendix A 240
Appendix B 246
Appendix C 252
Appendix D 254
Appendix E 256
Appendix F 261
References 265
Acknowledgements 281
Curriculum Vitae 287
Abstract 291
Samenvatting 295
LIST OF FIGuReS, TAbLeS ANd IMAGeS
Chapter Figure/table/ Title Page
images
Chapter 1 Figure 1.1: Schematic overview of the study 9
Chapter 2 Figure 2.1: Organisational chart positioning the study in the 23
oncology department of a Dutch hospital
Image 2.1: Hermeneutic seascape: looking at the whole and the 40
parts
Figure 2.2: Critical Creative Hermeneutic Analysis Framework 45
Figure 2.3: Praxis spiral of research journey 55
Chapter 3 Figure 3.1: Elaboration of descriptive stage within the reflexive 61
phase
Image 3.1: Recurring images in the creative analyses of stories 110
with five Clinical nurse specialists
Chapter 4 Figure 4.1: Elaboration of stages within the reflexive phase 144
Chapter 5 Figure 5.1: Elaboration of stages within reflexive and 175
contemplation phases
Image 5.1: ‘Lived experience’ an image of the interplay of the key 176
concepts identified in the analysis
Table 5.1: Overview of key-messages 210
Figure 5.2: A compass model of essential conditions for 212
facilitating PAR
Chapter 6 Figure 6.1: Elaboration of stages within contemplation phase 219
Image 6.1: Overview of ocean gyres around the world 225
Table 6.1: Framework Taking Action For Action 228
TheSIS’ PAINTINGS
The paintings used throughout the thesis were specially made for me by the Dutch artist Laury
Persoon. These were initially made to illustrate my story of facilitating PAR in a dynamic health
care context which I recited in my keynote speech at the international CARN/IPDC event in 2012
in Ashford, UK. Each image represents a particular critical moment in time for me while facilitat-
ing PAR. They are also collective for the research journey and so were used in the introductions
of the chapters.
Laury Persoon studied (Spanish) literature and fine arts and illustration. This gave her the
opportunity to bridge between art and literature. Laury wants to show the multi-faceted sig-
nificance and stratification of both (children’s) literature and art. At the moment she is mostly
working as an illustrator.
I dedicate this thesis to:
Pap
Fred van Lieshout 1950 – 2011
&
Mam
Liesbeth Beerens
Where ever I go
your support, faith and love
make me always come home
[Famke]