Job description of nurse managers

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Using Qualitative Research Methods in Nursing
Research

• Simon K. Macharia, MSN, BScN, CCN, KRN.

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Exploratory Research

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

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Exploratory Designs Purpose

• Describe phenomena
• Identify concepts
• Generate Theory starting with grounded theory

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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

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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

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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

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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

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Trustworthiness of quantitative and qualitative
findings

• QUANTITATIVE Vs
• Internal Validity
• Generalizability
• Statistical conclusion validity
• Reliability, consistency

• QUALITATIVE
• Credibility
• Transferability
• Dependability
• Confirmability

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Assumptions underlying qualitative methods
(Leininger, 1985)

• The natural environment provides rich and
  meaningful data about people.

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Assumptions underlying qualitative methods
(Leininger, 1985)

• Both subjective and objective life experiences
  help reveal the totality of reality

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Assumptions underlying qualitative methods
(Leininger, 1985)

• The nature of human beings is reflected in
  patterns and themes

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Assumptions underlying qualitative methods
(Leininger, 1985)

• Entering the individuals world to grasp intimate
  personalized information is essential to
  discovering and valuing humanistic expression

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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

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Qualitative Methods

• Phenomenology
• Grounded theory
• Ethnography
• Historical
• Critical Social Theory

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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

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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

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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

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Historical

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

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Critical Social Theory

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

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Mixing Methods

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

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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.

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Data collection methods

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

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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.

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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

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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

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

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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
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Objectives
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Background
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Background
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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.

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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.

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Literature search
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Methodology
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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.

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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.

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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.
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(No Transcript)
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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).


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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.

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(No Transcript)
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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

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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.
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(No Transcript)
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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

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Representative quotes
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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.

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 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!

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Emergent Themes

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

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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.
•  

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Findings
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Abraham Maslows theory of motivation
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Discussions
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Insightful view analogy
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(No Transcript)
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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.

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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.

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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
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Acknowledgements

• Nurse managers of Moi Teaching Referral
  Hospital
• Moderators,
• Adroit consultants

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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.
• .

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Other references
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References
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Thank You